Naoki Suenaga’s research while affiliated with Japan Community Healthcare Organization Sapporo Hokushin Hospital and other places

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Publications (110)


Long-term results of open extensive débridement arthroplasty for primary osteoarthritis of the elbow: What direct examination and computed tomography images revealed
  • Article

November 2024

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5 Reads

JSES International

Shuzo Morita

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Naoki Suenaga

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Naomi Oizumi

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[...]

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Figure 1 Flowchart of study enrollment.
Factors associated with subjective shoulder function preoperatively and postoperatively after arthroscopic rotator cuff repair
  • Article
  • Full-text available

July 2024

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44 Reads

JSES International

Background Understanding factors associated with improvements in subjective shoulder function after arthroscopic rotator cuff repair (ARCR) helps clinicians identify targets for postoperative rehabilitation. The aim of this study was to investigate the factors associated with subjective shoulder function after ARCR. Methods Patients who underwent ARCR for rotator cuff tear with at least 12 months of follow-up were included. Subjective shoulder function was assessed preoperatively and at 6 and 12 months postoperatively, using the Shoulder36 (Sh36) 5 domain scores (pain, range of motion [ROM], strength, activities of daily living, and general health). Stepwise multivariable regression analysis was performed to extract the relevant factors for each Sh36 domain score using active shoulder ROM, isometric shoulder and elbow strength, pain score, demographic data, intraoperative findings, medical complications, and cuff integrity. Results A total of 104 patients met the inclusion criteria for this study. Multivariable regression analysis identified active abduction ROM as the factor associated with 5 Sh36 domain scores at preoperatively. At 6 months postoperatively, isometric external rotation strength at the body side or 90° abduction position, but not the ROM factor, was identified as a significant associated factor with 5 Sh36 domain scores. At 12 months postoperatively, pain score was the most associated factor with pain, ROM, strength, and activities of daily living domain scores of Sh36. Conclusion Factors associated with subjective shoulder function after ARCR differed between the preoperative and postoperative periods. Postoperative treatment, including rehabilitation, should be modified according to the postoperative period after ARCR.

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Figure 1 Flowchart of participants selection and classification.
Passive shoulder abduction range of motion at three months postoperatively is the most important prognostic factor for achieving full recovery of range of motion at six months after arthroscopic rotator cuff repair

April 2024

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45 Reads

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3 Citations

JSES International

Background After arthroscopic rotator cuff repair (ARCR), it is crucial for clinicians to predict the functional recovery in the early postoperative period for considering rehabilitation strategies. The aim of this study was to identify the prognostic factors in the early postoperative period for achieving full recovery of range of motion (ROM) at 6 months after ARCR. Methods This study included 184 patients who underwent ARCR. Patients were divided into the full recovery and nonrecovery groups using the Constant ROM score at 6 months postoperatively. The area under the curve for predicting the full recovery group was calculated for all independent variables such as demographic data, ROM, shoulder functional scores at preoperative and 3 months postoperative using receiver operating characteristic curve analysis. Multivariable logistic regression analysis was then performed using candidate variables with an area under the curve of 0.7 or greater to determine prognostic factors for full recovery at 6 months postoperatively. The same analysis as above was also performed by dividing the patients into groups according to their preoperative ROM. Results Multivariable logistic regression analysis revealed that preoperative active flexion, 3 months postoperative passive abduction, and internal rotation at 90° abduction ROM were significant prognostic factors of achieving full ROM recovery at 6 months postoperatively. Only passive abduction ROM at 3 months postoperatively was significantly extracted in the preoperative ROM limitation group. Conclusion This study demonstrated that passive abduction ROM at 3 months postoperatively was a significant prognostic factor of achieving full recovery of ROM at 6 months after ARCR.


Figure 1 Modified Goya's Classification of glenoid wear. (A). Grade 0: No significant postoperative changes compared to the preoperative glenoid. (B). Grade 1: Postoperative glenohumeral joint space narrows than due to glenoid cartilage wear, with no contact between the glenoid and humeral head prosthesis. (C). Grade 2: Contact between the glenoid and humeral head prosthesis without glenoid erosion. (D). Grade 3: Glenoid erosion, further classified into 3 subtypes: 3A: Partial erosion of the anterior glenoid. 3B: Partial erosion of the superior glenoid. 3C: Concentric glenoid erosion.
Figure 2 Inoue's classification of bone resorption. (A). Grade 0: No bone resorption. (B). Grade 1: Decrease in the cortical bone density. (C). Grade 2: Thinning of the cortical bone comprising less than half of the original thickness. (D). Grade 3: Thinning of the cortical bone comprising more than half of the original thickness. (E). Grade 4: Complete disappearance of the cortical bone.
Figure 3 A female patient with CTA who was 76 years old at the time of surgery. HHR with a smaller head with partial subscapularis transfer and latissimus dorsi and teres major muscle transfer was performed. (A1-3): preoperative X-ray and magnetic resonance imaging image. (B): X-ray image 1.5 years postoperatively. (C1-4): Thirteen years postoperative ROM and X-ray image. The JOA score was 94 points and UCLA score was 34 points. The X-ray revealed grade 3C glenoid wear and grade 4 bone resorption. CTA, cuff-tear arthropathy; HHR, hemiarthroplasty; ROM, range of motion; JOA, Japanese Orthopaedics Association score; UCLA, University of California, Los Angeles shoulder score.
Long-term outcomes of hemiarthroplasty using a smaller head combined with rotator cuff reconstruction in patients with cuff tear arthropathy

January 2024

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27 Reads

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1 Citation

JSES International

Background Hemiarthroplasty (HHR) using a smaller head with rotator cuff reconstruction is a treatment option for cuff-tear arthropathy, offering advantages like facilitating rotator cuff-tear closure, increasing the lever arm of deltoid, and restoring function in irreparable cuff tears. This study aimed to evaluate the long-term outcomes of this procedure. Methods A retrospective analysis was conducted for 91 shoulders undergoing HHR using a smaller head with rotator cuff reconstruction between May 2005 and September 2012. Surgery involved reducing the size of humeral head and performing rotator cuff reconstruction based on the site of the deficient rotator cuff. The study analyzed University of California, Los Angeles shoulder scores, Japanese Orthopaedics Association shoulder scores, range of motion, and postoperative radiographs. Results Twenty-eight patients, divided into an elderly group (14 women, 2 men, mean age 74.5 ± 3.8 years) and a younger group (6 women, 6 men, mean age 63.5 ± 3.1 years) were followed up for a mean of 133.2 ± 14.1 months. No complications were reported. The clinical scores and range of motion significantly improved postoperatively and remained over 10 years. Radiographs revealed high incidence of glenoid wear (82.1%), bone resorption (43%) and cranial humeral head migration (54%), with no prosthesis loosening. Conclusion We believe that HHR using a smaller head with rotator cuff reconstruction is a surgical technique that can maintain stable long-term outcomes in both elderly and younger individuals with cuff-tear arthropathy.



Differences in incidence rate and onset timing of undiagnosed finger symptom among shoulder surgeries related to complex regional pain syndrome

November 2023

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1 Read

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1 Citation

The Journal of Medical Investigation

The purpose of this study was to clarify the difference in onset timing and incidence of undiagnosed finger symptom (UDFS) between various shoulder surgical procedures. In this study, UDFS symptoms included the following four symptoms in the fingers;edema, limited range-of-motion, skin color changes, and abnormal sensations. UDFS cases were defined as those presenting with at least one UDFS. In result, the incidence rate of UDFS cases was 7.1% overall (58/816 shoulders), 7.4% (32/432) in arthroscopic rotator cuff repair (ARCR), 9.0% (11/122) in open rotator cuff repair (ORCR), 1.4% (2/145) in arthroscopic subacromial decompression (ASD), 13.2% (5/38) in open reduction and internal fixation (ORIF), 11.1% (3/27) in humeral head replacement, 4.8% (1/21) in anatomical total shoulder arthroplasty, and 12.9% (4/31) in reverse total shoulder arthroplasty cases. The Rate was significantly higher with ARCR compared to ASD (p<.01). About onset timing in weeks postoperatively, the ORIF group had a statistically earlier symptom onset than the Rotator cuff repair (ARCR + ORCR) group (2.4 weeks vs. 6.0 weeks, p<.01). When classifying the onset timing into before and after the removal of the abduction pillow, the ORIF group showed a statistically higher rate of onset before brace removal than the Rotator cuff repair groups (p<.01). Differences in UDFS among shoulder surgeries were demonstrated in this study. J. Med. Invest. 70 : 415-422, August, 2023



Electromyographic activities of glenohumeral joint muscles during shoulder forward flexion with isometric horizontal abduction loading

January 2023

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53 Reads

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2 Citations

Journal of Shoulder and Elbow Surgery

Background: Isometric horizontal abduction loading has been applied to improve imbalanced scapular muscle activities during shoulder exercises; however, the effect on glenohumeral joint muscle activity remains unclear. The purpose of this study was to investigate the changes in electromyographic activity of shoulder muscles during forward flexion with isometric horizontal abduction loading in healthy participants. Methods: Thirteen healthy men were recruited for this study. Participants performed shoulder forward flexion with and without isometric horizontal abduction loading using an elastic band (Flex-band and Normal-flex conditions). Muscle activities were evaluated while maintaining shoulder flexion at 60°, 90°, 120° and 150° (static task) and during active shoulder flexion from 0° to maximum elevation (dynamic task). Surface electrodes were placed on the deltoid, pectoralis major, infraspinatus and teres minor muscles to measure the activities of the shoulder muscles during each task. The muscle activities during the static task were compared using a two-way analysis of variance with repeated measures of the two factors, loading condition and flexion position, and using a paired t-test between the two conditions during the dynamic task (P < 0.05). Results: For the static task, the Flex-band significantly increased the deltoid middle and posterior activities by 2-15 times, and infraspinatus and teres minor activities by 2-3 times compared to the Normal-flex at all positions. In contrast, the Flex-band significantly decreased (about half) the deltoid anterior (at 120° and 150°) and pectoralis major (at all positions) activities compared to the Normal-flex. For the dynamic task, the Flex-band significantly increased the deltoid middle, posterior, infraspinatus, and teres minor activities by 2-7 times and decreased the deltoid anterior activity by approximately two-thirds. Conclusions: Applying isometric horizontal abduction loading during shoulder forward flexion may be useful in improving the imbalanced muscle activities of the glenohumeral joint, such as excessive activity of the deltoid anterior and pectoralis major and dysfunction of the deltoid middle, posterior and shoulder external rotator muscles. Shoulder forward flexion with horizontal abduction loading would be available for exercise in patients with massive rotator cuff tears or after rotator cuff repair and shoulder arthroplasty.


Figure 1 The case of a 69-year-old woman who underwent arthroscopic rotator cuff repair (ARCR). (A) Intraoperative subacromial view from the lateral portal after suture tying. The lateral part of the decortication area ( , red area of Fig. 1C) was exposed. (B) The generation of hematoma-like tissue (HLT) is confirmed in the subacromial view. (C) Schema for ARCR with the surface-holding method. The decortication area is colored red. (D) Schema for generation of HLT after suture tying. HLT is illustrated as the red hatched area. (E) Coronal T2-weighted imaging in the slice demonstrating the center of the superior facet at 6 weeks postoperatively. HLT is shown within the red dotted line. (F) At 10 months postoperatively, tendon-like tissue has replaced HLT.
Relationship between hematoma-like tissue on the footprint and structural outcome of arthroscopic rotator cuff repair with a transosseous technique

January 2023

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14 Reads

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2 Citations

JSES International

Background We have tried to create hematoma over the footprint site at the end of arthroscopic rotator cuff repair (ARCR) surgery, expecting to apply biochemical effects of the platelet-related factors. The purpose of this study was to investigate the presence of hematoma-like tissue (HLT) on postoperative MRI, and to evaluate the relationship between the HLT and the structural outcomes of ARCR. Materials & Methods Twenty-five patients were reviewed with a mean age at surgery of 69.8 years (range, 52–85 years). Postoperative MRI was performed at 1 week, 6–8 weeks, and >6 months postoperatively. Structural outcomes for the repaired cuff and thickness of HLT were evaluated on coronal T2-weighted images. Signal intensity of HLT was evaluated on coronal T2-weighted fat-suppressed images as the ratio compared to supraspinatus tendon intensity (HLT/SSP ratio). Results Structural outcomes showed Sugaya type 1 in 12 shoulders, type 2 in 4, and type 3 in 9. HLT thickness was significantly thicker at 1 week and 6–8 weeks postoperatively in Sugaya type 1 patients than in type 3 patients (1 week; p=.014, 6-8 weeks; p<.001). HLT/SSP ratio gradually decreased (at 1 week; 1.9±0.7, 6–8 weeks; 1.6±0.6, >6 months; 1.2±0.5), and differed significantly between >6 months and both 1 week and 6–8 weeks (p<.001 each). Conclusion Cases with thicker HLT at 1 week and 6-8 weeks postoperatively can expect good structural outcomes at >6 months. Signal intensity of the HLT became close to that of the supraspinatus tendon over time.


Citations (64)


... Since it was impossible to distinguish the shoulder function right after surgery, we chose to evaluate the clinical outcome at 3 months after ARCR, which was the important prognostic factor for full shoulder functional recovery for ARCR. 29,30 Sample Size and Statistical Analysis ...

Reference:

The Effect of Postoperative Tranexamic Acid and Dexamethasone on Quality of Recovery After Arthroscopic Rotator Cuff Repair: a Double-Blinded, Randomized Controlled Trial
Passive shoulder abduction range of motion at three months postoperatively is the most important prognostic factor for achieving full recovery of range of motion at six months after arthroscopic rotator cuff repair

JSES International

... At 6 months postoperatively, in addition to improving ROM, enhancing external rotator muscle strength, such as infraspinatus and teres minor muscles, is crucial to reduce difficulty in ADL. Forward flexion exercise with horizontal abduction loading using a resistance band has been reported to be effective in increasing infraspinatus and teres minor muscle activity, 17 and may be recommended as a home self-exercise. Since the degree of pain is the most influential factor in subjective shoulder function at 12 months postoperatively, clinicians should identify and treat residual pain as early as possible while continuing to improve shoulder ROM and strength from 6 to 12 months postoperatively. ...

Electromyographic activities of glenohumeral joint muscles during shoulder forward flexion with isometric horizontal abduction loading
  • Citing Article
  • January 2023

Journal of Shoulder and Elbow Surgery

... Although the type and area of the suprascapular notch are considered predisposing factors for suprascapular nerve neuropathy, it is associated in 42% of the cases with solitary paralabral cysts, which are related with the presence of shoulder superior labrum superior labral anterior to posterior (SLAP) lesions [20]. Honoki et al. studied the 3D CT images in 53 patients with SSn palsy and compared the morphology of the SSN with the morphology in a series of 1010 patients without SSn palsy [21]. They did not find an association between narrow SSN or ossification of the STSL with SSn palsy [21]. ...

Correlation of suprascapular notch morphology with suprascapular nerve palsy: A 3D-CT study

JSES International

... Glenoid wear was evaluated using the modified Goya's classification, 10,15,16 which grades the extent of glenoid wear from grade 0 to grade 3 ( Fig. 1). Grade 3 is further divides into 3 subtypes based on the site of erosion. ...

Risk factors for eccentric glenoid wear after humeral head replacement for cuff tear arthropathy

JSES International

... Glenoid wear was evaluated using the modified Goya's classification, 10,15,16 which grades the extent of glenoid wear from grade 0 to grade 3 ( Fig. 1). Grade 3 is further divides into 3 subtypes based on the site of erosion. ...

Glenoid wear and its impact on clinical results after humeral head replacement using a single prosthesis in cuff tear arthropathy with more than 8 years of follow-up
  • Citing Article
  • June 2022

Journal of Shoulder and Elbow Surgery

... Relevant studies have shown that age, sex, coracoid overlap (CO), coracohumeral distance (CHD), long head of the biceps tendon (LHB) injury, and the dominant arm may be related to SSC tears [6,9,15,[17][18][19][20]. The purpose of our study was to summarize previously demonstrated correlations between the above indicators and SSC tears through meta-analysis and to identify the most valuable predictive indicators for SSC tears to help clinicians make early diagnoses and formulate early treatment plans for SSC injuries. ...

Morphology of the coracoid process as a predictor of articular side tear at the upper border of the subscapularis
  • Citing Article
  • January 2022

Journal of Shoulder and Elbow Surgery

... Superior glenoid component inclination amplifies superior-inferior (SI) shear and may result in cement failure at lower arm elevations, 19 as well as increase the incidence of subacromial impingement 14 and induce supraspinatus tears. 16,27 It has also been associated with radiolucency around the pegs in the inferior glenoid and cement, 25,40 which could further undermine glenoid stability. In contrast, other studies have suggested using the inferior circular plane of the glenoid to place the component in superior inclination to decrease shear forces. ...

Computed tomography revealed the correlation between radiolucency and alignment of all-polyethylene pegged glenoid component more than 10 years after total shoulder arthroplasty in the Japanese population
  • Citing Article
  • November 2021

Journal of Orthopaedic Science

... 5 Multimodal analgesia has been studied for alleviating postoperative pain in upper limb fracture surgery. 6 Peripheral nerve blocks (PNBs) are increasingly used as a component of multimodal analgesia, which has improved patient outcomes. 7 8 In our medical centre, supraclavicular brachial plexus block (SCB) anaesthesia, with or without sedation or general anaesthesia, has become the standard of care for upper limb fracture surgery below the axilla. ...

Dexamethasone added to levobupivacaine prolongs the duration of interscalene brachial plexus block and decreases rebound pain after arthroscopic rotator cuff repair
  • Citing Article
  • June 2020

Journal of Shoulder and Elbow Surgery

... 8,16,18 Due to the evidence that GBL increases shoulder instability, this pathological change is relevant for prognosis. In fact, Hirose et al found that glenoid rim resorption is one of the statistical risk factors for recurrence after ABR. 7 Glenoid rim resorption occurs in response to repair of the capsulolabral complex (CLC), so factors related to CLC repair procedures, such as The institutional review board in Osaka International Medical & Science Center approved the clinical study entitled "Anterior glenoid rim resorption after arthroscopic Bankart repair using footprint fixation technique and its correlation to the healing of repaired capsulolabral complex: an imaging study by CT and MR arthrography" by Takehito anchor insertion position, 9 insertion depth, 21 cartilage removal, 15 and stress shielding, 10 have been speculated to be potential contributors to rim resorption, although a definitive primary cause has yet to be identified. Furthermore, despite the pathological changes that occur around the area of the repaired CLC, the relationship between anterior glenoid rim resorption and CLC repair status has not been studied. ...

Glenoid bone resorption after Bankart repair -Finite element analysis of postoperative stress distribution of the glenoid-
  • Citing Article
  • June 2020

Journal of Shoulder and Elbow Surgery

... Reverse shoulder arthroplasty (RSA) with stemmed humeral implants has good longterm results with a low humeral loosening rate, but bone resorption rates remain high [1][2][3]. Thus, humeral stems have transitioned to short and stemless designs, accepting the risk of reduced primary fixation stability [4][5][6][7]. ...

Humeral bone resorption after reverse shoulder arthroplasty using uncemented stem

JSES International