Shiro Tabata

Conservative treatment of rotator cuff tears

Among 124 shoulders in 114 patients with complete rotator cuff tears who had been treated conservatively from 1980 until 1989, 62 shoulders in 54 patients were observed to identify the findings on initial examinations and correlate them with the final results. The follow-up period averaged 3.4 years. According to modified criteria of Wolfgang, 51 shoulders in 45 patients (82%) rates satisfactory (excellent or good). The overall scores of pain, motion, and function improved significantly. The results were less satisfactory in patients observed more than six years. The patients with satisfactory results (Group 1) and unsatisfactory results (Group 2) among those observed more than five years were compared. In Group 1, the scores of pain, motion, and strength improved significantly at follow-up examinations, whereas those of function did not. In Group 2, no improvement was recognized in any categories. The only significant differences in the initial findings between the two groups were the active abduction angle and the abduction strength: the patients in Group 1 retained a good range of motion and strength, whereas those with unsatisfactory results had a limited range and muscle weakness on first examinations. Conservative treatment affords satisfactory results when it is given to the patients with well-preserved motion and strength, although in some cases function may deteriorate with time.

Incomplete rotator cuff tears : results of operative treatment

Thirty-eight shoulders of 36 patients with incomplete rotator cuff tears surgically repaired were evaluated, with an average follow-up period of 4.9 years. The average age at operation was 52.2 years. Three types of incomplete tears were identified: superficial (12 shoulders), intratendinous (three), and deep surface tears (23). Full-thickness cuff involving the lesion was resected and repaired by side-to-side suture (13 shoulders), side-to-bone suture (eight), fascial patch grafting (16), or side-to-bone suture with fascial patch grafting (one). The overall results were satisfactory in 31 shoulders (82%). The results were not affected by the tear types, operative methods, or follow-up period. The patients with poor results were associated with major complications other than rotator cuff tears or with insufficient resection of the damaged cuff. When the full-thickness cuff involving the lesion is completely resected and repaired, long-term satisfactory results can be anticipated in a high percentage of patients regardless of tear types.

Range of motion and arthrography in the frozen shoulder

The relationship between the range of motion and the arthrographic measurements were assessed in 91 patients with frozen shoulders. Range of motion was recorded in flexion, abduction, external rotation, and internal rotation. On the arthrogram the following parameters were measured: depth of the axillary pouch, width of the anterior ballooning, extent of the subscapularis bursa, filling of the biceps tendon sheath, and the irregularity of the capsular outline in the anteroposterior view. Both the subscapularis bursa and the biceps tendon sheath were also assessed in the scapular Y view. There were mild correlations between external rotation and the anterior ballooning and between internal rotation and the axillary pouch, but the coefficient of determination (r-square) in each correlation was small. No significant correlation was observed between flexion or abduction and any of the arthrographic measurements. Although these arthrographic findings are characteristic to frozen shoulders, none of them is a good predictor of the severity of restricted motion.

Magnetic resonance arthrography in the assessment of anterior instability of the shoulder: Comparison with double-contrast computed tomography arthrography

Forty-seven shoulders with traumatic anterior instability were studied by magnetic resonance arthrography (MRA) and computed tomography arthrography (CTA) to compare the diagnostic performance of these examinations in the evaluation of Bankart lesions. All shoulders were examined by arthroscopy to verify the lesions. Labral damage evaluated by MRA and by CTA correlated significantly with arthroscopic findings (MRA, r = 0.55, p < 0.0001; CTA, r = 0.45, p = 0.0050). MRA possessed higher sensitivity in detecting torn labra (MRA, sensitivity = 87%, specificity = 75%; CTA, sensitivity = 33%, specificity = 88%). In detecting displaced labra, sensitivity and specificity were 65% and 94% for MRA and 75% and 69% for CTA. The inferior glenohumeral ligament was depicted as a lax structure in 74% by MRA but in only 21% by CTA. We conclude that MRA is superior to CTA in detecting lesions associated with shoulder instability.

Effect of lumbar disc herniation on clinical symptoms in lateral recess syndrome

This study investigated the differences in the clinical features of lateral recess syndrome attributable to the bony entrapment of the spinal nerve root under the superior articular facet, and lateral recess syndrome and associated lumbar disc herniation. Ninety patients with pure bony entrapment (47 men, 43 women) ranging in age from 19 to 83 years (mean age, 63 years) and 59 patients with lumbar disc herniation in the lateral recess (43 men, 16 women) 19 to 85 years of age (mean age, 49 years) were included in this study. All patients had L5 root radiculopathies and were treated surgically. Although the early symptoms of patients with lateral recess syndrome often were in the lower extremities, many of the patients with associated lumbar disc herniation had a transition initially experiencing low back pain and subsequently having lower extremity symptoms. Flexion and extension of the lumbar spine exacerbated symptoms, particularly in patients with lumbar disc herniation. The results of the current study show that the clinical presentation of lateral recess syndrome differs depending on the cause of the compression in the lateral recess.