Satoshi Iwashita

SLAP repair with arthroscopic decompression of spinoglenoid cyst.

Introduction: A spinoglenoid cyst with suprascapular nerve disorders is highly associated with superior labrum anterior posterior (SLAP) lesion. Conservative or surgical treatment is applied to relieve pain and neurological symptoms. The purpose of this study was to evaluate clinical outcomes of patients treated by arthroscopic surgery for SLAP lesion with a spinoglenoid cyst. Methods: The subjects of this study were six patients with SLAP lesion with a spinoglenoid cyst who underwent arthroscopic surgery. There was one female and five males with a mean age of 48.5 years. SLAP lesion was found in all the patients at arthroscopy. A small tear of the rotator cuff was found in the two patients. The SLAP lesion was repaired using suture anchors, and the rotator cuff tears were repaired by suture-bridge fixation. The spinoglenoid cyst was decompressed through the torn labrum in three patients, and through the released superior to posterior portion of the capsule in the other three patients. Results: All patients showed excellent improvement in pain and muscle strength at the final follow-up examination. The mean Constant score was improved from 60.5 points preoperatively to 97.2 points postoperatively. The mean visual analog scale (VAS) score decreased from 4.5 on the day of the surgery to 2.5 within one week postoperatively. Postoperative MRI showed disappearance or reduction of the spinoglenoid cyst in four and two patients, respectively. There were no complications from the surgical intervention and in the postoperative period. Discussion: The patients treated by decompression through the released capsule obtained pain relief at an early period after the surgery. Arthroscopic treatment for a spinoglenoid cyst can provide a satisfactory clinical outcome. Arthroscopic decompression of a spinoglenoid cyst through the released capsule is recommended for a safe and reliable procedure for patients with suprascapular nerve disorders.

Stress Fracture of the Radial Styloid Process in a Judo Player: A Case Report

Stress fractures of the upper limbs are uncommon, and are most often reported as individual cases or small series. In particularly, stress fractures around the wrist are even less common. A stress fracture of the radial styloid process in a judo player was surgically treated, and a favorable treatment outcome was obtained. A 16-year-old adolescent boy experienced pain in the right wrist, with no apparent trigger, while playing judo. Stress fracture of the radial styloid process was diagnosed with plain radiographs and was treated conservatively with cast immobilization. Although bone union was achieved, the fracture recurred after he resumed paying judo. Thus, surgical treatment was performed. The procedure was resection of the distal bone fragment. He resumed practicing 2 months postoperatively and returned to judo matches after 1 more month. As of 1 year after distal bone fragment resection, he was able to participate in judo without pain, limited range of motion, or instability of the wrist.

Arthroscopic Removal and Tendon Repair for Refractory Rotator Cuff Calcific Tendinitis of the Shoulder

BACKGROUND The purpose of this study was to evaluate clinical and radiological outcomes of arthroscopic treatment for refractory rotator cuff calcific tendinitis of the shoulder. METHODS Subjects were 37 patients (35 women and 2 men; mean age, 47.8 years; age range 34-61 years) who had undergone arthroscopic treatment for calcific tendinitis of the shoulder. Despite sufficient nonsurgical treatments, all patients had residual calcific deposit with persistent or recurrent pain. Before surgery, all patients underwent 3-directional radiographs of the shoulder and three-dimensional computed tomography to determine the location and size of calcific deposit. Arthroscopic surgery was performed with the patient under general anesthesia in the lateral decubitus position. A 2-cm single longitudinal incision was made with a radiofrequency hook blade on the tendon surface above calcific deposit. Calcific deposit was removed as much as possible with a curette and a motorized shaver. The incised tendon was repaired with a side-to-side suture with strong sutures. The Japanese Orthopaedic Association shoulder score was used to evaluate clinical outcomes. The extent of calcific deposit removal was evaluated with radiographs obtained before surgery, 1 week after the surgery and at the final follow-up examination. RESULTS The mean follow-up duration was 30.4 (range, 13-72) months. The mean shoulder score significantly improved from 69.7 (range, 58-80) points before surgery to 97.8 (range, 89-100) points at the final follow-up examination. Postoperative radiographs in all patients, showed that the calcific deposit was resolved or reduced and those from 1 week after surgery to the final examination showed no evidence of recurrence or enlargement of calcific deposit. The calcific deposit had completely resolved in 34 patients but remained in 3 patients. CONCLUSION When treating calcific tendinitis of the shoulder, it is important to accurately determine the size and location of calcific deposit by radiographs and 3-dimensional computed tomography. Satisfactory clinical and radiological outcomes can be expected after reliable removal of calcific deposit through a single longitudinal incision and side-to-side repair with strong sutures, in association with an appropriate rehabilitation program.

Characteristics of the patients with delaminated rotator cuff tear

Purpose: The purpose of this study was to analyze factors relating to delamination in full-thickness rotator cuff tears. Methods: 126 patients with full-thickness rotator cuff tears treated by arthroscopic rotator cuff repair were the subjects of this study. There were 52 females and 74 males whose average age was 64.2 years. Fifty-three patients had history of trauma. The average duration of disorder was 29.5 weeks. Nineteen patients were diagnosed with diabetes. On types of the tears, small tear was observed in 59 patients, medium tear in 47 patients, large tear in 6 patients, and massive tear in 14 patients. The average size of tear was 1.98 cm. Delamination of the torn cuff was observed in 45 patients. Factors compared between the patients without delamination and those with delamination were as follows: gender and age of the patients, history of trauma, duration of disorder, diabetes, smoking, size and number of rotator cuff tears. Results: The delamination rate of the smoking patients was significantly higher than non-smoking patients. The delamination rate of patients with more than two tendon tears was significantly higher than those with only one tendon tear. The average size of tear with delamination was significantly larger than that of tear without delamination. The other factors were not related to delamination. Conclusions: This study suggests that smoking, size of tear and number of torn cuffs are associated with delamination. The progression of torn cuff, anatomical features and nicotine of smoking affect the causes of delaminated tear of rotator cuff.

Clinical outcomes and structural integrity of arthroscopic double-row versus suture-bridge repair for rotator cuff tears

The purpose of this study was to compare clinical outcomes and retear rate between arthroscopic double row (DR) and suture bridge (SB) repair for rotator cuff tears. Postoperative Constant score and MRI findings were compared between 52 patients underwent DR repair and 63 patients underwent SB repair with medium tear of the supraspinatus. There was no significant difference in Constant score between the two groups. Postoperative MRI revealed that retear rate of SB group was significantly lower than DR group. This study suggests that SB repair can provide better clinical and structural outcomes compared with DR repair.

Factors influencing outcomes of nonsurgical treatment for baseball players with SLAP lesion

Background/objective Superior labrum anterior posterior (SLAP) lesion of the shoulder joint occurs in throwing athletes as a results of overuse, such as from repetitive baseball pitching. Nonsurgical treatments are usually the first-line therapy for symptomatic SLAP lesion. However, some patients cannot obtain satisfactory improvement of their symptoms, leading to dysfunction of the shoulder and diminished pitching performance. The purpose of this study was to analyze factors that influence outcomes of nonsurgical treatments for SLAP lesion. Methods Forty-five baseball players with SLAP lesion, whose mean age was 21.6 (range, 16–36) years and who underwent nonsurgical treatments, were the subjects of this study. SLAP lesion was diagnosed by shoulder arthrography and magnetic resonance imaging (MRI). Exclusion criteria included definite associated trauma such as dislocation, fracture or injuries related to sports activities. Playing positions included pitcher (21 patients), catcher (3 patients), infielder (13 patients) and outfielder (8 patients). Mean symptomatic duration from the onset of shoulder pain to the beginning of nonsurgical treatments was 8.5 (range, 1–72) months. Nonsurgical treatments included physical therapy, such as range of motion, stretching, and rotator cuff exercises, as well as prescription of nonsteroidal anti-inflammatory drugs if necessary. To identify factors that influenced outcomes of nonsurgical treatments for SLAP lesion, various factors of 13 nonresponsive patients were compared with those of 32 patients who responded to nonsurgical treatment. The factors were as follows: patient background, such as age or playing position; range of shoulder motion; shoulder joint laxity; and findings of radiographs and MRI. All data were statistically assessed using logistic analysis and Spearmans correlation coefficient. The significance level was set at P < 0.05, and odds ratios were determined. Results Factors identified as having significant difference between the 2 groups were age, duration of baseball experience, symptomatic period, playing position, range of internal and external rotation in the first medical examination, range of total rotation of 90° abduction 2 months after nonsurgical treatments, and presence of Bennett spur and partial-thickness tears of the articular-side rotator cuff. Factors with high odds ratios were symptomatic period, range of total rotation of 90° abduction 2 months after the treatment, age, and duration of baseball experience. Conclusion Symptomatic period, duration of baseball experience, age, and findings of radiographs and MRI are inevitable factors that cannot be improved by nonsurgical treatment. On the other hand, restriction of shoulder motion due to posterior muscular tightness is a factor that can be improved by nonsurgical treatment. Early improvement of shoulder motion is important to obtain satisfactory outcomes of nonsurgical treatments for SLAP lesion.