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