Condutas cinesioterapêuticas no tratamento das tendinopatias do manguito rotador em atletas de voleibol de quadra / Kinesiotherapeutic conducts in the treatment of rotator cuff tendinopathies in indoor volleyball athletes

Introdução: o ombro do jogador de voleibol é suscetível a lesões resultantes de sobrecargas biomecânicas e movimentos repetitivos. As frequentes queixas de dor nessa articulação evidenciam o elevado volume de ações motoras unilaterais em alta velocidade acima da cabeça, atingindo o manguito rotador (MR) e gerando limitação funcional na prática desportiva. As tendinopatias do MR, formado pelos músculos subescapular, redondo menor, infraespinhal e supraespinhal, atingem comumente os tendões do supraespinhal e do infraespinhal. Objetivo: descrever as condutas cinesioterapêuticas utilizadas no tratamento das tendinopatias do MR em atletas de voleibol de quadra. Metodologia: pesquisaram-se as bases de dados MEDLINE, SciELO e BVS. Descritores: lesões do ombro, manguito rotador, atletas, voleibol e Terapia por Exercício (pesquisados em inglês), associados dois a dois ou três a três, dentre os quais o termo atletas ou voleibol sempre foi mantido. Foram incluídos artigos de revisão, artigos originais, ensaios clínicos e estudos de coorte publicados em português e inglês, entre os anos de 2009 e 2019. Resultados: inicialmente a busca resultou em 480 artigos. Após o processo de seleção, seis estudos foram revisados na íntegra e incluídos na síntese qualitativa. Conclusão: as principais condutas cinesioterapêuticas descritas foram: fortalecimento dos rotadores externos, dos músculos do tronco, da coluna e periescapulares, alongamento da região posterior do ombro e mobilizações articulares.

Introduction: the volleyball player's shoulder is susceptible to injuries resulting from biomechanical overloads and repetitive movements. The frequent complaints of pain in this joint highlight the high volume of unilateral motor actions at high speed above the head, reaching the rotator cuff (RC) and generating functional limitation in sports. RC tendinopathies, formed by the subscapularis, teres minor, infraspinatus and supraspinatus muscles, commonly affect the supraspinatus and infraspinatus tendons. Objective: to describe the kinesiotherapeutic conducts used in the treatment of RC tendinopathies in indoor volleyball athletes. Methodology: MEDLINE, SciELO and VHL databases were searched. Descriptors: shoulder injuries, rotator cuff, athletes, volleyball and Exercise Therapy (searched in English), associated two by two or three by three, among which the term athletes or volleyball was always maintained. Review articles, original articles, clinical trials and cohort studies published in Portuguese and English between 2009 and 2019 were included. Results: initially the search resulted in 480 articles. After the selection process, six studies were fully reviewed and included in the qualitative synthesis. Conclusion: the main kinesiotherapeutic procedures described were strengthening of the external rotators, trunk, spine and periscapular muscles, stretching of the posterior region of the shoulder and joint mobilizations.

Shoulder Injury Related to Vaccine Administration: Case Series / Lesão de ombro relacionada à administração de vacina: Série de casos

Abstract Objective Shoulder pain is a common presentation in the primary care setting, and shoulder pain after vaccination has a growing body of literature. The present study sought to understand how a standardized treatment protocol would aid patients experiencing shoulder injury related to vaccine administration (SIRVA). Methods Patients experiencing SIRVA were retrospectively recruited between February 2017 and February 2021. All patients were treated with physical therapy and offered a cortisone injection. Post-treatment range of motion (i.e., forward elevation, external rotation, internal rotation) and patients' reported outcomes were collected with the visual analogue scale (VAS), American Shoulder and Elbow Surgeons (ASES), simple shoulder test (SST), and single assessment numeric evaluation (SANE) scores. Results A total of 9 patients were retrospectively examined. Among them, 6 patients presented within one month of a recent vaccination event, while 3 patients presented 67, 87, and 120 days after vaccination. Furthermore, 8 of the patients completed physical therapy, and 6 of them underwent a cortisone injection. The follow-up time averaged 8 months. At final follow-up, the mean external rotation was 61º (standard deviation, SD±3º) and the mean forward elevation was 179º (SD±45º). Internal rotation ranged between L3 and T10. The VAS pain scores were 3.5/10.0 (SD±2.4), the mean ASES score was 63.5/100.0 (SD±26.3), and the SST scores were 8.5/12.0 (SD±3.9). Finally, the SANE scores were 75.7/100.0 (SD±24.7) and 95.7/100.0 (SD±6.1) in the injured and contralateral shoulders respectively. Conclusion Shoulder pain after a vaccination treated with physical therapy and cortisone injection ultimately resulted in favorable shoulder range of motion and functional score outcomes. Level of Evidence IV

Resumo Objetivo A dor no ombro é um quadro comum na atenção primária e há cada vez mais relatos acerca de sua ocorrência após a vacinação. Este estudo buscou entender como um protocolo de tratamento padronizado ajudaria pacientes com lesão no ombro relacionada à administração de vacina (SIRVA). Métodos Os pacientes com SIRVA foram recrutados de forma retrospectiva entre fevereiro de 2017 e fevereiro de 2021. Todos os pacientes foram submetidos à fisioterapia e receberam uma prescrição de cortisona injetável. A amplitude de movimento pós-tratamento (ou seja, elevação anterior, rotação externa, rotação interna) e os desfechos relatados pelo paciente foram analisados a partir das pontuações da escala visual análoga (EVA), da American Shoulder and Elbow Surgeons (ASES), do teste simples do ombro (SST) e da avaliação numérica única (SANE). Resultados No total, 9 pacientes foram examinados de maneira retrospectiva. Entre eles, 6 pacientes foram atendidos no primeiro mês após a vacinação e os outros três, depois de 67, 87 e 120 dias. Ademais, 8 dos pacientes fizeram todo o tratamento fisioterápico e 6 receberam uma injeção de cortisona. O período médio de acompanhamento foi de 8 meses. À última consulta, a rotação externa média foi de 61° (desvio padrão, DP±3°)ea elevação anterior média foi de 179° (DP ± 45°). A rotação interna variou entre L3 e T10. As pontuações de dor à EVA foram de 3,5/10,0 (DP ± 2,4) e o escore médio ASES foi de 63,5/100,0 (DP ± 26,3); as pontuações de SST foram 8,5/12,0 (DP ± 3,9). Por fim, os escores de SANE foram de 75,7/100,0 (DP ± 24,7) e 95,7/100,0 (DP ± 6,1) nos ombros lesionados e contralaterais, respectivamente. Conclusão A dor no ombro após a vacinação tratada com fisioterapia e injeção de cortisona melhorou a amplitude de movimento e os escores funcionais. Nível de Evidência IV

Are Previous Joint Injuries Associated with Muscle Performance in Volleyball Athletes? / Lesões articulares prévias são associadas ao desempenho muscular de jogadores de voleibol?

Abstract Objective The aim of the present study is to determine whether previous shoulder and knee injuries were associated with isokinetic fatigue index and agonist/antagonist ratio of shoulder internal/external rotators and knee flexors/extensors in male volleyball athletes. Methods The current study is a cross-sectional investigation of 49 male elite volleyball players competing at a high level in Brazil. Isokinetic fatigue index and agonist/antagonist profiles were assessed during the preseason. Additionally, in order to record previous injuries, the athletes answered a standardized questionnaire. We conducted a receiver operating characteristic (ROC) curve analysis to determine the association strength and the clinically relevant cut-off point for variables presenting statistical significance for the area under the curve (AUC) (α = 0.05). An independent t-test was used to compare isokinetic variables between athletes with and without previous injury (α = 0.05). Results The results of the ROC curve analysis indicated that hamstring fatigue index values at 300o/s were associated with the presence of previous knee injury (area under the curve [AUC] = 73%, p= 0.004), and shoulder external rotators fatigue index values at 360°/s were not associated with the presence of previous shoulder injury (AUC = 68%, p= 0.053). Conclusions Elite volleyball athletes who reported previous knee injuries were prone to a higher fatigue index than those reporting no injuries. Knee flexor resistance training might be useful for those athletes who reported knee injuries in the previous season.

Resumo Objetivo O objetivo deste estudo é determinar se lesões prévias de ombro e joelho estavam associadas ao índice de fadiga isocinética e razão agonista/antagonista dos rotadores internos/externos do ombro e flexores/extensores do joelho em jogadores de voleibol. Métodos Esta é uma investigação transversal com 49 jogadores de voleibol de elite que competem em alto nível no Brasil. O índice de fadiga isocinética e os perfis de agonistas/antagonistas foram avaliados durante a pré-temporada. Além disso, para registro de lesões anteriores, os atletas responderam a um questionário padronizado. Conduzimos uma análise da curva de característica de operação do receptor (receiver operating characteristic, ROC) para determinar a força de associação e o ponto de corte clinicamente relevante de variáveis com significância estatística na área sob a curva (AUC) (α = 0,05). Um teste t independente comparou as variáveis isocinéticas entre atletas com e sem lesão prévia (α = 0,05). Resultados Os resultados da análise da curva ROC indicam que os valores do índice de fadiga dos isquiotibiais a 300o/s foram associados à presença de lesão prévia no joelho (área soba a curva [AUC] = 73%, p= 0,004), enquanto os valores do índice de fadiga dos rotadores externos do ombro a 360°/s não foram associados à presença de lesão prévia no ombro (AUC = 68%, p= 0.053). Conclusões Atletas de voleibol de elite que relataram lesões anteriores no joelho estavam propensos a um índice de fadiga maior do que aqueles que não relataram lesões. O treinamento de resistência de flexores do joelho pode ser útil para atletas com relatos de lesões no joelho na temporada anterior.

Clinical characteristics and significance of the supraspinatus fragment in proximal humeral fractures / 中华骨科杂志

Objective:To investigate the clinical characteristics and significance of supraspinatus fragments in proximal humerus fractures.Methods:A total of 210 patients with proximal humerus fractures who underwent surgical treatment in the Department of Orthopaedic and Trauma Surgery, Affiliated Hospital of Yunnan University from July 2016 to December 2020 were retrospectively analyzed. There were 91 males and 119 females, aged 52.4±11.3 years (range, 18-87 years). Preoperatively, the shoulder joint X-ray, CT and 3D reconstruction, and MRI were evaluated for the presence of a small fracture mass on the lateral side of the interarticular sulcus and an "M" shaped fracture mass at the interarticular sulcus. Intraoperative observation, management, postoperative functional exercise and follow-up were performed by the same group of doctors. Postoperative outpatient review was performed at 2, 4, 6, 12, and 24 weeks, shoulder joint X-ray and CT were taken at 2, 6, and 24 weeks to observe the presence of subacromial displaced bone mass. Constant-Murley scale was used to assess shoulder joint function.Results:All 210 patients completed the surgery successfully, and none of them had vascular, nerve or ligament injuries during the operation. According to Neer's classification: 59 cases of two-part humeral greater tuberosity fractures, 36 cases of two-part humeral surgical neck fractures, 50 cases of three-part humeral greater tuberosity fractures, and 65 cases of four-part proximal humeral fractures. 61.0% (128/210) of the patients showed the presence of a supraspinatus fragment on preoperative imaging, including 42 two-part humeral greater tuberosity fractures, 1 two-part humeral surgical neck fracture, and 31 three-part humeral greater tuberosity fractures with a small lateral fracture mass over the intertubular groove; 54 four-part proximal humeral fractures had an "M" shaped fracture mass containing the intertubular groove. All patients were followed up for 11.8±2.4 months (range, 6-20 months). Postoperative X-ray showed that all fractures healed, and the healing time was 3.4±0.3 months (range, 3-5 months). The Constant-Murley scale of the shoulder joint was 86.3±11.5 (range, 61-100).Conclusion:Supraspinatus fragments are more common in proximal humerus fractures. Proper recognition and management of supraspinatus fragments can help understand the mechanism of proximal humeral fracture occurrence, the relationship between fracture displacement and rotator cuff injury, reduce the incidence of postoperative complications, and improve the shoulder joint function.

Outcomes of using long head of biceps tendon transposition to augment arthroscopic massive rotator cuff repair / 中华创伤杂志

Objective:To investigate the outcome of using long head of biceps tendon (LHBT) transposition to augment arthroscopic massive rotator cuff repair.Methods:A retrospective case series study was performed on 22 patients with massive rotator cuff tear treated in Zhongshan Hospital, Xiamen University from June 2019 through July 2020, including 12 males and 10 females, aged 54-79 years [(63.9±6.8)years]. LHBT transposition was performed to augment arthroscopic repair of massive rotator cuff tear. The active range of motion (forward flexion, abduction, external rotation), visual analog scale (VAS), University of California Los Angeles (UCLA) score and American Shoulder and Elbow Surgeons (ASES) score were compared preoperatively and at 3 months and 12 months postoperatively. The cuff integrity was evaluated using MRI following Sugaya classification at 12 months postoperatively. LHBT dislocation or distal retraction was recorded at the last follow-up.Results:All patients were followed up for 12-24 months [(17.0±3.8)months]. The postoperative 3-month active forward flexion [162.5(160.0, 170.0)°] and abduction [170.0(160.0, 170.0)°] were improved compared with preoperative measurements [90.0(73.8, 120.0)°,85.0(70.0, 112.5)°](all P<0.05). However, no statistically significant difference was found between the preoperative and postoperative 3-month external rotation [50.0(37.5,60.0)° vs. 60.0(48.8,70.0)°] ( P>0.05). The postoperative 12-month active forward flexion, abduction and external rotation were 170.0(160.0, 175.0)°, 170.0(170.0, 177.8)° and 60.0(48.8, 70.0)°, showing no significant improvement from those at 3 months postoperatively (all P>0.05). The postoperative 3-month VAS [1.0(0.8, 2.0)points], UCLA score [23.0(23.0, 25.0)points] and ASES score [79.1(72.9, 83.3)points] were improved significantly compared with preoperative measurements [7.0(8.0, 9.0)points, 9.0(10.0, 14.0)points, 25.0(16.6, 31.6)points] (all P<0.05). The postoperative 12-month UCLA score [33.0(31.0, 35.0)points] and ASES score [91.6(86.6, 93.3)points] were further improved compared with those at 3 months postoperatively (all P<0.05). However, the postoperative 12-month VAS [0.0 (0.0, 1.0)points] showed no statistically significant difference with that at 3 months postoperatively ( P>0.05). The UCLA score was excellent in 6 patients and good in 16 at 12 months postoperatively.MRI revealed healed tendons with continuity in 16 patients, with the healing rate of 72.7%, and partially retears with good shoulder function in 6 patients, with the retearing rate of 17.3%. No LHBT dislocation or distal retraction was found at 12 months postoperatively in regardless of mild anterior shoulder pain in 2 patients. Conclusion:Using LHBT transposition to augment arthroscopic massive rotator cuff repair has yielded excellent shoulder range of motion, shoulder function recovery, pain relief and high tendon healing rate with rare postoperative complication.

Reverse Shoulder Arthroplasty: Evaluation of the Clinical and Functional Outcomes per Etiology / Artroplastia reversa de ombro: Avaliação dos resultados clínicos e funcionais de acordo com a etiologia

Abstract Objective The present study aimed to evaluate the clinical outcomes of reverse shoulder arthroplasty to treat several conditions. Methods Retrospective, longitudinal study analyzing the Constant and University of California at Los Angeles (UCLA) scores and range of motion of patients undergoing reverse shoulder arthroplasty. Results In total, 28 patients were analyzed, with a mean age of 75.6 years old. The mean duration of follow-up was 45 months. Overall, there was a significant variation (p< 0.0001) between the preoperative (10.2 points) and the postoperative UCLA scores (29.6 points), corresponding to a relative increase of approximately 200%. In addition, the mean Constant score was 67.8, and the complication rate was 17.8%. As for functional outcomes per etiology, fracture sequelae cases presented the best mean elevation (165°), Constant score (79 points), postoperative UCLA score (32.5 points), and absolute delta UCLA score increase (22 points), but with no statistical significance. However, cases operated for fracture sequelae showed significantly higher elevation (p= 0.027) and Constant score (p= 0.047) compared to rotator cuff arthropathy cases. In addition, the lowest mean postoperative Constant and UCLA scores were observed for the following etiologies: primary arthrosis, acute fracture, and arthroplasty revision. Conclusion Reverse shoulder arthroplasty showed satisfactory functional outcomes and may be a treatment option not only for rotator cuff arthropathy but for several other conditions.

Resumo Objetivo Avaliar os resultados clínicos da artroplastia reversa do ombro no tratamento de suas diversas indicações. Métodos Estudo longitudinal retrospectivo que analisou os resultados dos escores Constant, UCLA e amplitudes de movimentos dos pacientes submetidos à artroplastia reversa do ombro. Resultados Foram analisados 28 pacientes, a média de idade foi de 75.6 anos, com seguimento médio de 45 meses. No geral, obtivemos uma variação significativa (p< 0,0001) entre o escore UCLA pré-operatório (10,2 pontos) e o escore UCLA pós-operatório (29,6 pontos), o que corresponde a um aumento relativo de aproximadamente 200%. Além disso, obtivemos pontuação média do escore Constant de 67,8 e uma taxa de complicações de 17,8%. Quanto aos resultados funcionais segundo as indicações, os casos de sequela de fratura apresentaram as melhores médias de elevação (165°), escore Constant (79 pontos), escore UCLA pós-operatório (32,5 pontos) e aumento absoluto na variação do escore UCLA (22 pontos), sem significância estatística. Porém, identificou-se que os casos operados por sequela de fratura apresentaram elevação (p= 0,027) e pontuação no escore Constant (p= 0,047) significativamente maiores em relação aos casos de artropatia do manguito rotador. Além disso, observamos que as menores médias dos escores Constant e UCLA pós-operatórios foram obtidos nas seguintes etiologias: artrose primária, fratura aguda e revisão de artroplastia. Conclusão A artroplastia reversa de ombro apresentou resultados funcionais satisfatórios, podendo ser uma opção de tratamento não somente nos casos de artropatia do manguito rotador, mas também em várias outras patologias.

Intensive training effects on shoulder muscle injury in table tennis players / Efeitos do treinamento intensivo sobre a lesão muscular de ombro em tenistas de mesa / Efectos del entrenamiento intensivo en la lesión muscular del hombro en jugadores de tenis de mesa

ABSTRACT Introduction: The glenohumeral joint has the greatest range of motion. Its stability is relatively poor. It depends on muscle strengthening and increased proprioception in the articular and adjacent joint tissues. Muscle-strengthening training for this joint is still an empirical subject related to table tennis players. Objective: Explore muscle strengthening training's effect on shoulder muscle injury in table tennis players. Methods: Eight table tennis players from a university were selected as a research subject, separated, and classified between injured and control group. Three weeks of strengthening training were adopted to rehabilitate the rotator cuff injury of the table tennis team athletes. The joint angle test and kinematics were collected with isokinetic force measurement employing Cybex-6000. The EMG and other relevant data were collected before and after the experiment. Results: The infraspinatus strength test results of 8 athletes before the experiment were 1.88 ± 2.10 versus 1.61 ± 1.80 after the experiment; there was no change in pain among 5 of the eight athletes, the shoulder pain of 1 athlete increased, and the shoulder pain of the other 2 table tennis players decreased. Conclusion: Strengthening exercise by intensive shoulder training proved effective in conjunction with traditional rehabilitation, positively influencing hypertrophy and proprioception of the joint complex. Evidence Level II; Therapeutic Studies - Investigating the results.

RESUMO Introdução: A articulação glenoumeral é a que possui maior liberdade de movimento e sua estabilidade é relativamente precária, dependendo do fortalecimento muscular, da propriocepção da capsula articular e tecidos adjacentes. O treinamento de reforço muscular nessa articulação ainda é um tema empírico relacionado aos jogadores de tênis de mesa. Objetivo: Explorar o efeito do treinamento de reforço muscular na lesão muscular do ombro de jogadores de tênis de mesa. Métodos: Oito jogadores de tênis de mesa de uma universidade foram selecionados como objeto de pesquisa, separados e classificados entre lesionados e grupo controle. Três semanas de treinamento de reforço foram adotadas para reabilitar a lesão do manguito rotador dos atletas da equipe de tênis de mesa. Foram coletados dados no teste de ângulo articular e cinemática com medição de força isocinética empregando Cybex-6000, além de coleta de dados via EMG e outros dados relevantes antes e depois do experimento. Resultados: Os resultados do teste de força muscular do infra-espinal de 8 atletas antes da experiência foram de 1,88 ± 2,10 contra 1,61 ± 1,80 após o experimento; não houve alteração na dor entre 5 dos 8 atletas, a dor no ombro de 1 atleta aumentou e a dor no ombro dos outros 2 jogadores de tênis de mesa diminuiu. Conclusão: O exercício de reforço por treinamento intensivo sobre a lesão no ombro mostrou-se eficaz em conjunto com a reabilitação tradicional, influenciando positivamente na hipertrofia e na propriocepção do complexo articular. Nível de evidência II; Estudos Terapêuticos - Investigação de Resultados.

RESUMEN Introducción: La articulación glenohumeral tiene la mayor libertad de movimiento y su estabilidad es relativamente precaria, dependiendo del fortalecimiento muscular, la propiocepción de la cápsula articular y los tejidos adyacentes. El entrenamiento de fortalecimiento muscular de esta articulación sigue siendo un tema empírico relacionado con los jugadores de tenis de mesa. Objetivo: Explorar el efecto del entrenamiento de fortalecimiento muscular sobre el daño muscular del hombro en jugadores de tenis de mesa. Métodos: Se seleccionaron ocho jugadores de tenis de mesa de una universidad como objeto de la investigación, se separaron y clasificaron entre el grupo de lesionados y el de control. Se adoptaron tres semanas de entrenamiento de fortalecimiento para rehabilitar la lesión del manguito rotador de los atletas del equipo de tenis de mesa. Se recogieron datos en la prueba de ángulo articular y en la cinemática con medición de fuerza isocinética empleando el Cybex-6000, además de la recogida de datos mediante EMG y otros datos relevantes antes y después del experimento. Resultados: Los resultados de la prueba de fuerza del músculo infraespinoso de 8 atletas antes del experimento fueron de 1,88 ± 2,10 frente a 1,61 ± 1,80 después del experimento; no hubo cambios en el dolor entre 5 de los 8 atletas, el dolor de hombro de 1 atleta aumentó y el de los otros 2 jugadores de tenis de mesa disminuyó. Conclusión: El ejercicio de fortalecimiento mediante entrenamiento intensivo en la lesión de hombro demostró ser eficaz junto con la rehabilitación tradicional, influyendo positivamente en la hipertrofia y la propiocepción del complejo articular. Nivel de evidencia II; Estudios terapéuticos - Investigación de resultados.

Arthroscopy Limits on Anterior Shoulder Instability / Limites da artroscopia na instabilidade anterior do ombro

Abstract Much is discussed about the limits of the treatment of anterior shoulder instability by arthroscopy. The advance in understanding the biomechanical repercussions of bipolar lesions on shoulder stability, as well as in the identification of factors related to the higher risk of recurrence have helped us to define, more accurately, the limits of arthroscopic repair. We emphasize the importance of differentiation between glenoid bone loss due to erosion (GBLE) and glenoid edge fractures, because the prognosis of treatment differs between these forms of glenoid bone failure. In this context, we understand that there are three types of bone failure: a) bone Bankart (fracture); b) combined; and c) glenoid bone loss due to anterior erosion (GBLE), and we will address the suggested treatment options in each situation. Until recently, the choice of surgical method was basically made by the degree of bone involvement. With the evolution of knowledge, the biomechanics of bipolar lesions and the concept of glenoid track, the cutoff point of critical injury, has been altered with a downward trend. In addition to bone failures or losses, other variables were added and made the decision more complex, but a little more objective. The present update article aims to make a brief review of the anatomy with the main lesions found in instability; to address important details in arthroscopic surgical technique, especially in complex cases, and to bring current evidence on the issues of greatest divergence, seeking to guide the surgeon in decision making.

Resumo Muito se discute sobre os limites do tratamento da instabilidade anterior do ombro por artroscopia. O avanço no entendimento das repercussões biomecânicas das lesões bipolares sobre a estabilidade do ombro, bem como na identificação de fatores relacionados ao maior risco de recidiva têm nos ajudado a definir, de forma mais apurada, os limites do reparo por via artroscópica. Ressaltamos a importância de diferenciação entre perda óssea por erosão da glenoide (POAG) e fraturas da borda da glenoide, pois o prognóstico do tratamento diverge entre essas formas de falha óssea da glenoide. Neste contexto, entendemos que há três tipos de falha óssea: a) Bankart ósseo (fratura); b) combinada; e c) POAG, e abordaremos as opções de tratamento sugerido em cada situação. Até há pouco tempo, a escolha do método cirúrgico era norteada basicamente pelo grau de acometimento ósseo. Com a evolução do conhecimento, da biomecânica das lesões bipolares e do conceito do glenoid track (trilho da glenoide), o ponto de corte da lesão crítica, vem sendo alterado com tendência de queda. Além das falhas ou perdas ósseas, outras variáveis foram adicionadas e tornaram a decisão mais complexa, porém um pouco mais objetiva. O presente artigo de atualização tem como objetivo fazer uma breve revisão da anatomia com as principais lesões encontradas na instabilidade; abordar detalhes importantes na técnica cirúrgica artroscópica, em especial nos casos complexos, e trazer as evidências atuais sobre os assuntos de maior divergência, buscando guiar o cirurgião na tomada de decisão.

Relationship between rotator cuff muscle function and shoulder abduction function in patients with posterior superior rotator cuff tear: a dynamic biomechanical study / 中华创伤杂志

Objective:To evaluate the relationship of rotator cuff muscle function with shoulder abduction function after posterior superior rotator cuff tear via dynamic biomechanical study.Methods:By using the customized dynamic shoulder biomechanical testing system, seven freshly frozen cadaveric shoulders were used to stimulate shoulder abduction at 90° under four statuses: (1) intact rotator cuff with activation (normal rotator cuff group); (2) posterior superior rotator cuff tear with activation (posterior superior rotator cuff tear with activation group); (3) posterior superior rotator cuff tear with posterior superior rotator cuff deactivation (posterior superior rotator cuff tear with deactivation group); (4) none rotator cuff tissue above the geometric rotation center of the humeral head with deactivation (global tear group). The peak and stable value of middle deltoid force were used to evaluate biomechanical status in different rotator cuff tear conditions during shoulder abduction procedure. The peak subacromial pressure, average subacromial pressure, subacromial contact area, and subacromial force were used to evaluate subacromial pressed conditions under different rotator cuff tear conditions. The peak and stable ratio of glenohumeral contact force/middle deltoid force were used to evaluate shoulder stability under different rotator cuff tear conditions.Results:During dynamic abduction at 90°, the peak and stable value of middle deltoid force were (42.1±8.7)N and (29.9±7.4)N in normal rotator cuff group, (45.7±10.3)N and (30.5±7.2)N in posterior superior rotator cuff tear with activation group, and (48.4±13.4)N and (29.9±4.8)N in posterior superior rotator cuff tear with deactivation group (all P>0.05). But the peak and stable value of middle deltoid force were (69.7±9.7)N and (53.7±8.9)N in global tear group, significantly increased compared with other three groups (all P<0.05). The elevated middle deltoid force increased the subacromial contact pressure between glenohumeral head and acromion. The peak subacromial pressure, average subacromial pressure, subacromial contact area, and subacromial force were (0.40±0.05)MPa, (0.22±0.03)MPa, (7.71±5.09)mm 2, and (1.66±1.06)N respectively in normal rotator cuff group, (0.41±0.05)MPa, (0.26±0.07)MPa, (12.71±11.35)mm 2, and (2.93±2.46)N respectively in posterior superior rotator cuff tear with activation group, and (0.50±0.12)MPa, (0.26±0.07)MPa, (17.29±9.11)mm 2, and (4.09±1.46)N respectively in posterior superior rotator cuff tear with deactivation group (all P>0.05). However, the peak subacromial pressure, average subacromial pressure, subacromial contact area, and subacromial force were (3.64±1.70)MPa, (0.98±0.49)MPa, (47.63±11.91)mm 2, and (45.48±23.86)N respectively in global tear group, significantly higher than those in other three groups (all P<0.05). The peak and stable ratio of glenohumeral contact force/middle deltoid force were 2.24±0.30 and 2.46±0.13 in normal rotator cuff group, 2.21±0.19 and 2.52±0.08 in posterior superior rotator cuff tear with activation group, and 2.03±0.14 and 2.42±0.16 in posterior superior rotator cuff tear with deactivation group (all P>0.05). However, the peak and stable ratio of glenohumeral contact force/middle deltoid force were 1.40±0.14 and 1.52±0.41 in global tear group, significantly higher than those in other three groups (all P<0.05). No significant differences of the above parameters were observed in posterior superior rotator cuff tear with activation group, posterior superior rotator cuff tear with deactivation group and global tear group (all P>0.05). Conclusions:After posterior superior rotator cuff tear, rotator cuff muscle function does not affect the whole abduction function of shoulder. When the size of rotator cuff tear involves the whole superior humeral head rotation center, the normal abduction function of shoulder will be significantly impaired.

Application of ultrasound-guided adhesiolysis combined with platelet-rich plasma in the treatment of rotator cuff injuries / 中国基层医药

Objective:To investigate the efficacy of ultrasound-guided adhesiolysis combined with platelet-rich plasma in the treatment of rotator cuff injuries.Methods:The clinical data of 103 patients with rotator cuff injuries treated in The 72 nd Military Hospital of PLA from December 2017 to December 2019 were retrospectively analyzed. The patients were divided into two groups according to the treatment methods. The control group ( n = 48) was treated with ultrasound-guided adhesiolysis. The study group ( n = 55) was treated with ultrasound-guided adhesiolysis and intra-articular injection of platelet rich plasma. Therapeutic effects, pain score, shoulder function score, shoulder range of motion, healing rate, and re-tear rate were compared between the control and study groups. Results:Total effective rate was significantly higher in the study group than in the control group (96.36% vs. 81.25%, χ2 = 6.14, P < 0.05). Pain score in each group was significantly decreased after treatment compared with before treatment [study group: (1.69 ± 0.81) points vs. (6.13 ± 1.28) points; control group: (3.22 ± 1.05) points vs. (6.13 ± 1.28) points, t = 31.510, 8.33, both P < 0.001]. The University of California at Los Angeles (UCLA) shoulder score in each group was significantly increased after treatment compared with before treatment [study group: (33.26 ± 3.81) points vs. (14.03 ± 2.96) points; control group: (28.81 ± 3.20) points vs. (13.92 ± 3.03) points, t = 42.13, 33.12, both P < 0.001]. Constant-Murley Score in each group was significantly increased after treatment compared with before treatment [study group: (94.22 ± 4.15) points vs. (55.29 ± 8.18) points; control group: (82.11 ± 8.13) points vs. (56.33 ± 7.83) points; t = 46.83, 22.38, both P < 0.001]. After treatment, pain score was significantly lower in the study group than in the control group [(1.69 ± 0.81) points vs. (3.22 ± 1.05) points, t = 8.33, P < 0.001]. UCLA score and CMS were significantly higher in the study group than in the control group [(33.26 ± 3.81) points vs. (28.81 ± 3.20) points, (94.22 ± 4.15) points vs. (82.11 ± 8.13) points, t = 6.37, 9.70, both P < 0.001]. After treatment, there were improvements in flexion [study group: (159.26 ± 13.51)° vs. (85.26 ± 11.35)°; control group: (150.22 ± 14.35)° vs. (86.33 ± 11.51)°; t = 45.15, 34.23, both P < 0.001], internal rotation at 90° abduction [study group: (83.64 ± 5.29)° vs. (60.33 ± 4.12)°; control group: (76.81 ± 4.82)° vs. (60.61 ± 4.51)°; t = 36.74, 24.06, both P < 0.001], abduction [study group: (161.29 ± 10.76)° vs. (72.91 ± 5.16)°; control group: (152.81 ± 11.84) ° vs. (73.26 ± 5.22)°; t = 82.34, 64.61, both P < 0.001], external rotation at 90° abduction [study group: (87.82 ± 3.04)° vs. (4.29 ± 5.18)°; control group: (80.22 ± 4.13)° vs. (80.22 ± 4.13)°; t = 42.46, 21.55, both P < 0.001] , and external rotation in neutral position [study group: (43.18 ± 3.20)° vs. (22.85 ± 4.12)°; control group: (37.26 ± 4.12)° vs. (22.64 ± 3.95)°; t = 41.19, 25.10, both P < 0.001] in each group compared with before treatment. After treatment, range of motion of the shoulder in the above positions was significantly higher in the study group than in the control group [flexion: (159.26 ± 13.51)° vs. (150.22 ± 14.35)°; internal rotation at 90° abduction: (83.64 ± 5.29)° vs. (76.81 ± 4.82)°; abduction: (161.29 ± 10.76)° vs. (152.81 ± 11.84)°; external rotation at 90° abduction: (87.82 ± 3.04)° vs. (80.22 ± 4.13)°; external rotation in neutral position: (43.18 ± 3.20)° vs. (37.26 ± 4.12)°, t = 3.29, 6.81, 3.81, 10.72, 8.20, all P < 0.001]. There was no significant difference in healing rate between the study and control groups (1.82% vs. 16.67%, χ2 = 5.35, P < 0.05). Conclusion:Ultrasound-guided adhesiolysis combined with platelet-rich plasma is highly effective in the treatment of rotator cuff injuries because it can greatly improve shoulder function, reduce pain degree, and increase the range of motion of the shoulder.

Bifocal Stabilisation of Acute Acromioclavicular Joint Dislocation using Suture Anchor and Temporary K-Wires: A Retrospective Analysis

@#Introduction: The acromioclavicular joint (ACJ) is a major link connecting the upper limb to the torso. The acromioclavicular and coracoclavicular (CC) ligaments help in stabilising the joint. We feel it is prudent to address both these ligament injuries, to achieve optimum result. This study was undertaken to analyse the results of a simple frugal surgical technique we used to deal with this injury considering stabilisation for both these ligaments. Materials and methods: In this retrospective study, skeletally mature patients with Type III, IV or V ACJ dislocations who underwent open reduction and stabilisation of the joint with temporary K-wires, repair of the capsule and augmentation of CC ligaments with suture anchors were included. Clinico-radiological and functional outcome was evaluated. Functional assessment of the upper limb was analysed using the Disabilities of Arm, Shoulder, and Hand Score (DASH), Constant shoulder score (CSS) and Oxford shoulder score (OSS). Results: Clinical and radiological evaluation of the 32 patients who had completed two years from the index surgery, was done. Out of the 37 patients included initially, five were lost in follow-up. Majority of the subjects included were males and type V was the most common injury. Mean pre-operative CC distance on the affected side was 13.92±4.94mm. In the immediate post-operative radiograph, it was 7.63±2.08mm and in the final follow- up was 9.36±2.75mm. Measurements were taken by two independent investigators and inter, and intra-observer reliability were analysed by Interclass correlation coefficient. Excellent functional outcome was noted despite the 1.81±1.50mm average loss of correction. At final followup, mean DASH score was 4.67±4.18, Oxford shoulder score was 44.06±2.44 and Constant shoulder score was 86.37±5.81. The severity of the injury had no significant effect on the functional outcome post our method of stabilisation and rehabilitation. Conclusion: Bifocal fixation restores the multidirectional stability of the disrupted ACJ. Adequate radiological reduction, good functional outcome and simplicity of execution make this technique an undemanding one for use in regular practice.

Axial view of the shoulder. Description of a technique / Proyección axial de hombro. Descripción de una técnica

Shoulder fracture is one of the most frequently treated injuries in trauma centers, with an overall incidence that appears to have increased in recent years, ranging from 219 to 419 cases per 100 000 person-years. In clinical terms, shoulder girdle injury is difficult to diagnose due to the close relationship between the shoulder and the chest, and imaging identification of the different types of injuries can be challenging. In this context, X-rays are the most appropriate method and the cornerstone of the initial approach to shoulder trauma, and at least 3 views are recommended: true anteroposterior view (AP), axial or axillary projection or modified axial projection (Velpeau view), and lateral scapula shoulder or Y view. However, patient positioning is often problematic due to the additional pain associated with limb mobilization in order to achieve the proper position for radiographic projection. The following is the description of a technique for performing an axial shoulder projection that is free of these complications, easy to standardize, and applicable to any traumatic or degenerative disease of the proximal humerus or glenohumeral joint, which, to the best of the authors' knowledge, has not been previously published.

El trauma de hombro es una de las patologías más frecuentemente vista en los centros de trauma con una incidencia global que aparentemente ha aumentado en los últimos años y que se ha reportado entre 219 a 419 casos por 100000 personas-año. El diagnóstico del trauma de la cintura escapular no es fácil clínicamente por la íntima relación entre el hombro y el tórax, y la identificación imagenológica de las distintas lesiones puede ser desafiante. Las radiografías son el método más apropiado y piedra angular del estudio inicial en el trauma de hombro, el set de trauma tiene al menos 3 planos: la vista Anteroposterior (AP) verdadera, una proyección axial o axilar o su modificación descrita por Velpeau. Y una proyección Y de escápula. Sin embargo, el posicionamiento del paciente muchas veces no es fácil por el dolor adicional que puede generar la movilización de la extremidad para lograr la posición adecuada para la proyección radiográfica. Describimos una técnica para realizar una proyección axial de hombro sin estas dificultades, fácilmente estandarizable para cualquier patología traumática o degenerativa del húmero proximal o de la articulación gleno-humeral y que creemos no ha sido publicada previamente.

Extracorporeal shockwave therapy in shoulder injuries: prospective study / Uso de terapia de ondas de choque em doenças ortopédicas do ombro: estudo prospectivo

ABSTRACT Objective: To evaluate the functional results after the use of extracorporeal shockwave therapy (ESWT) in four groups of patients: tendinopathy, partial rotator cuff injury, adhesive capsulitis and calcareous tendinopathy of the rotator cuff at one month and three months after the end of treatment. Methods: Case series in which patients were evaluated according to the VAS of pain, range of motion of the shoulder, and functional questionnaires DASH and modified UCLA. Results: There was a significant increase in the measure of flexion, lateral rotation and shoulder abduction in the evaluations after treatment in relation to the baseline measurement (p < 0.001) and no evidence of significant difference was found between the post-treatment evaluations at one month and three months follow-up (p > 0.05). There was a significant reduction in the VAS score, increase in the UCLA score and a significant reduction in the DASH score in the post-treatment evaluations in relation to the baseline score (p < 0.001) and a significant improvement in the three-month evaluation in relation to one month (p < 0.05). Conclusion: Extracorporeal shockwave therapy proved to be efficient and safe in the treatment of shoulder pathologies, improving pain, range of motion and functional scores in all groups of patients evaluated in the study. Level of Evidence IV, Case series.

RESUMO Objetivo: Avaliar os resultados funcionais após uso de terapia de ondas de choque (TOC) em quatro grupos de pacientes: tendinopatia, lesão parcial de manguito rotador, capsulite adesiva e tendinopatia calcária do manguito rotador com 1 mês e 3 meses após término do tratamento. Métodos: Série de casos, na qual os pacientes foram avaliados de acordo com a EVA da dor, amplitude de movimento do ombro, e questionários funcionais DASH e UCLA modificados. Resultados: Houve aumento significativo das medidas de flexão, rotação lateral e abdução do ombro nas avaliações após tratamento, em relação à medida basal (p < 0,001) e não houve evidências de variação significativa entre as avaliações pós-tratamento com 1 mês e 3 meses de acompanhamento (p°> 0,05). Houve redução significativa do escore EVA, aumento do escore UCLA e redução significativa do escore DASH nas avaliações após tratamento em relação ao escore basal (p < 0,001) e melhora significativa na avaliação de três meses em relação a um mês (p < 0,05). Conclusão: A terapia de ondas de choque mostrou-se uma terapia eficiente e segura no tratamento das patologias do ombro, com melhora da dor, arco de movimento e escores funcionais em todos os grupos de pacientes avaliados no estudo. Nível de Evidência IV, Série de casos.

Reconstruction of upper limb soft tissue injuries, except for fingertips lesions / Reconstrução de lesões de partes moles do membro superior, exceto lesões das pontas dos dedos

ABSTRACT Objective: The main purpose of this work was to evaluate the advantages and disadvantages of reconstructive procedures applied in upper limb soft tissue injuries according to their location. Methods: The study involved 94 male and 22 female patients (116 total) operated between April 2001 and November 2017 due to traumatic injuries in a upper limb. Individuals were evaluated considering their age, sex, etiology, reconstruction area , applied methodology and complications. The finger injuries were excluded. Results: The performed reconstruction procedures include 29 skin grafts; six advancement flaps; seven rotation flaps; 33 pedicled fasciocutaneous flaps, 9 free fasciocutaneous flaps; 5 pedicled muscle flaps; 12 free muscle flaps, three pedicled musculocutaneous flaps; one free musculocutaneous flap; 11 neurovascular free flaps. Conclusion: Reconstructive procedures in the upper limbs are diverse, varying from skin grafting to free flaps. The indication of the best option depends on the type of injurie and the surgeon. The final goal is to reach the best functional result combined with the lowest possible morbidity. Level of Evidence IV, Case series.

RESUMO Objetivo: O objetivo deste estudo foi analisar as vantagens e desvantagens dos procedimentos reconstrutivos utilizados em lesões de partes moles do membro superior, conforme sua localização. Métodos: Foram analisados 116 pacientes, 94 do sexo masculino e 22 do sexo feminino, operados entre abril de 2001 e novembro de 2017 em consequência de lesões traumáticas no membro superior. As lesões restritas aos dedos foram excluídas. Foram avaliados quanto à idade, sexo, etiologia, área de reconstrução, método empregado e complicações. Resultados: Os procedimentos de reconstrução realizados incluem 29 enxertos de pele; 6 retalhos por avançamento; 7 retalhos por rotação; 33 retalhos fasciocutâneos pediculados, 9 retalhos fasciocutâneos livres; 5 retalhos musculares pediculados; 12 retalhos musculares livres, 3 retalhos musculocutâneos pediculados; 1 retalho musculocutâneo livre; 11 retalhos livres neurovasculares. Conclusão: Os procedimentos reconstrutivos nos membros superiores são muito variados, abrangendo desde a enxertia de pele até retalhos livres. A indicação depende do tipo de lesão e da escolha do cirurgião. O objetivo final é alcançar o melhor resultado funcional com a menor morbidade possível. Nível de Evidência IV, Série de casos.

Medición del defecto óseo del reborde glenoideo anterior en la inestabilidad glenohumeral / Measurement of the anterior glenoid rim defect in glenohumeral instability

RESUMEN Fundamento: la inestabilidad de la articulación glenohumeral es una enfermedad frecuente en especial en pacientes jóvenes, la medición preoperatoria de lesiones óseas en el reborde glenoideo anterior permite seleccionar el tratamiento quirúrgico más adecuado para cada paciente. Objetivo: proponer un método de medición factible para el defecto óseo anterior de la glenoides en enfermos con inestabilidad glenohumeral. Métodos: la búsqueda y análisis de la información se realizó en un periodo de cuatro meses (primero de mayo de 2018 al 31 de agosto de 2018) y se emplearon las siguientes palabras: glenoid bone loss, Bankart lesions, shoulder instability, unstable shoulder a partir de la información obtenida se realizó una revisión bibliográfica de un total de 352 artículos publicados en las bases de datos PubMed, Hinari, SciELO y Medline mediante el gestor de búsqueda y administrador de referencias EndNote, de ellos se utilizaron 46 citas seleccionadas para realizar la revisión, todas dentro de los últimos cinco años. Resultados: se mencionan la incidencia, importancia de los métodos de medición, entre los que se encuentran el del diámetro, área y comparativos bilaterales, en relación a los dos primeros se plasman las ventajas y desventajas. Se describe la técnica por pasos para realizar las mediciones. Conclusiones: los métodos de medición propuestos son factibles de realizar en el medio y permiten decidir la técnica quirúrgica a emplear en cada caso.

ABSTRACT Background: shoulder instability is a common desease, affecting mainly young patients, before surgery measures of anterior glenoid bone loss is crucial to define surgical treatment modality in each patient. Objetive: this review aims to provide a method to measure anterior glenoid bone loss in patients suffering from unstable shoulders. Methods: a four month research was conducted from May 1st 2018 to August 31th 2018. Our review included 352 articles published in PubMed, Hinari, SciELO and Medline databases by using EndNote. The words used were glenoid bone loss, Bankart lesions, shoulder instability, unstable shoulder. Forty six selected citations, all them within the last five years, were used to write the present paper. Results: incidence and importance of measure methods of anterior glenoid bone loss were mentioned, among them: diameter based and surface area methods, beside comparative one. In regards to the first two, advantages and disadvantages were pointed out. The technique was described by steps to measure bone defect. Conclusions: the proposed measure methods can be used in our health institutions and are useful to decide surgical plan.

A comparative study of technique of humeral ending insertion of rotator cuff under arthroscopy and traditional techniques in the treatment of giant rotator cuff tear / 中国骨伤

OBJECTIVE@#To explore the feasibility of arthroscopic humeral ending insertion of rotator cuff, and to provide a scheme for the treatment of giant rotator cuff tears.@*METHODS@#From February 2014 to April 2018, 40 patients with giant rotator cuff tears were operated on and divided into two groups. The study group consisted of 20 patients, including 8 males and 12 females, aged 42 to 82(57.55±8.90) years, with a course of 1 h to 2 years;the treatment of giant rotator cuff tears was carried out by using the technique of rotator cuff moving inward at the humeral head stop and reconstructing complete rotator cuff. The control group consisted of 20 patients, including 10 males and 10 females, aged 45 to 75 (57.75±9.10) years, with a course of 1 h to 5 years;after traditional cleaning, part of the rotator cuff was sutured or in situ high tension suture was used to treat the huge rotator cuff tear. The clinical effect of the two groups was evaluated by VAS, constant and UCLA.@*RESULTS@#All patients were followed up for 12 to 14 months. The VAS, Constant score, UCLA score before operation of two groups were significantly improved compared with those before operation (<0.05);the VAS, Constant score, UCLA score and excellent effect of the study group were significantly better than those of the control group (<0.05).@*CONCLUSION@#Arthroscopic transposition of rotator cuff and humerus ending insertion is a feasible method for the treatment of giant rotator cuff tears, which relieves shoulder pain and improves function satisfactorily.

Progress on effect of osteoporosis on rotator cuff repair / 中国骨伤

The rate of rotator cuff injury repair and retear is high in elderly patients due to the combination of different degrees of osteoporosis. To solve this problem, many surgeons try to reduce retear rate of rotator cuff injuries in these patients by increasing the initial fixation strength of anchors and changing local bone conditions. The rapid advances of tissue engineering have made it possible to use growth factors as an aid. However, repair of rotator cuff injury with osteoporosis is still a great challenge for clinical workers. How to better increase anchor fixation strength, improve micro-environment of tendon and bone healing, reduce the rotator cuff retear rate have become the research focus in recent years. The paper reviewed literatures on the relationshipbetween osteoporosis and rotator cuff injury, effect of osteoporosis in rotator cuff tendon healing, methods of reducing osteoporosis on rotator cuff tendon healing, in order to guide clinical treatment, improve operative effect and postoperative satisfaction.

Comparative Study between Multi-slice Computed Tomographic Arthrography and Arthroscopy in the Evaluation of Rotator Cuff Tears / Estudo comparativo entre artrotomografia computadorizada multi-slice e artroscopia na avaliação das lesões do manguito rotador

Abstract Objective To compare the imaging findings of anatomical alterations using multi-slice computed tomographic arthrography in the evaluation of rotator cuff tears in the shoulder, correlating them with the arthroscopy (the gold standard diagnostic test) findings. Materials and Methods A longitudinal, prospective, comparative study of diagnostic accuracy performed in the period between June 2016 and June 2017 in patients of both sexes, aged between 40 and 70 years, with shoulder rotator cuff tendon tears and therapeutic need to undergo shoulder arthroscopy. Patients with contraindication to magnetic resonance imaging were included. After multi-slice computed tomographic arthrography, all patients underwent arthroscopy. Results To obtain the results, the following parameters were determined: sensitivity, specificity, accuracy, positive predictive value, negative predictive value, and Kappa coefficient, and contrast between the imaging method and arthroscopy. Conclusion In the impossibility of performing magnetic resonance imaging (the gold standard imaging technique), multi-slice computed tomographic arthrography is an imaging examination capable of evaluating/diagnosing rotator cuff tears.

Resumo Objetivo Comparar os achados por imagem das alterações anatômicas da artrotomografia computadorizada multi-slice na avaliação das lesões do manguito rotador do ombro e correlacioná-los com os achados da artroscopia (exame diagnóstico padrão-ouro). Materiais e Métodos Estudo longitudinal, prospectivo, comparativo de acurácia diagnóstica, feito de junho de 2016 a junho de 2017, em pacientes de ambos os sexos, com idades entre 40 e 70 anos, com lesão dos tendões do manguito rotador do ombro, e que tinham necessidade terapêutica de fazer artroscopia do ombro. Foram incluídos pacientes com contraindicação à realização de ressonância magnética. Após a artrotomografia computadorizada multi-slice, todos os pacientes foram submetidos a artroscopia. Resultados Para a obtenção dos resultados, os seguintes parâmetros foram considerados: sensibilidade, especificidade, acurácia, valor preditivo positivo, valor preditivo negativo, coeficiente Kappa, e contraposição do método de imagem com a artroscopia. Conclusão Na impossibilidade da realização da ressonância magnética (exame de imagem padrão-ouro), a artrotomografia computadorizada multi-slice se mostra um exame de imagem capaz de avaliar/diagnosticar as lesões do manguito rotador.

Latissimus Dorsi Tendon Transfer using Tendinous Allograft for Irreparable Rotator Cuff Lesions: Surgical Technique / Transferência tendínea do grande dorsal com enxerto tendíneo homólogo para as lesões irreparáveis do manguito rotador: técnica cirúrgica

Abstract Latissimus dorsi transfer around the shoulder is the most frequently used surgical technique to treat young patients with irreparable posterosuperior rotator cuff lesions. This technique, as initially described and popularized by Gerber et al., has two main drawbacks thatmay predispose to complications and unsatisfactory functional results: 1) postoperative rupture of the origin of the deltoid, as its detachment from the acromion is necessary during the superior approach to the shoulder; and 2) postoperative rupture of the transferred tendon. In an attempt to avoid these problems, the authors have developed the following modifications to the original technique. Through a deltopectoral approach, the latissimus dorsi tendon is identified and detached from the humerus shaft. After being reinforced and elongated with a tendinous allograft, it is transferred around the humerus and fixed to the superolateral aspect of the greater tubercle. No rigid thoraco-brachial immobilization is used postoperatively.

Resumo No contexto do tratamento cirúrgico dos pacientes jovens com lesões irreparáveis da porção posterossuperior do manguito rotador, a técnica mais usada é a transferência do tendão do grande dorsal para a porção superolateral do tubérculo maior, conforme descrita e preconizada por Gerber et al. Entretanto, duas características dessa técnica podemlevar a resultados ruins e complicações: (i) a deiscência da origem do deltoide, que ocorre devido à sua violação durante a criação da via em golpe de sabre e (ii) a ruptura pós-operatória da inserção da transferência. Na tentativa de solucionar esses dois problemas, as seguintes modificações foram feitas à técnica cirúrgica original. Por meio de uma única via deltopeitoral, o tendão do grande dorsal é isolado e desinserido do úmero. Ele é então alongado e reforçado com um enxerto tendíneohomólogo, transferido ao redor do úmero e fixado à porção superolateral do tubérculomaior. Não foi usada imobilização pós-operatória comórtese toracobraquial rígida.

Variations in shoulder loading due to differences in the site of stepping foot contact during baseball pitching - Comparison between flat ground and mound conditions - / 体力科学

This study examined variations in shoulder loading due to differences in the site of stepping foot contact during baseball pitching, while comparing flat ground and mound conditions. Measurement was performed, involving 10 right-handed pitchers who belonged to university baseball clubs, under original flat ground and mound conditions. Pitching movements were classified into 3 categories: [normal], [narrow], and [outside]. Through 3-dimensional motion analysis using a motion capture system, the following results were obtained: 1. The pitching velocity was significantly higher in the [normal] compared with [narrow] and [outside] conditions and under the mound compared with flat ground condition. 2. The peak torque of the shoulder internal rotation was markedly lower in the [narrow] compared with [normal] condition. There were no significant differences between the [normal] and [outside] conditions or between the flat ground and mound conditions. 3. The posterior, superior, and inferior shearing forces, as well as the proximal traction force, which influence the humeral head of the shoulder, were markedly greater in the [normal] compared with [narrow] and [outside] conditions. The anterior and posterior shearing forces and proximal traction force were significantly greater under the mound compared with flat ground conditions. Based on the results, the internal rotation torque of the shoulder, as well as the shearing and traction forces influencing the humeral head of the shoulder, may vary due to differences in the site of stepping foot contact during baseball pitching and between flat ground and mound conditions. The former may also be useful to prevent pitching-related shoulder injuries.