Yukihiko Hata

Surgical procedure and results of repair of massive tears of the rotator cuff.

One hundred eighty-seven patients (189 shoulders) were treated surgically between 1970 and 1992 for massive rotator cuff tears using either a tendon-to-tendon repair or the McLaughlin procedure. The age of the patients ranged from 20 to 86 years; 95% of them were 45 years or older. The average followup was 6 years 9 months. Excellent or good functional results were attained in 93% of patients. Thirty-three percent of those who underwent tendon to tendon repair complained of pain after overuse compared with only 18% who had the McLaughlin Procedure.

Atrophy of the Deltoid Muscle Following Rotator Cuff Surgery

BACKGROUND Less invasive procedures have recently been introduced to facilitate an earlier return to sports or work activities after rotator cuff repair. Few reports, however, have verified whether such procedures are really less invasive than conventional open repair. The purpose of this study was to compare the postoperative thickness of the deltoid muscle in patients treated with either conventional or mini-open rotator cuff repair. METHODS Conventional open repair was performed from 1994 through 1997 in forty-three patients with rotator cuff tears. The mini-open deltoid-splitting approach was introduced in 1997, and the cases of thirty-five patients who underwent that procedure were reviewed. The two groups were compared with respect to the thickness of the anterior fibers of the deltoid muscle measured on the transverse magnetic resonance images, the degree of active forward flexion, and the times required for return to work and sports activities. RESULTS The thickness of the anterior deltoid fibers did not change significantly after surgery in the mini-open repair group, whereas it was significantly decreased in the open repair group at six months as well as at twelve months postoperatively (p < 0.05). At three months postoperatively, the mean University of California at Los Angeles score for active forward flexion in the patients treated with the mini-open repair (4.9 points) was significantly greater than that in the patients in the conventional open repair group (4.6 points) (p < 0.05). In addition, the mean time-period required for return to work in the mini-open repair group (2.4 months) was significantly shorter than that required in the control group (3.4 months) (p < 0.05). CONCLUSIONS The mini-open repair appeared to cause less postoperative atrophy of the deltoid muscle than did the conventional open rotator cuff repair, and patients treated with the mini-open repair recovered more quickly.

The two locations of ganglions causing radial nerve palsy.

Ganglions associated with radial nerve palsy at two different locations were identified at the elbow in 14 patients. The first type, found in 13 patients, arose from the anterior capsule of the proximal radioulnar joint and was located proximal to the proximal edge of the supinator muscle. It compressed the main radial nerve anteriorly. The second type, which has not been reported before in patients without abnormalities in the elbow joint, was found in the remaining patient. It was located in the supinator muscle, distal to the proximal edge of the supinator muscle, and compressed the posterior interosseous nerve against the proximal radius. Magnetic resonance imaging makes it possible to identify ganglions in a wide area around the elbow. This examination should be carried out in view of the possible presence of both types of ganglion. Magnetic resonance imaging also provides more accurate information than computed tomography or ultrasonography about the location and characteristics of the mass.

Extensor Tendon Rupture Associated with Osteoarthritis of the Distal Radioulnar Joint

Non-rheumatoid osteoarthritis of the distal radioulnar joint can cause extensor tendon rupture. We analysed the radiographic morphology of the distal radioulnar joint to identify the risk factors for this complication. Forty-one wrist X-rays of 37 patients with extensor tendon rupture caused by distal radioulnar joint osteoarthritis were evaluated retrospectively for the severity of osteoarthritis by the Kellgren/Lawrence scoring system. Measurements were obtained from posteroanterior views. All but one wrist had severe osteoarthritic changes exceeding grade 3. The radiographic features that were different from those of the contralateral wrists included deepening and widening of the sigmoid notch, radial shift of the ulnar head and dorsal inclination of the sigmoid notch. There was no significant association between tendon rupture and the morphology of the ulnar head or ulnar variance. The scallop sign, dorsal inclination of the sigmoid notch and radial shift of the ulnar head are radiological risk factors for extensor tendon ruptures.

Property analysis of ectopic calcification in the carpal tunnel identification of apatite crystals: a case report

IntroductionA 64-year-old woman presented with symptoms of subacute exacerbation of a year-long carpal tunnel syndrome that was caused by a large calcified mass in the tunnel.ConclusionThe resected mass consisted of very tiny rods, and x-ray diffraction analysis, as well as the component analysis using energy dispersive x-ray microanalysis, revealed the mass to be most compatible with apatite. The back-scattered electron images suggested that precipitation might be a mechanism for development of the calcified mass.

Callus resection for brachial plexus compression following stress-induced first rib fracture.

A 27-year-old man presented with a lower trunk brachial plexus injury due to excessive callus formation following a stress-induced first rib fracture. The callus, but not the first rib, was resected through a supraclavicular approach. His symptoms resolved in 2 months, and no recurrence was seen at 2 years follow-up.

Ectopic calcification following tibial fracture: property analysis.

Abstract We present a patient whose ectopic calcification following deep posterior compartment syndrome was studied by electron microscopy, chemical analyses, and X-ray diffraction. The patient complained of a toe flexion deformity following a tibial fracture which he sustained 18 years earlier. Damage to the peroneal artery was demonstrated by magnetic resonance angiography, suggesting that the patient had had deep posterior compartment syndro-me in the past. A large radiopaque mass, identified in the flexor hallucis longus muscle by radiographs and computed tomography, was resected, resulting in a dramatic improvement of the toe deformity. The resected material was analyzed in detail. It included no osseous tissue, and was not birefringent under a polarizing microscope, being compatible with ectopic calcification rather than ossification. On electron microscopy the material was found to be an assembly of tiny rods. Chemical and X-ray diffraction analyses suggested a carbonate-containing apatite as the most probable substance.

Anatomic study of the glenoid labrum

Thirty-one shoulder joints from the cadavers of 13 men and four women and from two cadavers of unspecified sex were dissected to investigate the anatomic characteristics of the glenoid labrum. The ages at death ranged from 63 to 90 years with a mean age of 78.5 years. The glenoids were divided with a bone saw along both their long and short axes. The size of the glenoid and the labrum of each specimen was then measured with calipers. No significant correlation existed between the size of the labrum and that of the glenoid. This indicated that even if the glenoid was large, the labrum was not always correspondingly large. If one aspect of the labrum was large, other portions of the labrum tended to be large also. The anterior and inferior portions of the labrum were the largest, and this may have contributed to stability in the anterior and inferior directions.

Tardy ulnar tunnel syndrome caused by Galeazzi fracture-dislocation: a neuropathy with a new pathomechanism.

We present a case of late-onset ulnar tunnel syndrome following a Colles fracture. The nerve palsy was caused by a vascular branch that stretched over the ulnar head, compressing the nerve and generating friction against the ulnar head when the forearm was rotated. This is the first report of such a pathomechanism.

Postoperative improvement in DASH score, clinical findings, and nerve conduction velocity in patients with cubital tunnel syndrome

We investigated a recovery pattern in subjective and objective measures among 52 patients with cubital tunnel syndrome after anterior subcutaneous transposition of the ulnar nerve. Disabilities of the Arm, Shoulder and Hand (DASH) score (primary outcome), numbness score, grip and pinch strength, Semmes-Weinstein (SW) score, static 2-point discrimination (2PD) score, and motor conduction velocity (MCV) stage were examined preoperatively and 1, 3, 6, 12, and ≥24 months postoperatively. Statistical analyses were conducted to evaluate how each variable improved after surgery. A linear mixed-effects model was used for continuous variables (DASH score, numbness, grip and pinch strength), and a proportional odds model was used for categorical variables (SW and 2PD tests and MCV stages). DASH score significantly improved by 6 months. Significant recovery in numbness and SW test scores occurred at 1 month. Grip and pinch strength, 2PD test scores, and MCV stage improved by 3 months. DASH scores and numbness recovered regardless of age, sex, or disease severity. It was still unclear if both subjective and objective measures improved beyond 1-year postoperatively. These data are helpful for predicting postoperative recovery patterns and tend to be most important for patients prior to surgery.