鏡視下腱板疎部縫縮術を行なった外傷性肩関節前下方亜脱臼の1例
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概要
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Studies have shown the effect of plication of rotator interval (RI) capsule on the stability of the glenohumeral joint. We reported a case of traumatic chronic antero-inferior shoulder subluxation treated by arthroscopic RI plication (ARIP) procedure. A 13 year-old female had pain in her left shoulder when she fell on her outstretched arm. Immediately she visited a hospital and had an X-ray examination which was diagnosied as shoulder subluxation, but she underwent only prescription of anti-inflammatory medicine. She was referred to our hospital 22 days after injury. She had severe pain and limitation of motion in her left shoulder, but did not have any neurological abnormality, general joint laxity or instability of the contralateral side. The X-rays revealed antero-inferior subluxation. MR arthrography showed pooling of the contract medium around the antero-superior corner of the shoulder and stress X-rays showed inferior instability diminished in the shoulder external rotation position, indicating slack of RI was thought to be the essential lesion for this shoulder subluxation. 5 weeks after injury she underwent surgical treatment. Arthroscopic examination revealed redness and zig-zag shaped tear of synovium in RI but no lesions in the anterior shoulder labrum or midsubstace tear of glenohumaral ligament were observed. We performed ARIP procedure. Postoperatively, congruity of the GH joint was improved and anterior instability was markedly decreased: therefore temporary transarticular fixation was not performed. The arm was immobilized with a Velpeau bandage for 3 weeks and subsequently active-assist exercises were initiated. 2 years after surgery, she had no pain and no recurrence of shoulder subluxation. One year after surgery, her left shoulder was stable in full range of motion.Efficacy of ARIP procedure for patients with loose shoulder and throwing injury has been reported. In our case, the short-term result of the ARIP procedure for traumatic chronic antero-inferior shoulder subluxation is favorable.
- 2010-08-04
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