Yoneda Minoru, Nakagawa Shigeto, Mizuno Naoko, Fukushima Sunao, Hayashida Kenji, Mae Tatsuo, Izawa Kazutaka
Shoulder and Sports Medicine Service, Osaka Kosei-nenkin Hospital, Osaka, Japan.
Arthroscopy. 2006 Jul;22(7):801.e1-5. doi: 10.1016/j.arthro.2005.12.056.
Posterior capsular tightness with glenohumeral internal rotation deficit is usually considered to be an acquired condition of the throwing shoulder and is usually treated conservatively. However, because posterior capsular tightness is sometimes irreversible, we have performed arthroscopic capsular release for painful throwing shoulder with posterior capsular tightness. The true loss of internal rotation and posterior stiffness was confirmed by examination with the patient under anesthesia, and contracture of the posterior capsule and the posterior band of the inferior glenohumeral ligamant was observed arthroscopically. Because an extensive adhesion between the capsule and the fascia of the external rotators was noted, a capsular release was performed from 6 o'clock to 11 o'clock (in the right shoulder) to completely expose the muscle belly of the external rotators. Of the first 16 consecutive patients, 4 had no concomitant lesions and underwent posterior capsular release alone. With a minimum of 2 years' follow-up, it was ascertained that the throwing pain completely disappeared in 14 patients and improved in 2. In all, 11 patients returned to their preinjury performance level, and 5 returned to a lower level of function. In the 4 patients who had no concomitant lesions, throwing pain completely disappeared, and all were able to return to their preinjury performance level.
伴有盂肱关节内旋受限的后囊紧张通常被认为是投掷肩的一种后天性病症，通常采用保守治疗。然而，由于后囊紧张有时是不可逆的，我们对伴有后囊紧张的疼痛性投掷肩进行了关节镜下囊松解术。在麻醉下对患者进行检查证实了内旋的真正丧失和后部僵硬，并且在关节镜下观察到后囊和下盂肱韧带后束的挛缩。由于注意到囊与外旋肌筋膜之间存在广泛粘连，因此在6点至11点（右肩）进行了囊松解，以完全暴露外旋肌的肌腹。在连续的前16例患者中，4例没有合并损伤，仅接受了后囊松解术。经过至少2年的随访，确定14例患者的投掷疼痛完全消失，2例有所改善。总共11例患者恢复到受伤前的表现水平，5例恢复到较低的功能水平。在4例没有合并损伤的患者中，投掷疼痛完全消失，并且所有人都能够恢复到受伤前的表现水平。
