Three-dimensional alignment of the upper extremity in the standing neutral position in healthy subjects.

BACKGROUND: Though alignment of the spine and lower extremities in the standing neutral position has been evaluated, a few studies evaluating the alignment of the upper extremities have also been made. This study assessed the normal alignment of the upper extremities in the standing neutral position and clarified the three-dimensional angular rotations of the upper extremity joints. METHODS: Computed tomography (CT) images of 158 upper extremities from 79 healthy volunteers were prospectively acquired in the standing neutral position using an upright CT scanner. Three-dimensional coordinate systems of the thorax, scapula, humerus, and forearm were designated, and three-dimensional angular rotations of the scapulothoracic, glenohumeral, and elbow joints were calculated. RESULTS: The median angle of the scapulothoracic joint was 9.2° (interquartile range [IQR], 5.2°-12.5°) of upward rotation, 29.0° (IQR, 24.9°-33.3°) of internal rotation, and 7.9° (IQR, 4.3°-11.8°) of anterior tilt. The median angle of the glenohumeral joint was 4.5° (IQR, 0.9°-7.8°) of abduction, 9.0° (IQR, 2.2°-19.0°) of internal rotation, and 0.3° (IQR, - 2.6°-3.1°) of extension. The median angle of the elbow joint was 9.8° (IQR, 6.9°-12.4°) of valgus, 90.2° (IQR, 79.6°-99.4°) of pronation, and 15.5° (IQR, 13.2°-18.1°) of flexion. Correlations in angular rotation values were found between the right and left upper extremities and between joints. CONCLUSIONS: This study clarified the three-dimensional angular rotation of upper extremity joints in the standing neutral position using an upright CT scanner. Our results may provide important insights for the functional evaluation of upper extremity alignment.

[Successful treatment of multiple pulmonary metastases of adenoid cystic carcinoma of the external auditory meatus with TS-1].

The patient, a 67-year old man, was referred to us with refractory otorrhea of the left ear. The diagnosis was adenoid cystic carcinoma of the external auditory meatus, so the primary focus was excised. During the postoperative observation period, multiple metastases to the lung were noted, for which TS-1 (120 mg/day, given for 28 consecutive days, each course followed by a discontinuation of 14 days) was administered. After the completion of 2 courses, reductions in the metastatic pulmonary lesions and the amount of pleural effusion were noted, while adverse effects were limited to mild anorexia. Thus, it was possible to continue medication for 15 months on an ambulatory basis. It was indicated that TS-1 may be effective in the treatment of multiple pulmonary metastases of adenoid cystic carcinoma.