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Post-traumatic osteolysis of the distal end of the clavicle in judo athlete: Case report
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33
J. Shoulder Elbow Surg. March/April 1996
Abstracts
MR Imaging of Painful Shoulders in Sports YT~flcubo,MI),K.Yam~ga,MD,M.Horii,MD, M,Kttroka~,a,MD, and Y.Hirasawa,MD Departmentof OrthopaedicSurgery,Kyoto f'refecatra/ Universityof Medicine
35
The purpose of this study is to clarify a factor of painful shoulders in throwing athletes using MR imaging. Using MR imaging, 24 shoulders ( 19 males, five females, ranging in age from 15 to 35 years, average 21.9 years, right 21, left three ) were examined. All of them had pain in throwing or overhead motion of shoulder ( baseball or softball in 13, volleyball in four, tennis in four, the others in three ). Oblique coronal sections ( scapular plane ) or axial sections were oblained with mainlyT2* weighted sequences. The changes of the rotator cuff and the humeral head were evaluated. On T2* weighted images, the supraspinatus tendon changed into diffuse or spotty high signals in 15 of 24 shoulders. Eight of 24 shoulders (33,3%) showed high cystic signals at the posterosuperior lesion of the humeral head on T2*. In painful shoulders of throwing athletes, not onJy the rotator cuff but also the humeral head changed on MR imaging scans. Recently, the idea of posterosuperior impingement was reported. We suspected that the change caused by impingement between the humeral head and the posterosuperior labrum.
Intra-osseous ganglia are tumor like lesions that usually occur in juxta-articular subchondral areas of hip joints and knee joints and so on. Lesions occuring in close relationship to shoulder joints are rare. Two cases of the shoulder are reported. CASE 1: A 16 year old woman presented with right shoulder pain. Range of motions of the right shoulder were slightly limited and tenderness on the great tubercle was there. Plain X ray film revealed round shaped radiolucent area in the proximal epiphysis of the right humerus. Computerized tomogram showed low density area rimmed by high density line. Magnetic resonance imaging film discovered low intensity by T1 weighted image, high intensity by T2 weighted image and no response by gadolinium injection. Gelatinous material was found in the cavity underlined fibrous connective tissue. CASE 2: A 40 year old man presented with left shoulder pain after playing golf Plain X ray film showed multilobular radiolucent area in the grenoid of the left scapula. Computerized tomogram, MRI revealed the same findings as Case 1.Macroscopic findings and microscopic findings were the same as Case 1, too. DISCUSSION: Intra-osseous gangrion must be always included in the differential diagnosis of cystic bone lesions in the vicinity of a joint, for example giant cell tumor of bone and benign chondroblastoma. M a s a h i k o Komai, M D Dept. of Orthopaedic Surgery, H y o g o C o l l e g e of Medicine, N i s h i n o m i y a Hyogo, Japan
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RESULTS OF BANKART OPERATION FOR RECURRENT ANTERIOR INSTABILITY OF THE SHOULDER.Tomohiro Tanabe (1),Kazuya Tamai (2),Atsushi Higashi (1) ,and Isamu Hara (1).Hara Orthopaedic Hospital (1) and Dokkyo University School of Medicine (2). We evaluated 71 shoulders in 71 patients (57 males and 14 females) who had had an open Bankart repair for recurrent anterior instability of the shoulder. Forty patients were operated with Rowe's modification, 12 with Statak, and 19 with Mitek G-~[ anchor device. Sixty of the 71 patients had been engaged in athletic or recreational sport activities preoperatively. The postpoerative functional results were assessed 0.5-6.9 (average, 2.8) years after surgery,using the Rowe's rating system and the Takagishi's scoring sheet for sporting ability derived from the Japan Shoulder Society, Overall, the dislocation recurred in 5 of the 71 shoulders.The Rowe's score ranged from 15 to 100 (average, 87) with excellent and good results in 61 patients. No patients who had Rowe-modified Bankart operation showed recurrence of dislocation. In contrast , 4 of the 12 patients operated with Statak had re-dislocation postoperatively, of which 3 showed incomplete insertion of the device into the bone. There was one re-subluxation in the patients operated with Mitek, although the other ! 8 were ranked as either excellent or good .The results of Takagishi's scoring indicated that the athletic performance did not change postoperatively, irrespective of the operative procedure, if the patient could return to the sports without fear of re-
dislocation. We conclude that the proper placement of an anchor device is most important when using it in the Bankart operation. This should also be true in an arthroscopic Bankart repair.
36
POST-TRAUMATIC OSTEOLYSIS OF THE DISTAL END OF THE CLAVICLE IN JUDO ATHLETE : CASE REPORT
H.Seki, T.Kutsuma, T.Tsuchiya, M.Kamihira, Dept. of Orthop Surgery, kofu City Hospital We reported a case of post-traumatic osteolysis of the distal end of the clavicle in judo athlete. The case was a 17-year,old high school student who had participated in judo for nine years. Left shoulder pain occurred after he fell on his shoulder. The shoulder radiography was normal at first, four months after injury characteristic resorption of the distal end of the clavicle was found. On physical examination there was local tenderness, but no Instability and swelling in the acromioclavicular joint. Range of motion of his left shoulder was not restricted. Despite of consen/ative treatment including nonsteroidal anti-inflammatory medication and limitation of sports activities, shoulder pain was persisted. As cortical thinning or irregularity of the distal clavicle had progressed on X-ray, open surgical excision of the distal clavicle was performed. There was no cartilaginous disc and the space between acromion and clavicle was substituted for granulation tissue. Histologic examination showed metaplastic bone formation with increased osteoclastic activity and no evidence of inflammation. Osteolysis of the distal end of the clavicle is a rare condition and it can occur during judo.
33
J. Shoulder Elbow Surg. March/April 1996
Abstracts
MR Imaging of Painful Shoulders in Sports YT~flcubo,MI),K.Yam~ga,MD,M.Horii,MD, M,Kttroka~,a,MD, and Y.Hirasawa,MD Departmentof OrthopaedicSurgery,Kyoto f'refecatra/ Universityof Medicine
35
The purpose of this study is to clarify a factor of painful shoulders in throwing athletes using MR imaging. Using MR imaging, 24 shoulders ( 19 males, five females, ranging in age from 15 to 35 years, average 21.9 years, right 21, left three ) were examined. All of them had pain in throwing or overhead motion of shoulder ( baseball or softball in 13, volleyball in four, tennis in four, the others in three ). Oblique coronal sections ( scapular plane ) or axial sections were oblained with mainlyT2* weighted sequences. The changes of the rotator cuff and the humeral head were evaluated. On T2* weighted images, the supraspinatus tendon changed into diffuse or spotty high signals in 15 of 24 shoulders. Eight of 24 shoulders (33,3%) showed high cystic signals at the posterosuperior lesion of the humeral head on T2*. In painful shoulders of throwing athletes, not onJy the rotator cuff but also the humeral head changed on MR imaging scans. Recently, the idea of posterosuperior impingement was reported. We suspected that the change caused by impingement between the humeral head and the posterosuperior labrum.
Intra-osseous ganglia are tumor like lesions that usually occur in juxta-articular subchondral areas of hip joints and knee joints and so on. Lesions occuring in close relationship to shoulder joints are rare. Two cases of the shoulder are reported. CASE 1: A 16 year old woman presented with right shoulder pain. Range of motions of the right shoulder were slightly limited and tenderness on the great tubercle was there. Plain X ray film revealed round shaped radiolucent area in the proximal epiphysis of the right humerus. Computerized tomogram showed low density area rimmed by high density line. Magnetic resonance imaging film discovered low intensity by T1 weighted image, high intensity by T2 weighted image and no response by gadolinium injection. Gelatinous material was found in the cavity underlined fibrous connective tissue. CASE 2: A 40 year old man presented with left shoulder pain after playing golf Plain X ray film showed multilobular radiolucent area in the grenoid of the left scapula. Computerized tomogram, MRI revealed the same findings as Case 1.Macroscopic findings and microscopic findings were the same as Case 1, too. DISCUSSION: Intra-osseous gangrion must be always included in the differential diagnosis of cystic bone lesions in the vicinity of a joint, for example giant cell tumor of bone and benign chondroblastoma. M a s a h i k o Komai, M D Dept. of Orthopaedic Surgery, H y o g o C o l l e g e of Medicine, N i s h i n o m i y a Hyogo, Japan
34
RESULTS OF BANKART OPERATION FOR RECURRENT ANTERIOR INSTABILITY OF THE SHOULDER.Tomohiro Tanabe (1),Kazuya Tamai (2),Atsushi Higashi (1) ,and Isamu Hara (1).Hara Orthopaedic Hospital (1) and Dokkyo University School of Medicine (2). We evaluated 71 shoulders in 71 patients (57 males and 14 females) who had had an open Bankart repair for recurrent anterior instability of the shoulder. Forty patients were operated with Rowe's modification, 12 with Statak, and 19 with Mitek G-~[ anchor device. Sixty of the 71 patients had been engaged in athletic or recreational sport activities preoperatively. The postpoerative functional results were assessed 0.5-6.9 (average, 2.8) years after surgery,using the Rowe's rating system and the Takagishi's scoring sheet for sporting ability derived from the Japan Shoulder Society, Overall, the dislocation recurred in 5 of the 71 shoulders.The Rowe's score ranged from 15 to 100 (average, 87) with excellent and good results in 61 patients. No patients who had Rowe-modified Bankart operation showed recurrence of dislocation. In contrast , 4 of the 12 patients operated with Statak had re-dislocation postoperatively, of which 3 showed incomplete insertion of the device into the bone. There was one re-subluxation in the patients operated with Mitek, although the other ! 8 were ranked as either excellent or good .The results of Takagishi's scoring indicated that the athletic performance did not change postoperatively, irrespective of the operative procedure, if the patient could return to the sports without fear of re-
dislocation. We conclude that the proper placement of an anchor device is most important when using it in the Bankart operation. This should also be true in an arthroscopic Bankart repair.
36
POST-TRAUMATIC OSTEOLYSIS OF THE DISTAL END OF THE CLAVICLE IN JUDO ATHLETE : CASE REPORT
H.Seki, T.Kutsuma, T.Tsuchiya, M.Kamihira, Dept. of Orthop Surgery, kofu City Hospital We reported a case of post-traumatic osteolysis of the distal end of the clavicle in judo athlete. The case was a 17-year,old high school student who had participated in judo for nine years. Left shoulder pain occurred after he fell on his shoulder. The shoulder radiography was normal at first, four months after injury characteristic resorption of the distal end of the clavicle was found. On physical examination there was local tenderness, but no Instability and swelling in the acromioclavicular joint. Range of motion of his left shoulder was not restricted. Despite of consen/ative treatment including nonsteroidal anti-inflammatory medication and limitation of sports activities, shoulder pain was persisted. As cortical thinning or irregularity of the distal clavicle had progressed on X-ray, open surgical excision of the distal clavicle was performed. There was no cartilaginous disc and the space between acromion and clavicle was substituted for granulation tissue. Histologic examination showed metaplastic bone formation with increased osteoclastic activity and no evidence of inflammation. Osteolysis of the distal end of the clavicle is a rare condition and it can occur during judo.