Foundation of Japan Shoulder Research Society

Katsuya Nobuhara
Nobuhara Hospital and Biomechanics Laboratory

1. Introduction

When I joined the Department of Orthopaedic Surgery, one of my seniors invited me to the library and recommended me to read a book. It was Bateman's famous book, "The Shoulder and Environs" (Fig. 1), and I remember that my interest in the shoulder became stronger here. His name was Dr. Kihachi Tomatsuri, and this was in 1959.

At that time, there was no shoulder instructors anywhere, so we learned from the books and articles of the pioneers and practiced treatment in our own way, using Bateman's book, De Palma's “Shoulder Surgery,” and Moseley's “Shoulder Lesions” as our daily practice. Articular capsule laxity and labral tears were discovered by Roger in the 13th century and are now known as Bankart lesions; the method of strengthening the anterior shoulder wall to prevent dislocation was developed by Platt in England and Putti in Italy around 1925; rotator cuff tears were discovered by Monro in 1788 and surgically repaired by Codman in 1911. Codman's brilliant work is summarized in his book “The Shoulder.” It has become the Bible for shoulder surgery and the cornerstone of modern shoulder surgery (Fig. 2).

• Figure 1. Bateman's
  The Shoulder and Environs" by Bateman.
• Figure 2. "The Shoulder" by Codman.

2. Status of the Shoulder in the Medical Community

From the perspective of the medical community as a whole, little attention was paid to the shoulder at that time. This clearly lagged behind advances in research and treatment in other areas. This fact is symbolized by Golding's lecture "Shoulder - the forgotten joint" in the United Kingdom in 1962.

The Japanese Orthopaedic Association had also neglected the shoulder to a greater or lesser extent. A review of the society's journal reveals that it was not until 1946 that Professor Isaharu Miki raised eyebrows with his homework report on the so-called "frozen shoulder". Later, "frozen shoulder" (1961, Miki) and "rotator cuff injury" (1969, the author) became topics of workshops, but it was still a minor field compared to the spine, hip, and knee. Nevertheless, interest in the "shoulder" increased with the birth of the Shoulder Research Society, and topics such as "Rotator Cuff Injuries" (1977, Naoto Takagishi), "Motion Analysis of the Shoulder Joint" (1979, author), "Pathophysiology and Treatment of Recurrent Dislocation" (1983, Ryuji Yamamoto), and "Diagnosis and Treatment of Rotator Cuff Injuries" (1986, Hiroaki Fukuda) were covered. The words of an authority at that time, "There are very few rotator cuff tears patients in Japan," still ring in my ears.

3. Birth of the Japan Shoulder Research Society

In 1970, Kobe University's research project on Kobe Bone, a heterologous bone graft, was discontinued.

Losing my reason for being there, I left the university and established my own fortress, an orthopedic hospital, in a rural town known for the song "Yuyake koyake no akatonbo.” Fortunately, I had friends with whom I could discuss my dreams. The intention was to talk about experiences that I could not talk about at a conference with its restrictions and to discuss them without reservation. The topics were endless, but in the end, Nagao Adachi (Associate Professor at Hiroshima University) discussed the etiology of periarthritis of the shoulder, I discussed the pathophysiology and surgical findings of rotator cuff tears, and Hisao Endo (Director of Naruto Hospital) discussed the results of epidemiologic studies on loose shoulders not described in conventional textbooks, and we lost track of time. This meeting was called the "Kata-Yose-Au-Kai (shoulder-to-shoulder each other meeting)" and was held seasonally at Nobuhara Hospital (Figs 3 and 4).

• Figure 3. Members of the "Kata-Yose-Au-Kai (shoulder-to-shoulder each other meeting)"
  From right to left: Dr. Endo, Dr. Adachi, and the author.
• Figure 4. Members of the "Kata-Yose-Au-Kai (shoulder-to-shoulder each other meeting)"
  From right to left: Drs. Ogawa, Fukuda, and Mikasa.

Over the years, the circle had gradually expanded to include Jiro Ozaki from the Kinki region; Ryuji Yamamoto, Motohiko Mikasa, Hiroaki Fukuda, and Kiyohisa Ogawa from the Kanto region; Shiro Tabata from the Tohoku region; and Nobuyuki Ito from Kyushu region (Fig. 5). I remember distributing papers describing new findings from around the world to my colleagues and discussing them while studying. The friendly atmosphere at the banquet the night before usually changed drastically at the study session the next day, when we engaged in deadly discussions, insisting on our own theory and showing no signs of yielding. This is difficult to imagine in the gentlemen debates of today's shoulder society (Fig. 6).

• Figure 5. Members of the "Kata-Yose-Au-Kai (shoulder-to-shoulder each other meeting)"
  From right to left: Drs. Mikasa, Tabata, and Ito (inside the circle).
• Figure 6. Members of the "Kata-Yose-Au-Kai (shoulder-to-shoulder each other meeting)"
  From right to left: Dr. Mikasa performed a solo, Dr. Yamamoto crossed his arms, and Dr. Fukuda ignored him.

This spontaneous "Kata-Yose-Au-Kai (shoulder-to-shoulder each other meeting)" evolved into the Japan Shoulder Research Society when Professor Naoto Takagishi, the president of the society, organized a symposium at the Western Japan Orthopaedic Association for Orthopaedic Surgery and Traumatology in 1974 and invited the above three members to speak at the symposium. In the waiting room after the lecture, we discussed the possibility of starting "Japan Shoulder Research Society" as soon as possible (Figs 7 and 8).

• Figure 7. Western Japan Orthopaedic Association for Orthopaedic Surgery and Traumatology, Shoulder Symposium.
• Figure 8. Meeting in the waiting room after the lecture. Above are the participants of the symposium.

On October 18, 1974, the world's first Japan Shoulder Research Society was established in Tokushima. The friends decided to hold an extra session of the 44th Central Japan Orthopaedic Association for Orthopaedic Surgery and Traumatology Conference, starting at 6:00 pm. The organizer was Hisao Endo. Although there were only 11 presentations, 87 people attended the meeting, which was enthusiastic. The door was open not only to doctors but also to all shoulder lovers; past programs (Table 1) also included reports from physical therapists.

(Table 1) Program of 1st meeting of Japan Shoulder Research Society

Date: Friday, October 18, 1974, 6:00 p.m.
Venue: Tokushima Prefecture Local Culture Hall, 5th Floor, Conference Room 8

I would like to mention a young doctor who was instrumental in establishing this research society. He was a trainee from the University of Tokushima at the time and said, "When I return home, I want to give my all to the establishment of society. There is a Chinese saying,’ When you drink water, you must not forget the person who dug the well. His name was Dr. Doi. I heard a rumor that he would go back to Ehime, but I have not heard from him since then.

4. After Japan Shoulder Research Society

The members of the "Kata-Yose-Au-Kai (shoulder-to-shoulder each other meeting)" decided to hold a second study session the following year, the day before the 45th meeting of the Central Japan Association of Orthopaedic Surgery and Traumatology, held in Yamaguchi in 1975 (Table 2). Dr. Oda was responsible for the meeting. At that time, it was well known and had huge success, with 15 presentations and 200 participants.

Table 2: Program of 2nd meeting of Japan Shoulder Research Society

Day and Time: 29th Oct 1975, 15:00 - 17:45
Venue: Yamaguchi City Medical Association Yamaguchi Health Care Center Auditorium

The 3rd meeting was held in Fukuoka and was successful, with 35 presentations and 186 participants.

In order to make the research society a nationwide organization, Professor Takagishi elected board members from among professors at universities throughout Japan (Table 3), in addition to the three members of the "Kata-Yose-Au-Kai (shoulder-to-shoulder each other meeting)." The board, composed of 20 members, immediately formulates the basic policy, including regulations, bylaws, and agreements. At that time, there was a problem when he stated that "he would hold the 1st meeting of Japanese Shoulder Research Society," but this was successfully settled by Professor Tsuchiya's ruling that the meeting in Fukuoka would be the 3rd meeting and that a presidential system would be adopted from that time on. This history was described in Shoulder Joints Vol. 1, No. 1 in 1977.

Table 3) Board members of the Shoulder Research Society (3rd Meeting)

Since the meeting in Fukuoka, the members of the former "shoulder-to-shoulder each other meeting" had anticipated to be in charge of the research group, but were forced to wait due to the demands of the pre-retirement board members, considering such as the dispersion of venues. Therefore, seven people, including Adachi, Endo, Yamamoto, Fukuda, Mikasa, Ogawa, and the author (Nobuhara), decided to prepare the materials for each, and go on a visit and lecture tour throughout the United States. I prepared the schedules for the Midwest and Fukuda prepared that for the East (Figs 9-16 and 17).

• Figure 9. Four samurais at the airport. From right to left, Ogawa, Nobuhara, Adachi and Endo
• Figure 10. Lecture at Mayo Clinic

• Figure 11. Photo at Campbell Clinic
• Figure 12. Reception with Professor Calandruccio

• Figure 13. Photo with Professor M. Post at Michael Reese Hospital
• Figure 14. Photo at Columbia Presbyterian Hospital

• Figure 15. Professor Neer, Nobuhara and Fukuda after the surgery
• Figure 16. Photo at Pennsylvania University

• Figure 17. Tired Endo, energetic Mikasa

The group, known as the "Team against the United States," held first lecture in Seattle, followed by Mayo Clinic in Rochester, Campbell Clinic in Memphis, Michael Reese Hospital in Chicago, Sports Center in Philadelphia's, Boston, and Columbia Presbyterian Hospital in New York. We were able to form friendships with U.S. experts, Professors Calandruccio, Post, Neer, and others. After that, I held the 6th research meeting: Adachi the 8th, Yamamoto the 9th, Fukuda the 11th, Mikasa the 14th, and Ogawa the 26th.

5. Advancement of the Japanese Shoulder Society

At its inception of research group, the members discussed case reports, treatments, and surgical techniques. As the number of members and presentations increased, the meeting date was extended, and multiple rooms were set up. The research society was renamed the Japanese Shoulder Society in 1991, the main theme was decided upon, and poster presentations began.

The activities of the research society have increased the number of young doctors with a desire to improve their knowledge and skills regarding shoulder joints throughout Japan, as well as the number of doctors from Asian studies in Japan. For example, colleagues trained at the Nobuhara Hospital became shoulder specialists. This number exceeded 115, most of whom were active shoulder specialists in Asian countries (Figs 18-24 and 25).

• Figure 18. Shoulder friends. From right to left, Koh (under training at Nobuhara Hospital at that time), Takagishi, Nobuhara, Inamochi, Kobayashi and Tsutsui
• Figure 19. Shoulder friends. From right to left, Ozaki, Tabata and Mikasa

• Figure 20. Shoulder friends. Photo in Nagasaki. Front row, Nobuhara, Koh, Kuroda and Ikeda. Back row, Inamochi, Tamai and Kobayashi
• Figure 21. Shoulder friends. Yoneda, Kuroda, and Kurokawa spent the same period at Nobuhara Hospital.

• Figure 22. Shoulder friends. Tsutsui, Maruyama and Ogawa
• Figure 23. Shoulder friends. Front row, from right to left, Mrs. Yamamoto, Yamamoto, Nobuhara, Koh and Mimori. Back row, from right to left, Takagishi, Shue (under training at Nobuhara Hospital at that time), Ogawa, Tsutsui, Hashimoto, Yamasaki and Kumagai. Left-upper circle, Mimori.

• Figure 24. Shoulder friends. Nakagawa, who was so moved that was singing aloud.
• Figure 25. Professor Matsuno who poured a glass of wine, for a junior not coming to pour.

As the research society became the Japan Shoulder Society, familiar disease groups, such as periarthritis of the shoulder, recurrent shoulder dislocation, neuropathic disease, and trauma, became classicized, and basic research, treatment of rotator cuff tears, and the pathophysiology and treatment of unstable shoulders became mainstream. Topics from Europe and the United States, such as sports injuries, arthroscopic techniques, and radiographic diagnosis, are now dominant.

In 2014, the Japan Shoulder Society was reorganized as a general incorporated association, with the theme of globalization of “From Japan to the World.” The Japan Shoulder Society has made great strides in international exchange. However, the achievements our members have made in the world are by no means small. In the academic journal “The Shoulder Joint,” we can see lots of great achievements, the concept of “loose shoulder” which was not reported in English and was not well known in other countries, the surgical techniques such as pectoralis major transfer and glenoid osteotomy, “rotator interval lesion” which did not attract much attention published in Clinical Orthopedics, but suddenly brought into the spotlight by Harryman's research, “traumatic shoulder dislocation with the arm in external rotation,” “classification of rotator cuff tears using radiography” and “analysis of sports motions using biomechanics.” I hope that our members have the belief “maintain our dignity and take care of our actions.”

(Honorifics omitted from text).