60 research outputs found

    Musculotendinous junction tear

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    We report a rare case of a partial thickness tear of the supraspinatus at the musculotendinous junction in a softball catcher. Preoperative magnetic resonance images of the shoulder showed high signal intensity areas at the musculotendinous junction, along with discontinuity of the articular side of the supraspinatus. Arthroscopic examination revealed articular-side partial tear at the musculotendinous junction. The patient was able to return to playing softball 20 weeks after arthroscopic side-to-side repair

    Reduction of perioperative blood loss and operating time for arthroscopic rotator cuff repair by intravenous administration of tranexamic acid

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    Background: Tranexamic acid (TXA) is widely used in hip and knee arthroplasty to reduce perioperative bleeding. Recently, its use has been expanded to arthroscopic surgery. The purpose of this study was to evaluate the efficacy of preoperative use of TXA in arthroscopic rotator cuff repair (RCR). Methods: A cohort comprising 129 consecutive patients who underwent arthroscopic primary RCR at our institution was retrospectively investigated according to whether they received TXA (April 2018 to December 2020, TXA group, n = 64) or did not receive TXA (April 2016 to March 2018, non-TXA group, n = 65). TXA was administered at a dose of 1 g intravenously. Rotator cuff tears were repaired by the suture bridge technique. Videos of the arthroscopic procedures were reviewed and rated for visual clarity using a 10-point numeric rating scale. Arthroscopic procedures were divided into glenohumeral, resection of bursal tissue and acromioplasty, and RCR steps. Each step was rated separately. Age, sex, body mass index, hemoglobin level before and on days 1 and 7 after surgery, operating time, mean arterial pressure, tear size, and number of anchors used for cuff repair were compared between the two groups. Results: There were no statistically significant differences in the patient demographic data. The operating time was significantly shorter in the TXA group than in non-TXA group (97.8 ± 21.8 min vs 116.2 ± 26.0 min). The clarity of the visual field was similar between the two groups during the glenohumeral phase but was significantly higher in the TXA group during the resection of bursal tissue and acromioplasty and RCR phases. Hemoglobin level was not significantly different between the groups on postoperative day 1 but was significantly higher in the TXA group on day 7. Conclusion: Administration of a single intravenous dose of TXA improved visual clarity in arthroscopic RCR, decreased the total operating time, and reduced hemoglobin loss on postoperative day 7

    Characteristics of gene expression in frozen shoulder

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    Background: Severe frozen shoulder (FS) is often resistant to treatment and can thus result in long-term functional impairment. However, its etiology remains unknown. We hypothesized that gene expression of FS would vary by synovial location. Methods: The synovial tissues of patients with FS were collected prospectively and analyzed for the expression of 19 genes. Synovial tissues from patients with rotator cuff tear (RCT) or shoulder instability (SI) were also analyzed as controls. A total of 10 samples were analyzed from each group. The specimens were arthroscopically taken from three different locations: rotator interval (RI), axillary recess (AX), and subacromial bursa (SAB). Total RNA was extracted from the collected tissues and was analyzed by real-time polymerase chain reaction for the following genes: matrix metalloproteinases (MMPs); tissue inhibitors of metalloproteinases (TIMPs); inflammatory cytokines (IL1B, TNF, and IL6); type I and II procollagen (COL1A1 and COL2A1); growth factors (IGF1 and TGFB1); neural factors (NGF and NGFR); SOX9; and ACTA2. Results: Site-specific analysis showed that MMP13, IL-6, SOX9, and COL1A1 were increased in all three sites. Four genes (MMP3, MMP9, COL2A1, and NGFR) were increased in the AX, MMP3 in the RI, and NGFR in the SAB were increased in the FS group than in the RCT and SI groups. In the FS group, there was a correlation between the expression of genes related to chondrogenesis (MMP2, IGF1, SOX9, COL2A1, NGF, and NGFR) or fibrosis (MMP9, TGFB1, and COL1A1). Conclusion: The expression levels of numerous MMPs, pro-inflammatory cytokines, and collagen-related genes were increased in the FS group, suggesting that catabolic and anabolic changes have simultaneously occurred. In addition, genes related to chondrogenesis or fibrosis were highly expressed in the FS group, which might have affected the range of motion limitation of the shoulder. Compared to RI and SAB, the AX was the most common site of increased expression in FS. Analyzing the lower region of the shoulder joint may lead to the elucidation of the pathogenesis of FS

    Position in reverse shoulder arthroplasty

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    The purpose of this study was to determine the optimal position of the baseplate on the small glenoid of female Japanese. Two sets of 3D scapular models were made according to the CT data of 7 female cadavers. We set two scenarios of the baseplate placement : A and B. In scenario A, the baseplate was placed on the glenoid face centrally in the anteroposterior direction. In scenario B, the baseplate was implanted at the point where the baseplate post was contained within the glenoid vault. Whether or not the baseplate post perforated the scapular neck was recorded. In scenario A, the central post penetrated the scapular neck posteriorly in 5 scapulae. In scenario B, the average distances from the guide pin position to the anterior glenoid rim was 9.7 ± 1.7 mm and the optimal position of the guide pin was 1.9 ± 1.7 mm anterior from the glenoid center. The central post was contained within the scapula without breakage of the cortex. This study demonstrated that shifting the center of the baseplate slightly anterior to the anatomic center is necessary to avoid perforation of the scapular neck in small female Japanese

    Effect of baseplate position on locking screws

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    Introduction : Superior screw insertion in reverse shoulder arthroplasty (RSA) carries the potential risk of suprascapular injury. The purpose of this study was to evaluate how the baseplate position affects the superior screw position and length in RSA. Methods : Three-dimensional (3D) computer simulation models of RSA were established using computed tomography data of baseplates with superior and inferior screws and 3D scapular models from 10 fresh cadavers. Superior screw position, the distance from the superior screw hole to the suprascapular notch, and the screw lengths were measured and compared among various baseplate positions with two inferior tilts (0 and 10 degrees) and three rotational patterns (11–5, 12–6, and 1–7 o’clock in the right shoulder). Results : For the 1–7 o’clock / inferior tilt 0 degrees baseplate, the superior screw located anterior to the SS notch in all shoulders, the distance to the SS notch was the longest (12.8 mm), and the inferior screw length was the shortest (23.1 mm). Conclusion : Although there is a concern of a short inferior screw length, initial fixation using a baseplate with 1–7 o’clock rotation and an inferior tilt of 0 degrees appears preferable for SS nerve injury prevention during superior screw insertion

    Shoulder elbow pain youth baseball players

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    Objectives: There are relatively few published epidemiological studies examining the differences in the risk of shoulder and elbow pain in young baseball players. Risk factors for shoulder pain are different from those for elbow pain in child and adolescent baseball players. Methods: A total of 1563 players aged 7 to 12 years participated in this investigation. Subjects were asked whether they had experienced episodes of shoulder or elbow pain. We investigated the following risk factors for shoulder and elbow pain: age, position, years of baseball experience, and training hours per week. Data from the groups with and without shoulder and elbow pain were analyzed using multivariate logistic regression models. Results: Among the 1563 participants, 15.9% and 29.2% reported episodes of shoulder and elbow pain, respectively. Multivariate analysis showed that shoulder pain was associated with age 10, 11, and 12 years, and that elbow pain was associated with age 10, 11, and 12 years, playing catcher, and >2 years of baseball experience. Training hours per week were not associated with either shoulder or elbow pain. Conclusion: In over 1000 baseball players aged 7 to 12 years, 15.9% reported episodes of shoulder pain, while 29.2% reported elbow pain in the throwing arm. The associated risk factors were different for each type of pain. Shoulder pain was associated with increased age while elbow pain was associated with increased age, increased years of baseball experience, and playing catcher

    Stress fracture of the thoracic spine in an elite rhythmic gymnast : A case report

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    Spondylolysis, a defect or stress fracture of the vertebral pars interarticularis, occurs most frequently in the lower lumbar spine and occasionally in the cervical spine,but is extremely rare in the thoracic spine.We report the case of a 17 year-old girl,an elite rhythmic gymnast,who reported with early-stage thoracic spondylolysis at T10 and T11 levels. Physicians should be aware that performance of unusual athletic movements, such as those by gymnasts, may lead to spondylolysis in rare locations

    Successful Outcomes Using Interlocking Prostheses for Periprosthetic Fractures with Loose Femoral Components

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    Periprosthetic femoral fractures with implant loosening are difficult to treat, especially when accompanied by severe bone loss.We report here the treatment outcomes of 4 patients (1 man, 3 women ; age range 69-86 years) with periprosthetic femoral fractures and implant loosening after bipolar hemiarthroplasty. Fractures were classified according to the Vancouver classification as type B2 and B3, with adequate or compromised bone stock, respectively. One patient was initially treated conservatively but symptoms due to implant loosening persisted and revision surgery was required. All patients underwent revision using a long-stem cementless implant with interlocking screws as well as a cancellous allograft to augment the bone stock. At final follow-up (mean, 25 months), all patients had stable implant fixation, bony union of the fracture, and marked recovery of the proximal femoral bone stock through allograft use. This revision procedure achieved implant fixation and fracture healing with reconstitution of the femur even in the short term and even in cases with severe bone deficiency

    Epidemiology of shoulder injuries in young baseball players and grading of radiologic findings of Little Leaguer’s shoulder

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    Relatively few epidemiological studies have examined shoulder injuries. This study aimed to investigate the epidemiology of such injuries in young baseball players. A total of 2,055 players aged 9-12 years who participated in a regional championship between 1983 and 1985 were the subjects of this investigation. They were assessed by questionnaire and radiographic examination. Prevalence of shoulder pain was determined according to position, years of baseball playing experience, and training hours per week. Radiographic examination was recommended to all players who complained of shoulder pain. Of the 2,055 subjects, 275 (13.4%) reported episodes of pain in the throwing shoulder. Years of baseball experience, but not player position or training hours per week, was significantly associated with shoulder pain. Forty-one of the 275 subjects reporting shoulder pain agreed to undergo radiography and 15 exhibited findings of Little Leaguer’s shoulder. Their lesions could be classified into three distinct grades based on radiographic findings : grade I, widening of the epiphyseal plate in the lateral area (n=9) ; grade II, widening at all areas of the epiphyseal plate and demineralization of the metaphysis (n=5) ; and grade III, a slipped epiphysis (n=1)

    Clinical Significance of High-intensity Zone for Discogenic Low Back Pain : A Review

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    High-intensity zone (HIZ) was originally described as a high-intensity signal on T2-weighted magnetic resonance (MR) images, located in the posterior annulus fibrosus, clearly separated from the nucleus pulposus. Among symptomatic patients with low back pain, HIZ is present in 28-59% of cases. In morphologically abnormal discs, high sensitivity and specificity of 81% and 79%, respectively, were reported for HIZs and concordant pain during discography. In contrast, another report indicated low rates. Although most papers reported high sensitivity and specificity for this relationship, it remains controversial. Regarding the pathology of HIZs, inflammatory granulation tissues are found at sites showing HIZs. Such inflammatory tissues produce pro-inflammatory cytokines and mediators, which sensitize the nociceptors within the disc and cause pain. An effective treatment for this condition is yet to be established. Recently, minimally invasive surgery using percutaneous endoscopic discectomy (PED) under local anesthesia was introduced. After removal of the degenerated disc material, the HIZ is identified with the endoscope and then coagulated and modulated with a bipolar radio pulse. This technique is called thermal annuloplasty. In conclusion, HIZs is an important sign of painful intervertebral disc disruption, if identified precisely based on factors such as location and intensity
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