Toyohisa Naniwa

Fractures of the acromion and the lateral scapular spine

We studied 37 fractures lateral to the spinoglenoidal notch to evaluate the validity of collectively handling these fractures as an acromion fracture and to ascertain the mechanism of injury. We divided them into three groups according to the location of the fracture line. Fracture of the anatomic acromion or the extremely lateral scapular spine (groups I and II, 28 fractures) was frequently associated with fracture of the coracoid base, acromioclavicular joint injury, or both. The mechanism of injury in most cases was presumed to be indirect force brought to bear on the shoulder from the lateral direction. Fracture descending to the spinoglenoidal notch (group III, nine fractures) was seldom associated with other shoulder injuries, and surgery was rarely needed. The mechanism was assumed to be direct force brought to bear on the shoulder from the posterior direction. Therefore fractures of the anatomic acromion and the extremely lateral scapular spine may be managed collectively. However, fracture descending to the spinoglenoidal notch should be managed separately. We advocate that these fractures should be classified into two types in terms of clinical consideration: type I fractures, comprising those of the anatomic acromion and the extremely lateral scapular spine, and type II fractures, located in the more medial spine and descending to the spinoglenoidal notch.

Subacromial Impingement Associated with Deltoid Contracture. A Report of Two Cases

Deltoid contracture can be caused either by repeated intramuscular injections or, in rare cases, by unknown etiologies2,3,6,8,11,12,14,19. The condition occurs in adults as well as in children2,4,8,9,12,13,17,18,21. The typical clinical manifestations are an abduction-extension contracture of the shoulder joint combined with winging of the scapula as compensation for the abduction contracture associated with the formation of a fibrous band within the deltoid muscle2,12,14,18. Adults who have a deltoid contracture commonly have pain that radiates from the neck and the shoulder to the lateral side of the arm4,8,9,12,13,16-18,20,21. We report the cases of two patients who had a deltoid contracture associated with subacromial impingement, and we describe the interrelationship of the two conditions. CASE 1. A forty-eight-year-old homemaker who had had a nephrectomy for the treatment of hydronephrosis four months earlier was seen because of pain in the right shoulder that occurred both at rest and with movement. Within a period of eleven days before and after the day of the nephrectomy, the patient had intramuscular injections of atropine sulfate (three injections of 0.5 milligram per milliliter), hydroxyzine hydrochloride (four injections of twenty-five milligrams per milliliter), pentazocine (four injections of fifteen milligrams per milliliter), and buprenorphine hydrochloride (one injection of 0.1 milligram per milliliter) into the right deltoid. Pain developed in the right shoulder on the tenth postoperative day and gradually increased. Physical examination of the right shoulder revealed a 15-degree abduction and 10-degree extension contracture and a winged scapula. Tender …

Clinical analysis of bennett lesion

In order to clarify the etiology and nature of a Bennett lesion, 37 symptomatic cases with this lesion were analyzed clinically and radiologically. The age at onset ranged from 13-30 years old with an average 21 years old. 86% of the cases felt pain in the late cocking and/or follow through phases. There was tenderness on the posterior joint space in 17 and on the bicipital groove and SSP in 6 cases. 12 6, and 19 cases respectivelyfelt pain in each of the posterior drawer test, the posterior apprehension test and the anterior apprehension test. The ROM was characterized by a restriction of horizontal adduction in internal rotation. The drop arm test(two finger test) was positive in 10 cases. Pain was triggered by a forced external rotation and abduction test in 89%, and by a forced internal rotation test during 90 ° flexion in 84%. According to the radiological findings, ossifications were classified into two types; thickening(29 cases) and spike types(8 cases). The thickening type was a mountain-shaped ossification rising from the glenoid rim and its proximity. The spike type indicated a spur formation from the glenoid rim growing towards the inside of the joint. Of 12 cases treated surgically, 9 cases had glenoplasty and reattachment of the labrum. All 5 cases of a thickening type had detachment of the labrum with subperiosteal ossification and all 4 cases of spike type had the thickening of the labrum without a detachment. A single structure and its pathological change that can explain the physical and surgical manifestations is a contracture of the postero-inferior portion of the IGHL. During the follow through phase a resultant traction stress is imposed on the postero-inferior labrum. If it is great enough to cause detachment of the labrum, a subperiosteal new bone formation would result. If it is not so great, a traction spur would form gradually. It is concluded that the etiology of a Bennett lesion is the contracture of the postero-inferior IGHL caused by repeated microtrauma inflicted by throwing and the resultant increase of traction stress imposed on the labrum.