Correlación entre la anatomía acromial y roturas del manguito rotador: estudio caso-control / Relationship between acromial anatomy and rotator cuff tears: a case control-study

Determinar si existe correlación entre la anatomía acromial documentada por radiología y la presencia de roturas del manguito rotador (MR) evaluadas en forma artroscópica. Hipótesis: Existe correlación positiva entre la morfología acromial y las roturas del MR. Métodos: Serie retrospectiva caso-control de 279 casos consecutivos tratados mediante cirugía artroscópica. Se analizaron 2 cohortes; un grupo con roturas completas del MR (N = 155) y un grupo control, tratados por inestabilidad glenohumeral (N = 124) a los que se documentó indemnidad del MR durante la artroscopia. Se documentó la anatomía acromial preoperatoria mediante radiografías de hombro anteroposterior verdadera y axial subacromial y se midieron la pendiente acromial según Bigliani (B), la inclinación acromial según Kitay (K) y el índice acromial según Nyffeler (AI). Resultados: Las diferencias entre los valores promedios de B y K entre grupos no fueron significativas (p = 0,6 y p = 0,3). No existió correlación entre B y AI (r = 0,054; p = 0,377). Evidenciamos una correlación positiva en ambos grupos entre la inclinación acromial (r = 0,2; p = 0,008) y la pendiente acromial (r = 0,1; p = 0,03). Encontramos diferencias significativas en el IA entre grupos, que fue mayor para los casos (p = 0,01). Conclusión: En los resultados de las mediciones radiológicas de la anatomía acromial en nuestra población, documentamos una correlación significativa entre extensión del AI y roturas del MR confirmadas durante artroscopia...

To study the anatomical relationship between acromial morphology documented on X- rays and rotator cuff (RC) tears evaluated using arthroscopy. Hypothesis: There is a positive correlation as regards acromial morphology and RC tears. Methods:A retrospective, case control series of 279 consecutives cases, who underwent arthroscopic surgery were included in this study; cases were separated into 2 cohorts; one group with complete RC tears (N=155) and a control group treated for glenohumeral instability (N=124) with indemnity of the RC confirmed during arthroscopy. Pre-operative acromial anatomy was documented with X- rays – true anteroposterior and sub-acromial outlet views – measuring the acromial slope according to Bigliani (B), acromial tilt according to Kitay (K), and acromial index according to Nyffeler (AI). Results: The differences in the mean values of B and K between groups were not significant (P=.6 and P=.3). There was no correlation between B and AI (r= 0.05; P=.3). A positive correlation was observed between the acromial tilt (r= 0.2; P=.008) and acromial slope (r= 0.1; P=.03). A significant difference was found regarding AI, with greater values in the case group (P=.01). Conclusion:In this study, the acromial slope according to Bigliani, and acromial tilt according to Kitay, does not correlate with RC tears. A positive correlation of the AI with RC tears was observed...

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

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

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

Anatomical basics and variations of the scapula in Turkish adults

To analyze the anatomical basis of the scapula, acromion, os acromiale, coracoid process, coraco-acromial arch, and glenoid cavity in Turkish adults. We performed the study at the Faculty of Medicine, Akdeniz University, Turkey between January 2004 and December 2005. A total of 90 dry bones of the scapula from human cadavers were randomly selected. The length, width, and anterior thickness of the acromion and the acromial facet of the acromioclavicular joint were measured with an electronic caliber and was examined visually. For the radiological evaluation, the posterior anterior and the lateral shoulder radiographs of 90 consecutive adult patients with normal findings were used. These films were evaluated and grouped according to the acromial arch morphology. The distribution of the acromial morphologic types according to slope was type I [flat] 10%, type II [curved] 73%, type III [hooked] 17%. Type I was seen in 11%, type II 66%, type III 23% of the specimens. The morphological shape of the tip of the acromion was 31% cobra shaped, 13% square shaped, and 56% intermediate type. The scapulas, coracoid process and the coraco acromial arch were measured. In 72% of the specimen, the glenoid notch of the scapulas were absent and oval shaped, whereas in 28% the notch was well expressed and the glenoid cavity was pear shaped. The mean vertical length of the glenoid cavity was 36.3 +/- 3 mm, and the mean transverse length was 24.6 +/- 2.5 mm. Os acromiale is a rare anatomical condition. Its incidence has been documented in radiographic and anatomical studies to be between 1-15%. The presence of os acromiale was 1% in shoulder radiographs [os pre-acromiale], and in dry bones [os meta-acromiale]. We reported the exact morphological measurements of the bone structures of the scapula in Turkish adult population. Our results present an instructive figures of anatomical preparations and radiological cases that can be used to make a more precise radiological and a differential diagnoses

Subacromial decompression using modified acromioplasty

The aim of this work was to study the clinical results of subacromial decompression using modified acromioplasty in cases of shoulder impingement syndrome. Thirty two patients who had shoulder impingement syndrome were included in this study. Twenty patients were females and 12 were males. The average age at the time of operation was 43.2 years; 40.6 years for females and 47.6 for males. There were two indications for operation. One was the persistence of pain in the anterior aspect of the shoulder when the arm was elevated and the second was progression of symptoms despite the use of anti-inflammatory medications and rehabilitation program. All cases were managed operatively with a modified Neer acromioplasty. In the classic anterior acromioplasty as described by Neer emphasis was placed on resection of the inferior prominence of the acromion. Modified acromioplasty was done in two steps; the portion of the acromion that projects anteriorly beyond the anterior border of the clavicle was resected vertically and then an anteroinferior acromioplasty was performed. The follow up period ranged between 6-24 months, average 13 months. Nineteen patients had excellent result, 7 had good result and 6 had no improvement

Displasia acromesomélica / Acromesomelic dysplasia

Os autores apresentam revisao bibliográfica sobre displasia acromesomélica, discutindo seus aspectos epidemiológicos, clínicos e radiográficos. Apresentam um paciente portador desta patologia e discutem suas características, comparando com as descritas na literatura.

Correlación clínica artrográfica, ultrasonográfica y quirúrgica en el diagnóstico de las lesiones del mango rotador del hombro / Clinical, arthrographic, ultrasonographic and surgical correlationship for diagnosis of injuries of the rotator cuff of the shoulder

Se presentaron 41 pacientes con diagnóstico clínico de síndrome doloroso subacromial, de los cuales en 27 se atribuyó a rotura del mango rotador. Todos los enfermos se estudiaron con artrografía y con ultrasonografía y en todos se realizó cirugía exploradora. La correlación fué la siguiente: el diagnóstico clínico-artrográfico-quirúrgico coincidión en 73.2% (30 pacientes), y el diagnístico clínico-ultrasonográfico-quirúrgico en 87% (36 enfermos).