34TH ANNUAL MEETING OF THE JAPAN SHOULDER SOCIETY 1 F Wave Monitoring After Arthroscopic Shoulder Surgery gers may be used to evaluate the functions of the shoulder joint. It is IWATA Yoshio, Department of Orthopaedics, Uji Takeda Hospital also believed that people can perform approximately half of the ac- MORIHARA Toru, HAYASHIDA Tatsurou, OGURA Akiko, KUBO tions even if the diseased hand is on their dominant side. Toshikazu, Department of Orthopaedics, Kyoto Prefectural Univer- sity of Medicine, Graduate School of Medical Science HORII Motoyuki, Department of Orthopaedic Surgery, Kyoto Inter- 3 The Shoulder Function of Congenital Clavicle Anomalies disciplinary Institute Hospital of Community Medicine KENMOKU Tomonori, Department of Orthopaedics Surgery, Chiba KUROKAWA Masao, Department of Orthopaedic Surgery, Saisei- Univercity Graduate School of Medicine kai Suita Hospital SAISU Takashi, KAMEGAYA Makoto, Division of Orthopaedics Sur- The purpose of this study was to evaluate the modulation of excit- gery, Chiba Children’s Hospital ability of spinal motor neuron function. We investigated F waves af- MIKASA Motohiko, Matsudo Orthopaedic Hospital ter arthroscopic shoulder surgery. We evaluated 7 subjects who There was no report on the shoulder function of congenital clav- underwent an arthroscopic shoulder surgery. There were 5 men icle anomalies. Our purpose was to clarify the role of the clavicle, and 2 women; the mean age at the time of surgery was 33.6 years investigating the shoulder function in patients with clavicle defect old. In our study, F waves were recorded from the abductor pollicis or pseudoarthrosis. muscle after transcutaneous median nerve stimulation at bilateral Thirteen shoulders of 9 patients with congenital clavicle anoma- wrists. Stimulation current was gradually increased to exceed that lies were retrospectively investigated for this study. Diagnoses were needed to evoke a maximum M wave. This supramaximal current congenital pseudoarthrosis in 3 patients, congenital complete de- was used for all subsequent stimulations. Amplification for F wave fect in 1, major defect due to cleidocranial dysplasia in 3, distal de- analysis of 16 consecutive stimuli was delivered. Preoperatively, fect related to congenital progeroid syndrome in 1, proximal half after 1 day, 3 days and 7 days, F waves were recorded. The defect related to Goltz syndrome in 1. The mean follow-up term mean F-wave amplitudes were determined in each time period, was 7 years. We evaluated their range of motion (ROM) of the shoul- and statistical analyses were performed. F wave amplitudes after der and activities of daily living. In a case of congenital defect of the 1 day recorded at each wrist were significantly lower than at pre- clavicle and 2 pediatric cases of cleidocranial dysplasia, slight operation. F wave amplitude gradually increased in time in the post- ROM limitation of the shoulder were seen. In the remaining cases, operative period. However, in case 4, the F wave amplitude was there was no limitation. All patients’ daily activities were not dis- lower than that of preoperation. F wave amplitude can be consid- turbed. In patients with less than a 2/3 defect of the clavicle, there ered a variable reflecting the functional integrity of the motor system was no functional problem of the shoulder. Although mooring mus- from the spinal portion of a motor neuron to the neuromuscular junc- cles of the scapula worked in compensation for the clavicle defect tion. These results suggested that inexcitability of spinal motor neu- in patients with more than a 2/3 defect, they needed to make the ef- ron function is potentially caused by the rest after the operation. F fort to keep not only the elevated position but also the neutral posi- wave monitoring could provide additional information on the state tion of their shoulders. of rehabilitation in the early postoperative period. 4 The Feature of Scapula Malposition with Rotator Cuff Tears 2 Spatial Zones for Activities of Daily Living Centered on KOBAYASHI Hirokazu, KIMIZUKA Kouichiro, Department of Ortho- Shoulder Joints paedic Surgery, Chushin-mastumoto General Hospital HARA Masafumi, Department of Orthopaedic Surgery, Hisatsune HATAYukihiko, Division of Rehabilitation Medicine, Shinshu Univer- Hospital sity School of Medicine TOMINAGA Natsuko, NOMIYAMA Naoko, Hara Baseball Medi- MURAKAMI Narumichi, Sports Medical Center, Aizawa Hospital cal Institute KATO Hiroyuki, Department of Orthopaedic Surgery, Shinshu Uni- Range of motion (ROM) was a functional evaluation of the shoul- versity School of Medicine der joint; yet, there were various methods to evaluate the activities of In the example of rotator cuff tears with a scapula malposition, daily living (ADL) using the upper arms. It was possible to evaluate especially the scapula was often accepted. This study investigated ROM of the shoulder joint and ADL simultaneously. Using spatial the characteristics of the rotator cuff tears with a scapula malposi- zones centered on the shoulder joint, a classification into 6 zones tion. One-hundred consecutive shoulders in 100 patients who under- was performed. Zone 1 for inner lower space, zone 2 for inner up- went rotator cuff repair were studied retrospectively. The age of the per space, zone 3 for exterior lower space, zone 4 for exterior up- patients ranged from 33 to 79 (mean, 62.4) years old and the man per space, zone 5 for lower and rear space, and zone 6 for and woman ratio was the male 57 shoulders and female 43 shoul- upper and rear space. Within each zone, upper arm actions in der. Roentgen-rays of an about the upper arm descent were photo- ADL were classified. (1) ADL items using the upper arm were given graphed to pre-operation, the straight line which connects to 20 adults, and 30 of the more frequent actions were extracted. a scapula socket inferior extremity and the angulus inferior scapula Subsequently, other actions were given, and 100 ADL items ex- with a scapula side image was defined as the scapula length axis, tracted. (2) The 100 ADL items were classified and compared, using and this angle was measured by making the angle with the straight the zone at the humerus and the zone at the hands and fingers. (3) line which connected the surface of the rib of the superior extremity The 100 ADL items were classified into each zone. (4) Actions of the located in that range, and the inferior extremity was the scapula an- dominant hand in ADL were A group, actions executable with 1 gle of inclination. The peak of this angle facing up was the peak of hand were B group, and actions with both hands were C group. a scapula anteversion group and facing down were the scapula ret- The above-mentioned 100 items were classified into respective roversion group. Comparison examinations were performed about groups. (2) When classifying at the humerus, inner /external rota- medical histories, range of motion and the cuff tear size at opera- tion in the shoulder joints was excluded, but when classifying at tion. The range of motion that internal rotation in 2nd position, in the hands and fingers, inner/external rotation was reflected. There- the retroversion group was significantly smaller than that in the ante- fore, it was possible that the classification zone at the hands and fin- version group (P < .05). The size of rotator cuff tear in the e1 e2 Abstracts J Shoulder Elbow Surg retroversion group was significantly larger than that in the antever- ally, we performed immunohisotochemical staining of Type Iand III sion group (P < .05).The inclination of a scapula was understood collagen. The coracohumeral ligament overlaid the tendinous por- to be the size of rotator cuff tear was one of the factors. By investigat- tion of the supraspinatus and infraspinatus; however, the coracohum- ing the angle of gradient of a shoulder blade by a shoulder blade eral ligament was distinguished from the tendinous portion of the Roentgen-rays side image showed that it was possible to guess the supraspinatus and infraspinatus by the immunohistochemical stain- size and shoulder joint function of a rotator cuff tear roughly. ing of TypeIcollagen. The tendinous portion of the supraspinatus con- sisted of an anterior thick tendinous portion and a posterior thin fibrous portion. The anterior thick tendinous portion attached to the 5 Can the Abduction Strength Become an Indicator to Express anterior portion of the highest impressions of the greater tuberosity. a Shoulder Function? The tendinous portion of the infraspinatus consisted of a superior thick MIZUNO Naoko, NAKAGAWA Shigeto, Department of Orthopae- tendinous portion and an inferior thin fibrous portion, both of which dic Surgery, Yukioka Hospital were attached to the remaining large portion of the greater tuberos- YONEDA Minoru, YAMADA Shinichi, GOHROKU Takahiro, Shoul- ity. This histological study supported our new anatomical findings. der and Sports medicine service, Osaka Kosei-nenkin Hospital HAYASHIDA Kenji, Department of Orthopaedic Surgery, Osaka Police Hospital 7 Anatomical and Histological Study of the Tendinous and MAE Tatsuo, Department of Orthopaedic Surgery, Kansai Rousai Muscular Structures of the Infraspinatu -Which Layer can be Hospital Delaminated in the Case of the Infraspinatus Tears?- Weakness of abduction strength was often seen in shoulder pa- MOCHIZUKI Tomoyuki, YAMAGUCHI Kumiko, SUGAYA Hiroyuki, tients. The causes were various, such as rotator cuff insufficiency, NAKAGAWATeruhiko, MUNETATakeshi, AKITA Keiichi, 1. Section pain, instability, limited ROM, paralysis and disuse. We hypothe- of Orthopaedic Surgery, Division of Cartilage Regeneration Gradu- sized that abduction strength might reflect a shoulder condition. ate School, Tokyo Medical and Dental University; 2. Funabashi Or- The purpose of this study was to clarify whether abduction strength thopaedic Sports Medicine Center; 3. Unit of Clinical Anatomy, could become an indicator to express a shoulder function. We stud- Graduate School, Tokyo Medical and Dental University; 4. Depart- ied 57 patients (38 males and 19 females) with shoulder disorders. ment of Orthopaedic Surgery, Douai Memorial Hospital; 5.