Luxación glenohumeral inferior recurrente ( luxatio erecta ) tratamiento artroscópico, revisión de la literatura y reporte de caso / Lower glenohumeral recurrent luxation ( luxatio erecta ) arthroscopic treatment, literature review and case report

Resumen: Es de suma importancia tener en cuenta las complicaciones de la luxación glenohumeral inferior que, aunque poco frecuentes, pueden llegar a ser incapacitantes a mediano y largo plazo, incluso en algunos casos reportados ponen en riesgo la vida del paciente. Material y métodos: Se presenta el caso clínico de un joven paciente adulto con diagnóstico de luxación glenohumeral inferior (luxatio erecta) recurrente derecha, con lesión de Bankart y lesión de Hill Sachs, tratado mediante artroscopía con reparación de la lesión de Bankart, plicatura del receso capsular inferior y remplissage. Resultados: Evaluamos la funcionalidad del paciente al cabo de 18 meses con la escala de UCLA obteniendo una puntuación final de 30 puntos con buenos resultados funcionales.

Abstract: It is extremely important to take into account the complications of inferior gelnohumeral dislocation, which, although infrequent, may become incapacitating in the medium and long term, even in some cases reported, endangering the life of the same. Material and methods: We present the case of a young adult patient diagnosed with inferior rectal glenohumeral dislocation (luxatio erecta), with Bankart lesion and Hill Sachs lesion, treated by arthroscopy with repair of the Bankart lesion, plication of the lower capsular recess and remplissage. Results: We evaluated the functionality of the patient at 18 months with the UCLA scale, obtaining a final score of 30 points with good functional results.

Chronic Irreducible Anterior Dislocation of the Shoulder without Significant Functional Deficit

Shoulder dislocation is frequently encountered by orthopedists, and closed manipulation is often sufficient to treat the injury in an acute setting. Although most dislocations are diagnosed and managed promptly, there are rare cases that are missed or neglected, leading to a chronically dislocated state of the joint. They are usually irreducible and cause considerable pain and functional disability in most affected patients, prompting the need to find a surgical method to reverse the worsening conditions caused by the dislocated joint. However, there are cases of even greater rarity in which chronic shoulder dislocations are asymptomatic with minimal functional or structural degeneration in the joint. These patients are usually left untreated, and most show good tolerance to their condition without developing disabling symptoms or significant functional loss over time. We report on one such patient who had a chronic shoulder dislocation for more than 2 years without receiving treatment.

Traducción, adaptación trans-cultural, validación y medición de propiedades de la versión en español del Indice Western Ontario Rotator Cuff (WORC) / Translation, cultural adaptation, validation and measurement properties of Western Ontario Shoulder Rotator Cuff Index (WORC)

El índice de Western Ontario Rotator Cuff (WORC) es un instrumento específico para medir la calidad de vida de pacientes con patología del manguito rotador. Dicho índice se encuentra validado en múltiples idiomas pero no al español. El propósito del presente trabajo es traducir al español, adaptar transculturalmente el WORC para su uso en Argentina, validar su versión y medir sus propiedades clinimétricas. Materiales y Métodos: El WORC fue traducido al español utilizando protocolos preestablecidos, y 50 pacientes con patología del manguito rotador lo completaron dos veces con una diferencia entre ellos de 2 semanas. El Alfa de Crombach y el Coeficiente de Correlación Interclase (ICC) se calcularon, para evaluar la validez y reproducibilidad del índice , utilizando un análisis de Bland-Altmann. Para construir la validez se contrasto con la Prueba Simple de Hombro (Simple Shoulder Test) y la Escala de Constant. Resultados: El Alfa de Crombach fue de 0,978 para el WORC total y de 0,924 a 0,942 para los 5 Dominios. Además presento un alto ICC de 0,676 para el WORC total y de entre =,859-0,870 para los dominios. El análisis de Bland-Altmann no mostró deferencias sistemáticas entre las evaluaciones. La correlación entre el SST y el WORC fue de 0,756 y entre el WORC y Constant de =,60. Conclusión: La versión en español del WORC es un instrumento validado y confiable para ser utilizado en pacientes con patología del manguito rotador. Tipo de Estudio: Ciencia Básica, Desarrollo o validación de Instrumentos de Resultados. Nivel de Evidencia: II...

The Western Ontario Shoulder Rotator Cuff Index (WORC) is a disease specific shoulder questionnaire to measure quality of life of patients with rotator cuff pathology. The aim of the present study was to translate to Spanish, crossculturally adapt the WORC for being used in Argentina and to evaluate its reproducibility inpatients with rotator cuff pathology. Materials and methods: The WORC was translated into Spanish according to established guidelines and 50 patients with rotator cuff pathology completed the score twice with at least 2 weeks difference between them. The Cronbach´s Alpha, the Interclass Correlation Coefficient (ICC) were calculated and a B land –Altmann analysis was applied. In addition, an spanish validated version of Simple Shoulder Test and Constant score were used to asses construct validity. Results: The Cronbachs α ranged from 0,978 for the total WORC and from 0,924 to 0,942 for the 5 domains. A high ICC was found for the WORC total score (0,676) and for the separate domains (0.859- 0,870). Bland-Altmann analysis showed no systematic differences between the assessments. The correlation between SST and the WORC was 0,756, and between the Constant scale was 0,60. Conclusion: The spanish version of WORC is a reliable and valid instrument for evaluating patients with rotator cuff tears or tendinitis...

Luxação aguda de ombro: avaliação e tratamento / Acute shoulder luxation: evaluation and treatment

A luxação glenoumeral é a mais frequente do corpo humano. Sendo geralmente luxações anteriores causadas por traumatismos, necessitando pronto atendimento e avaliação de lesões associadas através da história, exame físico e de imagem, visando à redução precoce para evitar ou minimizar sequelas futuras.

The glenohumeral dislocation is the most frequent in the human body. Being generally anterior dislocations caused by trauma, requiring immediate treatment and evaluation of the related injuries through history, physical examination and imaging, aimed at early reducing to avoid or minimize future sequels.

Luxación posterior de hombro bloqueada inveterada / Recurrent locked posterior shoulder dislocation

La luxación posterior de hombro representa menos del 5 por ciento de las lesiones que afectan a la articulación glenohumeral y su etiología más frecuente es la traumática. Lamentablemente en nuestro medio, dada la baja incidencia de esta patología hay un alto porcentaje de luxaciones posteriores que son diagnosticadas y tratadas tardíamente y las consecuencias pueden ser altamente incapacitantes para el paciente. El objetivo de este reporte es presentar el caso de una luxación glenohumeral posterior inveterada bloqueada, de 5 meses de evolución, en un paciente laboralmente activo, describir la técnica quirúrgica utilizada y llamar la atención acerca de la necesidad de hacer un diagnóstico adecuado en agudo de esta patología, previniendo de esta manera complicaciones que podrían ser evitadas.

Occult Interpositional Rotator Cuff - an Extremely Rare Case of Traumatic Rotator Cuff Tear

Traumatic interposition of a rotator cuff tendon in the glenohumeral joint without recognizable glenohumeral dislocation is an unusual complication after shoulder trauma. Here we report the clinical and imaging presentations of a 17-year-old man with trapped rotator cuff tendons in the glenohumeral joint after a bicycle accident. The possible trauma mechanism is also discussed.

Tratamento artroscópico da instabilidade anterior do ombro: estudo retrospectivo de 159 casos / Anterior instability of the shoulder: retrospective study on 159 cases

OBJETIVO: Análise dos resultados de 159 pacientes com instabilidade anterior do ombro submetidos ao tratamento artroscópico de janeiro de 2001 a dezembro de 2005. MÉTODOS: Estudo retrospectivo de prontuários com dados completos. RESULTADOS: Em 108 pacientes notou-se a lesão de Bankart e em 62 pacientes a lesão do tipo SLAP estava presente. Utilizou-se em média 2,7 âncoras. Apresentaram complicações 42 casos; 14 tinham dor aos esforços, 12 tinham algum grau de diminuição da rotação externa, 16 apresentaram recidiva. Os pacientes que evoluíram com complicações utilizaram em média 2,5 âncoras, enquanto naqueles sem complicações a média foi de 2,8 (p<0,05). De 35 pacientes com lesão óssea da borda anterior da glenóide 8 tiveram recidiva e de 124 casos sem fratura 8 recidivaram (p<0,05). De 113 pacientes com primo-luxação traumática 12 evoluíram com limitação da rotação externa enquanto em 46 casos atraumáticos nenhum apresentou limitação (p<0,05). Dos casos que apresentavam lesão SLAP 11 evoluíram com dor, enquanto que nos casos sem esta lesão três apresentaram dor (p<0,05). CONCLUSÃO: Houve maior índice de recidiva na presença da lesão óssea da borda anterior da glenóide. Dor pós-operatória foi mais frequente quando presente a lesão SLAP. Limitação da rotação externa está relacionada com instabilidade traumática.

OBJECTIVE: To analyze the results of 159 patients with anterior instability of the shoulder submitted to arthroscopic treatment from January 2001 to December 2005. METHODS: Retrospective study of complete patient records. RESULTS: In 108 patients the Bankart lesion was found, while in 62 patients, SLAP type lesions were found. An average of 2.7 anchors was used. 42 cases presented complications; 14 had pain on effort, 12 had some degree of reduction of external rotation, and 16 had recorrence. The patients who developed complications used an average of 2.5 anchors, while those without complications used an average of 2.8 anchors (p<0.05). Of the 35 patients with anterior glenoid bone lesion, 8 had recorrence, while of the 124 patients without fractures, 8 had recorrence (p<0.05). Of the 113 patients with first-time traumatic dislocations, 12 developed limitation of external rotation, while in 46 atraumatic cases none developed limitation (p<0.05). Of the patients with SLAP lesion, 11 developed pain, while in the cases without this lesion, only 3 presented pain (p<0.05). CONCLUSION: There were more recurrences (deveria ser plural e recurrences, nao recurrence) in cases of anterior glenoid bone lesion. Post-operative pain was more frequent when the lesion type was SLAP. Limitation of external rotation is associated to traumatic instability.

Luxação glenoumeral anterior bilateral: caso clínico / Bilateral anterior glenohumeral dislocation: clinical case

A luxação glenoumeral anterior bilateral é uma ocorrência rara. Apresentamos um caso de luxação glenoumeral anterior bilateral com origem após uma queda da própria altura. O interesse desta publicação reside no fato de se tratar de uma raridade clínica com poucos casos descritos na literatura. Paciente do sexo feminino com 89 anos recorre ao serviço de urgência (SU) após queda referindo dor intensa e incapacidade de mobilização de ambos os ombros. Ao exame objetivo apresentava sinais clínicos suspeitos de luxação glenoumeral anterior bilateral confirmados por radiografia. Ambas as luxações foram reduzidas no SU pela técnica de Milch modificada, com sucesso. Quando existe uma força simétrica e síncrona sobre os ombros e estes se apresentarem dolorosos e com limite funcional significativo, a suspeita de luxação glenoumeral bilateral, embora rara, é um diagnóstico diferencial a ter em conta.

Bilateral anterior glenohumeral dislocation is a rare occurrence. We present a case of bilateral anterior glenohumeral dislocation caused by a fall. The interest in publishing this case is that this is a clinical rarity with few cases reported in the literature. An 89-year-old female patient was brought to the emergency department after a fall, complaining of intense pain in both shoulders and inability to move them. Objective examination showed clinical signs giving the suspicion of bilateral anterior glenohumeral dislocation, which was confirmed by x-ray imaging. Both dislocations were successfully reduced in the emergency department using the modified Milch technique. When a synchronous and symmetrical force has acted on both shoulders and these are painful with significant functional limitation, the suspicion of bilateral glenohumeral dislocation is a differential diagnosis to be considered, even though it is rare.

The Spectrum of Lesions and Clinical Results of Arthroscopic Stabilization of Acute Anterior Shoulder Instability

PURPOSE: The purpose of this study is to investigate and analyze accom-panying lesions including injury types of anteroinferior labrum lesion in young and active patients who suffered traumatic anterior shoulder dislocation for the first time. Meterials and Methods: The study used magnetic resonance angiography (MRA) to 40 patients with acute anterior shoulder dislocation from April 2004 to April 2008, and of those, 36 with abnormal MRA finding were treated with arthroscopy. RESULTS: There was a total of 25 cases of anteroinferior glenoid labrum lesions. A superior labrum anterior-posterior lesion (SLAP) lesion was observed in 8 cases. For bony lesions, 22 cases of Hill-sachs lesions, 4 cases of lesions in greater tuberosity fracture of humerus, and 4 cases of loose body were found. For lesions involving rotator cuff, partial articular side rupture was found in 2 cases and 2 cases were found to have a complete rupture. CONCLUSION: Under MRA and arthroscopy performed on patients with acute anterior shoulder dislocation, it was observed to have varying types of anteroinferior labrum lesions such as Perthes, Bankart, ALPSA, and bony Bankart lesion. that MRA is a remar-kably useful tool to classify various lesions in acute anterior dislocation of the shoulder and to make a diagnosis, making it a useful tool to decide a treatment method while consulting patients and their families.

Arthroscopic Repair of Combined Bankart and SLAP Lesions: Operative Techniques and Clinical Results

BACKGROUND: To evaluate the clinical results and operation technique of arthroscopic repair of combined Bankart and superior labrum anterior to posterior (SLAP) lesions, all of which had an anterior-inferior Bankart lesion that continued superiorly to include separation of the biceps anchor in the patients presenting recurrent shoulder dislocations. METHODS: From May 2003 to January 2006, we reviewed 15 cases with combined Bankart and SLAP lesions among 62 patients with recurrent shoulder dislocations who underwent arthroscopic repair. The average age at surgery was 24.2 years (range, 16 to 38 years), with an average follow-up period of 15 months (range, 13 to 28 months). During the operation, we repaired the unstable SLAP lesion first with absorbable suture anchors and then also repaired Bankart lesion from the inferior to superior fashion. We analyzed the preoperative and postoperative results by visual analogue scale (VAS) for pain, the range of motion, American Shoulder and Elbow Surgeon (ASES) and Rowe shoulder scoring systems. We compared the results with the isolated Bankart lesion. RESULTS: VAS for pain was decreased from preoperative 4.9 to postoperative 1.9. Mean ASES and Rowe shoulder scores were improved from preoperative 56.4 and 33.7 to postoperative 91.8 and 94.1, respectively. There were no specific complication and no significant limitation of motion more than 10 degree at final follow-up. We found the range of motions after the arthroscopic repair in combined lesions were gained more slowly than in patients with isolated Bankart lesions. CONCLUSIONS: In recurrent dislocation of the shoulder with combined Bankart and SLAP lesion, arthroscopic repair using absorbable suture anchors produced favorable clinical results. Although it has technical difficulty, the concomitant unstable SLAP lesion should be repaired in a manner that stabilizes the glenohumeral joint, as the Bankart lesion can be repaired if the unstable SLAP lesion is repaired first.

Eficacia del test de aprehensión. Test de recolocación y Artro RNM para el diagnóstico de la inestabilidad anterior de hombro / Aprehension and relocation test and arthro MRI. Its significance on shoulder instability

Introducción: No existen estudios que evalúen en conjunto el examen físico y la artroresonancia para afirmar su complementariedad, en la eficacia o no del diagnóstico de la inestabilidad anterior de hombro. Objetivo: Determinar la precisión diagnóstica para la inestabilidad anterior de hombro del test de aprehensión (TA) y test recolocación (TR) con o sin artroresonancia (ArtroIRM) Diseño del estudio: Estudio de evidencia diagnóstica nivel III. Material y métodos: 52 pacientes conformaron el grupo de estudio con inestabilidad anterior de hombro y 30 pacientes el grupo control con otra inestabilidad de hombro. Se analizaron la sensibilidad (SEN), especificidad (ESP), VPP (valor predictivo positivo) y VPN (valor predictivo negativo) y exactitud diagnóstica por sí solos y combinados para los test diagnósticos tomando a la artroscopia como patrón de referencia. Resultados: La sensibilidad fue para la ArtroIRM 88,5 por ciento, Test de Recolocación 80,8 por ciento y TA 75 por ciento. El TR Y el TA tuvieron una baja especificidad, 20 por ciento y 40 por ciento respectivamente, comparado con la ArtroIRM (90 por ciento). La exactitud diagnóstica de la ArtroIRM fue 89 por ciento, el TA 62,2 por ciento Y el TR 58,5 por ciento. La ESP y VPP de la combinación de TA + TR fue de 43,3 por ciento y 68,5 por ciento, del TA + ArtroIRM fue de 71,2 por ciento y 90 por ciento y del TR + ArtroIRM de 75 por ciento y 90 por ciento respectivamente. Conclusión: en pacientes menores de 45 años que consultan por dolor o inestabilidad de hombro sin antecedente de luxación el test de recolocación predice un hombro inestable, y debería realizarse siempre ArtroRMN para el diagnóstico de inestabilidad anterior de hombro.

Tratamiento de la inestabilidad anterior de hombro con la técnica de Boytchev / Treatment of anterior inestability of the shoulder with boytchev´s technique

Objetivo: caracterizar los pacientes con inestabilidad anterior del hombro tratados con la técnica quirúrgica de Boytchev. Pacientes y Métodos: Estudio descriptivo, prospectivo, realizado en el Departamento de Ortopedia del Hospital Escuela de Tegucigalpa de julio del 2006 a junio del 2008 en pacientes con inestabilidad anterior de hombro tratados con la técnica de Boytchev. Se utilizó la escala de Constant para evaluar la función postoperatoria del hombro. Resultados. Se estudiaron 27 pacientes, 25 (92.6%) eran del sexo masculino. La edad promedio fue de 25.6 años, el 40.6% (11) eran obreros. El número de luxaciones promedio fue de 5.1; en 25 (92.6%) el hombro luxado fue el derecho. El resultado posquirúrgico fue excelente en 22 (81.5%) pacientes, bueno en 3 (11.1%) y regular en 2 (7.4 %). Se presentó complicación en un paciente (infección de herida quirúrgica). Conclusión: La mayoría de pacientes operados con la técnica quirúrgica de Boytchev en el Hospital Escuela fueron hombres en la tercera década de la vida, de ocupación obreros, con luxación predominante del hombro derecho y tuvieron excelente resultado posquirúrgico. Estos datos son coincidentes con los reportados en la literatura...

Ombro flutuante associado à luxação escápulo-umeral posterior: relato de caso / Floating shoulder combined with posterior scapulohumeral dislocation

Apresenta-se rara variação de ombro flutuante associada a luxação glenoumeral posterior em paciente masculino, 26 anos de idade, vítima de acidente motociclístico. Ao exame, queixava-se de dor no ombro esquerdo, limitação dos movimentos, principalmente da rotação externa. A radiografia em ântero-posterior (AP) verdadeiro mostrou fratura do colo da glenóide, sem envolvimento articular, e fratura do processo coracóide. A radiografia em perfil, axilar e a tomografia computadorizada confirmaram a luxação posterior. Os autores discutem as questões que fazem deste um caso singular no qual se optou por redução aberta e fixação da fratura com placa de reconstrução pélvica. O controle radiológico confirmou o restabelecimento da anatomia. A fratura consolidou-se, resultando em um ombro normal e funcional.

A rare variation of the floating shoulder is presented, combined with a posterior glenohumeral dislocation in a male, 26 year old patient, victim of a motorcycle accident. On physical examination, he complained of pain in the left shoulder, limitation of should movements, in particular external rotation. True anteroposterior X-ray showed a fracture of the glenoid neck without joint involvement and fracture of the coracoid process. Profile, axillary X-ray and CT scan confirmed the posterior dislocation. The authors discuss the features that make this case a unique case for which open reduction and fracture fixation with a pelvic reconstruction plate were chosen. Radiological follow-up confirmed recovery of the anatomy. The fracture healed and the result is a normal, functional shoulder.

[Audit on necessity of radiographs in anterior shoulder dislocations]

Anterior shoulder dislocation is the most common major joint dislocation. In most cases, this dislocation is being relocated in emergency departments. Routinely, pre and post reduction radiographs are performed. This study was done to determine the necessity of radiographs in the emergency department for management of patients with suspected anterior shoulder dislocation. In this case series study, 116 patients suspected of anterior shoulder dislocation were referred to Hazrat Rasoul Akram and Haftome Tir Hospitals emergency departments in Tehran, and were investigated for a one year period. The emergency physicians evaluated and documented the possibility of dislocation or relocation, before obtaining radiographs. Outcome measures were the assessment of joint positions on the x-rays by an orthopedic surgeon. 84 cases [72%] were male and 32 cases [28%] were female. Mean age of the patients was 31.5 +/- 8.5 yrs. Thirty [30] patients had recurrent dislocations without traumatic mechanism [group 1] and eighty six [86] patients had no prior dislocation or a blunt mechanism of injury [group 2]. The accuracy of the emergency physician's assessment in dislocations was 100% in group 1 and 98% in group 2. False assessments occurred only in patients with fractures. There is no significant difference between emergency physicians and orthopedic surgeons in the assessment of dislocations and relocations, when the emergency physicians did accuralty diagnose them. Our study showed that the physicians are highly accurate in clinical determination of anterior shoulder dislocation and relocation. Pre-reduction films should be obtained when the mechanism of injury is trauma. Post-reduction films should be obtained in fracture-dislocations or when the physicians are uncertain of correct relocation

[Report of a neglected bilateral fracture dislocation of the shoulder]

30 years old women with bilateral schoulder fractures dislocation following a convulsive episode is presented, the seizure was caused by gravidic toxaemia. The diagnosis of anterior fracture- dislocation of both schoulders was confirmed by X- rays and CT scan. Open reduction and internal fixation was carried out with considerable difficulty. The relevant literature is reviewed with special focus on diagnostics, causes, trauma mechanisms, and treatment

Luxação inveterada do ombro / Chronic unreduced shoulder dislocation

O melhor tratamento para a luxação inveterada do ombro é, na verdade, a prevenção. Por isso, devem ser sempre valorizados a história clínica e o exame físico. Atenção redobrada deve ser dada aos pacientes epilépticos, alcoólatras, politraumatizados e àqueles em tratamento prolongado de capsulite adesiva. A incidência em axilar na investigação radiológica é indispensável, pois ela é a chave para o diagnóstico. Muitas vezes o não fazer nada constitui a melhor forma de tratamento dessa lesão. No planejamento operatório, identificar: o tamanho do defeito da cabeça umeral, as perdas ósseas da glenóide, o estado do manguito rotador, principalmente o do músculo subescapular, e as lesões nervosas. A tomografia computadorizada e a ressonância magnética são exames complementares de grande valia. Para o ato cirúrgico são indispensáveis: material apropriado, auxiliares treinados e em número suficiente. Redução aberta está bem indicada nos casos mal definidos ou que datem mais de duas semanas do trauma. As cirurgias reconstrutoras são a indicação de eleição nos pacientes mais jovens e com lesão da cabeça umeral menor que 45 por cento da superfície articular. As hemiartroplastias são a melhor escolha quando o defeito umeral está acima desse percentual, e as artroplastias totais quando há comprometimento da glenóide, sempre dependendo da integridade do manguito rotador. É indicação questionável operar paciente desmotivado, pouco disposto a submeter-se ao programa de reabilitação funcional.

Bilateral posterior fracture dislocation of the shoulders following seizure

Bilateral posterior fracture dislocation is a rare injury known to be associated with seizures. Convulsion was found to be the cause of fracture dislocation in 78% of the cases reported. The mechanism of injury was described by Shaw in 1971. The management depends largely on the severity of the injury. In many cases reported, the fracture was a large compression defect in the anteromedial aspect of the articular surface of the humeral head. It has been suggested that for defects that involve less than 20% of the articular surface closed reduction can be attempted. Rush nail or percutaneous K wires can be used to maintain reduction. Open reduction is necessary for defects that are involving 20-40% of the surface. The aim in these cases is to reconstruct the proximal humerus if possible by the use of internal fixation. If reconstruction is not feasible, a modified McLaughlin procedure can be used to prevent chronic instability of the shoulder. This procedure involves re-implanting the subscapularis tendon into the defect. Reconstructing fractures that involve more than 40% of the articular surface or 4-part fracture is not usually successful. These fractures are associated with a high the risk of avascular necrosis. Hemi-arthroplasty or total shoulder replacement is generally regarded as better option as they offer rapid recovery and eliminate the possibility of multiple procedures if fixation fails

Avaliação da capacidade de mensuração visual da erosão em um modelo de gesso simulando a cavidade glenoidal na luxação recidivante anterior de ombro / Assessment of the visual ability to measure the glenoid rim erosion in recurrent anterior shoulder instability

Na luxação recidivante anterior traumática do ombro, a cabeça do £mero sobre um impacto em relação à borda ântero-inferior da cavidade glenoidal. Como resultado, ocorre uma desinserção do lábio glenoidal, conhecida como lesão de Bankart. ú medida que os sucessivos episodios de luxação ocorrem, essa lesão agrava-se progressivamente, podendo resultar numa EROSÇO da borda ântero-inferior da cavidade glenoidal (EROSÇO). Caso seja acentuada, necessita-se reconstruir a articulação utilizando-se enxerto osseo. A mensuração da gravidade da EROSÇO, assim como a indicação de enxertia ossea, são assuntos controversos. Este trabalho tem como objetivo analisar a capacidade do ortopedista de identificar o grau da EROSÇO, sem utilizar qualquer instrumento de medição. Para isso foram utilizados modelos de gesso que se assemelhavam à cavidade glenoidal, com variados graus de EROSÇO. A pesquisa baseou-se na coleta de opiniäes de dois grupos de ortopedistas, os especializados em cirurgia de ombro e os especializados em cirurgias de outras articulaçäes. Ao analisar os dados coletados, estatisticamente concluiu-se que os cirurgiäes especializados em cirurgia de ombro não foram capazes de mensurar, com precisão, os graus de EROSÇO dos modelos de gesso. Numa segunda entrevista, eles novamente não foram capazes de definir, com precisão, os graus de EROSÇO dos modelos de gesso. Comparando-se as duas entrevistas dos cirurgiäes especializados em ombro, concluiu-se que eles não mantiveram as opiniäes. Os resultados da entrevista £nica realizada com os cirurgiäes especializados em outras articulaçäes mostraram que eles não foram capazes de definir, com precisão, os graus de EROSÇO dos modelos de gesso. O trabalho em questão, por ter sido realizado em modelos de gesso, não pode ser aplicado nas situaçäes reais de cirurgia. Talvez, porém, se possa inferir que durante o ato cirurgico, provavelmente, o cirurgião também tenha dificuldades em calcular o grau de EROSÇO existente.