Prevention of shoulder injuries in overhead athletes: a science-based approach

The shoulder is at high risk for injury during overhead sports, in particular in throwing or hitting activities, such as baseball, tennis, handball, and volleyball. In order to create a scientific basis for the prevention of recurrent injuries in overhead athletes, four steps need to be undertaken: (1) risk factors for injury and re-injury need to be defined; (2) established risk factors may be used as return-to-play criteria, with cut-off values based on normative databases; (3) these variables need to be measured using reliable, valid assessment tools and procedures; and (4) preventative training programs need to be designed and implemented into the training program of the athlete in order to prevent re-injury. In general, three risk factors have been defined that may form the basis for recommendations for the prevention of recurrent injury and return to play after injury: glenohumeral internal-rotation deficit (GIRD); rotator cuff strength, in particular the strength of the external rotators; and scapular dyskinesis, in particular scapular position and strength.

Evaluation of the clinical-functional results from repairing extensive rotator cuff injury with inclusion of the tendon of the long head of the biceps

OBJECTIVES: To assess the outcomes of the arthroscopic margin convergence of the posterior cuff to the biceps tendon. METHODS: From October 2003 to December 2007, 20 patients with massive rotator cuff tear which include the rotator interval were treated with arthroscopic margin convergence of the posterior cuff to biceps tendon. Sixteen patients were female and four were male. The mean age was 58.95 years old. The dominant side was affected in 16 cases (80%). The outcomes were analysed according to the UCLA Score with a minimum follow-up period of two years. RESULTS: The UCLA score improved, on average, 14 points (p < 0.001). Six patients had excellent results; nine good; three fair and two poor results. The mean improvement of forward flexion was 33º (p < 0.001), 3º of external rotation (p < 0.396) and two vertebral levels for internal rotation (p < 0.025). CONCLUSION: The arthroscopic margin convergence of the posterior cuff to the biceps tendon leads to satisfactory results. .

Posterior shoulder tightness and rotator cuff strength assessments in painful shoulders of amateur tennis players

BACKGROUND: Previous studies have shown a relationship between shoulder posterior capsule tightness and shoulder pain in overhead athletes. However, this relationship has not been studied in tennis players. OBJECTIVES: Assessment of the shoulder range of motion (ROM), strength and posterior capsule tightness of skilled amateur tennis players who had complaints of dominant shoulder pain in comparison with tennis players without pain. METHOD: Forty-nine skilled amateur tennis players were distributed in 2 groups: Control Group (n=22) and Painful Group (n=27). The first group was composed of asymptomatic subjects, and the second was composed of subjects with shoulder pain on the dominant side. These groups were evaluated to determine the dominant and non-dominant shoulder ROM (internal and external rotation), isometric shoulder strength (internal and external rotation) and posterior shoulder tightness by blind evaluators. RESULTS: The ANOVA results indicated significant differences between the groups in the dominant shoulder ROM, posterior capsule tightness, external rotation strength and strength ratio (p<0.05). The intragroup analysis (dominant versus non-dominant) in the Painful Group displayed a significant difference for ROM, posterior capsule tightness and external rotation strength (p<0.05). CONCLUSIONS: The tennis players with pain in the dominant shoulder presented greater posterior capsule tightness, internal rotation deficit (ROM), external rotation gain (ROM) and deficits in external rotation strength than the tennis players without pain. .

Resultados do tratamento artroscópico das rupturas do manguito rotador / Outcomes of arthroscopic treatment for rotator cuff tears

OBJETIVO: Analisar os resultados do reparo artroscópico das rupturas do manguito rotador. MÉTODOS: Realizado estudo retrospectivo com avaliação dos resultados da técnica em 42 pacientes operados entre 2002 e 2006. O seguimento médio foi de 31 meses e a média de idade foi de 57 anos, sendo o lado dominante operado em 73,8 por cento dos casos. Para avaliação foram usadas escalas de UCLA e Escala Visual Analógica da dor no pós-operatório. RESULTADOS: Os resultados foram satisfatórios em 85,7 por cento (59,5 por cento excelentes e 26,2 por cento bons respectivamente) e insatisfatórios em 14,3 por cento dos pacientes. Nos casos com lesões associadas, a mais frequente foi no tendão da porção longa do bíceps (57,1 por cento). Associação com outras lesões não comprometeu o resultado. O mesmo aconteceu com relação a idade e tempo de acompanhamento pós-cirurgia. Quanto ao tamanho da lesão, diferença significativa ocorreu nos casos de lesões grandes e maciças demonstrando resultados inferiores em relação às pequenas e médias. A função foi inferior principalmente nos casos de lesão maciça. CONCLUSÃO: A reparação artroscópica das lesões do manguito rotador (MR) proporciona baixa morbidade cirúrgica e possibilita diagnóstico de lesões articulares associadas. O benefício do procedimento foi confirmado principalmente pela melhora significativa da dor, mesmo nos casos de lesões maiores.

OBJECTIVE: To evaluate the results of arthroscopic treatment for rotator cuff tears. METHODS: A retrospective study was carried out demonstrating the results of this technique in 42 patients operated between 2002 and 2006. The mean follow-up was 31 months and average age was 57 years. The dominant limb was operated in 73.8 percent of cases. Function and pain were evaluated using criteria of UCLA Score System and Visual Analogic Scale respectively. RESULTS: The results were satisfactory in 85.7 percent (59.5 percent excellent and 26.2 percent good), with 14.3 percent unsatisfactory. The most frequent associated lesion was the long head of the biceps tendon (57.1 percent). Nevertheless, the presence of other lesions did not alter the end results. The same occurred in relation to age and follow-up period. When comparing large and massive tears with small and mid-sized ones, the first group had significantly inferior functional results. The function was worse in cases of massive tear. CONCLUSION: Arthroscopic rotator cuff repair provides lower surgical morbidity and intrarticular diagnosis of associated lesions in comparison to open surgery. The benefit of the procedure was confirmed mainly by pain relief, even in cases of more extensive lesions.

Correlación clínico-ecográfica en pacientes operados de reparación artroscópica del manguito rotator / Clinical and echographic correlationship between patients with rotator cuff tear arthroscopic repair

Rotator cuff (RC) is crucial in shoulder’s movement. Lesions due to degenerative changes because of aging and activity are frequent. Surgery is an adequate approach when conservative measures have failed. The aim of this study is to evaluate the clinical and echographic evolution of patients with RC surgical repair. Methods: patients with arthroscopic RC repair underwent pre and postsurgical clinical–echographic evaluation. Results: From 24 evaluated shoulders, 8 were found to have RC tear and 24 were found to not have tear. Clinical evaluation improve substantially in both groups, with no statistical differences among them. Conclusion: There is a significant amount of patients without RC tear after surgical repair. Although there are patients with RC tear on the echographic evaluation, therte are no clinical differences compared with patients with no RC tear. Older has higher risk of retear.

El manguito rotador (MR), es fundamental para el movimiento del hombro. Su lesión es frecuente debido a los cambios degenerativos que ocurren con la edad y la actividad. La cirugía es la alternativa cuando fracasan los tratamientos conservadores. Se plantea un estudio que permita evaluar la evolución clínica y ecográfica de pacientes a los que se le reparó el MR. Metodología: A pacientes operados mediante reparación artroscópica del MR se les realizó ecografías de control y evaluación clínica del dolor pre y postquirúrgico. Resultados: De 24 hombros evaluados se encontró 16 sin rotura y 8 con rotura. La evaluación clínica mejoró sustancialmente en ambos grupos, no encontrándose diferencias estadísticamente significativas entre ellos. Conclusiones: Existe un porcentaje importante de pacientes con MR sin lesión completa posterior a reparación. A pesar de haber pacientes con rotura de MR en la evaluación ecográfica, no hay diferencias clínicas con respecto a los sin rotura. A mayor edad existe una mayor posibilidad de re-rotura.

Los desgarros del manguito rotador en atletas / Rotator cuff injuries in athletes

La patología del hombro en deportistas de uso dominante del miembro superior son tan habituales como problemáticas, y las lesiones del manguito rotador, especialmente del supraespinoso son las más frecuentes, abarcando desde tendinopatías, desgarros parciales y desgarros completos. Los factores predisponentes en general son la inadecuada utilización del hombro junto con disbalances musculares sometidos a microtraumas o macrotraumas, y en deportistas de mediana edad se agrega el estado degenerativo del manguito rotador. En este trabajo se abordan estas lesiones para comprender su fisiopatología, cuadro clínico, estudios complementarios, y las opciones de tratamiento.

Comparison of self-report and interview administration methods based on the Brazilian versions of the Western Ontario Rotator Cuff Index and Disabilities of the Arm, Shoulder and Hand Questionnaire in patients with rotator cuff disorders

OBJECTIVE: The purpose of the present study was to compare self-report and interview administration methods using the Western Ontario Rotator Cuff Index (WORC) and Disabilities of the Arm, Shoulder and Hand Questionnaire (DASH) in patients with rotator cuff disorders. METHODS: Thirty male and female patients over 18 years of age with rotator cuff disorders (tendinopathy or rotator cuff tear) and Brazilian Portuguese as their primary language were recruited for assessment via administration of the Western Ontario Rotator Cuff Index and and Disabilities of the Arm, Shoulder and Hand Questionnaire. A randomization method was used to determine whether the questionnaires would be self-reported (n=15) or administered by an interviewer (n=15). Pearson correlation coefficients were used to evaluate the correlation between the Western Ontario Rotator Cuff Index and and Disabilities of the Arm, Shoulder and Hand Questionnaire in each group. The t-test was used to determine whether the difference in mean questionnaire scores and administration time was statistically significant. For statistical analysis, the level of significance was set at 5 percent. RESULTS: The mean subject age was 55.07 years, ranging from 27 to 74 years. Most patients had a diagnosis of tendinopathy (n=21). With regard to level of schooling, the majority (n=26) of subjects had completed a college degree or higher. The mean questionnaire scores and administration times did not significantly differ between the two groups (p>0.05). There were statistically significant correlations (p<0.05) between Western Ontario Rotator Cuff Index and and Disabilities of the Arm, Shoulder and Hand Questionnaire, and strong correlations were found between the questionnaires in both groups. CONCLUSION: There are no differences between the Western Ontario Rotator Cuff Index and Disabilities of the Arm, Shoulder and Hand Questionnaire administration methods with regard to administration time or correlations...

Síndrome de hombro doloroso / The painful shoulder syndrome

El hombro doloroso es una patología cuyo síntoma principal es el dolor, asociada generalmente a limitación funcional de cualquiera de los distintos movimientos que realiza la articulación. Su prevalencia es alta y es motivo de consulta frecuente para el médico general. Se presenta habitualmente después de la cuarta década de la vida, aunque puede aparecer en edades más precoces, asociada principalmente a traumas y actividad deportiva intensa. Este cuadro clínico puede ser producido por diversas patologías, originadas tanto en las múltiples estructuras anatómicas del hombro, como en ubicaciones fuera de la articulación; a pesar de la complejidad que esto pudiera significar, una anamnesis detallada y un examen físico acucioso, asociado en algunos casos a exámenes complementarios, nos permitirán hacer un diagnóstico adecuado e instaurar precozmente un tratamiento efectivo, que evite las secuelas funcionales y la perpetuación del cuadro

El ultrasonido en el hombro doloroso: estudio de 42 pacientes / Ultrasound of the painful shoulder: study of 42 patients

Los autores valoran la eficacia del Ultrasonido para el diagnóstico y etapificación de lesiones del manguito rotador. El estudio se llevó cabo en forma prospectiva y longitudinal, en pacientes con diagnóstico de hombro doloroso, en quienes realizaron un examen pasivo y lo compararon con el hombro contralateral. Se estudiaron 42 pacientes, en 29 de los cuales se comparó el resultado con el de la cirugía y en 24 con la Resonancia Magnética. Las lesiones se clasificaron de acuerdo a los criterios de Wiener y Seitz, la que permite el conocimiento de la extensión del daño y correlacionarlo con el encontrado en la cirugía. Los resultados de Ultrasonido concordaron con los de la cirugía en 28/29 pacientes, obteniendo valores de significancia 0.0001, lo que demuestra que el ultrasonido es un método confiable y seguro para el abordaje del paciente con hombro doloroso

Ultrasonido del hombro doloroso / Ultrasound of the pain shoulder

La ecografía o ultrasonido de alta resolución es un método de muy alto rendimiento en el diagnóstico de una variedad de patologías que causan dolor de hombro, especialmente la relacionada con el mango rotador. En manos experimentadas presenta altísimo rendimiento y permite diagnosticar en etapas más precoces, lo cual redunda en una instauración más temprana de la terapia

Shoulder impingement syndrome: MRI imaging

Twenty five patients [21 males and 4 females] clinically diagnosed as rotator cuff impingement syndrome, were evaluated by MRI. Impinging structures were low acromion in 20 cases, subacromial spur in 9 cases and acromioclavicular osteoarthritis in 19 cases. Supraspinatous tendon was variably affected in 24 cases [96%] while subacromial bursa involvement was noticed in 22 cases [88%]. Surgical interference in 10 cases confirmed MRI findings. The rest of cases were treated either conservatively or with manipulations under anesthesia. Clinical improvement was excellent in 22 patients [88%], fair in 2 patients [8%], while only one patient showed no improvement. It is concluded that MRI can clearly delineate the soft tissue and bony abnormalities involved in shoulder impingement syndrome. This should offer a better understanding and treatment of such chronic painful condition

Síndrome do impacto: I. Anatomia e biomecânica do ombro e correlaçöes clínicas com a síndrome do impacto / Impingement syndrome: I. Anatomy and biomechanics of the shoulder and clinical correlations with the impingement syndrome

As síndromes dolorosas do ombro relacionadas com o impacto das estruturas tendinosas contra o arco córaco-acromial säo muito freqüentes na clínica diária e podem ser muito incapacitantes para os pacientes acometidos. O conhecimento da anatomia e da biomecânica da articulaçäo do ombro pode ser elucidativo para melhor compreensäo da etiopatogenia dessas síndromes. O objetivo deste trabalho é realizar uma revisäo bibliográfica sobre o assunto, tentando melhor definir a etiopatogenia dessa síndrome