All patients were initially treated with conservative management consisting of combinations of nonsteroid antiinflammatory medication, brief immobilization, and physical therapy for range of motion and muscle strengthening.
Two of the six shoulders that had subluxation were initially treated with immobilization.
Grade 3 also was treated symptomatically.
The judicious use of no more than three steroid injections into the subacromial space can be helpful.
Patients underwent a period of rest and a rehabilitation program and treatment with nonsteroidal anti-inflammatory drugs for three to four months before arthroscopic surgery.
Partial tears have been treated by plaster immobilization and complete tears have been treated either by plaster immobilization or by operative repair.
Rest and non-operative management soon after the onset of symptoms may arrest the progression to instability and allow the athlete to return to competition.
Non-operative treatment had consisted of an initial period of rest and oral administration of non-steroidal anti-inflammatory medication. A supervised program of exercises for stretching and strengthening of all of the muscles about the elbow began after the acute inflammation had ended, and appropriate modalities of physical therapy were used.
No single piece of information or test can be used to make treatment decisions.
Epidural steroid injection is a low-risk alternative to surgical intervention in the treatment of lumbar disc herniation.
手術療法に関する表現（レシピ②）
Sixty total shoulder replacements were performed by the senior one of us or under his supervision at the New York Orthopaedic hospital.
All surgery was performed under the direction of the senior author.
Repair of the tears required tendon-to-tendon or tendon-to-bone suturing in 14, subscapularis transposition in 17.
Surgical treatment at revision consisted of removal of the implant and cement in two, arthrodesis in three, NeerII total shoulder in 34.
Patients who had a history of anterior dislocation and clinical examination demonstrating frank subluxation or dislocation in the test position of 90° or more of abduction, external rotation, and extension were treated by open reconstructive procedures.
Associated disease of the capsule, rotator cuff, biceps tendon must be identified and treated as a part of the surgical procedure.
This prosthesis had been applied to the treatment of patients with traumatic, degenerative, and arthritic conditions in the shoulder.
In young patients, only rheumatoid arthritis and bone tumors were regarded as justifiable indications for shoulder arthroplasty.
The indication for surgery was shoulder pain unresponsive to conservative treatment.
Desire to return to sports was given as the most important reason for operative repair by all but two patients.
Moderate or severe pain was the primary reason for operation in all patients.
The patient is advised to have it repaired.
In young patients, however, operative treatment was actively chosen because persistence of motion pain or impingement sign would prevent young active patients from participating in vigorous activities.
The 21 patients had twenty arthroscopic and three open operative procedure.
Attempts to repair the rotator cuff had been made in eight shoulders.
Incomplete tears, however, which extend into or exist within the substance of the cuff, can only be treated by open method.
Sutures placed through tunnels in the bone will ensure firm fixation during rehabilitation.
These included fixation of labral tears with either bioabsorbable fixation devices or sutures and debridement of superior labral anterior and posterior (SLAP) lesions and other labral tears.
Various surgical options have been employed to control posterior instability of the glenohumeral joint.
After identification and classification of the type of labral tear and associated ligament injury, primary treatment consisted of partial excision of the torn labrum in all patients.
Surgical exposure of the ulnar nerve leads to a low but definite, incidence of iatrogenic nerve damage.
18 patients had their fractures fixed within 1 week after injury, and 7 patients were operated on more than 1 week after injury.
The method of surgical treatment for osteochondritis dissecans often depends on whether the involved segment is attached, partially attached, or completely detached.
An upper-arm tourniquet is applied.
The patient was placed in a lateral (decubitus) position on the unaffected side with the involved arm on a support.
At surgery, the patients arm was positioned at 60 °of abduction and neutral flexion, extension, and rotation with 10 to 12 pounds of longitudinal traction applied.
Five to ten pounds of traction are applied to the humerus.
The patient was placed in beach chair position.
A deltopectoral approach was used.
The anterior aspect of the shoulder was identified via a deltopectoral approach. For purposes of this study, the conjoined tendon was incised at its attachment to the coracoid and retracted medially and distally.
An incision was made 1-cm inferior and 1-cm medial to the posterolateral corner of the acromion.
Begin the skin incision just lateral to the tip of the acromion, pass it medially and posteriorly along the border of the acromion, curve it slightly distal to the spine of the scapula, and end it at the base of the spine of the scapula.
Begin a vertical incision at the posterior aspect of the acromion and carry it inferiorly for 10 cm.
Reflect the skin and fascia, and expose the origin of the deltoid muscle from the spine of the scapula.
The skin flap is elevated and the radial sensory nerve branches are protected.
The deltopectoral interval is identified and developed down to the cephalic vein, which in the majority of instances is ligated proximally and distally and removed.
Release the medial 2-cm of its origin from the scapula spine.
Adhesions were released between the capsulolabral complex and the dislocated head.
The capsule is incised longitudinally to allow visualization of the articular surface and the avulsion fracture.
The arm, still at the side of the body, is then externally rotated, exposing the subscapularis muscle.
The defect of the head was tentatively filled with allograft.
The allograft was contoured to fit the segmental defect and to restore the original sphericity of the humeral head.
The graft was fixed with the 3.5-millimeter cancellous-bone screws.
A 26-gauge stainless steel wire is passed in a figure-eight configuration through the drill hole and the collateral ligament's insertion into the fracture fragment.
If there is a bony avulsion of the UCL, one of two methods is employed. If the bony fragment is large, it is anatomically replaced and secured with one or two smooth K-wires. If the bony fragment is small or comminuted, it is excised and repair is the same as that for a complete soft tissue avulsion.
K-wires are not used to transfix the joint.
The size and number of the Rush rods or Ender nails that were inserted depended on the level and pattern of the fracture.
Freshen the fracture surfaces, and fix the fragment to the humerus with two screws.
The screw heads were seated below the articular surface.
In two of the three bony avulsions the fragments were so small that they were excised and a traditional soft tissue repair was done.
This has the functional advantage of less deltoid detachment and the cosmetic advantage of less indentation.
The patient was placed in a lateral decubitus position supported by a beanbag, prepared for surgery, and was draped with the injured arm free. We used a longitudinal incision that began 2-cm medial to the posterolateral corner of the acromion and coursed distally to the posterior axilla. The underlying deltoid muscle was then split in line with its fibers in a blunt fashion to reveal the underlying infraspinatus and teres minor muscles.
This is a very important step in the operation and can be effectively accomplished by holding the knife blade in the horizontal plane and separating the tendon from the capsule by sharp dissection.
The muscle can be separated from the capsule by blunt dissection, using a wing-type periosteal elevator.
Each double suture is passed through the edge of the lateral capsular flap and tied so as to hold the lateral flap securely against the freshened rim of the glenoid.
Layered closure is performed to repair the capsule and adductor aponeurosis.
The tourniquet is released and hemostasis carried out.
The image intensifier is positioned on the contralateral side of the injury, with its c-arm parallel to the floor. Depending on the model of the image intensifier, the base of the machine may have to approach the operating-room table at a 45-degree angle. This is mandatory in order to see two views, 90 degrees apart, of the fractured extremity. 2.3 to 4.5 kilograms of traction is applied to the humerus and several folded sheets are placed beneath the ipsilateral shoulder to ensure visualization of the entire humerus, including the elbow, the fracture, and the humeral head.
Before preparation of the operative site, the surgeon must demonstrate that the fracture is reducible. The fracture is manipulated by an unscrubbed surgeon and alignment is verified by means of the image intensifier.
Management and Rehabilitation after treatment（レシピ③）
Postoperatively, the elbow is held in 30 degrees flexion on a plaster back-slab for 36 hours.
Group-3 patients are splinted for six weeks in a position of adequate extension to reduce tension on the skin incision.
The patient's arm was kept in a sling for 6 weeks.
Postoperatively, the shoulder was maintained in a shoulder immobilizer for 4 weeks.
After either operation, the operated arm is immobilized in an abduction splint for four to six weeks before physiotherapy is instituted.
Postoperatively, the patient spent 3 weeks in bed with skin traction and then 3 months of non-weight bearing mobilization on crutches.
Passive range of motion was begun on the initial postoperative day to minimize adhesion formation.
Physiotherapy was begun four to six days after surgery for all shoulders.
At 3 weeks, active range-of-motion exercises were begun with progressive resistance isolating the rotator cuff and scapular stabilizers.
The patient is taught these exercises by the therapist and is asked to do them in five five-minute sessions per day. Passive and active exercises are started at 6 weeks.
At 6 weeks, gentle active motion was allowed.
The internal and external rotators are gently strengthened by patient-conducted exercises.
Active motion of all directional and strengthening exercises began at 8 weeks postoperatively. The return to sports activity was permitted 6 months after surgery.
These patients'shoulders were immobilized for 4 weeks. Subsequently, they underwent supervised rehabilitation emphasizing strengthening of the rotator cuff, especially the subscapularis and scapular stabilizing muscles. At 4 months, these patients were allowed to return to full activity and sports participation.
Supervised motion rehabilitation should generally begin within 2 to 5 days after surgery.
Non-operative treatment had consisted of an initial period of rest and oral administration of non-steroidal anti-inflammatory medication. A supervised program of exercises for stretching and strengthening of all of the muscles about the elbow began after the acute inflammation had ended, and appropriate modalities of physical therapy were used.
The patients were followed at intervals of six to eight weeks to observe their progress.
The shoulder of the patient was immobilized for 6 weeks if the injury was atraumatic in origin and for 4 weeks if the injury was traumatic. After 4 or 6 weeks, the orthosis was removed from the patient and a three-phase rehabilitation program was started. The first phase focused on passive range of motion exercises for 2 weeks. The second phase of the program, which consisted of active range of motion and a terminal stretching program for 4 weeks, was then performed. The third phase consisted of a rotational and scapular strengthening program with ongoing terminal stretching.
Until the early 1960's, we immobilized the shoulder for three to six weeks in a special shoulder sling, but during the last ten years most patients have used the sling for only two to three days, after which the arm has been completely free.
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