Ageing was found to be the major factor in progressive degeneration of the rotator cuff, and should be considered the single most important contributing factor in the pathogenesis of rotator cuff tears. In addition, degenerative tendonopathy appeared the primary pathology in rotator cuff tear, preceding hypertrophic spur formation. Rotator cuff tears are therefore unlikely to be initiated by impingement; rather, they develop as an intrinsic degenerative tendonopathy.

Nonerosive reflux disease (NERD) is classified into grade M (minimal change, endoscopically; erythema without sharp demarcation, whitish turbidity, and/or invisibility of vessels due to these findings) and grade N (normal) in the modified Los Angeles classification system in Japan. However, the classification of grades M and N NERD is not included in the original Los Angeles system because interobserver agreement for the conventional endoscopic diagnosis of grades M or N NERD is poor. Flexible spectral imaging color enhancement (FICE) is a virtual chromoendoscopy technique that enhances mucosal and vascular visibility. The aim of this study is to evaluate whether the endoscopic diagnosis of grades M or N NERD using FICE images is feasible. Between April 2006 and May 2008, 26 NERD patients and 31 controls were enrolled in the present study. First, an experienced endoscopist assessed the color pattern of minimal change in FICE images using conventional endoscopic images and FICE images side-by-side and comparing the proportion of minimal change between the two groups. Second, three blinded endoscopists assessed the presence or absence of minimal change in both groups using conventional endoscopic images and FICE images separately. Intraobserver variability was compared using McNemar's test, and interobserver agreement was described using the kappa value. Minimal changes, such as erythema and whitish turbidity, which were detected using conventional endoscopic images, showed up as navy blue and pink-white, respectively, in color using FICE images in the present FICE mode. The NERD group had a higher proportion of minimal change, compared with the control group (77% and 48%, respectively) (P= 0.033). In all three readers, the detection rates of minimal change using FICE images were greater than those using conventional endoscopic images (P= 0.025, <0.0001, and 0.034 for readers A, B, and C, respectively). The kappa values for all pairs of three readers using FICE images were between 0.683 and 0.812, while those using conventional endoscopic images were between 0.364 and 0.624. Thus, the endoscopic diagnosis of grades M or N NERD using FICE images is feasible and may improve interobserver agreement.

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Zusammenfassung OperationszielOperative Behandlung der rezidivierenden vorderen Schulterluxation über einen kleinen vorderen Zugang. IndikationenRezidivierende vordere Schulterluxation. KontraindikationenMultidirektionale Schulterinstabilität. Infektion. OperationstechnikKurze vertikale Hautinzision lateral des Processus coracoideus. Durchtrennung der Sehne des Musculus subscapularis gemeinsam mit der Gelenkkapsel 2,4 cm medial ihres Ansatzes. Naht des lateralen Stumpfs der Sehne des Musculus subscapularis zur tiefen Oberfläche der Gelenkkapsel von der 2-Uhr-bis zur 6-Uhr-Position (rechte Schulter). Doppelung der Sehne durch Umlagerung des medialen Stumpfs an die mediale Seite des Sulcus bicipitalis. Der Schlüssel zu dieser Technik besteht darin, dass die Sehne des Musculus subscapularis in 30° Abduktion und Flexion des Arms vernäht wird. Ergebnisse Von 1970 bis 1999 wurden 340 Patienten (356 Schultergelenke) mit rezidivierender vorderer Schulterluxation mit der Nobuhara-Hospital-Methode behandelt. 46 Patienten wurden nachuntersucht, wobei der durchschnittliche Nachuntersuchungszeitraum 14,1 Jahre betrug. Die Stabilität ließ sich bei 44 Patienten (95,6%) vollständig wiederherstellen. Eine tolerable Einschränkung der Außen-rotation, die mit abduziertem Arm in der Skapularebene erhoben wurde, fand sich bei 44 Patienten. Zwei Patienten klagten über ein Instabilitätsgefühl. Abstract ObjectiveSurgical repair of recurrent anterior shoulder dislocation using a mini-incision anterior approach.

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