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Latissimus dorsi transfer for massive rotator cuff tears
Abstracts $81
J. Shoulder Elbow Surg. Volume 4, Number 1, Part 2
57
58
COMPUTERIZED TOMOGRAPHIC STUDY OF RHEUMATOID SHOULDER DESTRUCTION. S.Wakitani,MD, N. Murata,MD, T.Yamamoto,MD*, M.Yoneda,MD**,& T.Ochi, MD***, Dept. of Orthop. Surg, Osaka-Minami National Hospital, *Gracia Hospital, **Osaka Kosei-Nenkin Hospital, ***Osaka Univ. Medical School, Osaka, Japan. We have reported that the natural course of rheumatoid arthritis(RA) shoulder destruction on X-ray is classified into 5 types (Yoneda M, et al, Proceedings of the 3rd international conference on surgery of the shoulder, pp77-81, 1986). To clarify this more precisely, we analysed shoulder joint destruction on computerized tomography (CT). Methods: 69 shoulder joints of 35 patients with RA were the subject of this study. Radiographic grading of RA according to Larsen was used(Scand.J.Rheum. 4:225-233,1975). 12 joints were classified as grade0, 12 as grade 1, 10 as grade 2, 7 as grade 3, 14 as grade 4,14 as grade 5.Glenohumeral transverse index(GHI), glenoid tilting angle(GTA), humeral antero-posterior rmigration (HAM) were measured on CT, and patterns of humeral head and glenoid destruction were analysed on CT. Results: Although mean GHI of grade 0,1, & 2 was 64%, that of grade 3&4 was 74%.With the destruction of shoulder joint, glenoid got wider. Mean GTA of superior part of glenoid of grade 0,1,&2 was 11 degrees tilted posteriorly, but that of grade 3&4 was 4 degrees posteriorly. In few cases of grade 3,4,&5,HAM was larger than 5mm, but no instability was observed. Humeral head was destroyed by erosions or cysts which appeared at first at the insertion of joint capsule. Conclusion:CT is a useful method to know the way of RA shoulder destruction precisely.
LATISSIMUS DORS1 TRANSFER FOR MASSIVE ROTATOR CUFF TEARS. K. Okamura, MD, & T. Takahashi, Dept of Orthopedic Surgery, Sapporo Med., Univ. We have performed the latissimus dorsi (LD) transfer described by Gerber (1988) for the treatment of irreparable massive rotator cuff tears. the results of this procedure.
Here we present
[Materials and Methods] Since 1991, 13 shoulders in 11 cases with a irreparable massive rotaor cuff tear have been treated with LD transfer. They consist of 10 males and a female with an average age of 64 years. An average follow-up is 25 months. These cases were evaluated by JOA shoulder score and EMG analysis. [ R e s u l t s ] Active flexion averaged 104 ° preoperatively and 139 ° postoperatively. JOA shoulder score averaged 60 points preoperatively and 79 points postoperatively. Electromyographic analysis revealed that transfered LD actived more with the abducted arm than the arm at the side. On flexion, apparent contuction was obseved over 90 ° . [ Conclusion ] T h e L D trnsfer relieves pain and a i d s functional recovery of the shoulder with massive rotator cuff tear. This procedure may act as not only repair of the cuff but also reconstruction of the shoulder.
59
60
THREE-DIMENSIONAL ANALYSIS OF SHOULDER MOTION K0u Mimori, Teruhiko Nakagawa, Kohtaro Furuya, Katsuya Nobuhara, Dep. of Orthopaedic Surgery, Tokyo Medical and Dental Univ., Tokyo, Japan P u r p o s e Three dimensional analysis of shoulder kinematics was performed using by cineradiography. Subjects and Methods The subjects were consisted of J-00 normal shoulders (group N), 8 loose shoulders (group L) and 27 shoulders with rotator cuff tear (group C). Joint kinetics in AP and in axial views were recorded in a video recorder when the subjects elevated actively on the scapular plane. Using an image analyzing system, both the center of humeral heads and the instant center were measured. R e s u l t s 1.The center of humeral heads shifted to upward with the arm elevation in all groups. 2. In group N, the instant center was on the center of humeral heads. In group L, the instant center was scattered under 30 degrees elevation in AP view, and over 90 degrees elevation in axial view. In group C, the instant center was located below the center of humeral heads over 90 degrees elevation in AP view, while the instant center was around the center of humeral heads in axial view. Conclusion These results show gleno-humeral rhythms in loose shoulder and in rotator cuff tear differ from that of normal shoulder.
THE RESULTS OF OUR MODIFICATION OF BOYTCHEV'S PROCEDURE AND MODIFIED BRISTOWS PROCEDURE ACCOMPANIED WITH ANTERIOR CAPSULAR SHIFT. S. Kuroda, MO, J. Moriishi, MD, T. Sumiyoshi,MD, M. Sai,MD & K. Maruta, MD Matsudo Orthopaedic H o s p i t a l The r e s u l t s and c o m p l i c a t i o n s were i n v e s t i g a t e d in 90 c a s e s which were followed-up over one year a f t e r the surgery. Our modification of Boytchev's procedure in which the s u b s c a p u l a r muscle i s cut and resutured on the conjoined tendon after c a p s u l o r r h a p h y has been performed in 62 cases. The mean age was 24.4 y e a r s old. The mean f o l l o w - u p p e r i o d was 62.5 months. T r a n s i e n t musculocutaneous nerve p a l s y was r e c o g n i z e d in t h r e e cases. It recovered w i t h i n s i x months. One case needed r e o p e r a t i o n because o f p a i n f u l c r e p i t a t i o n appeared 27 months a f t e r the surgery. Recurrence was recognized in four cases. The r e c u r r e n c e r a t e was 6. 4%. In the modified B r i s t o w ' s procedure, the g l e n o i d was exposed and the c o r a c o i d p r o c e s s was t r a n s f e r r e d on the a n t e r o i n f e r i o r g l e n o i d rim then s h i f t o f a n t e r i o r c a p s u l e and s u b s c a p u l a r muscle was added. The r e s u l t s was e v a l u a t e d in 28 cases. The mean age was 23.2 years old. The mean f o l ] o ~ u p p e r i o d was 38.2 months. Recurrence was not recognized. S l i g h t deformity of the humeral head was r e c o g n i z e d in two cases. The screw breakage o c c u r r e d in two cases. These c o m p l i c a t i o n s could he avoided with care of e x c e s s i v e e x t e r n a l r o t a t i o n of the shoulder.
J. Shoulder Elbow Surg. Volume 4, Number 1, Part 2
57
58
COMPUTERIZED TOMOGRAPHIC STUDY OF RHEUMATOID SHOULDER DESTRUCTION. S.Wakitani,MD, N. Murata,MD, T.Yamamoto,MD*, M.Yoneda,MD**,& T.Ochi, MD***, Dept. of Orthop. Surg, Osaka-Minami National Hospital, *Gracia Hospital, **Osaka Kosei-Nenkin Hospital, ***Osaka Univ. Medical School, Osaka, Japan. We have reported that the natural course of rheumatoid arthritis(RA) shoulder destruction on X-ray is classified into 5 types (Yoneda M, et al, Proceedings of the 3rd international conference on surgery of the shoulder, pp77-81, 1986). To clarify this more precisely, we analysed shoulder joint destruction on computerized tomography (CT). Methods: 69 shoulder joints of 35 patients with RA were the subject of this study. Radiographic grading of RA according to Larsen was used(Scand.J.Rheum. 4:225-233,1975). 12 joints were classified as grade0, 12 as grade 1, 10 as grade 2, 7 as grade 3, 14 as grade 4,14 as grade 5.Glenohumeral transverse index(GHI), glenoid tilting angle(GTA), humeral antero-posterior rmigration (HAM) were measured on CT, and patterns of humeral head and glenoid destruction were analysed on CT. Results: Although mean GHI of grade 0,1, & 2 was 64%, that of grade 3&4 was 74%.With the destruction of shoulder joint, glenoid got wider. Mean GTA of superior part of glenoid of grade 0,1,&2 was 11 degrees tilted posteriorly, but that of grade 3&4 was 4 degrees posteriorly. In few cases of grade 3,4,&5,HAM was larger than 5mm, but no instability was observed. Humeral head was destroyed by erosions or cysts which appeared at first at the insertion of joint capsule. Conclusion:CT is a useful method to know the way of RA shoulder destruction precisely.
LATISSIMUS DORS1 TRANSFER FOR MASSIVE ROTATOR CUFF TEARS. K. Okamura, MD, & T. Takahashi, Dept of Orthopedic Surgery, Sapporo Med., Univ. We have performed the latissimus dorsi (LD) transfer described by Gerber (1988) for the treatment of irreparable massive rotator cuff tears. the results of this procedure.
Here we present
[Materials and Methods] Since 1991, 13 shoulders in 11 cases with a irreparable massive rotaor cuff tear have been treated with LD transfer. They consist of 10 males and a female with an average age of 64 years. An average follow-up is 25 months. These cases were evaluated by JOA shoulder score and EMG analysis. [ R e s u l t s ] Active flexion averaged 104 ° preoperatively and 139 ° postoperatively. JOA shoulder score averaged 60 points preoperatively and 79 points postoperatively. Electromyographic analysis revealed that transfered LD actived more with the abducted arm than the arm at the side. On flexion, apparent contuction was obseved over 90 ° . [ Conclusion ] T h e L D trnsfer relieves pain and a i d s functional recovery of the shoulder with massive rotator cuff tear. This procedure may act as not only repair of the cuff but also reconstruction of the shoulder.
59
60
THREE-DIMENSIONAL ANALYSIS OF SHOULDER MOTION K0u Mimori, Teruhiko Nakagawa, Kohtaro Furuya, Katsuya Nobuhara, Dep. of Orthopaedic Surgery, Tokyo Medical and Dental Univ., Tokyo, Japan P u r p o s e Three dimensional analysis of shoulder kinematics was performed using by cineradiography. Subjects and Methods The subjects were consisted of J-00 normal shoulders (group N), 8 loose shoulders (group L) and 27 shoulders with rotator cuff tear (group C). Joint kinetics in AP and in axial views were recorded in a video recorder when the subjects elevated actively on the scapular plane. Using an image analyzing system, both the center of humeral heads and the instant center were measured. R e s u l t s 1.The center of humeral heads shifted to upward with the arm elevation in all groups. 2. In group N, the instant center was on the center of humeral heads. In group L, the instant center was scattered under 30 degrees elevation in AP view, and over 90 degrees elevation in axial view. In group C, the instant center was located below the center of humeral heads over 90 degrees elevation in AP view, while the instant center was around the center of humeral heads in axial view. Conclusion These results show gleno-humeral rhythms in loose shoulder and in rotator cuff tear differ from that of normal shoulder.
THE RESULTS OF OUR MODIFICATION OF BOYTCHEV'S PROCEDURE AND MODIFIED BRISTOWS PROCEDURE ACCOMPANIED WITH ANTERIOR CAPSULAR SHIFT. S. Kuroda, MO, J. Moriishi, MD, T. Sumiyoshi,MD, M. Sai,MD & K. Maruta, MD Matsudo Orthopaedic H o s p i t a l The r e s u l t s and c o m p l i c a t i o n s were i n v e s t i g a t e d in 90 c a s e s which were followed-up over one year a f t e r the surgery. Our modification of Boytchev's procedure in which the s u b s c a p u l a r muscle i s cut and resutured on the conjoined tendon after c a p s u l o r r h a p h y has been performed in 62 cases. The mean age was 24.4 y e a r s old. The mean f o l l o w - u p p e r i o d was 62.5 months. T r a n s i e n t musculocutaneous nerve p a l s y was r e c o g n i z e d in t h r e e cases. It recovered w i t h i n s i x months. One case needed r e o p e r a t i o n because o f p a i n f u l c r e p i t a t i o n appeared 27 months a f t e r the surgery. Recurrence was recognized in four cases. The r e c u r r e n c e r a t e was 6. 4%. In the modified B r i s t o w ' s procedure, the g l e n o i d was exposed and the c o r a c o i d p r o c e s s was t r a n s f e r r e d on the a n t e r o i n f e r i o r g l e n o i d rim then s h i f t o f a n t e r i o r c a p s u l e and s u b s c a p u l a r muscle was added. The r e s u l t s was e v a l u a t e d in 28 cases. The mean age was 23.2 years old. The mean f o l ] o ~ u p p e r i o d was 38.2 months. Recurrence was not recognized. S l i g h t deformity of the humeral head was r e c o g n i z e d in two cases. The screw breakage o c c u r r e d in two cases. These c o m p l i c a t i o n s could he avoided with care of e x c e s s i v e e x t e r n a l r o t a t i o n of the shoulder.