若年者の肩関節前方脱臼 • 亜脱臼症例に対する外旋位固定法の予後と前方関節包付着部との関連性

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Purpose: We reported the position of the anteroinferior labrum on MRI after immobilization in external rotation (ER immobilization) may not correlate with the result of ER immobilization in young highly active men with primary traumatic anterior shoulder dislocation in our previous study. We investigated relation between the prognosis of ER immobilization treatment and capsular insertion type in this study.Material and Methods: 9 patients (10 shoulders) who were performed MR or CT arthrography after 3-week ER immobilization were enrolled in this study. Average age at the primary injury was 21.0 years (17-24 years). No patient had multidirectional shoulder instability. Two patients had a small fragment fracture of the anterinferior glenoid rim. The site of anterior capsular insertion was examined at the middle glenoid level on MR or CT arthrography and we investigated the difference of capsular insertion type between shoulders with recurrence and without recurrence.Result: All of 4 shoulders without recurrence for more than 2 years had type 1 capsular insertion (capsule arose from the labrum). In 6 shoulders with recurrence, 2 shoulders had type 1, 1 shoulder had type 2 (capsule arose from the scapular neck within 1 cm of the labral base) and 3 shoulders had type 3 (capsule arose from the scapular neck more than 1 cm medial to the labral base) capsular insertions.Discussion: Type 3 capsular insertion is considered a predisposing factor in the development of shoulder instability. This study also showed type 3 capsular insertion might indicate poor result of ER immobilization treatment.

若年者の肩関節前方脱臼 • 亜脱臼症例に対する外旋位固定法の予後と前方関節包付着部との関連性

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