THE 26TH ANNUAL MEETING of the JAPAN SHOULDER SOCIETY Omiya, Japan November 18 and 19, 1999

THE 26TH ANNUAL MEETING OF THE JAPAN SHOULDER SOCIETY Omiya, Japan November 18 and 19, 1999

Kiyohisa Ogawa, MD, President

1 CLINICAL EVALUATION OF MASSIVE ROTATOR CUFF of Orthop Surg,2 Osaka Kosei-Nenkin Hospital, Japan; Dept of TEAR—POSTOPERATIVE ASSESSMENT AT MR IMAGING Pathology,3 Osaka Kosei-Nenkin Hospital, Japan; Dept of Pathol- Y. Abe, MD, and T. Nakano, MD; Dept of Orthopaedic Surgery, ogy,4 Kagoshima University, Japan; Dept of Orthop Surg,5 Ohsa- Tamana Central Hospital, Kumamoto, Japan ka-Minami National Hospital, Japan Six patients underwent operative repair of massive rotator cuff Purpose: A histological study of B.B. was performed to analyze tear with fascial patch. MRI was used for assessment of the postop- bone and ligamentous degeneration through H.&E. staining, espe- erative condition. Pre and postoperative shoulder flexion were 90.0° cially as to osteonecrosis and ligamentous hyalinization. Methods: and 165.8°, respectively. All patients showed satisfactory pain relief This study included 28 patients, mean age of 24.7 years. This analy- and improved abduction strength. T2-weighted image demonstrated sis included six categories, including age at primary injury, and fre- increased signal intensity in the grafted fascia and the site after ten- quency of dislocation. Result: Osteonecrosis was observed in 4 don-to-tendon repair for up to 13 months after operation. It is not pos- cases and ligamentous degeneration in 20. Eight of 20 cases had sible to distinguish between the original cuff and the grafted fascia extensive degeneration and experienced more frequent dislocations. on final MR images. The repair of massive rotator cuff tears with fas- No statistical significance was observed in other subjects. Conclu- cia lata is useful method. sion: Our study evidenced a low frequency of osteonecrosis in B.B. and an extensive ligamentous degeneration with frequent disloca- 2 TWO CASES OF THE POST-TRAUMATIC OSTEOLYSIS tions. OF THE DISTAL CLAVICLE H. Asano, MD, K. Mimori, MD, T. Nakagawa, and K. Shinomiya, 5 EVALUATION OF THE TENSION OF REPAIRED ROTA- MD, Dept of Orthopedic Surg, Tokyo Medical and Dental Univ, TOR CUFF Tokyo, Japan Kenji Fujita, MD, H. Sakai, Y. Sakai, Y. Iwasaki,* and K. Mizuno; Purpose: This report concerns two patients with post-traumatic Dept of Orthopaedic Surg, Kobe Univ Sch of Med, Kobe, Japan, osteolysis of the distal clavicle and discusses the pathogenesis. Case Dept of Orthopaedic Surg,* Shin-Suma Hospital, Kobe, Japan Reports: Two men injured shoulder and radiograph showed osteol- The purpose of this study is to evaluate the tension of repaired ysis of the distal clavicle. Surgical excisions of the distal clavicle were rotator cuff and to show the correlation with postoperative results. performed and these sections revealed overgrowth of the synovium in Nineteen patients were evaluated. The tension was decreased with the acromio-clavicular joint and granulation tissue with vascular pro- elevation. The JOA score was significantly correlated to the tension of liferation and multinuclear giant cells covered distal clavicle. Discus- repaired rotator cuff. Too much tension on repaired rotator cuff cause sion: Both cases had minor recess of the articular surface of the dis- the dysfunction of the rotator cuff postoperatively. Our results have tal clavicle. We suggest the possibility that the post-traumatic osteol- shown that the lower JOA score in the patients with higher tension of ysis of the distal clavicle arose from osteochondral fracture and the repaired cuff. These results suggest that the tension of the repaired synovial invasion. cuff, indeed, change the results of rotator cuff repair.

3 LIGAMENTOUS RESTRAINTS AND MUSCLE EFFECTS 6 EVALUATION OF HUMERAL HEAD PERFUSION BY LIMITING EXTERNAL ROTATION OF THE GLENOHUMERAL DYNAMIC MRI JOINT IN THE NEUTRAL AND ABDUCTED POSITIONS H. Goto, MD, F. Fujiyoshi, MD, H. Senda, MD, H. Muro, MD, S. J.E. Kuhn, MD,1 L.J. Huston, MS,1 L.J. Soslowsky, PhD,2 and R.B. Furuyama, MD, T. Hato, MD, Y. Ishiguro, MD, M. Nozaki, MD, M. Blasier, MD3; Univ of Michigan,1 Ann Arbor, Mich, Univ of Penn- Haba, MD, and K. Sugimoto, MD;* Dept of Orthopaedic Surgery, sylvania,2 Philadelphia, Pa, Wayne State Univ,3 Detroit, Mich Ogaki Municipal Hospital; Dept of Orthopaedic Surgery,* Midori Fifteen shoulders were each mounted in a custom fixture which Municipal Hospital allowed for abduction/adduction and application of loads to the sub- The purpose of this study is to evaluate humeral head perfusion scapularis, supraspinatus, external rotators, and biceps. The humerus by using dynamic MRI. Proximal humeral fractures diagnosed 4-part was rotated by a servohydraulic testing machine. Testing was carried fracture (4 cases, mean age 35.5 years) were evaluated. Dynamic out over a rotation range near the toe region of the torque/rotation MRI were performed for both normal and injured shoulder joints. The curve. Muscle forces were varied and ligaments were cut. Conclu- center of the humeral head was determined as the region of interest sions: The IGHL strongly resists external glenohumeral rotation, par- (ROI). The intensity of the ROI in normal sides increased gradually ticularly in abduction. CHL resists external rotation in abduction and and reached the maximum after 200 seconds. In two cases, the inten- adduction. SGHL and MGHL resist external rotation only in adduc- sity of the ROI did not reach the same point in normal cases. This tion. The subscapularis and external rotators behave predictably. study indicates that it is possible to evaluate humeral head perfusion Biceps resists terminal external rotation in abduction. by using dynamic MRI.

4 HISTOLOGICAL STUDY OF BONY BANKART LESION 7 ONE-PORTAL ENDOSCOPIC TECHNIQUE FOR PRO- (B.B.) IN RECURRENT DISLOCATION AND SUBLUXATION OF LONGED NIGHT PAIN AND FROZEN SHOULDER THE SHOULDER K. Imada, MD, J. Ozaki, Y. Yoshizumi, G. Sakurai, and K. Yukata; Yasunari Fujii,1 Minoru Yoneda,2 Yoshio Miyazaki,2 Masanori Dept of Orthop Surg, Kurobe City Hospital, Kurobe, Japan Obata,2 Yasushi Kobayashi,3 Hiroki Yoshida,4 and Shigeyuki Wak- One-portal endoscopic soft tissue decompression under local itani5; Dept of Orthop Surg,1 Kagoshima University, Japan; Dept block was performed as “Day surgery” to 31 cases with night omal-

457 458 JSS Abstracts J Shoulder Elbow Surg September/October 2000 gia or frozen shoulder. The transparent sheath with endoscope was 93.7 points. Twelve cases have returned to their preinjury perfor- inserted into the subacromial space through 1cm of skin incision. mance level, and two cases have changed their position. Discussion: Blunt release of subacromial space, removal of coracoacromial liga- The arthroscopic treatment has thought to be useful to identify the ment, and blunt release of rotator interval were done. Three months lesion and to give the benefit for the cases of throwing injury of the after operation, night pain improved in 21 of 24 cases and ranges of shoulder joint. motions increased significantly. Self-assessment study declared that 76% of complaints were improved on an average. Three cases with 12 NATURAL HISTORY OF POSITIONAL POSTERIOR complete cuff tear remained omalgia. Under appropriate indication, INSTABILITY OF THE GLENOHUMERAL JOINT this is useful operation. M. Nagai, N. Suenaga, A. Minami, H. Kato, N. Iwasaki, H. Kamishima, and N. Oizumi; Dept of Orthopedic Surgery, Hokkai- 8 THE TWO CASES OF THE LIMB SALVAGE OPERATIONS do Univ of Sapporo, Japan FOR THE MALIGNANT TUMOR OF THE PROXIMAL The purpose of this study is to investigate clinical outcomes of HUMERUS untreated positional posterior instability of the shoulder by question- J. Ito, MD, T. Morioka, MD, N. Omibuchi, MD, N. Sakai, MD, A. naire. Seventeen patients who were diagnosed positional posterior Enomoto, MD, S. Abe, MD, N. Kato, MD, and T. Watanabe, MD; instability of the shoulder were evaluated by questionnaire. The shoul- Dept of Orthop Surgery, Yokohama Municipal Citizens Hospital, der pain, instability and restriction of daily and sports activities were Yokohama, Japan investigated. In 3 cases, the symptom of the shoulder was disap- Case I. The radiogram of a 39-year-old woman showed the peared after 3-5 years from first visit to our hospital. Thirteen cases in destruction of the proximal humerus by chondrosarcoma. Case II. The 17 cases, which had shoulder pain at first visit, shoulder pain were invasion of giant cell tumor of the proximal humerus into glenohumeral continued in 10 cases. In 5 of 6 cases which had instability at first joint and the deltoid muscle was found in MRI of a 54-year-old man. visit, symptom continued. The limb salvage operations were performed following scapulohumer- al resection with deltoid resection for “the clinically malignant tumors” 13 PROBLEMS OF TREATMENT OF FRACTURES OF THE in the both cases. Arthroplasty without glenoid component was per- CLAVICULAR END BY THE WOLTER CLAVICULAR PLATES formed in case I. An arthrodesis was performed by using a free fibula Kimio Nakagaki, Jiro Ozaki, and Yasuharu Tomita; Dept of Orthop graft in case II. The two salvaged limbs were functionally limited. Surg, Gojo Prefectural Hospital, Japan We studied the problems of fixation of the fractures of the distal ends 9 RANGE OF MOTION AFTER BANKART REPAIR: VERTI- of the clavicles by using the “Wolter clavicular plate.” Ten fractures of CAL VERSUS HORIZONTAL CAPSULOTOMY the Neer type 2 distal clavicle fractures were treated by the plates. A E. Itoi, W. Watanabe, S. Yamada, T. Shimizu, I. Wakabayashi, and wire had to be used to fix the plate instead of a screw because the plate N. Konno;* Dept of Orthop Surg, Akita Univ, Dept of Orthop was not fit for the clavicle in one patient. The hook holes expanded in Surg,* Akita City Hospital, Akita, Japan two patients and one patient had the fracture of the acromion. We hope This study was performed to determine the effect of capsulotomy a new plate which can be bended to be fit for a clavicle. on the range of motion after Bankart repair. Bankart lesion was repaired through the vertical (11 shoulders) or horizontal capsuloto- 14 MUSCLE STRENGTH AROUND THE SHOULDERS IN my (12 shoulders). After the repair, the capsule was closed with the HIGH SCHOOL SUMO WRESTLERS arm in 30° of abduction and neutral rotation. The horizontal group Y. Nakagawa, MD, Y. Matsusue, MD, and T. Nakamura, MD; Dept showed significantly greater external rotation both in adduction (2-6 of Orthop Surgery, Faculty of Medicine, Kyoto University months postoperatively) and in abduction (4-10 months postopera- Purpose: We examined high school sumo wrestlers to study the tively). Flexion and internal rotation did not show any differences. relationship between their sport performance and their shoulder mus- Bankart repair through the horizontal capsulotomy seems more ben- cle strength. Materials and Methods: Sixteen wrestlers were exam- eficial in the recovery of external rotation. ined in 1998. The isokinetic strength of their internal (IR) and external rotators (ER) and flexor (FX) and extensor (EX) were measured using 10 LABRAL CHANGES OF THE ANTERIOR DISLOCATION the Cybex. We divided them into two groups; strong group (S) and OF THE SHOULDER—RELATION WITH CLINICAL FINDINGS weak group (W). Results: Their FX and IR of S were significantly larg- T. Kawamata, J. Kumagai, H. Sano, K. Sato,* T. Komatsuda,* and er than one of W. IR increased more than EX for about 6 months. T. Narishige;* Dept of Orthop Surg, Tohoku Univ Sch of Med; Conclusion: To improve their sport performance in them, it was sig- Tohoku Rosai Hosp,* Miyagi, Japan nificant to increase their FX and IR, especially. This study was undertaken to compare the histological changes of the torn labra in a recurrent dislocation of the shoulder with clinical 15 LATISSIMUS DORSI TRANSFER FOR THE MASSIVE findings such as age at the initial dislocation, period of symptoms and ROTATOR CUFF TEARS numbers of the dislocation. We investigated thirty-four biopsy speci- Y. Nakagawa, MD, T. Mondori, MD, Y. Tomita, MD, K. Nakagaki, MD, mens, there was no significant correlation between the morphologi- T. Kondo, MD, G. Sakurai, MD, and J. Ozaki, MD; Dept of Orthop cal changes and clinical findings. However, the period of symptoms Surg, Haibara General Hospital, Nara Med Univ, Nara, Japan of patients with extended fatty degeneration was statistically longer Nineteen shoulders with irreparable massive rotator cuff tears than that of patients with mild one. It should be considered in carry- have been treated with the Latissimus Dorsi (LD) transfer. Marlex mesh ing out Bankart repairs. were used to reinforce the tendon of the LD. Japanese Orthopaedic Association score averaged 61.5 preoperatively and 83.4 postoper- 11 THE CLINICAL RESULTS OF THE ARTHROSCOPIC TREAT- atively. Acromio-humeral interval (AHI) was spread in 3 shoulders, MENT FOR THROWING INJURY OF THE SHOULDER JOINT unchanged in 11 and narrowed in 5. Progression of the osteoarthritis Yu Mochiziki,1 Kazuhiko Kikugawa,1 Kenji Kashiwagi,1 Takeo of the glenohumeral joint was shown in 6 shoulders. The LD transfer Iamda,2 Nobuyoshi Okuhira,3 and Nagao Adachi;4 Dept of Orthop with Marlex mesh showed satisfactory results. In cases with narrowing Surg,1 Hiroshima Univ, School of Medicine; Dept of Orthop Surg,2 of the AHI and osteoarthritis of the glenohumeral joint, it may be diffi- Hiroshima Kakechouritu Hospital; Dept of Orthop Surg,3 Hiroshima cult to reconstruct the rotator cuff by the LD transfer. Matsuda Hospital; Dept of Orthop Surg,4 Chuugoku Rousai Hospital Purpose: The purpose of this study is to investigate the clinical 16 THE STRESS DISTRIBUTION AT THE UNDERSURFACE results of arthroscopic treatment for throwing injury of the shoulder OF THE ACROMION USING CT OSTEOABSORPTIOMETRY joint. Materials and Methods: Fourteen baseball players who had N. Oizumi, MD, N. Suenaga, MD, N. Iwasaki, MD, A. Minami, undergone arthroscopic treatment were studied. Average age was MD, and H. Kato, MD; Dept of Orthop Surg, Hokkaido Univ Sch of 23 years old. Results: JOA score has improved from 80.3 points to Med, Sapporo, Japan J Shoulder Elbow Surg JSS Abstracts 459 Volume 9, Number 5

The purpose of this study is to investigate the subacromial stress shoulders underwent MRI. In 10 cases with complete tear, the stump using CT osteoabsorptiometry which is a method of predicting the was clearly enhanced in three, but not so clearly in six. In 4 cases long-standing stress distribution by measuring subchondral bone den- with incomplete tear, three with bursal side tear were clearly sity. CT values of undersurface of the acromion were measured in 9 enhanced. GD-enhanced MRI for diagnosis of rotator cuff tear was cuff tear shoulders and 5 normal shoulders. The stress distribution pat- not clearly defined in this study, but useful for bursal side partial-thick- terns were classified into 3 types. Five cuff tear shoulders were type A ness tear. (antero-lateral type) and 4 were type B (anterior type). All but one normal shoulders were type C (posterior type). High density area at the 21 KATAKORI IN YOUNG PEOPLE—FROM A SURVEY OF antero-lateral part of the acromion in cuff tear shoulders was consid- HIGH SCHOOL STUDENTS ered to reflect the long-standing stress by subacromial impingement. Takumi Takakuwa, MD; Department of Orthopaedic Surgery, Asahikawa Habilitation Center for Disabled Children, Asahikawa 17 HYPERTROPHY OF THE TERES MINOR MUSCLE IN We conducted a survey of high school students in order to deter- SHOULDERS WITH ROTATOR CUFF TEARS mine the cause of and background factors related to KATAKORI Togo Shimizu, Eiji Itoi, and Ikuko Wakabayashi; Dept of Orthop (mixed sensation of stiffness, dullness, or dull pain around scapula Surg, Akita University School of Medicine, Akita, Japan and neck) in young people. The subjects were 894 students of a high The cross-sectional area of the teres minor muscle on T1-weighted school. The survey was conducted by questionnaires. Of the total MR image in the oblique sagittal plane of 28 shoulders with rotator cuff number of students, 45.8% suffered from KATAKORI. The results indi- tears was measured using an image-processing software to relate it cated that stress in daily life, spinal deformity, hours of sleep, hours of with the tear size, location of the tear, range of motion, and shoulder study, sports activity, and history of whiplash injury are factors affect- strength. The teres minor muscle became hypertrophic in 7 shoulders ing the incidence of KATAKORI. with combined tears of the supraspinatus and infraspinatus tendons. In rotator cuff tears with hypertrophic teres minor muscle, external rotation 22 A NEW TREATMENT FOR NONUNION OF PROXIMAL strength and shoulder function was better preserved than in those with HUMERUS IN THE ELDERLY—CORE FIXATION the atrophic muscle. T. Yamakawa, N. Nishijima, and K. Yasuda; Dept of Orthop Surg, Shizuoka General Hospital 18 PROPHYLACTIC ANTIBIOTICS FOR ARTHROSCOPIC We report a new method of core fixation for nonunions of proxi- SURGERY OF SHOULDER—COMPARATIVE STUDY BETWEEN mal humerus, using a fibula graft as an intramedullary rod. Four TWO GROUPS women (av. 66 years) were operated with the core fixation method. H. Shishido, MD, and S. Kikuchi, MD; Dept of Orthop Surg, A fibula graft was inserted intramedullary into the humeral shaft and Fukushima Medical College, Fukushima, Japan head as a core (core fixation). Supplemental fixation between the Purpose: The purpose of this study was to evaluate and find out graft and the humeral head was provided by a wire. Furthermore, a adequate prophylactic antibiotics for arthroscopic surgery of shoulder. hook plate and nails were penetrated toward the core. Thereby, a Materials and Methods: 26 patients who underwent arthroscopic firm fixation was obtained between humeral shaft and head in surgery of shoulder were studied. We compared a single preoperative nonunion. Bone union was completed and no residual complaints in administration (group A) with 3 postoperative days treatment (group B) all cases. as prophylaxis. In these two groups, comparative study was performed on following items: rate of infection after operation, duration of fever 23 TWO CASES OF BORDERLINE CARTILAGE LESIONS IN and the results of blood biochemical tests. Results: None of the cases PROXIMAL HUMERI showed sign of infection. No significant difference was noted between Hitoshi Yasumizu, MD, Gentarou Kinosita, MD, Manaba Mat- the two groups in duration of fever and blood biochemical tests. Con- sumoto, MD, Ryouichi Mori, MD, and Takashi Maruoka, MD; clusion: A single preoperative administration is effective as prophylac- Takrazuka City Hospital tic antibiotics for arthroscopic surgery of shoulder. Two lesions in the proximal humeri seemed to be benign enchon- dromas by images were curetted widely and packed with bone 19 FUNCTIONAL RECONSTRUCTION OF THE SHOULDER cement and beta tricalcium phosphate respectively. Both lesions were BY MULTIPLE MUSCLE TRANSFER FOLLOWING UPPER diagnosed as low-grade chondrosarcoma histologically. The differ- BRACHIAL PLEXUS PARALYSIS ential diagnosis between enchondroma and low-grade chondrosar- K. Suzuki, MD, M. Yamada, MD, and T. Tanaka, MD; Dept of coma is very difficult to be made. The standard treatment for malig- Orthopaedic Surgery, Fujita Health Univ Sch of Med, Toyoake, nant bone tumor is curative wide resection, and the impairment after Japan wide resection is very tough to be mended, especially in the shoulder. We transferred the sternal head of pectoralis major for flexion So the overdiagnosis has to be admonished. Recently, low risk of reconstruction, trapezius for abduction reconstruction, and one or recurrence of low-grade chondrosarcoma was reported. Curettage more of latissimus dorsi, teres major, or serratus anterior for recon- with adjuvant therapy was recommended for these lesions. struction of external rotation. Five patients (all: men, the mean age: 21.8 years) were operated on and the mean follow-up period was 24 DROOPING SHOULDER WITH SEPTIC SUBACROMIAL 51.6 months. The ROM for flexion, abduction, and external and inter- BURSITIS nal rotation was improved significantly after surgery. The muscle G-I. Yoshikawa, MD, M. Murakami, MD, K. Hori, MD, S. Hiraoka, strength for flexion, abduction, and external rotation was also signifi- MD, N. Tanaka, MD, and S. Hukuda, MD; Dept of Orthop Surg, cantly improved from 0 or 1 before surgery to 2 while standing and Shiga Univ of Med Sci, Otsu, Japan 3 while on the bed after surgery. A 60-year-old woman, with right shoulder pain, first visited another hospital. Corticoid injection and physical therapy were given, but 20 GD-DTPA ENHANCED MAGNETIC RESONANCE IMAG- failed. Thereafter, drooping shoulder was seen by x-ray examination. ING FOR ROTATOR CUFF TEAR At our examination, her right shoulder was swollen and elevation was Takashi Ishikawa,1 Kenji Takagishi,1 Takuya Kaneko,1 Hideki limited. MRI revealed swelling of the subacromial bursa (SAB). The Yoshihara,1 Toshihisa Osawa,1Masayuki Aramaki,1 and Saturo patient underwent surgery during which septic subacromial bursitis Arita,2 Dept of Orthop Surg,1 Gumma University, Dept of Orthop was discovered. Therefore, an SAB resection was performed. SAB Surg,2 Cardio-Vascular Center of Gumma Pref bacteriologic testing revealed Streptococcus constellatus. Seven The purpose of this study is to determine diagnostic performance months later, her shoulder pain was relieved but the humeral head of MRI including GD-enhanced MRI in evaluation of rotator cuff tear. remained somewhat drooped. A drooping shoulder due to septic The subjects were 41 shoulders with rotator cuff tear that performed subacromial bursitis is thought to be caused by muscle dysfunction in MRI before surgery. After intravenous injection of GD-DTPA, 14 order to avoid severe pain. 460 JSS Abstracts J Shoulder Elbow Surg September/October 2000

25 MRI OF PERIARTHRITIS SCAPULOHUMERALIS—EFFU- contrast MRI for detecting the superior glenoid labral detachment in SION AND CLINICAL SYMPTOMS painful throwing shoulder. Forty painful throwing shoulders were Mako Hirano and Kazutoshi Nomura; Dept of Orthop Surg, included in this study. Intensity and morphological features in the Kumamoto National Hospital, Kumamoto biceps tendon/labral complex in T1 weighted images were evaluat- Materials and Methods: We examined MRI findings in patients ed and classified into 4 groups (Type I, II (-A,B), III, and IV). Then with periarthritis scapulohumeralis. Subjects comprised 75 cases, 77 these MRI findings were compared with arthroscopic findings. When shoulders (45 men and 30 women), with an average age of 58.3 the Type III or IV were diagnosed as the superior glenoid labral years (range 40-78). Results: Joint effusion was observed in 68.8% detachment, this study showed 68.8% of sensitivity, 95.8% of speci- of glenohumeral joints, 23.4% of subacromial bursa. 69.4% had effu- ficity, and 85.0% of accuracy. sion in the sheath of the long head of the biceps long tendon. We studied the relationship between MRI findings and clinical symptoms. 30 ROTATOR CUFF TEAR ACCOMPANIED BY CONTRAC- Conclusion: Glenohumeral joint effusion was observed in 68.8%. TURE This suggested that there was arthritis in the cases of periarthritis T. Hirooka,1 K. Yamasu,1 H. Hashizume,2 M. Nagoshi,2 and H. scapulohumeralis. Inoue;2 Dept of Orthop Surg,1 Tottori Municipal Hospital, Tottori; Dept of Orthop Surg,2 Okayama University, Okayama, Japan 26 SCAPULAR NECK FRACTURE WITH IPSILATERAL Purpose: This study is to clarify the pathology of rotator cuff tear ACROMION, SCAPULAR BODY FRACTURE AND ACROMIO- accompanied by contracture. Material and Methods: Contracture CLAVICULAR DISLOCATION–A CASE REPORT groups were subdivided two groups by arthroscopy; Group A (4 Mako Hirano and Kazutoshi Nomura; Dept of Orthop Surg, patients) showing synovial congestion in both the glenohumeral joint Kumamoto National Hospital, Kumamoto and subacromial bursa, and Group B (5 patients) showing these find- Nineteen-year-old female met traffic accident. X-rays showed ings only in the glenohumeral joint. Two groups were compared with acromioclavicular dislocation, acromion fracture, scapular neck and pathologic and clinical findings. Result: Significant differences were body fracture on the right side and showed distal clavicular fracture observed in age and morphology of the cuff tear. Conclusion: on the left side. There was no sensory disturbance. The motion of Group A was characterized by aged and a tear mainly involving the elbow and hand was normal. Plate fixation was performed for scapu- bursar surface, while Group B by young and the articular surface. la neck fracture with the dislocated fragments of scapular body remained. The fixation of acromion was done with K-wire and soft 31 MORPHOLOGICAL CHANGES OF THE SUBSCAPU- wire. The fixation of acromioclavicular joint was done with screw LARIS IN THE SHOULDER INSTABILITY ON MRI ARTHROG- between clavicula and coracoid process. On the left side, K-wire and RAPHY IMAGES soft wire fixation was done for distal clavicular fracture. Yasumoto Matsui, Masaki Shin, Masaki Yoda, and Shiroh Imaga- ma; Dept of Orthopaedic Surgery, Toyohashi Municipal Hospital, 27 STUDY ON THE CASES HAVING ROTATOR CUFF Aichi, Japan INJURY WITH THE SEPARATION OF THE ACROMIO-CLAVICU- Morphological changes of subscapularis were examined on MRI LAR JOINT arthrography (MRA) of 39 shoulders, (male 31, female 8), mean age Kie Mimori and K. Nobuhara;* Orthopaedic Surgery, Tamagawa 26.3 y.o. (16-46), 26 anterior instability (group A), 6 multidirection- Hospital, Tokyo, Japan; *Nobuhara Hospital and Institute of Bio- al instability (Group M) and 7 non-instability (Group P) cases. On mechanics, Hyogo, Japan axial images (3 o’clock), length, thickness, distance AG (articular sur- We reported clinical results of patients with both the acromio- face — glenoid attachment), distance AS (glenoid anterior edge — clavicular separation and the rotator cuff tear. Materials were 9 men subscapularis) and surface irregularity. Statistical differences were and 1 woman, and all of them were diagnosed as the acromio-cla- examined between groups. Between Group A and P, length, thick- vicular separation and treated at another orthopaedic surgeons, and ness, distance AS and irregularity were significantly different. were overlooked rotator cuff injuries. They visited our hospital by pain Between Group A and M, length and distance AS were so. Sub- and dysfunction of the shoulder, and were repaired rotator cuff scapularis were elongated and stay redundant in anterior shoulder lesion. Satisfactory results were achieved in 9 cases. However, 2 instability cases. cases were at law. Attention to the existence of hidden rotator cuff injury must be required, when violent force affects around the 32 MEDICAL CHECK FOR THE BASEBALL INJURIES OF acromio-clavicular joint. THE SHOULDER JOINT ON THE JUNIOR AND SENIOR HIGH SCHOOL STUDENTS IN THE KOCHI PREFECTURE 28 14 CASES OF POST-TRAUMATIC OSTEOLYSIS OF THE Yutaka Morisawa,1 Teruhiko Kawakami,2 Hiroshi Yamamoto,2 and DISTAL CLAVICLE Tetsuro Sadahiro;3 Dept of Orth Surg,1 Kochi Prefectural Hata Ken- N. Ishige, MD,1 S. Kuroda, MD,1 J. Moriishi, MD,1 K. Maruta, min Hospital; Dept of Orth Surg,2 Kochi Med School; Flec Clinic,3 MD,1 T. Saisu, MD,2 and K. Fujita, MD;2 Matsudo Orthopaedic Kochi, Japan Hospital,1 Dept of Orthop Surg,2 Chiba Univ, Japan We performed the medical check for the baseball injuries of the We had treated 14 patients (average age: 33.1 years, 13 men shoulder by means of the questionnaire and physical examination on and 1 woman, 9 cases with acute injury and 5 with repeated minor the 116 junior high school baseball players and 76 high school play- trauma) with post-traumatic osteolysis of the distal clavicle. Outcomes ers in 1997 and 105 junior and 95 high school players in 1998. The by Cahill’s grading system had some association with style of injury positive findings (tenderness and limited R.O.M. of the shoulder joint) but not osteolysis. Findings of discs of A-C joint on MRI were divided were revealed almost 30% numbers of them. Our results suggest that into 3 types. Normal types tend toward good results but degenerative the early search for the shoulder injuries of the young baseball play- or disappeared ones toward bad. 3 pathological specimens showed ers is useful for treating the throwing injuries of the shoulder joint. osteolytic lesions on the border of A-C joint. This study suggested that these osteolyses were related to some changes of A-C joint. 33 INFECTION WITH MRSA AFTER AN OPEN BANKART & BRISTOW PROCEDURE 29 MRI DIAGNOSIS OF SUPERIOR GLENOID LABRAL Y. Gotoh, MD, D. Tsuruta, MD, N. Mura, MD, M. Matsuda, MD, DETACHMENT IN PAINFUL THROWING SHOULDER and Y. Momonoi, MD; Dept of Orthop Surg, Municipal Sakata T. Yamazaki, MD,* R. Sasaki, MD,* and H. Takazawa, MD;** Hospital, Yamagata, Japan Dept of Orthopaedic Surg, Yokohama City Kowan Hosp,* Yoko- A 19-year-old man underwent a combined Bankart & Bristow hama Sports Medical Center,** Yokohama City, Japan operation for recurrent anterior dislocation of his left shoulder. After The purpose of this study was to investigate the usefulness of non- the 2nd postoperative day, his temperature rose to 39°C, and he had J Shoulder Elbow Surg JSS Abstracts 461 Volume 9, Number 5 watery diarrhea and diffuse erythrodermatous rash, but a focal sign dence of recurrence for 6 months. The diagnosis of tuberculous arthri- of wound infection was not found. On the 11th day, wound had pus tis in early stage is difficult. It’s important to give thought to tubercu- and underwent incision and drainage. Micro-organism cultured was lous arthritis in some arthritis. MRSA. Arbekacin was administered, infection disappeared. Howev- er wound infection recurred the next year. Fistelectomy and resection 38 INFLUENCE OF THE OCCUPATION UPON THE ROTA- of abscess were performed. Thick suture threads were a core of TOR CUFF TEAR abscess. Fortunately septic arthritis didn’t arise, his shoulder function Katsumi Sato, Tatsuro Komatsuda, Takashi Narishige, Tadao was preserved. Ojima, Jun Kumagai,* and Koji Ishibashi;** Department of Orthopaedic Surgery, Tohoku Rosai Hospital, Tohoku University 34 EFFECT OF TGF-ß1 ON THE PATELLA TENDON OF School of Medicine,* Ishibashi Hospital,** Sendai, Japan THE RAT The present study was undertaken to elucidate the influence of the K. Mimori, T. Muneta, and K. Shinomiya; Dept of Orthopaedic occupation upon the symptomatic rotator cuff tears. 283 patients Surgery, Tokyo Medical and Dental University, Tokyo, Japan (218 males, 65 females) who received the cuff repairs were ana- Purpose: Effect of TGF-ß1 on a free tendon graft was investigat- lyzed. Tear types were 236 complete and 47 incomplete tears. They ed. Material & Methods: Patella tendons with patella and tibia were categorized as follows: A) persons engaged in manual labors, (BTB) of Sprague Dawley rats were removed. A contraction force B) farmers, fishermen, C) housewives, D) sedentary workers, E) dri- (0.5N) was given continuously on a frame. And TGF-ß1 (0.4µg) was vers, F) teachers and G) retail dealers. The incidence of each cate- given around BTB in only TGF group. And BTB was transplanted gory was as follows: A)=30%, B)=24%, C)=11%, D)=10%, E)=9%, below the skin. After 4 weeks, the length was measured and BTB was F)=6% and G)=5%. The ratio of cuff tears/the population of occu- examined dynamically. Results: Length of the tendon in TGF group pation category was as follows: B)=3.6, E)=2.2 and A)=1.1. were significantly longer than in control group. Maximum load and linear stiffness in TGF group were smaller than those in control group. 39 THE ACTIVITIES OF SHOULDER MUSCLES IN THE EXTERNAL ROTATIONAL MOTION OF THE SHOULDER—EVAL- 35 ARTHROSCOPIC FINDINGS AND SURGICAL RESULTS UATION BY ELECTROMYOGRAPHY OF MODIFIED BRISTOW PROCEDURE FOR RECURRENT DIS- Hiroshi Noguchi, Masataka Sakane, Tomohiro Kizuka, and Naoyu- LOCATION OF THE SHOULDER ki Ochiai; Dept of Orthop Surg, Mitsukaido-Seibu Hospital; Dept Mitsuru Nagoshi, H. Hashizume, and H. Inoue; Dept of Orthop of Orthop Surg, Ibaraki-Kenritsu-Iryo University; National Institute Surg, Okayama Univ Med School, Okayama, Japan of Bioscience and Human Technology; Dept of Orthop Surg, Tsuku- Purpose: We analyzed the clinical results of modified Bristow ba University, Japan procedure and arthroscopic findings. Material and Methods: 32 The purposes of this study were to evaluate activity of shoulder patients (25 men, 7 women, the average age: 26.5 yrs) were evalu- muscles with various load in external rotational motion and to find the ated. Surgical results were evaluated according to JOA instability load in which inner muscles work mainly. We examined non-domi- score system. Arthroscopy was performed preoperatively and post- nant side of 8 adult males having no shoulder disorder. Each person operatively. Results: JOA score averaged 89.5 points (before performed external rotational motion in various load (0~18Nm, surgery: 52.5 points). In postoperative arthroscopies, bone defects maximum voluntary muscle contraction [MVC]), with Cybex- and labrum injuries seemed to increase, and cartilaginous defects of NORM770. We obtained electromyogram of 7 outer and 3 inner anterior glenoid undetected before surgery were seen. Conclusion: muscles. Under 46.8% MVC load, activities of inner muscles were From the arthroscopic findings, we considered that this procedure always superior to that of outer muscles. It was under 10% MVC load cannot maintain the centripetal position. to activate only inner muscles but not outer muscles.

36 EVALUATING THE POST-DEBRIDEMENT SIZE OF ROTA- 40 GLENOHUMERAL LIGAMENT COMPLEX IN TRAUMAT- TOR CUFF TEARS USING MRI IC ANTERIOR INSTABILITY OF THE SHOULDER T. Takizawa, MD, S. Akizuki, MD, Y. Yasukawa, MD, and H. J. Ide, MD, M. Yamaga, MD, S. Maeda, MD, S. Maruta, MD, and Kobayashi, MD; Dept of Orthopaedic Surg, Nagano Matsushiro K. Takagi, MD; Dept of Orthopaedic Surgery, Kumamoto Univ Sch General Hospital, Nagano, Japan of Med, Kumamoto, Japan We compared the post-debridement size of rotator cuff tears The purpose of this study was to determine the prevalence and determined from surgical findings with that measured by MRI. The characteristics of glenohumeral ligament complex (GHLC) in trau- subjects were 20 patients (21 shoulders) with complete rotator cuff matic anterior instability (TAI) of the shoulder. Control group: 84 tear who underwent MRI before surgery. The mean difference shoulders (44 cadavers) were examined. TAI group: 24 shoulders between the operative findings and the values measured with MRI (24 patients) were examined arthroscopically. GHLC was assigned was 10.1±9.2mm for fast T2-weighted images and 4.6±9.1mm for to one of four anatomical categories: type 1 has three distinct liga- T2*-weighted images obtained in the oblique coronal plane. The ments; type 2 has three ligaments but a narrow MGHL; type 3 has mean differences obtained using oblique sagittal images were two ligaments, no MGHL; type 4 has no ligament pattern. The preva- 9.1±5.7mm and 2.7±7.0mm, respectively. Our findings indicate that lence of SGHL, MGHL and IGHL in the TAI group was same as in the T2*-weighted image is useful for estimating the post-debridement size control group. On the other hand, the prevalence of GHLC type 2 in of rotator cuff tears. the TAI group was significantly higher than in the control group. This study suggests that a narrow MGHL (GHLC type 2 ) predisposes to 37 TUBERCULOUS ARTHRITIS OF THE STERNOCLAVICU- traumatic anterior instability. LAR JOINT—A CASE REPORT M. Matsuda,1 Y. Gotoh,2 N. Mura,2 and Y. Momonoi;2 Dept of 41 POSTOPERATIVE OUTCOME OF MODIFIED INFERIOR Orthop Surg,1 Yamagata Saisei Hospital, Dept of Orthop Surg,2 CAPSULAR SHIFT (MICS) WITH DIFFERENT ARM POSITIONS Yamagata University, Yamagata, Japan OF IMMOBILIZATION IN ATHLETES Tuberculous arthritis is slightly increasing. We describe a case Y. Uchiyama,1 K. Hamada,2 T. Nakajima,2 K. Kobayashi,2 S. with sterno-clavicular joint tuberculous. An 83-year-old man had a Miyazaki,1 K. Shioda,1 and H. Fukuda;2 Departments of Orthope- painless swelling over the sternoclavicular joint for 3 months. Needle dic Surgery, Shioda Hospital1 and Tokai University School of Med- biopsy didn’t reveal its pathology. The tuberculin skin test and PCR of icine,2 Japan his sputum were positive. Surgical debridement was performed. The Purpose: To evaluate the effects of the postoperative arm posi- medial end of clavicula, the first rib, and a portion of the sternum tion on the postoperative results. Materials and Methods: 47 were excised. Chemotherapy was administered. There was no evi- patients were operated with MICS. The patients were immobilized at 462 JSS Abstracts J Shoulder Elbow Surg September/October 2000 internal rotation (IR, 27) and, in neutral rotation (NR, 20). Postoper- 45 EXPERIMENTAL SUPRASPINATUS TENDON REPAIR ative results were evaluated by difference in ROM, JOA score and USING FASCIAL PATCH AUTOGRAFTING Rowe score in 6 and 12 months after surgery. Results: These aver- H. Sano, MD,1 J. Kumagai, MD,1 and T. Sawai, MD, PhD;2 Dept of age limitations showed significant difference. (Table) JOA-sports and Orthopaedic Surgery,1 Tohoku Univ Sch of Med, Dept of Patholo- Rowe scores were greater in NR than IR. Conclusion: Arm positions gy,2 Iwate Med Univ, Sendai, Japan of immobilization should not be immobilized at anatomical position The purpose of this study is to clarify the remodeling of grafted in IR postoperatively. fascia and the reformation of fibrocartilaginous enthesis after fascial patch autografting using rabbit model. Histologically, the number of Table newly appeared fibroblasts increased until 8th week and gradually decreased thereafter. Fibrocartilage cells started to appear around 6 months 12 months the grafted fascia on 2nd week and increased thereafter. The graft- IR NR IR NR ed fascia gradually remodeled to the tendinous tissue and the reformed insertion showed similar histologic structure to that of nor- ER in anatomical position 20.6 10.4* 11.9 3.3* mal supraspinatus tendon insertion. These changes almost completed ER in abducted position 23.8 14.6* 12.7 5.4* by 8 weeks after surgery.

*Mann-Whitney, P < .05. 46 TWO CASES OF THE PRIMARY SYNOVIAL CHONDRO- MATOSIS IN THE SUBACROMIAL BURSA 42 ONE-PORTAL ENDOSCOPIC TECHNIQUE FOR PRO- M. Horii, MD, K. Kido, MD, M. Tamai, MD, M. Kurokawa, MD, and LONGED NIGHT PAIN AND FROZEN SHOULDER Y. Hirasawa, MD; Dept of Orthop Surg, Kyoto Prefectural Univer- K. Imada, MD, J. Ozaki, Y. Yoshizumi, G. Sakurai, and K. Yukata; sity of Medicine, Kyoto, Japan Dept of Orthop Surg, Kurobe City Hospital, Kurobe, Japan We report two cases of the primary synovial chondromatosis in the One-portal endoscopic soft tissue decompression under local block subacromial bursa with anterior acromial spurs and no complete rota- was performed to 31 cases with night omalgia or frozen shoulder. The tor cuff tear. A 54-year-old male printer had three loose bodies and transparent sheath with endoscope was inserted into the subacromial three nodules in the mild proliferative synovial tissue. A 60-year-old space through 1cm of skin incision. Blunt release of subacromial space, male wine merchant had thirty-one small loose bodies and signifi- removal of coracoacromial ligament, and blunt release of rotator inter- cantly proliferated synovial tissue with four attached nodules. Histo- val were done. Three months after operation, night pain improved in 21 logically, no fragments of cartilage nor bone were seen within the sy- of 24 cases and shoulder motions were improved significantly. Self- novial membrane and within the nodules in both cases. Their overhead assessment study declared that 76% of complaints were improved on labor in the routine works seems to indicate that persistent subacromial an average. Three cases with complete cuff tear remained omalgia. impingement may be an inducement for chondrometaplasia.

43 THREE DIMENSIONAL RECONSTRUCTION OF THE 47 DEGENERATIVE GLENOHUMERAL ARTHROSIS FOL- SHOULDER MRI: A PRELIMINARY REPORT LOWING RECURRENT ANTERIOR DISLOCATION OF THE H. Minagawa, E. Itoi,* E. Takaoki,** and T. Nishi; Dept of SHOULDER Orthopaedic Surgery, Ugo Municipal Hospital, Akita, Japan; Dept A. Yoshida, MD,* K. Ogawa, MD,** M. Takahashi, MD,** W. of Orthopaedic Surgery,* Akita University, Akita, Japan; META Inokuchi, MD,** M. Ui, MD,** T. Naniwa, MD,** N. Nakamichi, Corporation Japan,** Tokyo, Japan MD,** and S. Kobayashi, MD,** Dept of Orthop Surg,* Nation- Purpose: To clarify the possibility and the value of 3D-recon- al Saitama Hospital, Dept of Orthop Surg,** Sch of Med, Keio struction of the shoulder MRI. Methods: The shoulder of a 50-yr-old University, Saitama, Japan man with a rotator cuff tear was imaged using an 0.5T MRI-system. 113 shoulders of recurrent anterior shoulder dislocation with Sagittal oblique images were obtained with 1.0-mm thick, contiguous Bankart operation were examined at an average 7.6 year followup. sections. Data were transferred to a personal computer running The radiographs showed an osteophyte on the anteroinferior margin VOXEDIT (META Corporation Japan) for 3D-reconstruction. Results: of the humeral head in 17 (15.0%) shoulders. The variables, which are 3D-reconstruction allowed reproduction of good virtual images of the age, duration, and ROM, were compared between the osteophyte- rotator cuff with a tear. Comparison between surgical findings and group and the non-osteophyte-group. The age at followup, operation reconstructed images revealed excellent morphological correlation. and initial dislocation were significantly higher in the osteophyte- Conclusion: A precise 3D reconstruction of the rotator cuff with a group. It was noted by reviewing preoperative CT-pneumoarthrogra- tendon tear is possible using MR images. phy that the osteophyte existed in 76.5% of the osteophyte-group and 15.6% of the non-osteophyte-group. It was suggested that the risk fac- 44 DEVELOPMENT OF FIBROUS TISSUE THAT CONNECT tor of development of the arthrosis existed in the preoperative factor. TENDON TO BONE: THE MOST EFFECTIVE BONY SURFACE FOR TENDON ATTACHMENT 48 MR ARTHROGRAPHIC FINDINGS AFTER ARTHRO- M. Aoki, MD, PhD, H. Oguma, MD, K. Okamura, MD, A. Kimura, SCOPIC BANKART REPAIR REINFORCED WITH THE SUB- MD, S. Fukushima, MD, and S. Ishii, MD, PhD; Dept of Physical SCAPULARIS TENDON Therapy School of Health Science, Sapporo Medical University, M. Obata, M. Yoneda, Y. Miyazaki, K. Kagaya,* and T. Taki-uchi,* Sapporo, Japan Dept of Orthop Surg, Osaka Kosei-nenkin Hosp, Dept of Orthop The purpose of this histological study was to identify the most Surg,* Sapporo Med Univ, Osaka, Japan effective bony surface for connection of newly formed collagen fibers Seventy-two patients (73 shoulders) were evaluated about postop- to bone. The left infraspinatus tendons of fifteen beagle dogs were erative findings of arthroscopic Bankart repair reinforced with the sub- repaired to 3 different surfaces: Group 1, tendon end adjacent to ten- scapularis tendon using MR arthrography (MRA) before and 6 months don insertion; Group 2, calcified fibrocartilage layer; Group 3, can- after surgery. The mean age 27 years, the mean follow-up period 18 cellous surface. Tendon repair to distal tendon ends restored the four- months. All cases showed good healing of the Bankart lesion. Twenty- layered enthesis, whereas tendon repair to the calcified fibrocarti- six cases showed smooth transition between the labrum and the gle- lage layer considerably delayed fiber development into bone. Fiber noid, others showed protrusion. Large bony defect of the glenoid fossa connection to cancellous surface developed according to the remod- (fourteen cases) was filled with soft tissue-like mass postoperatively. In eling of trabecular bone and formation of four-layered enthesis devel- 70 cases the subscapularis muscle showed good contact with the gle- oped by postoperative week 16. noid neck. Atrophic change of the subscapularis muscle wasn’t noted. J Shoulder Elbow Surg JSS Abstracts 463 Volume 9, Number 5

49 JOINT LAXITY IN BASEBALL SHOULDER WITH BEN- 53 REPAIR OF THE ROTATOR CUFF TEAR IN RELATION TO NETT OSSIFICATION AGE AND ITS SIZE S. Nakagawa, M. Yoneda,* M. Obata,* N. Mura,** and Y. Y. Shibata, MD, K. Midorikawa, MD, and M. Naito, MD; Dept of Miyazaki;* Dept of Orthop Surg, Hoshigaoka Kosei-nenkin Hosp, Orthop Surg, Fukuoka University, Fukuoka, Japan Osaka Kosei-nenkin Hosp* and Yamagata Univ Med School,** Surgical results of 100 shoulders with cuff tear were studied in Osaka, Japan relation to ages and size of the tear. These were divided to 4 groups Purpose: To investigate joint laxity in baseball shoulder with Ben- according to their ages. Width and length were ave 3.5 and 3.1 cm nett ossification. Methods: Twenty-eight players were studied retro- in >70 yrs, 3.2 and 3 cm in 60-69 yrs, 2.7 and 2.5 cm in 50-59 yrs, spectively. Eight were painful, and the mean age was 23. Slipping 2.4 and 2.2 cm in <49 yrs. Older pts had a larger tear size. Larger and anterior-posterior and inferior joint laxity of bilateral shoulders width of the tear size revealed lower range of motion and JOA score were evaluated radiologically. Results and Conclusion: Slipping in at pre- and post-operative state. Larger width of the tear is risk factor unaffected shoulder was positive in 12 and negative in 16. In patients for cuff repairs. with positive slipping in unaffected-side, in affected shoulder slipping was similar in 6, reduced in 4, and negative in 2. In patients with neg- 54 RESULTS OF ARTHROSCOPIC SUBACROMIAL DECOM- ative slipping in unaffected-side, no slipping was seen in affected-side. PRESSION FOR SHOULDER IMPINGEMENT SYNDROME Posterior joint laxity was larger in affected-side regardless of slipping. K. Kagaya, MD,* K. Okamura, MD,* S. Fukushima, MD,* M. Aoki, MD,** and S. Ishii, MD;* Dept of Orthop Surg,* Sapporo Med 50 RESTORATION OF THE SHOULDER FUNCTION IN Univ, Dept of Physical Therapy,** Sapporo Med Univ School of BRACHIAL PLEXUS INJURY AND BIRTH PALSY Health Sciences, Sapporo, Japan M. Eto, MD, T. Tomonaga, MD, and H. Shindo, MD; Dept of We investigated the clinical outcome of arthroscopic subacromi- Orthop Surg, Nagasaki Univ Sch of Med, Nagasaki, Japan al decompression in patients with shoulder impingement. We retro- 16 patients with brachial plexus injury and 11 patients with birth spectively studied 52 patients. The mean follow-up period was 2.9 palsy underwent the restoration. The restorations were performed by months. The average JOA pain score improved from 13.6 to 26.3 trapezius and levator scapulae transfer in 13 cases and arthrodesis points. Thirty-seven patients were satisfied with this procedure, 9 were in 3 cases with brachial plexus injury. Multiple muscle transfer were fairly satisfied, and 6 were not satisfied. Five of the six unsatisfied carried out in 9 cases and humeral rotation osteotomy in 2 birth palsy patients underwent a second-look operation. The average α angle cases. In brachial plexus injury, abduction angle improved to 45°. improved from 30.6 to 34.3 degrees. Six out of 52 patients (12%) Two arthrodesis patients had humeral fracture. In birth palsy, abduc- were unsatisfied. The causes of postoperative pain were adhesive tion angle improved from 52° to 98°. Rotation osteotomy patients subacromial bursitis, insufficient decompression, impingement sec- gained 30° in external rotation. We believe that the results achieved ondary to posterior instability, capsulitis, and unknown. with muscle transfer better than arthrodesis. 55 FAILURE OF BICEPS-SUPERIOR LABRAL COMPLEX 51 CONTRACTURE OF THE GLENOHUMERAL JOINT AS (SLAP LESION) IN THE THROWING ATHLETE: A BIOME- ONE OF THE REASONS FOR SLIGHT POSTOPERATIVE PAIN CHANICAL MODEL COMPARING MAXIMAL COCKING TO IN PATIENTS WITH ROTATOR CUFF TEAR EARLY DECELERATION Y. Hata, MD,* S. Saitoh, MD,** N. Murakami, MD,* H. Seki, J.E. Kuhn, MD,1 S.R. Lindholm, MS,1 L.J. Huston, MS,1 L.J. MD,** and K. Takaoka, MD;** Division of Rehabilitation Med* Soslowsky, PhD,2 and R.B. Blasier, MD;3 University of Michigan,1 and Dept of Orthopaedic Surg,** Shinshu Univ Sch of Med, Ann Arbor, Mich, University of Pennsylvania,2 Philadelphia, Pa, Nagano, Japan Wayne State University,3 Detroit, Mich Our previous studies demonstrated that the contracture of the SLAP lesion may occur during early deceleration or maximal glenohumeral joint was associated with postoperative pain. The pur- cocking. We compared biceps overload in these positions using ten pose of this study was to find out within the glenohumeral joint by paired cadaver shoulders. Results: The biceps labral complex failed arthrography at which site the contracture occurs. Glenohumeral under significantly less force in the maximal cocking position than in arthrography was performed in 36 patients around one year after the early deceleration position. Failure occurred at the superior gle- the McLaughlin procedure. Of the 36 patients, 21 presented slight noid in 9/10 specimens in maximal cocking and only 2/10 in early postoperative pain. The size of the anterior, inferior and posterior deceleration. Type II SLAP lesions were created in 5/20 specimens pouches was measured in the A-P and the scapula Y arthrograms. with 4 in the maximal cocking position and only 1 in the early decel- The size of the inferior pouch was significantly smaller in the patients eration position. Conclusion: Maximal cocking may be an important with postoperative pain than in those without pain (p < 0.01). position for the development of the SLAP lesion.

52 TWO CASES WITH A SUPRASINOUS FOSSA GAN- 56 HEALING CAPACITY OF ROTATOR CUFF AND THE GLION TREATED BY ARTHROSCOPIC DECOMPRESSION EFFECT OF SYNOVIUM OF SUBACROMIAL BURSA ON THE Koji Midorikawa, Yozo Shibata, and Masatoshi Naito; Department HEALING PROCESS—ORGAN CULTURE EXPERIMENTS of Orthopaedic Surgery, School of Medicine, Fukuoka University, K. Kikugawa,1 Y. Mochizuki,1 K. Kashiwagi,1 T. Imada,2 N. Okuhi- Fukuoka City, Japan ra,3 and N. Adachi;4 Dept of Orthop Surgery, Hiroshima Universi- Purpose: We performed arthroscopic decompression in 2 ty,1 Dept of Orthop Surgery, Kake Choritu Hospital,2 Dept of patients with pain and paralysis due to a supraspinous fossa gan- Orthop Surgery, Mazda Hospital,3 Dept of Orthop Surgery, glion. Surgical Procedure: Under anterior arthroscopy, the postero- Chugoku Rosai Hospital,4 Hiroshima, Japan superior joint capsule and the ganglion capsule was partially resect- The purpose of this study is to examine the self-healing capacity ed and opened into the joint. Subjects and results: Patient 1 was a of rotator cuff and the effect of synovium of SAB on healing process 24-year-old male and 2 was a 47-year-old male with pain. In both using organ culture system. The following groups (F group: only cylin- patients, marked atrophy of the ISP was observed. MRI showed a drical hole in rotator cuff, R group: hole filled with rotator cuff, S large cystic lesion in the scapular spine. Early after arthroscopic group: hole filled with synovium) were investigated using H-E staining decompression, the nocturnal pain disappeared, and postoperative and immunostaining with antibodies against procollagen I. In S MRI revealed no findings suggesting recurrence. With recovery of group, incorporation between rotator cuff and synovium was muscle strength, the complaints disappeared. Conclusion: Arthro- observed, and PCI staining around the hole was remarkable. These scopic decompression performed in this study allows accurate findings suggested that rotator cuff would possess the self-healing decompression without risks of a functional decrease or scars. capacity and synovium would play the important role. 464 JSS Abstracts J Shoulder Elbow Surg September/October 2000

57 DAYTIME AND NIGHTTIME ACTIVITIES OF THE DELTOID EMG was continually recorded from 18:00 PM to 10:00 AM (16 MUSCLE IN PAINFUL SHOULDERS: A PRELIMINARY STUDY hours) with ME3000 devices. The averaged EMG were calculated Ikuko Wakabayashi, Eiji Itoi, and Togo Shimizu; Dept of Orthop the integral value per one hour and compared in daytime and night- Surg, Akita University School of Medicine, Akita, Japan time. EMG activities of the deltoid muscle at night were approxi- To determine the shoulder activity of the patients with painful mately 1/5 of those during the daytime in both involved and unin- shoulder. Six patients (5 rotator cuff tears, one subacromial bursitis) volved sides. Deltoid activities in the involved side were lower than in were observed using surface EMG of the deltoid muscle. The surface the uninvolved side during daytime.

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