Bilateral Shoulder Joints Research Articles

腫瘍合併リウマチ性多発筋痛症から高齢発症関節リウマチの診断に至った1例

The differential diagnosis between polymyalgia rheumatica and elderly-onset rheumatoid arthritis is difficult because these diseases share similar clinical findings, especially at onset. We report a case of elderly-onset rheumatoid arthritis that was distinguished from polymyalgia rheumatica with malignancy. A 77-year-old woman was admitted to our hospital because of pain and bilateral stiffness in her shoulders and her hips. Tests for rheumatoid factor and anti-cyclic citrullinated peptide antibody were negative. Bone erosions and joint space narrowing were not detected radiographically, and polymyalgia rheumatica was suspected. Her arthralgia disappeared with a few days after treatment with prednisolone (10 mg per day) was started, and ESR and CRP were normalized. Computed tomographic scanning of the chest showed a nodular lesion in the right lower lobe, and biopsy revealed lung cancer. Positron-emission tomography with 18F-fluorodeoxyglucose (FDG) performed before lung surgery showed increased uptake of FDG in the bilateral shoulder joints and wrist joints. Enhanced MRI showed synovitis and bone erosions in the right acromioclavicular joint and bilateral carpal bones and also radiographically bone erosions were seen in the carpometacarpal joint of the right thumb. Therefore, a diagnosis of elderly-onset rheumatoid arthritis was made. In patients with polymyalgia rheumatica, the detection of rheumatoid synovitis should be routinely evaluated.

Comparison of Open and Arthroscopic Inferior Capsular Shifts for Multidirectional Instability of the Shoulder

Purpose: To compare outcomes of open and arthroscopic inferior capsular shifts in multidirectional instability of the shoulder and to evaluate the factors affecting the outcomes. Materials and Methods: We measured outcomes in 81 patients (84 shoulders) receiving open or arthroscopic inferior capsular shifts because of multidirectional instability of the shoulder from February, 1994, to April, 2006. There were 76 males and 8 females. Their mean age was 22 years at the time of surgery. The visual analogue scale (VAS) for pain, shoulder range of motion (ROM), and Rowe scores were evaluated preoperatively and postoperatively. Results: In open surgery, the VAS for pain was 5.3 preoperatively and 2.1 postoperatively. VAS for instability changed from 4.6 to 1.7, and the average postoperative Rowe score was 83.7. Forward flexion was preoperatively and postoperatively. External rotation on the side changed from to . In arthroscopic surgery, the VAS for pain was 4.6 preoperatively and 1.2 postoperatively. VAS for instability changed from 5.9 to 1.2, and the average postoperative Rowe score was 87.4. Forward flexion was preoperatively and postoperatively. External rotation changed from to . Conclusion: Arthroscopic surgery was more effective in decreasing pain and conserving forward flexion of the shoulder than open surgery. Postoperative instability appeared to be related with generalized or bilateral shoulder joint laxity. Pain during motion after the operation was more significant during a voluntary subluxator. Low clinical scores were related with the operation on the dominant side or postoperative instability.

両側肩関節血腫を来した一例

Spontaneous hemorrhage in shoulder joint is rare. We experienced a patient with spontaneous hemorrhage in the bilateral shoulder joint. The case was a 61-year old woman who suffered from bilateral shoulder pain, especially in motion. She also complained of spontaneous bilateral shoulder pain, when the hemorrhage from her shoulder joint did not occur. We performed arthroscopic synovectomy, which revealed a small cuff-tear in the right side scope. No cuff-tear was found in the left side. No osteoblastic or osteolytic changes were also found at both sides. Synovium was extremely multiplied at both bursal sides. Specimens showed atypical synovitis. Diagnosis was spontaneous hemorrhage to the exclusion of PVS, hemangioma, aneurysm, and varix. Several authors have described that spontaneous hemorrhage occur in the shoulder joint associate with massive cuff-tears. In this case, we only found a small cuff-tear in the right side and not in the left. Her pain alleviated during a period from surgery to the final follow-up.