Takakazu Hirayama

Compression of the Suprascapular Nerve by a Ganglion at the Suprascapular Notch

The suprascapular nerve was compressed by a ganglion in the suprascapular notch in a 28-year-old carpenter. Electromyogram studies, especially mean latency time, were essential for accurate diagnosis. Excision of the ganglion relieved the pain and led to recovery of the motor function of the shoulder.

Trigger Wrist Caused by a Giant Cell Tumour of Tendon Sheath

Trigger wrist is a rare condition unlike the trigger finger of the metacarpophalangeal joint. This report describes a case of trigger wrist secondary to a giant cell tumour of the flexor tendon sheath. No previous reports are available in the medical literature.

Long term results using a modified King's method for cubital tunnel syndrome

Forty-six elbows in 40 patients with cubital tunnel syndrome were evaluated after using a modified Kings method. The average postoperative followup period was 79 months. The severity of cubital tunnel syndrome was graded before and after operation by the modified method of Stuffer et al which evaluated the amount of numbness, sensation, muscle strength, and muscle atrophy. The results were positively correlated with the preoperative severity of the disease and the ulnar nerve sulcus angle as measured in the axial view of the elbow. When the amount of the medial epicondylectomy was large, a good result was obtained, but the risk of medial collateral ligament insufficiency increased. Because the results of medial epicondylectomy are inconsistent with stability of the elbow, when doing a modified Kings operation, careful repair of the medial collateral ligament is essential to minimize instability of the elbow.

Reinnervation of denervated muscle by transplantation of fetal spinal cord to transected sciatic nerve in the rat

When motor neurons in the spinal cord are destroyed, regeneration of motor axons and muscle reinnervation cannot be expected. We attempted reinnervation of the denervated muscle, i.e. motor unit reconstruction, using transplantation of the fetal spinal cord to the peripheral nerve. The sciatic nerve of an adult rat was resected for 20 mm, and a cavity was prepared using an autologous femoral vein at the distal stump of the nerve. The fetal spinal cord was then transplanted into the venous cavity. After 3-6 months, no voluntary muscle contraction was observed due to the absence of communication with the central nervous system. However, reinnervation of the muscles via the sciatic nerve by the transplanted spinal neurons was demonstrated electrophysiologically and histochemically. This suggested that a motor unit can be reconstructed by fetal spinal cord transplantation even if the original motor neurons in the spinal cord are not available.

The occurrence of soft tissue sarcomas in three siblings with Werner's syndrome

Werners syndrome, a relatively rare and autosomal recessive disorder, is well known to be characterized by a high frequency of malignant neoplasm. The occurrence of familial neoplasm in patients with this condition, however, has been recorded only once before in the literature. Reported are the findings with regard to the occurrence of sarcomas in three siblings with Werners syndrome. Two of the current three cases were of malignant fibrous histiocytomas, one in a 36‐year‐old man and one in a 32‐year‐old woman. The other case was of a leiomyosarcoma in a 26‐year‐old man. Two of the patients died of the tumors, although the third is still alive. The exact cause of the high incidence of malignant tumor in this family remains unknown, as is still so in other cases of Werners syndrome.

Extensor tendon rupture after osteoarthrosis of the wrist associated with nonrheumatoid positive ulnar variance.

Rupture of the extensor tendon after osteoarthrosis of the wrist associated with nonrheumatoid, positive ulnar variance is uncommon. Eight cases were seen in the last five years. They included five men and three women, whose ages ranged from 54 to 82 years (average, 70 years). In all the cases, roentgenograms revealed osteoarthrotic changes in the wrist and dorsal subluxation or dislocation of the ulnar heads. Seven cases had operations. Friction with the dorsally subluxated or dislocated ulnar head and the osteophytes surrounding it caused these tendons to rupture. It was impossible to use end-to-end sutures, so tendon transfers or tendon grafts were performed. The patients were evaluated one to four years after surgery. Three patients complained of some disability in their daily lives, notably, limited flexion of their fingers. It is important that during surgery the reconstructed tendons should not be strained excessively.

Palmaris Longus Transfer for Replacement of the First Dorsal Interosseous

Using palmaris longus, the first dorsal interosseous was reconstructed without free tendon graft. Palmaris longus prolonged with a strip of palmar fascia was transferred rectilinearly to the site of insertion of the first dorsal interosseous via a subcutaneous tunnel and fixed. This method was applied to seven hands of six patients and the follow-up observation continued for more than six months postoperatively. In six hands, favourable stability and abduction function of the index finger was achieved. In one hand, adhesion occurred at the site of the first dorsal interosseous muscle resulting in tenodesis. This operative method appears to be useful in the reconstruction of the first dorsal interosseous muscle from non-recovering paralysis following injury of the first dorsal interosseous muscle, or ulnar nerve. This method may also be utilized after decompression of chronic compression of the ulnar nerve giving no expectation of complete recovery by the reconstruction and augmentation of the first dorsal interosseous muscle. No unpleasant side effect was encountered.

Restoration of elbow flexion by complete latissimus dorsi muscle transposition

Flexor-plasty of the elbow has been performed using either a tubed complete latissimus dorsi muscle or musculocutaneous transposition in eight patients, six of whom had brachial plexus palsy and two traumatic loss of the anterior brachial musculature and overlying soft tissue. The range of follow-up was from one to eight years. When the postoperative results were evaluated according to the criteria of Segal (1959), the results were excellent in four cases and good in three, with one failure. The indications, operative technique and results are discussed.

Avulsion fracture of the scapular spine: A case report

Fractures of the scapula are infrequent injuries usually associated with direct, violent trauma to the shoulder girdle. We present a rare case of an avulsion fracture of the scapular spine occurring in a patient during a game of badminton. Open reduction and internal fixation with a tension band-wiring technique was performed. The patient had an uncomplicated recovery and rapidly returned to sporting activity.

Postoperative course of patients treated with iliac osteocutaneous free flaps: a two- to five-year follow-up study

The clinical and radiologic course was reviewed in seven patients treated with an iliac osteocutaneous free flap (iliac flap) for treatment of large bone defects in the tibia and first metacarpal bone and overlying skin. Application of the iliac flap was followed by free bone grafting in four patients and aesthetic surgery in four patients. All patients obtained solid bony union and good skin coverage; none had complaints upon walking. An iliac flap was useful as a salvage procedure for the treatment of massive defect of bone and skin in extremities, especially in the lower one-third of the lower leg. Transient osteoporosis occurred before osteosclerosis and bony union. Bone remodeling with change in the trabecular pattern preceded transformation from cancellous to cortical bone.