Hiroyasu Ikegami

Morphologic features of humeral head and glenoid version in the normal glenohumeral joint

BACKGROUNDnThe morphologic features and clinical significance of version of the humeral head and glenoid remain unclear. The purpose of this study was to evaluate the normal values of humeral head version and glenoid version on computed tomography scans and to clarify their features in the normal glenohumeral joint.nnnMETHODSnImages for analysis were computed tomography scans of 410 normal shoulders from healthy volunteers. Values of humeral head and glenoid version were measured. In glenoid version measurement, 3-dimensionally corrected slices were reconstructed to eliminate scapular inclination. Differences in humeral head version and glenoid version were assessed between dominant and nondominant shoulders and between men and women. Correlation analyses were also performed in the values of version between dominant and nondominant shoulders and between humeral head version and glenoid version.nnnRESULTSnThe values of humeral head retroversion were widely distributed from -2° to 60°, with an average of 26° ± 11°. Average glenoid retroversion was 1° ± 3°, ranging from -9° to 13°. Both humeral head retroversion and glenoid retroversion were significantly higher on the dominant side than on the nondominant side and significantly higher in men than in women. Humeral head version and glenoid version values were well correlated with those of the contralateral shoulder. No correlation was found between humeral head version and glenoid version.nnnCONCLUSIONSnThis study found differences in humeral head version and glenoid version by sex and shoulder dominance in a large sample. Both the humeral head and glenoid are thought to be more retroverted in high-demand shoulders.

Short-term results of transcatheter arterial embolization for abnormal neovessels in patients with adhesive capsulitis: a pilot study

BACKGROUNDnNeovessels and accompanying nerves are possible sources of pain. We postulated that transcatheter arterial embolization of abnormal neovessels would relieve pain and symptoms in patients with adhesive capsulitis.nnnMETHODSnAdhesive capsulitis was treated by transcatheter arterial embolization in 7 patients. Adverse events, changes in visual analog scale scores for night pain and overall shoulder pain, and changes in range of motion and American Shoulder and Elbow Surgeons scores were assessed at 1 week and at 1, 3, and 6 months after the procedure.nnnRESULTSnAbnormal neovessels were identified at the rotator interval in all patients. No major or minor adverse events were associated with the procedures. Transcatheter arterial embolization rapidly decreased nighttime pain scores from 67 ± 14 mm to 27 ± 14 mm at 1 week after the procedure, with further improvement at 1 and 6 months (6 ± 8 mm and 2 ± 5 mm, respectively). The American Shoulder and Elbow Surgeons score significantly improved from 17.8 ± 4.5 to 39.8 ± 12.0, 64.3 ± 13.9, and 76.2 ± 4.4 at 1, 3, and 6 months, respectively.nnnCONCLUSIONnAll patients with adhesive capsulitis had abnormal neovessels at the rotator interval. Transcatheter arterial embolization was feasible, relieved unrelenting pain, and restored shoulder function.

Acromioclavicular joint ligamentous system contributing to clavicular strut function: A cadaveric study

HYPOTHESISnWe hypothesized that the clavicle overrides the acromion during certain shoulder motions for individuals with acromioclavicular (AC) joint separation producing clinical symptoms. We measured 3-dimensional clavicular and scapular motions in AC joint separation models during humerothoracic motions, which should be impacted by the loss of AC joint continuity.nnnMATERIALS AND METHODSnTen shoulders from 6 whole cadavers were used. The scapular and clavicular motions were measured in intact and AC joint separation models using an electromagnetic tracking device. The measurement was performed during shoulder abduction with humerothoracic neutral rotation. It was also measured during shoulder abduction with humerothoracic internal rotation, which could cause clavicular overriding. The kinematic changes caused by ligament sectioning were evaluated in these 2 arm motions.nnnRESULTSnThe clavicle completely overrode the acromion in all AC separation models during abduction with internal rotation, but not in any shoulders during abduction with neutral rotation. Upward clavicular rotation increased, posterior clavicular rotation decreased, and external scapular rotation decreased with ligament sectioning. These kinematic changes were common for both of the measured arm motions. Scapular upward rotation and posterior tilt did not change because of ligament sectioning during abduction with neutral rotation. However, these scapular rotations significantly decreased with ligament sectioning during shoulder abduction with internal rotation.nnnCONCLUSIONnScapular and clavicular kinematics were affected in AC separation models. Abduction with humeral internal rotation resulted in a decrease in scapular posterior tilt and upward rotation in AC separation models, and thereby could lead to AC joint articulation dysfunction.

Comparison of surgical treatments for triple extensor tendon ruptures in rheumatoid hands: A retrospective study of 48 cases

Objective. This retrospective study was designed to evaluate the outcomes of four different surgical reconstructions for extensor tendon ruptures in ulnar three fingers in 48 patients with rheumatoid arthritis. Methods. The following four techniques were performed; palmaris longus tendon grafting (PL group; n = 9), extensor indicis proprius (EIP) tendon transfers (EIP group; n = 8), end-to-side transfers with tension-reduced early mobilization (End-to-side group; n = 16), and a combination of end-to-side and EIP transfers (Combination group; n = 15). Loss of extension was evaluated to determine the mean postoperative range of motion of the metacarpophalangeal (MP) joint and clinical outcomes were categorized using modified Geldmacher criteria. Results. Combination group demonstrated the best mean MP joint extension (− 3°), followed by End-to-side group (− 12°), EIP group (− 16°), and PL group (− 21°). Combination group yielded the best clinical outcomes with all cases showing good results. Conclusions. The combination of end-to-side and EIP transfer was an effective surgical reconstruction procedure for triple fingers extension loss.

Weekly Injection of Teriparatide for Bone Ingrowth after Cementless Total Knee Arthroplasty

Purpose. To compare bone mineral density (BMD) in patients with or without weekly injection of teriparatide to promote bone ingrowth after cementless total knee arthroplasty (TKA). Methods. Records of 8 men and 32 women (mean age, 75.6 years) who underwent cementless TKA for medial knee osteoarthritis with (n=20) or without (n=20) once-weekly subcutaneous/hypodermic injection of teriparatide for 48 weeks were reviewed. BMD and bone volume/total volume (BV/TV) of the bone-prosthesis interface of the proximal tibia in 6 regions of interest (ROI) were assessed at 3, 6, 9, and 12 months using multi-detector computed tomography. Results. Patients with or without weekly injection of teriparatide after cementless TKA were comparable in terms of baseline characteristics and pre- and postoperative knee range of motion and Knee Society knee and function scores. In ROI 1 (medial), ROI 3 (anteromedial), and ROI 4 (posteromedial), the BV/TV increased throughout the postoperative period in patients with weekly injection of teriparatide and declined after 6 months in patients without weekly injection of teriparatide. These 3 ROIs of the 2 groups differed significantly only in BMD at 6, 9, and 12 months. In ROI 2 (lateral), ROI 5 (anterolateral), and ROI 6 (posterolateral), both BV/TV and BMD showed a decreasing trend, and these 3 ROIs of the 2 groups did not differ significantly. Conclusion. Weekly injection of teriparatide after cementless TKA promoted bone ingrowth mostly in the medial aspect of the bone-prosthesis interface.

Isolated dorsal fracture-dislocation of the scaphoid: a case report.

This paper reports an isolated dorsal fracture–dislocation of the scaphoid at its waist with the proximal fragment dislocated dorsally. Such a fracture–dislocation is extremely rare. We believe the pathomechanics of this injury to have been a flexion and radial deviation with an axial force on the wrist.

Clinical Outcomes of Transcatheter Arterial Embolization for Adhesive Capsulitis Resistant to Conservative Treatment

PURPOSEnTo evaluate clinical outcomes of transcatheter arterial embolization (TAE) for adhesive capsulitis resistant to conservative treatments.nnnMATERIALS AND METHODSnThis study comprised 25 patients (18 women and 7 men; mean age, 53.8 y; range, 39-68 y) with adhesive capsulitis resistant to conservative treatments. TAE was performed, and adverse events (AEs), pain visual analog scale (VAS) score changes, range of motion (ROM), and American Shoulder and Elbow Surgeons (ASES) scores were assessed.nnnRESULTSnAbnormal vessels were identified in all patients. No major AEs were associated with TAE. One patient was lost to follow-up. The remaining 24 patients were available for final follow-up (mean, 36.1 months; range, 30-44 months). Of the 24 patients, 16 (67%) experienced quick improvement of nighttime pain (ie, VAS scores decreased > 50% from baseline) within 1 week, and 21 (87%) improved within 1 month. In terms of mean overall pain (ie, pain at its worst), VAS scores significantly decreased at 1, 3, and 6 months after treatment (82 mm before treatment vs 52, 19, and 8 mm after treatment; P < .001). ASES scores significantly improved at 1, 3, and 6 months after treatment (16.1 before treatment vs 41.4, 69.1, and 83.5 after treatment; P < .001). No symptom recurrence or late-onset AEs were observed. Shoulder ROM and function further improved during midterm follow-up.nnnCONCLUSIONSnTAE is a possible treatment option for patients with adhesive capsulitis that has failed to improve with conservative treatments.

Shoulder and elbow pain in elementary school baseball players: The results from a nation-wide survey in Japan

BACKGROUNDnDespite recommendations on how to prevent baseball injuries in youths by the Japanese Society of Clinical Sports Medicine, shoulder and elbow pain still frequently occurs in young baseball players. We conducted a questionnaire survey among baseball players at elementary schools across the country to understand the practice conditions of players, examining the risk factors of shoulder and elbow pain in baseball players.nnnMETHODSnThe questionnaire survey was conducted among elementary school baseball players as members of the Baseball Federation of Japan in September 2015.nnnRESULTSnA total of 8354 players belonging to 412 teams (average age: 8.9) responded to the survey. Among 7894 players who did not have any shoulder and/or elbow pain in September 2014, elbow pain was experienced in 12.3% of them, shoulder pain in 8.0% and shoulder and/or elbow pain in 17.4% during the previous one year. A total of 2835 (39.9% of the total) practiced four days or more per week and 97.6% practiced 3xa0h or more per day on Saturdays and Sundays. The risk factors associated shoulder and elbow pain included a male sex, older age, pitchers and catchers, and players throwing more than 50 balls per day.nnnCONCLUSIONSnIt has been revealed that Japanese elementary school baseball players train too much. Coaches should pay attention to older players, male players, pitchers and catchers in order to prevent shoulder and elbow pain. Furthermore, elementary school baseball players should not be allowed to throw more than 50 balls per day.nnnSTUDY DESIGNnRetrospective cohort study.

Re-dislocation after corrective osteotomy for chronic dislocation of the radial head in children

This retrospective study was designed to evaluate the outcomes of re-dislocation of the radial head after corrective osteotomy for chronic dislocation. A total of 12 children with a mean age of 11 years (5 to 16), with further dislocation of the radial head after corrective osteotomy of the forearm, were followed for a mean of five years (2 to 10). Re-operations were performed for radial head re-dislocation in six children, while the other six did not undergo re-operation (non-re-operation group). The active range of movement (ROM) of their elbows was evaluated before and after the first operation, and at the most recent follow-up. In the re-operation group, there were significant decreases in extension, pronation, and supination when comparing the ROM following the corrective osteotomy and following re-operation (p < 0.05). The children who had not undergone re-operation achieved a better ROM than those who had undergone re-operation. There was a significant difference in mean pronation (76° vs 0°) between the non- re-operation and the re-operation group (p = 0.002), and a trend towards increases in mean flexion (133° vs 111°), extension (0° vs 23°), and supination (62° vs 29°). We did not find a clear benefit for re-operation in children with a re-dislocation following corrective osteotomy for chronic dislocation of the radial head.

The History and Future of Unlinked Total Elbow Arthroplasty

Unlinked total elbow arthroplasty (TEA), which has no mechanical connection between the humeral and ulnar components, has theoretical advantages based on its near-normal elbow kinematics and the preservation of bone stock. Unlinked TEA is appropriate only for patients who have limited bone loss or limited deformity and good ligamentous function. This is because postoperative instability has been a major complication of unlinked prostheses. The concept and goal of unlinked TEA is to share the loading stress on the bone implant interface with the surrounding tissues. Although the loosening rate of unlinked prostheses theoretically should be lower than that of linked prostheses (which have a mechanical connection between the humeral and ulnar components), there is no clear evidence that unlinked TEAs are superior to linked TEAs in this respect. However, we believe that primary TEA should be performed using an unlinked TEA, especially for younger patients, because revision surgery for unlinked TEA results in longer prosthesis survival than revision surgery for linked TEA. Improvement of the design of unlinked prostheses and the introduction of less invasive surgical techniques are required to reduce postoperative instability.