Tomohisa Hashiuchi

Accuracy of the biceps tendon sheath injection: ultrasound-guided or unguided injection? A randomized controlled trial

BACKGROUND Patients often localize pain in the anterior shoulder; however, this patient-localized pain does not necessarily correlate to the location of disease. Unguided shoulder injections are common in clinical practice. The accuracy of unguided biceps tendon sheath injections has not been studied. Patient management may be aided by the knowledge of injection accuracy. This study compared the accuracy of ultrasound-guided biceps tendon sheath injection with unguided injection. MATERIALS AND METHODS The study comprised 30 patients (30 shoulders) with reported anterior shoulder pain who had a primary diagnosis of tenosynovitis or tendinitis of the biceps tendon, or both. Shoulders were randomly allocated into ultrasound-guided and unguided injection groups. Computed tomography (CT) imaging was performed immediately after a contrast agent was injected into the biceps tendon sheath. The locations of contrast seen on CT scan were classified into 3 types: only within the tendon sheath (type 1); inside the tendon, tendon sheath, and surrounding area (type 2); and only the area outside the tendon sheath (type 3). RESULTS Ultrasound-guided injections resulted in 86.7% type 1 and 13.3% type 2 locations. Unguided injections resulted in 26.7% type 1, 40.0% type 2, and 33.3% type 3 locations. The difference for each location type was significant (P < .05). CONCLUSION Injection into the tendon sheath of the long head of the biceps brachii can be more accurately performed using ultrasound guidance than by the blind method.

The changes occurring after the Putti-Platt procedure using magnetic resonance imaging.

Abstract The purpose of this study is to evaluate the magnetic resonance imaging (MRI) following Putti-Platt procedure for recurrent anterior dislocation of the shoulder. Six shoulders of six patients who had received Putti-Platt procedure were evaluated by the MRI before and after operation. After the Putti-Platt procedure the subscapularis tendon was thickened and an increased signal area on T2-weighted images were observed in four patients. The area of subscapularis tendons after operation was increased maximally 3.46-fold and the volume was increased on average 1.51-fold. The course of subscapularis muscle fiber before operation was described as a mild arc, but changed to a straight line after the procedure in five patients. The findings in this study suggest that the Putti-Platt procedure leads to a remarkable increase in strength of subscapularis tendon and an improvement of laxity of subscapularis muscle. In conclusion, there is a good possibility that this procedure will increase the stability of the glenohumeral joint and be a successful treatment for recurrent anterior dislocation of the shoulder.

In vivo microstructural analysis of the humeral greater tuberosity in patients with rotator cuff tears using multidetector row computed tomography

BackgroundIn arthroscopic surgery, the suture anchor technique has become popular for rotator cuff repair. Preoperative evaluation of the bone microstructure is of utmost importance because, especially in elderly patients, osteoporotic changes may cause anchor pullout, which results in failure of rotator cuff repair. Many groups have reported humeral microstructural analysis; however, most studies were experiments using porcine specimens or human cadavers. In this study, we used multidetector row computed tomography to successfully perform in vivo evaluation of the bone microstructure of the humeral greater tuberosity in patients with rotator cuff tears.MethodsTen patients were examined. Regions of interest were defined in six quadrants of the greater tuberosity (medial, lateral, and far lateral rows of the anterior and posterior areas). The local bone mineral density and the trabecular microstructural parameters, including the mean bone volume to total volume (BV/TV), trabecular thickness, trabecular separation, and structure model index (SMI), were measured using bone analysis software.ResultsThe BV/TV of the posteromedial region was highest and the SMI of the posteromedial region was lowest. These findings suggest that the bone quality of the posteromedial portion is the highest within the greater tuberosity.ConclusionBecause the bone quality may be correlated with the pullout strength of suture anchors, our method can help to understand the individual and regional variance in bone quality and may lead to the creation of personalized surgical protocols.

Ultrasound-guided arthroscope insertion and decompression of a supraspinous fossa cyst

A cyst arising in the scapular supraspinous fossa may cause shoulder pain; subsequently, enlargement of the cyst may result in severe compression of the adjacent suprascapular nerve, leading to muscle weakness and sensory disorder. Decompression of the nerve through cyst removal is effective in resolving these symptoms. However, treatment can also be performed less invasively through arthroscopy. Insertion of an arthroscope without visual guidance could cause tissue damage and, consequently, would become an invasive procedure itself. The use of ultrasonography to guide the scope to the cyst decreases the invasiveness of the procedure. Here, we present the case of a patient with a cyst arising in the scapular supraspinous fossa, in whom we could relatively readily and safely observe the cyst by advancing an arthroscope under ultrasonographic guidance. The suprascapular nerve was decompressed via cyst removal.