MRI is a Reliable Method for Measurement of Critical Shoulder Angle and Acromial Index / A ressonância magnética é um método confiável para medida do ângulo crítico do ombro e do índice acromial

Abstract Objective The objectives of this study are to compare absolute values of acromial index (AI) and critical shoulder angle (CSA) obtained in both radiographs and magnetic resonance image (MRI) of the shoulder; and to compare the interobserver and intra-observer agreement for AI and CSA values measured in these image modalities. Methods Patients who had medical indication of investigating shoulders conditions through radiographs and MRI were included. Images were taken to two fellowship-trained shoulder surgeons, which conducted measurements of AI and CSA in radiographs and in MRI. Twelve weeks after the first evaluation, a second evaluation was conducted. Inter- and intra-observer reliability was presented as an Intraclass Correlation Coefficient (ICC) and agreement was classified according to Landis & Koch criteria. The differences between two measurements were evaluated using Bland-Altman plots. Results 134 shoulders in 124 subjects were included. Mean intra-observer ICC for CSA in X-rays and in MRI were 0.936 and 0.940, respectively; for AI, 0.908 and 0.022. Mean inter-observer ICC for CSA were 0.892 and 0.752 in X-rays and MRI respectively; for AI, ICC values were 0.849 and 0.685. All individual analysis reached statistical power (p< 0.001). Mean difference for AI values measured in X-rays and in MRI was 0.01 and 0.03 for observers 1 and 2, respectively. Mean difference for CSA values obtained in X-rays and MRI was 0.16 and 0.58 for observers 1 and 2, respectively. Conclusion Both MRI and X-rays provided high intra- and interobserver agreement for measurement of AI and CSA. Absolute values found for AI and CSA were highly correlated in both image modalities. These findings suggest that MRI is a suitable method to measure AI and CSA. Level of Evidence II, Diagnostic Study.

Resumo Objetivo Os objetivos deste estudo foram comparar os valores absolutos do índice acromial (IA) e do ângulo crítico do ombro (ACO) obtidos em radiografias e ressonâncias magnéticas (RM) do ombro e comparar a concordância interobservador e intraobservador dos valores de IA e ACO medidos nessas modalidades de imagem. Métodos Pacientes com indicação médica de investigação de doenças dos ombros por meio de radiografias e RM foram incluídos no estudo. As imagens foram levadas para dois cirurgiões de ombro treinados que realizaram medidas de IA e ACO em radiografias e RM. Doze semanas após a primeira avaliação, uma segunda avaliação foi realizada. A confiabilidade inter e intraobservador foi apresentada como coeficiente de correlação intraclasse (CCI) e a concordância foi classificada segundo os critérios de Landis e Koch. As diferenças entre duas medidas foram avaliadas por meio de gráficos de Bland-Altman. Resultados Cento e trinta e quatro ombros de 124 indivíduos foram incluídos no estudo. O CCI intraobservador médio para ACO em radiografias e RM foi 0,936 e 0,940, respectivamente; para IA, foi 0,908 e 0,022. O CCI interobservador médio para ACO foi 0,892 e 0,752 em radiografias e RM, respectivamente; para IA, os valores de CCI foram 0,849 e 0,685. Todas as análises individuais apresentaram poder estatístico (p < 0,001). A diferença média dos valores de IA em radiografias e RM foi 0,01 e 0,03 para os observadores 1 e 2, respectivamente. A diferença média dos valores de ACO em radiografias e RM foi 0,16 e 0,58 para os observadores 1 e 2, respectivamente. Conclusão Tanto a RM quanto as radiografias tiveram alta concordância intra e interobservador para medida de IA e ACO. Os valores absolutos de IA e ACO foram altamente correlacionados em ambas as modalidades de imagem. Esses achados sugerem que a RM é um método adequado para determinação de IA e ACO. Nível de Evidência II, Estudo Diagnóstico.

Varmam Therapy for Common Shoulder Joint Pathological Conditions- A Review

Varmam- a discrete medical science and a great contribution of Siddhars to Tamil Nadu. It encompases Varma martial arts, Varma therapy, internal and external medicines. Varma therapy and medicines effectively treat neuro musculoskeletal conditions which is admirable. Shoulder pain is most common orthopaedic condition. It is the third common cause of musculoskeletal consultations in primary care. Approximately 1% of adult develops new shoulder pain annually. Common pathological conditions of shoulder like rotator cuff disorders and adhesive capsulitis etc exhibits similar clinical features like pain and stiffness of shoulder joint and restricted movements. Varma therapy rearranges and regulates the “Vaasi” and consequently helps to maintain the equilibrium of trihumours (Vatham, Pitham, Kapham). This review article explicates the Varma points for the treatment of shoulder pathological conditions, the exact anatomical location of Varma points and the appropriate method of its manipulation, certainly a key to further research articles.

Acromial type in Brazilian young adults: a radiological study / Tipo acromial em adultos jovens brasileiros: um estudo radiológico

Introduction: curved and hooked acromia play a key role in shoulder impingement syndrome. Little is known about acromial type in the Brazilian population. Aim: To describe the acromial profile of Brazilian young adults; to evaluate its correlation with gender and handedness and the occurrence of symmetry between the genders. Methodology: forty acromia in 20 Brazilian adults of both genders, aged 21-25 years, were studied. The acromial type was classified through the Bigliani/Epstein method using radiographs in supraspinatus outlet view. Results: as there was no gender difference in occurrences of acromial type, we considered the male and female groups together. Thus, among the 20 right acromia, we found 5 type I (25%), 8 type II (40%) and 7 type III (35%). Among the 20 left acromia, we found 4 type I (20%), 11 type II (55%) and 5 type III (25%). The only left-handed volunteer (100%) presented acromial type III in both the right and the left shoulder. Among the 19 right-handed volunteers, 5 (26.3%) presented right acromion type I, 8 (42.1%) had type II and 6 (31.6%) had type III; for the left acromion, 4 (21.1%) presented type I, 11 (57.9%) had type II and 4 (21.1%) had type III. Acromial symmetry occurred in 60% of females and 70% of males. Conclusion: type II acromion was predominant, in both the right and the left shoulder in Brazilian young adults. There was no correlation between acromial type and gender. It was not possible to analyze the correlation between acromial type and handedness. Acromial type tended to be symmetrical in our sample.

Introdução: o acrômio curvo e gancho desempenham um papel fundamental na Síndrome do impacto do ombro. Pouco se sabe sobre o tipo acromial na população brasileira. Objetivo: descrever o perfil do tipo acromial em adultos jovens brasileiros e avaliar sua correlação com o gênero e a lateralidade e a ocorrência de simetria entre os sexos. Metodologia: foram estudados 40 acrômios de 20 adultos brasileiros, de ambos os sexos, com idade entre 21 e 25 anos. O tipo acromial foi classificado pelo método de Bigliani/ Epstein nas radiografias de perfil de escápula. Resultados: como não houve diferença na ocorrência do tipo acromial quanto ao gênero, consideramos os grupos masculino e feminino juntos. Assim, dos 20 acrômios direitos, foram encontrados 5 (25%) do tipo I, 8 (40%) do tipo II e 7 (35%) do tipo III, enquanto que dos 20 acrômios esquerdos, foram encontrados 4 (20%) tipo I, 11 (55%) tipo II e 5 (25%) tipo III. O único voluntário canhoto (100%) apresentou para o ombro direito e esquerdo o tipo acromial III. Dos 19 voluntários destros, 5 (26,3%) apresentavam acrômio direito tipo I, 8 (42,1%) tipo II e 6 (31,6%) tipo III; para o acrômio esquerdo, 4 (21,1%) apresentavam tipo I, 11 (57,9%) tipo II e 4 (21,1%) tipo III. A simetria acromial ocorreu nos grupos feminino (60%) e masculino (70%). Conclusão: o acrômio tipo II foi o mais predominante para os ombros direito e esquerdo em adultos jovens brasileiros. Não houve correlação entre o tipo de acromial e o gênero. Não foi possível analisar a correlação entre o tipo acromial e a lateralidade. O tipo acromial tende a ser simétrico em na amostra estudada.

Confiabilidade interavaliador do método de Bigliani para classificação do tipo acromial / Inter-rater reliability of the method of Bigliani for classifying acromial type

Introdução: em 1875, Hamilton identificou o formato do acrômio como uma etiologia de dor no ombro. Neer, em 1972, descreveu a síndrome do impacto no ombro como uma relação de causa e efeito entre a morfologia do acrômio e o impacto subacromial. Em 1986, Bigliani et al. apresentaram um esquema de classificação do acrômio de acordo com o formato de sua superfície inferior: plano (tipo I), curvo (tipo II) e gancho (tipo III). Em 1993, Epstein et al. proporam que o acrômio tipo II apresentaria um declive em seu terço médio e o tipo III no seu terço anterior. Objetivo: avaliar a reprodutibilidade/confiabilidade interavaliador do método de Bigliani et al. (1986) refinado por Espstein et al. (1993) para a classificação do tipo acromial. Metodologia: casuística composta por 20 voluntários brasileiros, de ambos os gêneros, entre 21-25 anos. A incidência radiográfica utilizada para visualizar o formato do acrômio foi perfil de escápula. O tipo acromial foi classificado por três avaliadores. A reprodutibilidade e confiabilidade foram avaliadas pelo teste McNemar e pelo índice Kappa. Resultados: teste de McNemar com p > 0,05; índice Kappa entre 0,61 e 0,8; e probabilidade de significância p de Kappa < 0,05 confirmam a muito boa reprodutibilidade e confiabilidade do método para classificação do tipo acromial entre os três avaliadores. Conclusão: o método de Bigliani et al. (1986) refinado por Epstein et al. (1993) para classificação do tipo acromial mostrou concordância entre todos os avaliadores confirmando a muito boa reprodutibilidade e confiabilidade entre os avaliadores do estudo.

Introduction: in 1875, Hamilton identified that acromion shape was an etiology for shoulder pain. In 1972, Neer described shoulder impact syndrome as a cause and effect relationship between acromion morphology and subacromial impact. In 1986, Bigliani et al. presented an acromion classification scheme according to the shape of its lower surface: flat (type I), curved (type II) and hook (type III). In 1993, Epstein et al. proposed that the type II acromion would have a slope in its middle third and type III in its anterior third. Objective: to evaluate the inter-rater reproducibility and reliability of the method of Bigliani et al. (1986) for classifying acromial type, as refined by Epstein et al. (1993). Methodology: this was a case series composed of 20 Brazilian volunteers of both genders, aged 21-25 years. The shape of the acromion was visualized radiographically using the supraspinatus outlet view. Acromial type was classified by three evaluators. Reproducibility and reliability were assessed using the McNemar test and kappa index. Results: the McNemar test showed probability p > 0.05 and the kappa index was between 0.61 and 0.8 significant result: p < 0.05. These confirmed that this method had very good reproducibility and reliability for classifying acromial type among the three evaluators. Conclusion: the method of Bigliani et al. (1986) for classifying acromial type, as refined by Epstein et al. (1993) showed agreement among all the evaluators. This confirmed that there was very good reproducibility and reliability among the evaluators of this study.

A Simple Bone Cyst of the Acromion: Case Report / Cisto ósseo simples do acrômio: Relato de caso

Abstract Simple bone cysts rarely occur in the scapula, and, to our knowledge, they have not been reported in the acromion. In the present report, we present the case of a 24-year-old female patient who was successfully treated by curettage and grafting using xenografting. No recurrence findings were observed during the follow-up six months postoperatively, the patient had recovered full range of motion, and she was able to perform all routine activities satisfactorily.

Resumo Cistos ósseos simples são raros na escápula, e, pelo que sabemos, não foram relatados no acrômio. Aqui, apresentamos uma paciente do sexo feminino, de 24 anos, submetida com sucesso ao tratamento composto por curetagem e xenoenxerto. Não foram observados achados de recidiva no acompanhamento pós-operatório de seis meses, quando a paciente apresentou amplitude total de movimento e foi capaz de realizar todas as atividades rotineiras de maneira satisfatória.

Effect of the acromial inferolateral tilt on subacromial impingement syndrome: a retrospective magnetic resonance imaging assessment / A contribuição da inclinação inferolateral do acrômio na síndrome do impacto subacromial: uma avaliação retrospectiva por ressonância magnética

Abstract Objective: To evaluate the effect of acromial inferolateral tilt on subacromial impingement syndrome. Materials and Methods: The acromial inferolateral tilt was retrospectively quantified by two researchers on 346 shoulder magnetic resonance images using the glenoacromial (between the inferior proximal acromial surface and the glenoidal face) and acromioclavicular (between the axis of the proximal acromion and distal clavicle) angles. Results: The glenoacromial angle was associated with subacromial impingement syndrome (p < 0.001) and complete supraspinatus tendon rupture (p < 0.001), and the acromioclavicular angle was associated with partial or complete supraspinatus tendon rupture (p = 0.003). The area under the receiver operating characteristic curve (AUC), best cut-off angle, and odds ratio (OR) of the glenoacromial angle for impingement syndrome were 0.579 (95% confidence interval [CI]: 0.508-0.649; p = 0.032), 72°, and 2.1 (95% CI: 1.136-4.053), respectively. For complete supraspinatus tendon rupture, the AUC, best cut-off angle, and OR of the glenoacromial angle were 0.731 (95% CI: 0.626-0.837; p = 0.001), 69°, and 8.496 (95% CI: 2.883-28.33), respectively. For partial or complete supraspinatus tendon rupture, the AUC, best cut-off angle and OR of the acromioclavicular angle were 0.617 (95% CI: 0.539-0.694; p = 0.002), 17°, and 3.288 (95% CI: 1.886-5.768), respectively. Interobserver agreement found for the glenoacromial and acromioclavicular angles were 0.737 (95% CI: 0.676-0.787; p < 0.001) and 0.507 (95% CI: 0.391-0.601; p = 0.001), respectively. Conclusion: Inferolateral acromial tilt may have some impact on subacromial impingement syndrome; however, the best quantification method identified (glenoacromial angle) showed a moderate interobserver agreement and a fair performance to assess the risk of complete supraspinatus tendon rupture.

Resumo Objetivo: Avaliar a contribuição da inclinação inferolateral do acrômio na síndrome do impacto subacromial. Materiais e Métodos: A inclinação inferolateral do acrômio foi quantificada retrospectivamente por dois pesquisadores em 346 ressonâncias magnéticas de ombro por meio dos ângulos glenoacromial (entre a superfície inferior proximal do acrômio e a face glenoidal no plano coronal) e acromioclavicular (entre o eixo do acrômio proximal e o eixo da clavícula distal no plano coronal). Resultados: Houve associação entre ângulo glenoacromial e síndrome do impacto subacromial (p < 0,001) e ruptura completa do tendão supraespinal (p < 0,001). Ângulo acromioclavicular associou-se a ruptura parcial ou completa do tendão supraespinal (p = 0,003). A área sob a curva (area under the curve - AUC) característica de operação do receptor, o melhor ângulo de corte e a razão de chances (odds ratio - OR) do ângulo glenoacromial para a síndrome do impacto foram, respectivamente: 0,579 (intervalo de confiança [IC] 95%: 0,508-0,649; p = 0,032), 72° e 2,1 (IC 95%: 1,136-4,053). Para ruptura completa do tendão supraespinal, a AUC, o melhor ângulo de corte e a OR do ângulo glenoacromial foram, respectivamente: 0,731 (IC 95%: 0,626-0,837; p = 0.001), 69° e 8,496 (IC 95%: 2,883-28,33). Para ruptura parcial ou completa do tendão supraespinal, a AUC, o melhor ângulo de corte e a OR do ângulo acromioclavicular foram, respectivamente: 0,617 (IC 95%: 0,539-0,694; p = 0,002), 17° e 3,288 (IC 95%: 1,886-5,768). As concordâncias interobservador encontradas para os ângulos glenoacromial e acromioclavicular foram, respectivamente: 0,737 (IC 95%: 0,676-0,787; p < 0,001) e 0,507 (IC 95%: 0,391-0,601; p = 0,001). Conclusão: Inclinação inferolateral do acrômio pode determinar alguma influência sobre a síndrome do impacto subacromial, entretanto, o melhor método de quantificação identificado (o ângulo glenoacromial) apresentou moderada concordância interobservador e desempenho moderado para estratificar o risco de ruptura completa do tendão supraespinal.

Mercury Concentration Testing in Local Fish Populations in Anguilla with Correlations of Potential Complications Related to Long Term Mercury Ingestion in Caribbean Populations

Mercury is a common element found in household, industrial and medical products. Mercury waste has the potential to leak into rivers that flow to the oceans where bacteria can convert mercury into a soluble form that can allow concentrations to build up in local fish populations. Previous research performed in Anguilla in 2013 - 2014 found that the fish species Mahi mahi had the highest mercury concentration at 0.08 mg / Kg. The FDA and WHO recommend a maximum of 1 mg / Kg per year. Chronic ingestion of mercury has been linked to pregnancy complications, early childhood developmental complications, and various neurological and gastrointestinal manifestations. METHODSFish tissue samples were acquired locally on the Caribbean Island of Anguilla from 10 different fish species, documented, prepared for temporary preservation and sent to the Biodiversity Research Institute where mercury concentration processing was performed on their DMA (Direct Mercury Analyzer). RESULTSData showed that mercury concentrations have risen for certain fish species and fallen in others since samples were last taken in 2013. The mercury concentration of Mahi mahi decreased, back in 2013 the reported concentration was 0.08 mg / Kg while the 2020 result was 0.023 mg / Kg. On the other end of the spectrum, the mercury concentration of the Red Hind species in 2013 was 0.07 mg / Kg and had increased to 0.2604 mg / Kg in 2020. CONCLUSIONSOur findings support the notion that mercury concentrations within the tissues of fish around the Caribbean island of Anguilla have increased. Future mercury testing should be performed around other local Caribbean islands so as to compare the relative mercury concentrations and so that local governments can also appropriately inform the Caribbean communities of the potential risks they take with chronic ingestion of local seafood

Is Acromio-Axillo-Suprasternal Notch Index a Reliable Test to Predict Difficult Tracheal Intubation in Adults in Supine Position - an Observational Study

Introduction: The applicability of the Modified Mallampatitest in supine patients is doubtful. We undertook this studyto evaluate the efficacy of acromio-axillo-suprasternal notchindex (AASI) for predicting difficult intubation and tocompare it with modified Mallampati test in supine position(MMT-S).Material and Methods: This prospective observationalstudy included 200 patients of American Society ofAnaesthesiologist (ASA) physical status I and II ofeither gender, aged 18-60 years. Patients with anatomicalabnormalities involving head and neck, pregnant, edentulousand BMI>35Kg/m2 were excluded. AASI and MMT-S wereassessed preoperatively. Direct laryngoscopy was performedby an experienced anaesthesiologist blinded to the result ofairway assessment tests. Cormack Lehane grade (CL grade)and number of attempts to successful intubation were noted.Primary objective was to assess AASI as predictor of difficultvisualisation of larynx (DVL) and secondary objective was tocompare it with MMT-S. Statistical analysis- McNamer testwas used to compare sensitivity and specificity of both themethods. Comparison of Area under Curve(AUC) of both themethods was performed.Results: AASI was 92% sensitive and 97.71% specificin predicting difficult intubation whereas sensitivity andspecificity of MMT-S was 76% and 84.57% respectively. AreaUnder Curve (AUC) of AASI was 0.97 with cut-off value>0.49 as a predictor of difficult intubation.Conclusion: AASI with cut off value >0.49 has highersensitivity and positive predictive value and is better inpredicting difficult airway in supine patients as compared toMMT-S.

Acromio-Clavicular Joint Dislocation Types IV to VI: Does the Outcome with the modified Weaver-Dunn Procedure Justify the Treatment?

@#clavicular joint (ACJ) injuries remains controversial. Themodified Weaver-Dunn (WD) procedure is one of thefrequently used techniques. Recently when it was comparedwith anatomical autogenous tendon graft reconstructionprocedures, the results were inferior. However, theseanatomical procedures are technically more demanding withsmall margin of error and they have tendency forpostoperative pain because of extra donor site incision.Materials and Methods: Forty patients with type IV to VIACJ dislocations were treated by modified WD procedureusing non-absorbable synthetic suture passed through thebase of coracoid process for augmentation of transferredcoraco-acromial (CA) ligament. Functional outcome wasassessed using the Oxford Shoulder Score, NottinghamClavicular Score and Visual Analog Score (VAS) at the finalfollow-up after surgery.Results: The mean pre-operative Oxford Shoulder Scoreimproved from 25.22±2.64 (range 20 to 30) to 44.75±1.99(range 40 to 48) and mean pre-operative NottinghamShoulder Score improved from 49.25±4.91 (range 39 to 58)to 87.27±4.39 (range 79 to 96) at last follow-up after surgerywith p-value <0.001. Thirty-five (87.5%) patients hadexcellent outcomes, four (10%) patients had good outcomesand one (2.5%) patient had fair outcome. Thirty-eight (95%)patients had no pain while two (5%) had moderate painbased on VAS score.Conclusion: Modified Weaver-Dunn is a simple wellestablished technique for grade IV to VI ACJ dislocation.We cannot consider this procedure as old and outdated on theargument that the long term functional outcomes are notsubopti

Re-definition of position and calculation of safe area for axillary nerve in deltoid muscle with its clinical relevance: a cadaveric study / 대한해부학회지

Several authors have made efforts to define the position of the axillary nerve within deltoid muscle and to calculate the so called safe area for this nerve but it still remains a matter of debate. The primary aim of the study was to investigate the acromio-axillary (AA) distance and its correlation with upper arm length. The secondary aim was to re-define the safe area for axillary nerve within deltoid muscle. Sixty shoulders of thirty adult human cadavers were dissected using standard methods. The distance from the anterior and posterior edge of acromion to the upper border of the course of the axillary nerve was measured and recorded as anterior and posterior AA distance respectively. Correlation analysis was done between the upper arm length and AA distance for each limb. The ratios between anterior and posterior AA distance and upper arm length were calculated and mentioned as anterior index and posterior index, respectively. The mean of anterior and posterior AA distance was 5.22 cm and 4.17 cm, respectively. The mean of upper arm length was 29.30 cm. The means of anterior index and posterior indices were 0.18 and 0.14, respectively. There was a significant correlation between upper arm length and both the anterior and posterior AA distance. The axillary nerve was found to lie at variable distance from the acromion. The minimum AA distance was found to be 3.50 cm. So this should be considered as the maximum permissible length of the deltoid split. Upper arm length has strong correlation with both anterior and posterior AA distances. The ideal safe area for the axillary nerve was found to be a quadrangular area above it and the size of which depends on the length of the upper arm.

Relationship between the critical shoulder angle and the development of rotator cuff lesions: a retrospective epidemiological study / Associação entre o ângulo crítico do ombro e lesão do manguito rotador: um estudo epidemiológico retrospectivo

ABSTRACT OBJECTIVE: To perform a retrospective epidemiological study of radiographs in order to evaluate the relationship between the anatomy of the scapula and the development of rotator cuff injuries (RCIs). METHODS: This study retrospectively evaluated the relation of the critical shoulder angle (CSA) and RCIs from January 2011 to November 2013; patients were examined in the Orthopedics and Traumatology Department of a university hospital. The CSA was measured by radiographic standardization of two groups: a control group of 34 asymptomatic shoulders and a study group of 44 shoulders with complete RCIs. RESULTS: The mean age in the control group was 59.97 years (45-84) and the mean age in the group with RCIs was 59.75 years (45-84). Regarding the CSA, the control group had a mean angle of 33.59° (±3.37) and the group with RCIs had a mean angle of 39.75° (±5.35; p< 0.007). CONCLUSION: There is an association between CSA and RCIs.

RESUMO OBJETIVO: Fazer um estudo epidemiológico retrospectivo em radiografias para avaliar a relação entre a anatomia da escápula e o desenvolvimento de lesões do manguito rotador (LMR). MÉTODOS: O presente estudo avaliou retrospectivamente a relação do ângulo crítico do ombro (ACO) e LMR de janeiro de 2011 a novembro de 2013, em pacientes atendidos em um hospital universitário pelo Departamento de Ortopedia e Traumatologia. Para tanto, o ACO foi medido após a padronização radiográfica de dois grupos, um grupo controle de 34 ombros assintomáticos e um segundo grupo de 44 ombros com LMR. RESULTADOS: A média de idade no grupo controle foi de 59,97 anos (45-84) e de 59,75 anos no grupo com LMR (45-84). Em relação ao ACO, os pacientes do grupo controle tiveram média de 33,59 graus de angulação (± 3,37) e o grupo de pacientes com LMR apresentou uma média de 39,75 graus de angulação (± 5,35; p < 0,007). CONCLUSÃO: Há uma relação entre ACO e LMR.

A natação aumenta a amplitude de movimento e a força dos músculos rotadores mediais do ombro sem alterar o espaço subacromial / Swimming increases range of motion and strength of the medial rotator muscles of the shoulder without altering the subacromial space

Introdução: Na natação, de modo geral, as estruturas que compõem o ombro são afetadas pelo gestual esportivo, porém, não se pode afirmar que isso promove o impingement. Objetivo: Avaliar o efeito da natação sobre o espaço subacromial, a amplitude de movimento e a força de rotação medial e lateral dos ombros de nadadores. Métodos: Foram analisados 52 sujeitos de ambos os gêneros, entre 12 e 17 anos e divididos em 2 grupos pareados: 1) grupo experimental: 26 nadadores (14 homens e 12 mulheres) e grupo controle: 26 sujeitos ativos não nadadores (13 homens e 13 mulheres). Resultados: Os dados foram analisados no SPSS (20.0) pelos testes t Student (independente) e Mann-Whitney, considerando-se α ≤ 0,05. A força de rotação medial foi 57 e 54% maior que a força de rotação lateral no grupo experimental (P<0,01), e 32 e 25% no grupo controle (P<0,01) para o membro dominante e membro não dominante, respectivamente. A razão força de rotação medial/força de rotação lateral e a amplitude de movimento foram maiores no grupo experimental (P<0,02 e P<0,01, respectivamente) quando comparada ao grupo controle. Conclusão: Os nadadores apresentaram maior amplitude de movimento, força de rotação medial e razão força de rotação medial/força de rotação lateral comparados ao grupo controle, sem alterar o espaço subacromial, comparado a valores normativos.(AU)

Introduction: In swimming, in general, the structures that make up the shoulder are affected by the sportive gesture, however, it cannot be said that this promotes the impingement. Objective: To evaluate the swimming effect on the subacromial space, range of motion and medial and lateral rotation force shoulders of swimmers. Methods: Fifty-two subjects of both genders were analyzed between 12 and 17 years and divided into two matched groups: 1) experimental group: 26 swimmers (14 men and 12 women) and control group: 26 active subjects not swimmers (13 men and 13 women). Results: The results were analyzed using SPSS (20.0) by Student t (independent) and Mann-Whitney tests, considering α ≤ 0.05. The medial rotation force was 57 and 54% greater than the lateral rotation force in the experimental group (P<0.01), and 32 e 25% in the control group (P<0.01) for the dominant limb and non-dominant limb, respectively. The ratio medial rotation force/lateral rotation force and range of motion performed higher in the experimental group (P<0.02 and P<0.01, respectively) compared to the control. Conclusion: The swimmers had greater range of motion, medial rotation force and medial rotation force / ateral rotation force ratio compared to control without changing the subacromial space compared to normative values.(AU)

Evaluation of the acromiohumeral distance by means of magnetic resonance imaging umerus / Avaliação da distância úmero-acromial por meio da ressonância magnética

OBJECTIVE: To demonstrate the relationship between the size, degree of retraction and topography of rotator cuff injuries and the degree of rise of the humeral head, and to evaluate the influence of gravity, using magnetic resonance imaging (MRI). METHODS: We evaluated 181 shoulder MRIs from 160 patients aged over 45 years, between November 2013 and July 2014. The patients were divided into two groups: one control (no lesion or partial damage to the rotator cuff); and the other with complete tears of the rotator cuff. We measured the acromiohumeral distance in the sagittal plane, and established the shortest distance between the apex of the head and the acromion. RESULTS: In this study, 96 examinations on female patients (53.04%) and 58 on male patients (46.96%) were evaluated. The mean age was 63.27 years: in the control group, 61.46; and in the group with injuries, 65.19. From analysis on the measurements of the subacromial space, we observed significantly higher values in the control group (7.71 mm) than in the group with injuries (6.99). In comparing the control group with some specific subgroup, i.e. posterosuperior (6.77), anteroposterior-superior (4.16) and retraction Patte III (5.01), we confirmed the importance of topography and degree of retraction in relation to the rise of the humeral head. CONCLUSION: The rise of the humeral head was directly related to the size, degree of retraction and topography of the rotator cuff injuries, with greater degrees of rise in cases of superior and posterior lesions and anteroposterior-superior (massive) lesions. The assessment using MRI was not influenced by the force of gravity.

OBJETIVO: Demonstrar a relação entre o tamanho, grau de retração e topografia das lesões do manguito rotador com o grau de ascensão da cabeça umeral e avaliar a influência da força da gravidade na ressonância magnética. MÉTODOS: Avaliamos 181 ressonâncias magnéticas de ombro de 160 pacientes com mais de 45 anos, entre novembro de 2013 e julho de 2014. Os pacientes eram divididos em dois grupos, um de controle (sem lesão ou com lesão parcial do MR) e outro com lesão completa do MR. Fizemos a mensuração da distância acrômio-umeral nos cortes sagitais e foi estabelecida a menor distância entre o ápice da cabeça e o acrômio. RESULTADOS: Foram avaliados neste estudo 96 (53,04%) exames de pacientes do sexo feminino e 58 de pacientes do sexo masculino (46,96%). A idade média foi 63,27 anos, a do grupo controle 61,46 e a do grupo com lesão 65,19. Ao analisar as medidas do espaço subacromial, observamos valores significativamente maiores no grupo controle (7,71 mm) do que no grupo com lesão (6,99). Quando comparamos o grupo controle com alguns subgrupos específicos, posterossuperior (6,77), anteroposterossuperior (4,16) e retração Patte III (5,01), confirmamos a importância da topografia e grau de retração para ascensão da cabeça umeral. CONCLUSÃO: A ascensão da cabeça umeral tem relação direta com o tamanho, grau de retração e a topografia das lesões do manguito rotador, com graus maiores de ascensão nas lesões posterossuperiores e anteroposterossuperiores (extensas). A avaliação feita pela ressonância magnética não sofre influência da força da gravidade.

Analysis on the acromial curvature and its relationships with the subacromial space and types of acromion / Análise da curvatura acromial e sua relação com o espaço subacromial e os tipos de acrômio

Objective: To correlate the acromial curvature, using the angles proposed, with the subacromial space and types of acromion. Methods: Ninety scapulas were studied. The acromia were classified as types I, II or III. The acromial curvature was analyzed by means of the alpha, beta and theta angles. We also measured the distance between the anteroinferior extremity of the acromion and the supraglenoid tubercle (DA). The scapulas were grouped in relation to sex and age. The angles proposed were analyzed in relation to each type of acromion and also in relation to the measurements of the distance DA. Results: Out of the total number of acromia, 39 (43.3%) were type I, 43 (47.7%) type II and eight (9%) type III. The mean ages for each type of acromion (I-III) were 45.6, 55.2 and 51.1 years, respectively. The proportions of the different types of acromion varied in relation to sex and age. The evaluations on the mean beta angle (p = 0.008) and theta angle (p = 0.028), with comparisons in relation to each type of acromion and measurements of the distance DA (p = 0.037), were shown to be statistically significant. Conclusion: The angles proposed in our study can be used for morphometric analysis on the acromion, especially regarding its curvature, and can contribute towards studies on diseases of the shoulder and aid in surgical planning and analysis of the acromial slope, by means of radiography or magnetic resonance...

Objetivo: Correlacionar a curvatura acromial, por meio dos ângulos propostos, com o espaço subacromial e os tipos de acrômio. Métodos: Foram estudadas 90 escápulas. Os acrômios foram classificados em tipos I, II ou III. A curvatura acromial foi analisada por meio dos ângulos alfa, beta e teta. Mensuramos também a distância entre o extremo anteroinferior do acrômio e o tubérculo supraglenoidal (DA). As escápulas foram agrupadas em relação ao sexo e à idade. Os ângulos propostos foram analisados em relação a cada tipo de acrômio e também em relação à medida da distância DA. Resultados: Do total de acrômios, 39 (43,3%) foram do tipo I, 43 (47,7%) do tipo II e oito (9%) do tipo III. A média de idade para cada tipo de acrômio I-III foi de 45,6 anos, 55,2 e 51,1, respectivamente. A proporção dos diferentes tipos de acrômio variou em relação ao sexo e à idade. A avaliação das médias dos ângulos β (p = 0,008) e θ (p = 0,028), comparadas em relação a cada tipo de acrômio e às medidas da distância DA (p = 0,037), mostrou-se estatisticamente significativa. Conclusão: Os ângulos propostos no nosso trabalho podem ser usados para análise morfométrica do acrômio, em especial de sua curvatura, contribuir para os estudos das doenças do ombro e auxiliar na programação cirúrgica e na análise da inclinação acromial por meio de radiografia ou ressonância magnética...

Osteoma osteóide de acrômio que simula dor acrômio-clavicular / Osteoid osteoma of the acromion simulating acromioclavicular pain

O osteoma osteóide é um tumor ósseo benigno que se apresenta geralmente em adultos jovens com dor noturna, aliviada por repouso e anti-inflamatórios. Pode acometer qualquer osso. Entretanto, sua ocorrência no acrômio é rara. Os autores descrevem um caso de osteoma osteóide localizado no acrômio, com sintomas que simulavam artrose acrômio-clavicular. O diagnóstico foi feito por meio de tomografia computadorizada e o tratamento proposto foi a exérese do nidus por meio de artroscopia. O diagnóstico definitivo foi confirmado por exame histopatológico. No segmento ambulatorial, a paciente permaneceu assintomática e com recuperação completa da função do membro acometido.

The osteoid osteoma is a benign bone tumour that usually presents with nocturnal pain in young adults, relieved by rest and anti-inflammatories. It can affect any bone; however, their occurrence is rare in the acromion. The authors describe a case of osteoid osteoma located in the acromion, with symptoms that simulated acromion claviculararthrosis. The diagnosis was made by CT scan and treatment was excision of the nidus through arthroscopy. The diagnosis was confirmed by histopathology. In the outpatient segment, the patient remained asymptomatic, with complete recovery of function of the affected limb.

An anthropometry study of the shoulder region in a chinese population and its correlation with shoulder disease / Estudio antropométrico de la región del hombro en una población china y su relación con enfermedad del hombro

Purpose: There is a paucity of data which reflected the relationship between morphology and incidence of shoulder disorders with respect to the ethnic Chinese population. We used anteroposterior radiographs to measure the Acromion Index (AI) and Acromioglenoid Angle (AA) of Chinese patients. The baseline was defined as the line that connected the superior and inferior osseous margins of the glenoid cavity. In order to calculate the AI, the distance from the baseline to the lateral margin of the acromion was measured and then divided by the distance from the baseline to the lateral aspect of the humeral head. The AA was defined as the angle formed by the intersecting line drawn tangent to the sclerotic line of the acromion undersurface and the baseline point. The AI and AA were determined in three groups: 165 patients (average age, 60.2 years) with chronic shoulder symptoms; in an age and gender-matched acute injury group of 61 patients (average age, 44.3 years); and in an age and gender-matched control group of 63 volunteers (average age, 37.3 years).The average AI and standard deviation was 0.72 +/- 0.06 in shoulders with subacromial impingement syndrome, 0.59 +/- 0.06 in those with acute injury, and 0.66 ± 0.06 in normal shoulders. The average AA and standard deviation was 76.8°+/-7.02 in shoulders with subacromial impingement syndrome, 84.2°+/-7.81 in those with acute injury, and 80.0°+/- 7.33 in normal shoulders. The AI and AA varied between patients with acute and chronic shoulder problems.

Hay escasez de datos que reflejen la relación entre la morfología y la incidencia de los trastornos de hombro con respecto a la población de origen chino. Se utilizó radiografías anteroposteriores para medir el índice acromial (IA) y ángulo acromioglenoido (AA) de los pacientes chinos. La línea de base se define como la que conecta los márgenes óseos superior e inferior de la cavidad glenoidea. Con el fin de calcular el IA, se midió la distancia desde la línea base hasta el margen lateral del acromion y luego se dividió por la distancia desde la línea base hasta la cara lateral de la cabeza humeral. El AA se define como el ángulo formado por la línea de intersección dibujada tangente a la línea esclerótica de la superficie inferior del acromion y el punto de línea base. El AI y AA se determinaron en tres grupos: 165 pacientes (edad media, 60,2 años) con síntomas crónicos en el hombro; en un grupo de 61 pacientes (edad media, 44,3 años) con herida aguda, y en un grupo control de 63 voluntarios (edad media, 37,3 años). La IA promedio fue de 0,72 +/- 0,06 en los hombros con el síndrome de pinzamiento subacromial, 0,59 +/- 0,06 en los pacientes con lesión aguda, y 0,66 +/- 0,06 en los hombros normales. El AA promedio fue de 76,8 ° +/- 7,02 en los hombros con el síndrome de pinzamiento subacromial, 84,2 ° +/- 7,81 en los pacientes con lesión aguda, y 80,0 ° +/- 7,33 en los hombros normales. La IA y AA variaron entre los pacientes con problemas en el hombro agudos y crónicos.

Técnica de Copeland Kessel versus técnica de Bosworth en el tratamiento de la luxación acromio clavicular tipo III - V / Copeland Kessel technical versus Bosworth technical in treatment of acromio-clavicular dislocation type III - V

La luxación acromioclavicular es una patología condicionada por problemas traumáticos y aplicación de sobrecarga, que da como resultado una lesión del sistema capsulo-ligamentario y muscular, que conlleva a una lesión incapacitante al individuo que la padece; por lo general son del sexo masculino y por un mecanismo de lesión con contusión directa en la punta del hombro. La técnica de Copeland Kessel, es una alternativa para su estabilización, basándonos en la baja tasa de complicaciones y la reincorporación del paciente a su vida normal al cabo de 12 semanas(AU)

Acromioclavicular dislocation is a condition influenced by trauma and application problems of overload that results in injury to the capsular ligamentous system and muscle that leads to a disabling injury to the person who suffers it, usually are male and the mechanism is a direct contusion injury on the tip of the shoulder. Copeland Kessel technique is an alternative for stabilization, based on the low rate of complications and the patient return to normal alter 12 weeks(AU)

Associação clínico-radiográfica do índice acromial e do ângulo de inclinação lateral do acrômio / Association clinical-radiographic of the acromion índex and the lateral acromion angle

OBJETIVO: Avaliar o perfil clínico-radiográfico correlacionando sintomatologia de doença subacromial com adaptação da medida do ângulo de inclinação lateral do acrômio para uma mensuração radiográfica e seu respectivo índice acromial. MÉTODOS: No período de outubro de 2010 a fevereiro de 2011 foram avaliados 55 ombros dolorosos, com teste de Neer e radiografia em anteroposterior verdadeiro. Os pacientes foram divididos em dois grupos, com teste de Neer positivo e negativo. A aferição do índice acromial e do ângulo de inclinação lateral do acrômio foi padronizada e comparada através de médias estatísticas em 0,7 e 75º, respectivamente. RESULTADOS: Houve predomínio na população sintomática, do sexo feminino (72,73%), idade menor que 59 anos (62,5%) e lado dominante (65,31%). O índice acromial acima de 0,7 mostrou-se sintomático em 66,67% e a inclinação lateral do acrômio menor que 75º em 82,61%. Quando associados os métodos, 62,5% apresentavam clínica positiva (p < 0,083). CONCLUSÃO: A determinação radiográfica do índice acromial e da inclinação lateral do acrômio conjuntamente parecem estar associadas estatisticamente com a doença do impacto subacromial.

OBJECTIVE: To evaluate the clinical-radiographic subacromial disease symptoms correlated with adaptation of the measure of lateral acromion angle and its respective measuring ra diographic acromial index. METHODS: In the period between october 2010 and february 2011 were evaluated 55 painful shoulders with Neer test and true anteroposterior radiogra phy. Patients were divided into two groups, with Neer test positive and negative. The index measuring the acromion and the lateral acromion angle have been standardized, and compared using statistical averages of 0.7 and 75º, respec tively. RESULTS: The predominant symptom in the population, females (72.73%), age less than 59 years (62.5%) and domi nant side (65.31%). The acromion index above 0.7 was found to be symptomatic in 66.67% and lateral acromion angle less than 75 º in 82.61%. When associated methods, 62.5% had positive clinical (p<0.083). CONCLUSION: The determination of radiographic acromial index and the lateral acromion angle together seem to be statistically associated with the disease of subacromial impingement.

Fratura do acrômio associada a lesão arterial: relato de caso / Fracture of the acromion associated with arterial lesion: case report

A fratura do acrômio com lesão arterial é uma associação rara. O quadro clínico caracteriza-se por dor no ombro, incapacidade funcional e edema do membro acometido, com pulso e temperatura distais diminuídos. A radiografia do ombro e a arteriografia definem o diagnóstico e auxiliam na evolução pós-operatória. Os autores relatam um caso raro de fratura da base do acrômio associada a lesão da artéria ulnar ipsilateral, seu tratamento, bem como a avaliação pré e pós-operatória.

Fracture of the acromion and arterial injury are a rare association. The clinical picture is characterized by shoulder pain, functional disability and swelling of the affected limb with decreased distal pulse and temperature. Radiography of the shoulder and arteriography define the diagnosis and assist in postoperative follow-up. The authors report a rare case of fracture of the acromion associated with injury of the ipsilateral ulnar artery and describe its treatment, as well as pre- and postoperative evaluations.

Tratamento cirúrgico para os acromiale sintomático / Surgical treatment of symptomatic os acromiale

Foi avaliado o tratamento cirúrgico do os acromiale associado à síndrome do impacto. Entre janeiro de 1995 e outubro de 2006, 44 pacientes foram submetidos a tratamento cirúrgico, compondo 50 ombros dolorosos associados à síndrome do impacto e ao os acromiale, refratários ao tratamento clínico e fisioterápico realizado durante 6 meses. A idade média dos pacientes, na ocasião da cirurgia, foi de 44 anos e 6 meses (mínimo de 28 e máximo de 65 anos), sendo 21 (47,7%) do sexo masculino e 23 (52,3%) do sexo feminino. Houve 31 (63%) os acromiales classificados como terminal, 17 (34%) como mediano e dois (4%) basal. O tempo de seguimento médio após a cirurgia foi de 67,3 meses (mínimo de 2 anos e 2 meses e máximo de 13 anos e 9 meses). A técnica cirúrgica adotada foi ressecção do os acromiale do tipo terminal, seguida pela redução aberta e fixação nos tipos mediano e basal. A sutura do manguito rotador foi realizada quando este foi lesado, seguida de imobilização no pós-operatório por quatro semanas e reabilitação fisioterápica. Os resultados foram classificados de acordo com protocolo de reabilitação da Universidade da Califórnia em Los Angeles (UCLA), sendo 10 (20%) excelentes, 31 bons (62%), 7 (14%) regulares e 2 (4%) ruins, mostrando a superioridade do tratamento cirúrgico associado a um diagnóstico preciso no tratamento dessa entidade nosológica.

A surgical treatment of the os acromiale associated with the impingement syndrome was evaluated. Between January 1995 and October 2006, 44 patients were submitted to surgical treatment, consisting of 50 painful shoulders associated with the impingement syndrome and with the os acromiale resistant to clinical and physical therapy performed during 6 months. The mean age of the patients, at the time of surgery, was 44 years and 6 months (minimum of 28 and maximum 65 years), of which 21 (47.7%) were male and 23 (52.3%) female. There were 31 (63%) os acromiales classified as terminal, 17 (34%) as median and 2 (4%) basal. Time of mean follow-up after surgery was 67.3 months (minimum of 2 years and 2 months and maximum 13 years and 9 months). Excision surgical technique for terminal os acromiale was adopted, followed by open reduction and fixation in the median and basal types. The suture of the rotator cuff tear was carried out when it was injured, followed by immobilization in the postoperative period for four weeks, and physical therapy rehabilitation. The results were classified according to the University of California at Los Angeles (UCLA) rehabilitation protocol, being 10 (20%) excellent, 31 (62%) good, 7 (14%) regular and 2 (4%) poor, showing advantage in surgical treatment associated with a precise diagnosis in the treatment of this nosological entity.