Nobuo Terabayashi

Nonunion of a first rib fracture causing thoracic outlet syndrome in a basketball player: a case report.

Fractures of the first rib occur infrequently in athletes. This report describes a basketball player with thoracic outlet syndrome (TOS) resulting from nonunion of a first rib fracture with a hypertropic callus. Conservative therapy had been ineffective for 1 year after the patient sustained the injury, and he had complained of numbness in the left upper extremity when his shoulder was in abduction and external rotation. We performed resection of the first rib through a transaxillary approach to achieve neurovascular decompression. This resulted in immediate resolution of the symptoms. There was no recurrence of the numbness in the left upper extremity at 2 years after surgery. Previous reports of sports-associated first rib fracture have indicated that it has a relatively good prognosis. However, nonunion of a first rib fracture may lead to TOS that is unresponsive to conservative treatment. Therefore, this type of fracture should be followed-up carefully.

Shoulder impingement syndrome due to a ganglion cyst below the coracoacromial ligament: a case report.

Young athletes who employ overhead arm movements frequently develop shoulder pain caused by muscle tightness or scapula dysfunction1-3. Generally, they are instructed to perform a stretching and muscle-conditioning regimen1,3, but refractory pain without muscle tightness sometimes persists. In such cases, magnetic resonance imaging (MRI) should be used to look for other lesions, and occasionally a cystic lesion may be identified. Cysts located near the labrum, referred to as paralabral cysts or labral cysts, may cause shoulder pain or suprascapular nerve palsy4,5. To our knowledge, there have been no previous reports of ganglion cysts that were located below the coracoacromial ligament as being the cause of shoulder impingement syndrome in athletes. We report the presence of such a cyst in a patient who had the typical symptoms of shoulder impingement syndrome. For diagnostic imaging, we carried out radiographs, MRI, ultrasonography, and cystographic three-dimensional computed tomography (CT) examinations. Ultrasonography was particularly helpful for understanding the movement of the ganglion, while shoulder-dynamic and cystographic three-dimensional CT was very useful for identifying the location of the stalk and estimating the size of the cyst. Our patient was informed that data concerning the case would be submitted for publication, and he consented. A twenty-one-year-old male, right-hand-dominant volleyball player developed pain in the anterior aspect of the right shoulder when spiking the ball. The pain had persisted for more than a year as of the time that the patient presented to our institution, but there was no history of trauma. Physical examination revealed tenderness on compression of the area over the coracoacromial ligament. The examination findings did not suggest shoulder instability, and the patient had no limitation of motion in the shoulder. There was no evidence of local heat, a mass, muscle weakness, or …

Increased blood flow in the anterior humeral circumflex artery correlates with night pain in patients with rotator cuff tear

AbstractBackground Night pain is a particularly vexing symptom in patients with rotator cuff tear. It disturbs sleep and decreases quality of life, and there is no consensus regarding its etiology. Based on arthroscopic surgical observations of synovitis around the rotator interval or capsule surface in rotator cuff tear, we hypothesized that blood flow from the artery feeding the capsule increases blood supply to the synovium. This study aimed to investigate the relationship between blood flow and night pain using pulse Doppler ultrasonography.MethodsA series of 47 consecutive patients with rotator cuff tear was evaluated. The peak systolic velocity and resistance index of blood flow in the ascending branch of the anterior humeral circumflex artery were evaluated using pulse Doppler ultrasonography. We also investigated 20 normal shoulders in healthy volunteers. The peak systolic velocity and resistance index were compared between affected and unaffected sides in patients and between dominant and nondominant sides in controls.ResultsAnterior humeral circumflex artery peak systolic velocity and resistance index did not differ between sides in control subjects or in patients with rotator cuff tear without night pain. However, anterior humeral circumflex artery peak systolic velocity and resistance index did differ significantly between sides in patients with rotator cuff tear with night pain.ConclusionsThis study revealed anterior humeral circumflex artery hemodynamics in patients with rotator cuff tear and normal subjects using Doppler ultrasonography. Night pain, particularly involving aching, appears to be related to the hemodynamics. These findings suggest that investigating the hemodynamics of patients with rotator cuff tear with night pain may lead to greater understanding of the etiology of this symptom.

A Pilot Study to Assess Fatty Infiltration of the Supraspinatus in Patients with Rotator Cuff Tears: Comparison with Magnetic Resonance Imaging

The aim of this study was to quantitatively assess the echo intensity of the supraspinatus muscle and compare magnetic resonance imaging and ultrasound findings for 27 patients (12 women, 15 men, 65.8 ± 11.5 y). Tear size and fatty infiltration were determined by magnetic resonance imaging; five stages were assigned based on Goutalliers classification. Gray-scale histogram analysis was used for ultrasound assessment, which was performed in both subcutaneous fat and supraspinatus muscle in three different regions; the echo intensity ratio was the ratio of echo intensity in subcutaneous fat to that in the supraspinatus muscle. Sonograms of 27 shoulders revealed 3 shoulders with a partial tear, and 4 with a small tear, 6 with a medium tear, 6 with a large tear and 4 with a massive tear; 4 shoulders had no tear. Supraspinatus muscle echo intensity and echo intensity ratio were significantly lower in the stage 0 and 1 than in stages 2-4. Our study suggests that ultrasound can quantitatively and objectively assess fatty infiltration in the rotator cuff muscle.

Cementless Total Hip Arthroplasty Using a Spongy Metal Surface Hip Prosthesis With a Collarless, Proximally Porous-Coated Stem

A collarless, proximally porous-coated type of Spongiosa Metal II hip prosthesis was used for cementless total hip arthroplasty in 52 hips, and 48 hips were followed and assessed during a mean follow-up period of 6.3 years (minimum 5 years). There were 8 hips (16.7%) that had stress shielding, and 2 hips (4.2%) that had thigh pain. In terms of stability, the stem was bony stable in 39 hips, fibrous stable in 6, and unstable in 3. The stability of the stem was significantly correlated with the stem canal filling ratio. It was suggested that the much more proximal transfer of loading stress by a collarless, proximally porous-coated stem is not suitable for the Spongiosa Metal II series because it may unacceptably reduce the stability of the stem.

Stress Fractures of the First Rib Related to Swinging of a Baseball Bat: Two Case Reports.

Abstract:Stress fractures of the first rib are uncommon, and few reports have described the occurrence of this injury in overhead-throwing athletes. Furthermore, although there have been a few reports of first rib stress fractures on the throwing side in baseball players, fractures on the nonthrowing side are very rare. Here, we report 2 cases of first rib stress fractures on the nonthrowing side related to swinging of a baseball bat. The cause of the fractures in the present cases may have been repetitive traction and shear force on the first rib resulting from muscle exertion while swinging a bat. Conservative treatment that considered the mechanism of stress fractures resulted in a symptom-free and complication-free return to baseball. The patients background should be considered for an accurate understanding of the injury mechanism, adequate conservative therapeutic plan, and a successful return to baseball.

Morcellized bone grafting for acetabular deficiency in cementless total hip arthroplasty.

Morcellized bone grafting was performed to significant acetabular deficiency in 35 hips of 29 patients in cementless total hip arthroplasty (THA). Bridging trabeculation across the graft-host interface, remodeling of the graft, and trabecular reorientation were observed at 4 weeks, 3.7 months, and 10.7 months postoperatively, respectively. These remodeling processes were observed in all cases. Morcellized bone grafting for acetabular deficiency in cementless THA stock, which is necessary to make the cup stable, revealed encouraging early trabecular reorientation and recovery of acetabular bone even in cases in which structural bone grafting is needed.

Primary Total Hip Arthroplasty With a Spongy Metal Surface Acetabular Component for Hip Dysplasia

We evaluated the clinical and radiographic results of primary total hip arthroplasty for 81 dysplastic hips (71 patients) using cementless Spongiosa Metal II cups (ESKA Implants, Lübeck, Germany). The mean follow-up period was 6.4 years (minimum 5 years), and the preoperative mean Japanese Orthopaedic Association hip score had improved from 45.2 to 87.4 points at the latest follow-up. The radiographic outcome was no aseptic loosening in all 81 hips. The hip center was located significantly more superior than in the contralateral normal hip in 45 patients, but the difference was less than 10 mm; however, there was no significant difference in the lateral position of the hip center. The use of a Spongiosa Metal II cup for dysplastic hips provided satisfactory 5- to 10-year clinical and radiographic results.

Association of lubricin concentration in synovial fluid and clinical status of osteoarthritic knee.

Abstract Objectives: Although lubricin plays a role in controlling inflammation and pain as well as being a mechanical lubricant, clinical relevance of lubricin concentration in synovial fluid (SF) is unknown. The purpose was to determine whether lubricin concentration in SF is associated with the clinical status of the knee. Methods: SF was obtained from 61 knee joints from patients who underwent any knee surgery with several stages of knee osteoarthritis. Lubricin/PRG4 concentration in SF was measured by enzyme-linked immunosorbent assay (ELISA). Clinical evaluations of the knee by the Kellgren and Lawrence (K–L) system, Knee Society Score (KSS), and the range of knee motion, and assessment of joint laxity were performed. Association of lubricin concentration in SF and these clinical factors was statistically analyzed. Results: There was no significant correlation between lubricin concentration in SF and age, sex, K–L grade, or KSS. However, lubricin concentration was significantly correlated with anteroposterior laxity (R = 0.50, p < 0.001), full flexion angle (R = 0.39, p  < 0.01), and range of knee motion (R = 0.38, p  < 0.01), but not full extension angle, varus laxity, or valgus laxity. Conclusions: Lubricin concentration was correlated with joint flexibility, but not with clinical symptoms, including pain at that time.

Quantitative Sonographic Assessment of the Quadriceps Femoris Muscle in Healthy Japanese Adults

The aim of this study was to evaluate the relationships among aging, muscle strength, and image feature analysis of the quadriceps femoris muscle and to evaluate the relationship between aging, muscle strength, and sonographic findings.