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A study on the mechanoreceptors in the rotator cuff the subacromial bursa and the coracoacromial ligament —Morphology and distribution
J. Shoulder Elbow Surg. Volume 5, Number 2, Part 2
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54
Abstracts $135
OSTEOPHYTE ON A POSTERIOR SURFACE OF THE GLENOID IN ATHLETES. Y.Shibata, K.Midorikawa, T.Izaki, G. Emoto, K.Ogata, Dept. of Orthop. Surg., Sch. of Med., Univ. of Fukuoka, JAPAN Operative results of athletes having spur in posterior surface of the glenoid are reported. Five shoulders of five patients were evaluated after removing a spur on the posterior surface of the glanoid. Preoperative and postoperative evaluation of the patients included subjective pain, function and patient satisfaction, as well as objective assessment of the active range of motion, plane X-ray, double contrast arthrography, CT arthrography and MRI, The duration of follow-up ranged form 7 to 35 months (mean, 16.8 months). They were five men and their ages were from 23 to 26 year old(mean, 24 year). They were three baseball players and two volleyball players. They had performed their sports for an average of 12 years and their symptom duration ranged from four to seven years(mean, 5.2 years). Muscle atrophy of the supraspinatus was seen in all patients, Axial X-p showed all examples spur, but Bennett view revealed it in only 2 shoulders. All patients had tenderness on the posterior joint line. Lidocaine test directly injected to the spur was effective, but the injections to both the subacromial bursae and the glenn-humeral joint were not. Range of motion in-internal rotation, horizontal internal rotation and horizontal flexion was limited. Those restricted motion recovered postoperative state. All histological specimens showed maturated bone trabeculae. Three baseball players showed full recover at more than one year after surgery, but two volleyball players showed from 70 to 80% of satisfaction, at 7 months after surgery. These are traction spurs from the point of views, that is, the property of the restricted range of motion, shape on X-p and histological findings of the spur. The operation is effective for the patients who doesn't relief their symptom for conservative therapy.
55
Role of Long H e a d o f Biceps Brachii in R o t a t o r Cuff T e n d o n F a i l u r e : A n EMG S t u d y . G. Sakurai, MD, Y. T o m i t a , MD, K. Nakagaki ME), & S. Tamed, MD, Dept of O r t h o p Surg Nara Medical Univ., J. Ozaki MD, Dept of O r t h o p Surg Nara Pref Hospital. T h e p u r p o s e of this s t u d y was to d e t e r m i n e t h e function of t h e long h e a d o f biceps brachii in r o t a t o r cuff ini ury. ( M a t e r i a l s a n d M e t h o d s ) Ten m e n ( l O s h o u l d e r s ) w i t h i n t a c t c u f f a n d ten m e n (10 shoulders) with r o t a t o r cuff tears were studied. The average ages were 51.7 years a n d 56.6 years respectively.The e l e c t r o m y o g m p h i c signals were recorded from t h e LI-IBwith surface electrodes T h e subject p u t o n a n elbow brace locked in neutral forearm rotation a n d 0 degree of flexion to m i n i m i z e the elbow-related biceps activity; At six a n n positions a n d MVC, EMG signals were collected. T h e positions were a b d u c t i o n in t h e s c a p u l a r p l a n e (90, 150 degrees} in external or internal r o t a t i o n (30 degrees) a n d 90 degrees flexion in external o r i n t e r n a l r o t a t i o n (30 degrees).The root m e a n square (RMS} v a l u e w a s used a s a single e s t i m a t e of t h e myoeleclric p o w e r spectrum. ( R e s u l t s ) 1) T h e signal levels did not increase in b o t h groups w h e n the forearm load was applied. 2) T h e control g r o u p ' s RMS v a l u e s in e x t e ~ a l rotation were h i g h e r t h a n those in internal rotation a t all positions. The cuff t e a r group did not show a n y d e p e n d e n c e o n u p p e r a r m rotation. 3} T h e RMS was significantly increased in the cuff t e a r group with i n t e r n a l rotation t h a n t h a t in the i n t a c t cuff group ( C o n c l u s i o n ) We suggest t h a t in the shoulders w i t h cuff tears, m n s d e activity of t h e kHB increased in i n t e r n a l r o t a t i o n a t t h e u p p e r a r m elevation to corn p e n s a t e t h e cuff insuffidency.
A STUDY ON THE MECHANORECEPTORSIN THE ROTATOR CUFF
56
MR IMAGING0F THE FROZEN SHOULDER. K. 0kamura & J. Ozaki, MD, Dept of 0rthopaeciic Surgery, Nara Prefectural Hospital, i 30-1 Hiramatu.eho,Nara 631, Japan. Purpose : In the diagnosis of the shoulder [eaton, MRI is useful in demonstrating abnoJma{ities in the soft tissue structures. But the frozen shoalder is still diagnosed after other shonlder lesion are luled out. We reported on the localization and pathology of the frozen shoulder using MR imaging. Materials and methods : We have examined 35 shoulders in patients, 18 men and 17 womenwith the frozen shoulder since july in 1992 till january in ?.995. Scanning was performed on GE 1.5 T magneticimaging system with using a surface coil. T1weighted and T2 weightedsequense of all patients were obtained in the oblique plane along the supraspinatus muscle and in the axial plane. MR observation of the shoulder disorders were performed on the shoulder joint space, the sheath of the long head of the biceps tendon and the subaernminal bursa. Results : in All patients, the MR appearances of the frozen shoulder were excellent with the T2.weighted sequense. Twenty five patients had fluid retention in the jont space, and 30 patients also had that in the sheath nI the long head of the biceps tendon. Ten patients had fluid retention in the subacrominal bursa. Conclusion : The effusion accompanywith the frozen shoulder were observed within the shoulder joint space and the sheath of the long head of the biceps tendon rather than the subacrominal bursa. These results demonstrate that at the observation of the frozen shoulder, the inflammatorychange is considered adjacent to the rotator interval region.
THE SUBACROMIALBURSA AND THE CORACOACROMIALLIGAMENT - - MORPHOLOGY AND DISTRIBUTION-Yutaka Morisawa, Department of Orthopaedic Surgery, Niycxio Hospital, Tetsuro Sadahiro, Flee Clinic, Temhiko Kawakami, Hirostfi Yeatlareoto, Koehi Medical School KOEHI, JAPAN The pathogenesis of the rotator cuff lesions of the shoulder is still controversial.
The authors investigated the mechanoreceptors
ir~ the rotator cuff (RC), the subacromial bursa (SAB) and the corneoacromial ligament (CAL) for the purpose of claryfying the proprioception of the shoulder joint. [ Materials and Method ] Fifteen pieces of the RC, the SAB and the CAL were obtained at the time of surgery for the rotator cuff tears. The specimens were stained in bulk using the modified gold chloride stain by Gairns. The serial sections were studied by microscope. [ Results and Discuss{on ] Four different types of the mechanoreceptors were identified in the RC, the SAB and the CAL. They were Paciniaa corpuscles, Ruffini receptors, Golgi tendon organ like receptors and free nerve endings.
They mostly existed at the SAB side in thO RC,
The mechanoreceptors in the RC, the SAB and the CAL are thought to be related to the proprioception and the painful condition of the shoulder joint,
53
54
Abstracts $135
OSTEOPHYTE ON A POSTERIOR SURFACE OF THE GLENOID IN ATHLETES. Y.Shibata, K.Midorikawa, T.Izaki, G. Emoto, K.Ogata, Dept. of Orthop. Surg., Sch. of Med., Univ. of Fukuoka, JAPAN Operative results of athletes having spur in posterior surface of the glenoid are reported. Five shoulders of five patients were evaluated after removing a spur on the posterior surface of the glanoid. Preoperative and postoperative evaluation of the patients included subjective pain, function and patient satisfaction, as well as objective assessment of the active range of motion, plane X-ray, double contrast arthrography, CT arthrography and MRI, The duration of follow-up ranged form 7 to 35 months (mean, 16.8 months). They were five men and their ages were from 23 to 26 year old(mean, 24 year). They were three baseball players and two volleyball players. They had performed their sports for an average of 12 years and their symptom duration ranged from four to seven years(mean, 5.2 years). Muscle atrophy of the supraspinatus was seen in all patients, Axial X-p showed all examples spur, but Bennett view revealed it in only 2 shoulders. All patients had tenderness on the posterior joint line. Lidocaine test directly injected to the spur was effective, but the injections to both the subacromial bursae and the glenn-humeral joint were not. Range of motion in-internal rotation, horizontal internal rotation and horizontal flexion was limited. Those restricted motion recovered postoperative state. All histological specimens showed maturated bone trabeculae. Three baseball players showed full recover at more than one year after surgery, but two volleyball players showed from 70 to 80% of satisfaction, at 7 months after surgery. These are traction spurs from the point of views, that is, the property of the restricted range of motion, shape on X-p and histological findings of the spur. The operation is effective for the patients who doesn't relief their symptom for conservative therapy.
55
Role of Long H e a d o f Biceps Brachii in R o t a t o r Cuff T e n d o n F a i l u r e : A n EMG S t u d y . G. Sakurai, MD, Y. T o m i t a , MD, K. Nakagaki ME), & S. Tamed, MD, Dept of O r t h o p Surg Nara Medical Univ., J. Ozaki MD, Dept of O r t h o p Surg Nara Pref Hospital. T h e p u r p o s e of this s t u d y was to d e t e r m i n e t h e function of t h e long h e a d o f biceps brachii in r o t a t o r cuff ini ury. ( M a t e r i a l s a n d M e t h o d s ) Ten m e n ( l O s h o u l d e r s ) w i t h i n t a c t c u f f a n d ten m e n (10 shoulders) with r o t a t o r cuff tears were studied. The average ages were 51.7 years a n d 56.6 years respectively.The e l e c t r o m y o g m p h i c signals were recorded from t h e LI-IBwith surface electrodes T h e subject p u t o n a n elbow brace locked in neutral forearm rotation a n d 0 degree of flexion to m i n i m i z e the elbow-related biceps activity; At six a n n positions a n d MVC, EMG signals were collected. T h e positions were a b d u c t i o n in t h e s c a p u l a r p l a n e (90, 150 degrees} in external or internal r o t a t i o n (30 degrees) a n d 90 degrees flexion in external o r i n t e r n a l r o t a t i o n (30 degrees).The root m e a n square (RMS} v a l u e w a s used a s a single e s t i m a t e of t h e myoeleclric p o w e r spectrum. ( R e s u l t s ) 1) T h e signal levels did not increase in b o t h groups w h e n the forearm load was applied. 2) T h e control g r o u p ' s RMS v a l u e s in e x t e ~ a l rotation were h i g h e r t h a n those in internal rotation a t all positions. The cuff t e a r group did not show a n y d e p e n d e n c e o n u p p e r a r m rotation. 3} T h e RMS was significantly increased in the cuff t e a r group with i n t e r n a l rotation t h a n t h a t in the i n t a c t cuff group ( C o n c l u s i o n ) We suggest t h a t in the shoulders w i t h cuff tears, m n s d e activity of t h e kHB increased in i n t e r n a l r o t a t i o n a t t h e u p p e r a r m elevation to corn p e n s a t e t h e cuff insuffidency.
A STUDY ON THE MECHANORECEPTORSIN THE ROTATOR CUFF
56
MR IMAGING0F THE FROZEN SHOULDER. K. 0kamura & J. Ozaki, MD, Dept of 0rthopaeciic Surgery, Nara Prefectural Hospital, i 30-1 Hiramatu.eho,Nara 631, Japan. Purpose : In the diagnosis of the shoulder [eaton, MRI is useful in demonstrating abnoJma{ities in the soft tissue structures. But the frozen shoalder is still diagnosed after other shonlder lesion are luled out. We reported on the localization and pathology of the frozen shoulder using MR imaging. Materials and methods : We have examined 35 shoulders in patients, 18 men and 17 womenwith the frozen shoulder since july in 1992 till january in ?.995. Scanning was performed on GE 1.5 T magneticimaging system with using a surface coil. T1weighted and T2 weightedsequense of all patients were obtained in the oblique plane along the supraspinatus muscle and in the axial plane. MR observation of the shoulder disorders were performed on the shoulder joint space, the sheath of the long head of the biceps tendon and the subaernminal bursa. Results : in All patients, the MR appearances of the frozen shoulder were excellent with the T2.weighted sequense. Twenty five patients had fluid retention in the jont space, and 30 patients also had that in the sheath nI the long head of the biceps tendon. Ten patients had fluid retention in the subacrominal bursa. Conclusion : The effusion accompanywith the frozen shoulder were observed within the shoulder joint space and the sheath of the long head of the biceps tendon rather than the subacrominal bursa. These results demonstrate that at the observation of the frozen shoulder, the inflammatorychange is considered adjacent to the rotator interval region.
THE SUBACROMIALBURSA AND THE CORACOACROMIALLIGAMENT - - MORPHOLOGY AND DISTRIBUTION-Yutaka Morisawa, Department of Orthopaedic Surgery, Niycxio Hospital, Tetsuro Sadahiro, Flee Clinic, Temhiko Kawakami, Hirostfi Yeatlareoto, Koehi Medical School KOEHI, JAPAN The pathogenesis of the rotator cuff lesions of the shoulder is still controversial.
The authors investigated the mechanoreceptors
ir~ the rotator cuff (RC), the subacromial bursa (SAB) and the corneoacromial ligament (CAL) for the purpose of claryfying the proprioception of the shoulder joint. [ Materials and Method ] Fifteen pieces of the RC, the SAB and the CAL were obtained at the time of surgery for the rotator cuff tears. The specimens were stained in bulk using the modified gold chloride stain by Gairns. The serial sections were studied by microscope. [ Results and Discuss{on ] Four different types of the mechanoreceptors were identified in the RC, the SAB and the CAL. They were Paciniaa corpuscles, Ruffini receptors, Golgi tendon organ like receptors and free nerve endings.
They mostly existed at the SAB side in thO RC,
The mechanoreceptors in the RC, the SAB and the CAL are thought to be related to the proprioception and the painful condition of the shoulder joint,