Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 20 de 34
Filter
1.
Rev. bras. ortop ; 57(1): 14-22, Jan.-Feb. 2022. tab, graf
Article in English | LILACS | ID: biblio-1365757

ABSTRACT

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.


Subject(s)
Arthroscopy , Shoulder Dislocation , Shoulder Joint , Glenoid Cavity , Rotator Cuff Injuries , Shoulder Injuries
2.
Rev. bras. ortop ; 57(1): 136-143, Jan.-Feb. 2022. tab, graf
Article in English | LILACS | ID: biblio-1365747

ABSTRACT

Abstract Objective To evaluate the functional outcome of patients who underwent partial arthroscopic repair of massive rotator cuff tears. Methods Retrospective case series evaluating patients with massive rotator cuff tears who underwent partial arthroscopic repair. The primary outcome was the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) at 24 months. The secondary outcomes were the Modified-University of California at Los Angeles Shoulder Rating Scale (UCLA), and the following subdomains: satisfaction, active forward flexion and strength of forward flexion subdomains. Results We evaluated 33 patients. The ASES scale evolved from 39.7 ± 19.6 to 77.6 ± 17.4 (p< 0.001). The UCLA scale evolved from 13.3 ± 5.5 to 27.9 ± 5.6 (p< 0.001). The satisfaction rate was 97%. The number of patients with active forward flexion > 150° increased from 12 (36.4%) to 25 (75.8%) (p= 0.002). The number of patients with normal or good strength of forward flexion increased from 9 (27.3%) to 22 (66.7%) (p = 0.015). Conclusion Partial repair of irreparable rotator cuff tears leads to significant improvement according to the ASES and UCLA scales.


Resumo Objetivo Avaliar o resultado funcional de pacientes submetidos ao reparo parcial por via artroscópica de roturas extensas do manguito rotador. Métodos Série de casos retrospectiva, avaliando pacientes com roturas extensas do manguito rotador submetidos ao reparo parcial por via artroscópica. O desfecho primário foi a escala American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES, na sigla em inglês) aos 24 meses. Foram desfechos secundários a escala Modified-University of California at Los Angeles Shoulder Rating Scale (UCLA, na sigla em inglês), e seus subdomínios satisfação, flexão anterior ativa e força de flexão anterior ativa. Resultados Avaliamos 33 pacientes. A escala da ASES evoluiu de 39,7 ± 19,6 para 77,6 ± 17,4 (p< 0,001). A escala da UCLA evoluiu de 13,3 ± 5,5 para 27,9 ± 5,6 (p< 0,001). A taxa de satisfação foi de 97%. O número de pacientes com flexão anterior ativa > 150° passou de 12 (36,4%) para 25 (75,8%) (p= 0,002). O número de pacientes com força de flexão anterior ativa normal ou boa passou de 9 (27,3%) para 22 (66,7%) (p= 0,015). Conclusão O reparo parcial nas roturas irreparáveis do manguito rotador leva a melhora significativa de acordo com as escalas da ASES e UCLA.


Subject(s)
Humans , Male , Female , Arthroscopy , Evaluation of Results of Therapeutic Interventions , Rotator Cuff/surgery , Shoulder Injuries
3.
Rev. colomb. ortop. traumatol ; 36(1): 16-19, 2022. ilus.
Article in English | LILACS, COLNAL | ID: biblio-1378763

ABSTRACT

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.


Subject(s)
Humans , Radiography , Shoulder Dislocation , Shoulder Fractures , Diagnostic Imaging , Shoulder Injuries
4.
Article in Spanish | LILACS, BINACIS | ID: biblio-1367135

ABSTRACT

Introducción: El 10-30% de las fracturas de clavícula ocurren en el tercio distal. El diagnóstico se realiza con radiografías de hombro (de frente y de perfil, y proyección de Zanca). La mayoría de estas fracturas se tratan de forma conservadora, pero aquellas con gran desplazamiento, patrones transversos o conminutos pueden requerir tratamiento quirúrgico debido a la alta tasa de seudoartrosis. Se han descrito diversos tipos de fijación para este grupo de fracturas. Si bien la osteosíntesis con placas logra resultados clínico-funcionales y de consolidación satisfactorios, no está exenta de complicaciones y las más frecuentes son: intolerancia al material de osteosíntesis (hasta un 30%), infección, lesión neurovascular y seudoartrosis. Sin embargo, según nuestro conocimiento, no existen reportes sobre la osteólisis de la apófisis coracoides secundaria a la osteosíntesis con placa LCP en fracturas del tercio distal de la clavícula. Conclusión: La erosión de la apófisis coracoides debido a la fijación con placa y tornillos es una complicación que no ha sido publicada previamente. Debe tenerse extrema precaución al realizar el túnel óseo y al medir la longitud de los tornillos para evitar potenciales complicaciones. Nivel de Evidencia: IV


Background: Several surgical techniques have been developed to reduce the nonunion rate and improve functional outcomes after displaced distal clavicle fractures, including the use of a tension band, the modified Weaver-Dunn procedure, coracoclavicular screw fixation, or locking plates. None of these techniques have been universally accepted, and each one has its own complications. To our knowledge, there are no previous publications describing osteolysis of the coracoid process caused by the tip of a cortical screw of a distal LCP plate. Case summary: We present the case of a 29-year-old male patient who had been treated with an anatomic pre-contoured plate for a distal clavicle fracture. Six months later he presented to our institution with limiting shoulder pain and tenderness upon the right coracoid process. Standard radiographs of the shoulder showed that the tip of a cortical screw was eroding the coracoid process. A surgery with hardware removal was then performed. One month after the surgery the patient was painless and with a full active shoulder ROM. Conclusion: Erosion of the coracoid process with plate screw fixation has never been described before. We suggest that extreme precaution should be taken in drilling and measuring the length of screws to avoid potential complications. Level of Evidence: IV


Subject(s)
Adult , Postoperative Complications , Clavicle/surgery , Fractures, Bone , Shoulder Injuries , Fracture Fixation, Internal
5.
Artrosc. (B. Aires) ; 29(1): 39-41, 2022.
Article in Spanish | LILACS, BINACIS | ID: biblio-1369639

ABSTRACT

La fijación de luxaciones acromioclaviculares de alto grado con métodos de cerclaje coracoclavicular exige una manipulación cuidadosa del instrumental y de los dispositivos de fijación como suturas o injertos a nivel subcoracoideo. La estrecha relación de la apófisis coracoides con el plexo braquial y la arteria axilar hace que esta sea una zona riesgosa y técnicamente demandante durante la cirugía. Para esta instancia, se han desarrollado dispositivos específicos, pero pueden ser costosos y poco disponibles. Se presenta una técnica manual, reproducible, segura y sencilla, que evita el uso de dispositivos adicionales para realizar cerclaje coracoclavicular en fijación o reconstrucción acromioclavicular.


Stabilization of high-grade acromioclavicular dislocations with coracoclavicular cerclage methods requires careful manipulation of instruments and fixation devices when approaching the coracoid process. This is risky and technically challenging surgical area due to the close relationship with the brachial plexus and the axillary artery. Specific devices have been developed for this instance, but they can be expensive and rarely available. A reproducible, safe and simple manual technique is presented, which avoids the use of additional devices to perform coracoclavicular cerclage in acromioclavicular fixation or reconstruction.


Subject(s)
Suture Techniques , Clavicle/injuries , Shoulder Injuries/surgery
6.
Artrosc. (B. Aires) ; 29(1): 42-48, 2022.
Article in Spanish | LILACS, BINACIS | ID: biblio-1369640

ABSTRACT

Las luxaciones acromioclaviculares son lesiones frecuentes del hombro en jóvenes y deportistas. Luego de tres semanas del trauma inicial, las estructuras ligamentarias tienen un pobre potencial biológico de cicatrización. Por este motivo, en los casos en los que no se diagnostica oportunamente y/o el tratamiento conservador no es exitoso, debe enfrentarse esta dificultad con una técnica de reconstrucción ligamentaria. Para ello, el uso de injertos, además de optimizar la estabilidad mecánica de la reducción de la luxación, mejora la capacidad biológica de cicatrización. Sin embargo, hasta el momento no existe una técnica estandarizada ni un patrón de oro para el tratamiento quirúrgico reconstructivo de las luxaciones crónicas acromioclaviculares. Se presenta una síntesis de la literatura más reciente y disponible sobre el uso de diferentes tipos de injertos en reconstrucción de luxación acromioclavicular. Nivel de Evidencia: V


Acromioclavicular dislocations are common shoulder injuries in young people and athletes. After three weeks of the initial trauma, the ligament structures have a poor biological healing potential. For this reason, in cases of late diagnosis or unsuccessful conservative management, this difficulty must be addressed with a ligament reconstruction technique. The use of grafts, in addition to optimizing the mechanical stability of the reduction, improves the biological healing capacity. However, to date there is no gold standard among the many techniques described for reconstructive surgical treatment of chronic acromioclavicular dislocations. A synthesis of the most recent literature available on the use of different types of grafts in reconstruction of acromioclavicular dislocation is presented. Level of Evidence: V


Subject(s)
Acromioclavicular Joint/surgery , Acromioclavicular Joint/injuries , Bone Transplantation , Shoulder Injuries/surgery
7.
Rev. bras. ortop ; 56(6): 733-740, Nov.-Dec. 2021. tab, graf
Article in English | LILACS | ID: biblio-1357128

ABSTRACT

Abstract Objective To evaluate and compare the glenoid track method in 3D-reconstructed computed tomography (3D-CT) scans with magnetic resonance imaging (MRI) and/or arthro-MRI. Methods Forty-four shoulders with clinical and radiographic diagnosis of traumatic anterior instability were assessed using 3D-CT, MRI, and/or arthro-MRI scans. Glenoid track (GT), Hill-Sachs interval (HSI), and glenoid bone loss (GBL) were determined by a radiologist using 3D-CT images, and classified as on-track/off-track. Three surgeons, blinded to the radiologist's evaluation, performed the same determinations using MRI/arthro-MRI. Descriptive analysis, variance analysis, results disagreement analysis, and receiver operating characteristic (ROC) curves were performed. Results Results from the 4 examiners were fully consistent in 61.4% of the cases. Magnetic resonance imaging/arthro-MRI diagnosed off-track injuries with 35 to 65% sensitivity and on-track injuries, with 91.67 to 95.83% specificity. Accuracy ranged from 68.1 to 79.5%. The greatest data divergence occurred for off-track injuries diagnosed by MRI/arthro-MRI. The greatest data variability referred to HSI calculation. Higher HSI and GBL values were associated with greater disagreement among examiners. Hill-Sachs interval values were lower at MRI/arthro-MRI when compared to 3D-CT. Agreement between CT and MRI/arthro-MRI for the GT method was only moderate (kappa value, 0.325-0.579). Conclusion Magnetic resonance imaging/arthro-MRI showed low accuracy and moderate agreement for the GT method; as such, it should be used with caution by surgeons.


Resumo Objetivo Comparar a avaliação do método glenoid-track (GT) em exames de tomografia computadorizada com reconstrução 3-D (TC-3D) com a avaliação realizada em exames de ressonância magnética (RM) e/ou artro-ressonância magnética (ARM). Métodos Quarenta e quatro ombros com diagnóstico clínico e radiográfico de instabilidade anterior traumática foram avaliados por meio de exames de TC-3D, RM e/ou ARM. As variáveis GT, intervalo de Hill-Sachs (IHS) e a perda óssea da glenoide (POG) foram realizadas por um médico radiologista, utilizando imagens de TC-3D, e classificadas em on-track/off-track. Três cirurgiões cegos à avaliação do radiologista realizaram o mesmo método utilizando RM/ARM. O estudo realizou análise descritiva, de variância, de associação da discordância de resultados, de concordância e curva característica de operação do receptor. Resultados Os resultados dos 4 examinadores foram totalmente concordantes em 61,4%. A RM/ARM diagnosticou lesões off-track com a sensibilidade variando de 35 a 65%, e lesões on-track com a especificidade variando de 91,67 a 95,83%. A acurácia variou de 68,1 a 79,5%. A maior divergência de dados ocorreu para o diagnóstico por RM/ARM de lesões off-track. A maior variabilidade dos dados ocorreu para o cálculo do IHS. Valores maiores de IHS e de POG foram associados a maior discordância entre os examinadores. A RM/ARM apresentou menor medida de valores de IHS quando comparado com a TC-3D. Ocorreu apenas moderada concordância no método GT entre a TC e a RM/ARM (Kappa 0,325-0,579). Conclusão A RM/ARM apresentou baixa acurácia e moderada concordância para o método GT, devendo ser utilizada com cautela por cirurgiões.


Subject(s)
Humans , Magnetic Resonance Spectroscopy , Tomography, X-Ray Computed , Clinical Diagnosis , Glenoid Cavity , Shoulder Injuries
8.
Rev. bras. ortop ; 56(3): 299-306, May-June 2021. tab, graf
Article in English | LILACS | ID: biblio-1288669

ABSTRACT

Abstract Adverse reactions to vaccine injections are usually mild and incredibly rare in nature, but multiple cases of shoulder events including bursitis, generalized pain or decreased range of motion have been reported following routine vaccine administrations. These events are known as Shoulder Injury Related to Vaccine Administration or SIRVA. A systematic review of literature was performed to identify all published accounts of SIRVA. Twenty-seven papers reporting one or more accounts of SIRVA were identified. The most common vaccination involved was the Influenza vaccine. The most common symptoms were pain that began in 48 hours or less and loss of shoulder range of motion. The most common treatment modalities were physical therapy, corticosteroid injections and anti-inflammatory medication; but in some patients, surgery was required. Regardless of intervention, the vast majority of outcomes demonstrated improved pain and functional except in the occasions of nerve injury. The etiology of SIRVA injuries has multiple possibilities including needle length, mechanical injury from needle overpenetration and the possibility of an immune inflammatory response from the vaccine components, but a unique definitive test or quantifiably result does not yet exist.


Resumo As reações adversas às injeções de vacina tendem a ser brandas e são incrivelmente raras. No entanto, vários casos de eventos em ombros, como bursite, dor generalizada ou diminuição da amplitude de movimento, foram relatados após vacinações de rotina. Esses eventos são conhecidos como lesões em ombro relacionadas à administração de vacina (SIRVA, do inglês shoulder injury related to vaccine administration). Uma revisão sistemática da literatura foi realizada para identificar todos os relatos publicados de SIRVA. Vinte e sete artigos que relataram um ou mais casos de SIRVA foram encontrados. A vacina mais comumente citada foi a vacina contra influenza. Os sintomas mais comuns foram dor com início em até 48 horas e perda da amplitude de movimento do ombro. As modalidades de tratamento mais comuns foram fisioterapia, injeções de corticosteroides e administração de medicamentos anti-inflamatórios; alguns pacientes, porém, precisaram de cirurgia. Independentemente da intervenção, a grande maioria dos casos apresentou melhora da dor e da função, à exceção dos pacientes com lesão nervosa. A SIRVA tem múltiplas possíveis etiologias, inclusive comprimento da agulha, lesão mecânica por penetração excessiva da agulha e resposta inflamatória aos componentes da vacina; no entanto, ainda não há um exame definitivo ou resultado quantificável.


Subject(s)
Humans , Bursitis , Influenza Vaccines , Shoulder Impingement Syndrome , Shoulder Pain , Shoulder Injuries , Anti-Inflammatory Agents
11.
Rev. bras. ortop ; 56(2): 213-217, Apr.-June 2021. tab, graf
Article in English | LILACS | ID: biblio-1251351

ABSTRACT

Abstract Objective The present paper aims to evaluate the quality of a mobile phone application (app) designed to guide patients after shoulder surgical procedures. Methods A free and easily accessible app was developed to help patients at home. Patients were monitored for app use and adaptation before physical therapy started. At the end of 6 weeks, a qualitative questionnaire was employed to determine the usability of the app. Results In total, 97% of the respondents reported that the app was easy to download, the exercises were readily understood, and they would recommend the app. Ninety-three percent of the participants agreed that the app made them feel a greater degree of participation in the treatment of their illness, while 90% considered the app self-explanatory. Conclusion The virtual platform helps the patients to understand the treatment, aiding the medical prescription of postoperative exercises to be performed at home.


Resumo Objetivo Avaliar a qualidade de um aplicativo de celular desenvolvido para orientar pacientes em período pós-operatório de procedimentos cirúrgicos do ombro. Métodos Desenvolveu-se um aplicativo gratuito e de fácil acesso para auxiliar os pacientes em domicílio. Os indivíduos foram monitorados quanto ao uso do aplicativo e adaptação à sua prática antes do início da fisioterapia. Ao final de 6 semanas, aplicou-se um questionário qualitativo para avaliar a usabilidade do aplicativo. Resultados Um total de 97% dos respondentes afirmaram que foi fácil executar o download do aplicativo, que os exercícios sugeridos foram prontamente entendidos, e relataram que indicariam o aplicativo. Noventa e três por cento da amostra concorda que o aplicativo fez com que se sentissem mais participativos com relação ao tratamento de sua doença, enquanto 90% consideraram o aplicativo autoexplicativo. Conclusão O uso de uma plataforma virtual é uma ferramenta de compreensão sobre o tratamento e auxilia na prescrição médica de exercícios pós-operatórios domiciliares.


Subject(s)
Humans , Male , Female , Adult , Shoulder/surgery , Patient Education as Topic , Physical Therapy Specialty , Mobile Applications , Shoulder Injuries/therapy , Cell Phone Use
12.
Rev. chil. ortop. traumatol ; 62(1): 19-26, mar. 2021. ilus
Article in Spanish | LILACS | ID: biblio-1342598

ABSTRACT

OBJETIVO:Comparar el promedio de curva de presión de contacto y el porcentaje de presión de contacto residual final en la interfase tendón-huella de una reparación transósea (TO) realizada con nudos cruzados y una configuración Mason-Allen modificada (MAM). MÉTODOS: Se utilizaron ocho hombros de cordero para simular una rotura de manguito rotador. Se midió la presión con un sensor digital. Se registró la presión basal durante la aplicación de carga cíclica y al final de la intervención. Se compararon dos reparaciones: dos túneles TOs con nudos cruzados (TOCs) (n » 4) y dos puntos MAMs (n » 4) utilizando suturas MaxBraid #2 (Zimmer Biomet, Warsaw, IN, EEUU). Se realizaron 1.000 ciclos, con una frecuencia de 2 Hz y una carga de 30 N. Se utilizó el test de t de Student, y se consideraron significativos valores de p < 0,05. RESULTADOS: El promedio de curva de presión de contacto en las piezas que fueron reparadas con suturas TOCs fue de 86,01 8,43%, mientras que con MAM fue de 73,28 12,01% (p < 0,0004). El promedio del porcentaje residual al final del ciclado fue de 71,57% para suturas TOCs y de 51,19% para MAM (p < 0,05). CONCLUSION: La reparación TOC presenta mayor promedio de curva de presión de contacto y mayor porcentaje de presión de contacto residual final en la interfase tendón-huella que la reparación con sutura MAM luego de carga cíclica estandarizada, lo que podría traducirse en una mejor cicatrización del tendón. NIVEL DE EVIDENCIA: Estudio de ciencia básica.


OBJECTIVE: To compare the average contact pressure curve and the percentage of final residual contact pressure at the tendon-footprint interphase of a transosseous (TO) repair performed with crossover sutures or a modified Mason-Allen (MMA) configuration. METHODS: Eight lamb shoulders were used to simulate a rotator cuff tear. The pressure was measured with a digital sensor. The baseline pressure was recorded during the application of the cyclic load and at the end of the intervention. Two repairs were compared: 2 crossover TO (CTO) sutures (n » 4) and 2 MMA sutures MMA (n » 4), using MaxBraid #2 (Zimmer Biomet, Warsaw, IN, US) sutures. A thousand cycles were performed, with a frequency of 2 Hz and a 30-N load. The Student t-test was used, and significance was set at p < 0.05. RESULTS: The average contact pressure curve was of 86.01 8.43% for parts repaired with CTO sutures, and of 73.28 12.01% for those repaired with MMA sutures (p < 0.0004). The mean residual percentage at the end of cycling was of 71.57% for CTO sutures, and of 51.19% for MMA sutures (p < 0.05). CONCLUSION: The CTO repair shows a higher average contact pressure curve and a higher percentage of final residual contact pressure at the tendon-footprint interphase than the MMA suture repair after standardized cyclic loading, potentially resulting in improved tendon healing. LEVEL OF EVIDENCE: Basic Science Study.


Subject(s)
Animals , Pressure , Suture Techniques , Rotator Cuff Injuries/surgery , Arthroscopy , Tendon Injuries/surgery , Sheep , Shoulder Injuries/surgery
13.
Artrosc. (B. Aires) ; 28(2): 134-139, 2021.
Article in Spanish | LILACS, BINACIS | ID: biblio-1282678

ABSTRACT

Introducción: el objetivo de este trabajo es reportar y analizar los resultados con un mínimo de dos años de seguimiento en pacientes no deportistas tratados por lesión SLAP. Secundariamente, analizar las variables: tipo se lesión, score ASES y antecedente de trauma y su relación con el retorno a las actividades habituales.Materiales y métodos: se evaluaron veintinueve pacientes tratados por lesiones de SLAP con seguimiento mínimo de veinticuatro meses, operados por dolor, sin inestabilidad evidente, 82.76% fueron hombres. La edad promedio fue 36.82 años. Se evaluó la función en el preoperatorio y en el último seguimiento con el score de ASES, movilidad y retorno a las actividades previas. Se analizaron los resultados y los factores de riesgo para impedir este retorno.Resultados: catorce pacientes (48.28%) asociaron un trauma. Fueron ocho (27.59%) SLAP tipo I, diecisiete (58.62%) tipo II y cuatro pacientes (13.79) tipo V. Retornaron a su actividad previa veintiuno de ellos (72.41%). Se repararon las lesiones SLAP tipo II y V y se realizó desbridamiento en aquellas tipo I. Se obtuvo una diferencia estadísticamente significativa entre los valores pre y postoperatorios con mejoría de la movilidad en flexión anterior de 163.96 a 173.4°, rotación interna de 58.27 a 71.72°, rotación externa de 61.55 a 76.89° (p <0.05) y en el score ASES preoperatorio 56.51 a 90.24 (p <0.05). No así en el subgrupo que no retornó a su actividad previa. La complejidad de la lesión SLAP influyó negativamente en dicho retorno.Conclusión: los resultados con la reparación o desbridamiento artroscópico son funcionales, con alta tasa de retorno a la actividad previa. Los peores resultados se relacionaron a las lesiones SLAP de mayor severidad


Introduction: The objective of this work will be to report and analyze the results with a minimum of two years of follow-up in non-athlete patients treated for SLAP lesion and to analyze the following variables: type of SLAP, ASES score and history of trauma with the return to normal activities. Materials and methods: twenty-nine patients treated for SLAP lesions with a minimum follow-up of twenty-four months, operated due to pain, without evident instability were evaluated, 82.76% were male. The average age was 36.82. The function was evaluated in the preoperative period, and in the last follow-up with the ASES score and mobility. The results and risk factors for not returning to their previous activity were analyzed as well. Results: fourteen patients (48.28%) had associated trauma. There were eight (27.59%) SLAPS type I, seventeen (58.62) type II and four (13.79) type V. Twenty-one (72.4%) patients returned to their previous activity. SLAP type II and V were repaired and type I were debrided. A statistically significant difference was obtained between the preoperative and final evaluation of anterior flexion (163.96 to 173.4°), internal rotation (58.27 to 71.72°), external rotation (61.55 to 76.89°) ( p <0.05) and ASES score (56.51 to 90.24) (p <0.05). Instead, this does not occur in the subgroup that did not return to its previous activities. The complexity of the SLAP lesion influenced this return. Conclusions: the results of SLAP lesion arthroscopic reconstruction are functional with a high rate of return to the patient previous activity. The worst results are related to greater slap severity


Subject(s)
Adult , Arthroscopy , Treatment Outcome , Patient Selection , Shoulder Injuries
14.
Rev. bras. ortop ; 55(1): 106-111, Jan.-Feb. 2020. tab, graf
Article in English | LILACS | ID: biblio-1092682

ABSTRACT

Abstract Objective To evaluate the functional results of patients submitted to reverse shoulder arthroplasty for the treatment of rotator cuff arthropathy refractory to conservative treatment. Methods A retrospective study of 20 patients (21 shoulders), 17 women (81%) and 3 men (19%), underwent a reverse shoulder arthroplasty between October 2012 and September 2017, for a rotator cuff arthropathy treatment, operated by a single surgeon in a single center. The patients were assessed using the Disabilities of the Arm, Shoulder and Hand (DASH) score, the Short-Form (36) Health Survey (SF-36), the visual analogue scale (VAS) of pain rating, and the University of California - Los Angeles (UCLA) score. The mean age at surgery was of 66 years old (range: 55 to 83 years old). The duration of symptoms before surgery was of ∼ 2.5 years (range: 12 months to 6 years). The mean follow-up was of 42.4 months (range: 19 to 56.7 months). Results The mean postoperative scores were 18.2 points in DASH; 2 points in EVA, of which 16 (77%) corresponded to mild pain, 4 (18%) to moderate pain, and 1 (5%) to severe pain; 29 points in UCLA, of which 6 patients presented a regular result (28%), 10 patients a good result (48%), and 5 patients an excellent result (24%); and 63 points in the SF-36. The complications were four cases of notching, one case of acromial fracture due to stress, and one case of postoperative infection. Conclusions Reverse arthroplasty of the shoulder presents good functional results in the evaluated scores, providing a significant improvement in the quality of life of the patients.


Resumo Objetivo Avaliar os resultados funcionais dos pacientes submetidos a artroplastia reversa de ombro, para tratamento da artropatia do manguito refratária a tratamento conservador. Métodos Estudo retrospectivo de 20 pacientes (21 ombros), 17 mulheres (81%) e 3 homens (19%), submetidos a artroplastia reversa de ombro no período de outubro de 2012 a setembro de 2017, para tratamento de artropatia de manguito rotador, operados por um único cirurgião em um único centro. Os pacientes foram avaliados pelo escore de disfunções do braço, ombro e mão (DASH, na sigla em inglês), pelo questionário genérico de avaliação de qualidade de vida SF-36 (SF-36), pela escala visual analógica de dor (EVA) e pelo escore da Universidade de Los Angeles - Califórnia (UCLA, na sigla em inglês). A média de idade na cirurgia foi de 66 anos (variação de 55 a 83 anos). O tempo de sintomas antes da realização da cirurgia foi de ∼ 2,5 anos (variação de 12 meses a 6 anos). O seguimento médio foi de 42,4 meses (variação de 19 a 56,7 meses). Resultados A média dos escores pós-operatórios foi de 18,2 pontos no DASH; de 2 pontos na EVA, sendo 16 (77%) de dores leves, 4 (18%) de dores moderadas e 1 (5%) de dor intensa; de 29 pontos no UCLA, sendo 6 pacientes com resultado regular (28%), 10 pacientes com resultado bom (48%), e 5 pacientes com resultado excelente (24%); e de 63 pontos no SF-36. Tivemos como complicações quatro casos de notching, um caso de fratura de acrômio por estresse, e um caso de infecção pós-operatória. Conclusões A artroplastia reversa do ombro apresenta bons resultados funcionais nos escores avaliados, propiciando melhora significativa na qualidade de vida dos pacientes.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Pain , Shoulder/surgery , Signs and Symptoms , Surveys and Questionnaires , Retrospective Studies , Rotator Cuff , Rotator Cuff Tear Arthropathy , Rotator Cuff Injuries , Shoulder Injuries , Arthroplasty, Replacement, Shoulder , Infections
15.
ABCS health sci ; 44(3): 167-171, 20 dez 2019. tab
Article in English, Portuguese | LILACS | ID: biblio-1047667

ABSTRACT

INTRODUÇÃO: A Tendinopatia do Manguito Rotador (TMR) acarreta dor e prejuízo na função do ombro, porém não se sabe se ambas na mesma proporção. OBJETIVO: Verificar se a intensidade dolorosa se correlaciona com a função do membro superior em sujeitos com TMR. MÉTODOS: Estudo observacional transversal, com 60 indivíduos com TMR. Utilizou-se a Escala Visual Analógica (EVA) para avaliar a dor e o questionário Disabilities of the Arm, Shoulder and Hand Questionnaire (DASH) para função do ombro. Para análise dos dados foi realizada estatística descritiva (médias e desvio-padrão, apresentação numérica e percentual) e aplicada a correlação de Spearman utilizando nível de significância de 5%. RESULTADOS: A dor média pela EVA foi de 5,02 (moderada). Verificou-se limitação leve (pontuação média de 34,43) nas 30 questões do questionário DASH. Em relação aos módulos opcionais, no módulo destinado a atletas/músicos, não houve limitação dos sujeitos que praticavam este (média de pontuação de 11,82). No módulo referente ao trabalho houve limitação leve (média de pontuação de 35,38). Houve correlação baixa entre dor e a função do ombro (rs=0,2949; p=0,0222). CONCLUSÃO: Embora os sujeitos com TMR apresentassem dor moderada, a correlação foi fraca entre dor e função do ombro.


INTRODUCTION: Rotator Cuff Tendinopathy (RMR) causes pain and impairment in shoulder function, but it is not known if both in the same proportion. OBJECTIVE: Verify whether pain intensity correlates with upper limb function in subjects with RMR. METHODS: Cross-sectional observational study of 60 individuals with RMR. The Visual Analogue Scale (VAS) was used to assess pain and the Disabilities of the Arm, Shoulder and Hand Questionnaire (DASH) for shoulder function. For data analysis, descriptive statistics (means and standard deviation, numerical and percentage presentation) were performed and Spearman correlation was applied using a significance level of 5%. RESULTS: The average pain by VAS was 5.02 (moderate). Mild limitation (mean score 34.43) was found in the 30 questions of the DASH questionnaire. Regarding the optional modules, in the module intended for athletes/musicians, there was no limitation of the subjects who practiced this (average score of 11.82). In the work module there was a slight limitation (average score 35.38). There was a low correlation between pain and shoulder function (rs=0.2949; p=0.0222). CONCLUSION: Although subjects with RMR had moderate pain, the correlation was weak between pain and shoulder function.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Rotator Cuff/pathology , Shoulder Pain , Tendinopathy , Rotator Cuff Injuries , Shoulder Injuries , Activities of Daily Living
16.
Med. leg. Costa Rica ; 36(2): 56-67, sep.-dic. 2019.
Article in Spanish | LILACS | ID: biblio-1040445

ABSTRACT

Resumen La base fundamental de la valoración médico legal de un individuo es establecer la relación de causalidad entre la historia narrada por el mismo y los hallazgos documentados. La biomecánica del trauma es una herramienta que permite dilucidar dicha concordancia, ya que su estudio involucra los mecanismos de trauma implicados en la génesis de las distintas lesiones. Este artículo consiste en una revisión bibliográfica y crítica de la literatura actual en materia de etiopatogenia de las lesiones en hombro por su alta incidencia laboral y capacidad de generar secuelas.


Abstract The basis of the forensic evaluation of an individual is to establish the relationship of causality between the story that has been told by the patient and the documented findings. The study of injury biomechanics is a tool that helps to clarify said concordance, since it involves the trauma mechanisms that are implied in the genesis of the different lesions. This article consists of a bibliographical revision and critique of the current literature about the etiopathogenesis of the shoulder lesions, since they are frequent in the work place and can generate sequels.


Subject(s)
Humans , Shoulder , Occupational Risks , Bursitis , Coroners and Medical Examiners , Bankart Lesions , Rotator Cuff Injuries , Shoulder Injuries , Forensic Medicine , Occupational Medicine
17.
Rev. bras. ortop ; 54(5): 579-586, Sept.-Oct. 2019. tab, graf
Article in English | LILACS | ID: biblio-1057928

ABSTRACT

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.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Arthroscopy , Shoulder , Arthrography/methods , Magnetic Resonance Spectroscopy , Predictive Value of Tests , Rotator Cuff , Diagnostic Tests, Routine , Shoulder Injuries/classification , Contraindications
18.
Fisioter. Pesqui. (Online) ; 26(3): 329-336, jul.-set. 2019. graf
Article in Portuguese | LILACS | ID: biblio-1039883

ABSTRACT

RESUMO Na artrocinemática do ombro, o manguito rotador atua estabilizando a cabeça umeral em contato com a cavidade glenoidal, enquanto realiza a translação inferior para contrabalancear a força rotacional promovida principalmente pelo deltoide. Exercícios de rotação externa (RE) vêm sendo utilizados na reabilitação de pacientes com disfunções no complexo do ombro buscando restaurar a artrocinemática. Porém, poucos estudos abordam a utilização da faixa elástica e a avaliação dos músculos da cintura escapular, determinantes para uma cinemática adequada. O objetivo deste estudo é comparar a atividade eletromiográfica (EMG) de músculos do complexo do ombro durante exercícios de rotação externa com faixa elástica. Participaram 11 sujeitos do sexo masculino que foram avaliados durante os movimentos de (1) RE em ortostase; (2) RE com abdução de ombro; (3) RE em decúbito lateral (DL). Os músculos avaliados pela EMG foram: (1) trapézio superior (TS); (2) deltoide médio (DM); (3) deltoide posterior (DP); e (4) infraespinal (IN). A resistência foi determinada por uma faixa elástica cinza calibrada com carga de 5% do peso corporal. A análise dos dados foi realizada no software Biomec-SAS e as estatísticas foram calculadas por meio da Anova de medidas repetidas no software SPSS v20.0. Pôde-se constatar que os músculos TS e DM obtiveram maior atividade EMG durante o exercício de RE com abdução de ombro, o músculo DP durante a RE com abdução de ombro e RE em decúbito lateral, enquanto o IN a obteve durante a RE em ortostase e RE em decúbito lateral.


RESUMEN En la artrocinemática del hombro, el manguito rotador actúa estabilizando la cabeza umeral en contacto a la cavidad glenoidal, mientras realiza la traslación inferior para contrarrestar la fuerza rotacional promovida principalmente por el deltoides. Los ejercicios de rotación externa (RE) se han utilizado en la rehabilitación de pacientes con disfunciones en el complejo del hombro buscando restaurar la artrocinemática. Pocos estudios abordan la utilización de la banda elástica y la evaluación de los músculos de la cintura escapular, determinantes para una cinemática adecuada. El objetivo de este estudio es comparar la actividad electromiográfica (EMG) de los músculos del complejo del hombro durante ejercicios de rotación externa con banda elástica. Participaron 11 sujetos, varones, que fueron evaluados durante el movimiento de (1) RE en ortostasis; (2) RE con abducción de hombro; y (3) RE en decúbito lateral (DL). Los músculos evaluados por la EMG fueron: (a) trapecio superior (TS); (b) deltoides central (DC); (c) deltoides posterior (DP) e (d) infraespinoso (IN). La resistencia se determinó mediante una banda elástica gris calibrada con carga del 5% del peso corporal. El análisis de los datos se realizó con la utilización del software BIOMEC-SAS, y las estadísticas por medio de la Anova de medidas repetidas en el software SPSS v20.0. Se pudo constatar que los músculos TS y DC obtuvieron mayor actividad EMG durante el ejercicio de RE con abducción de hombro, el músculo DP durante la RE con abducción de hombro y RE en decúbito lateral, mientras que el IN durante la RE en ortostasis y en decúbito lateral.


ABSTRACT In shoulder arthrokinematics, the rotator cuff acts on a lower base to counterbalance a glenoid cavity, while performing a lower translation to counterbalance a rotational force mostly provided by the deltoid. External rotation (ER) exercises have been used in the rehabilitation of patients with shoulder joint dysfunction, with the aim of restoring arthrokinematics. Few studies approached the use of the elastic band and the evaluation of the shoulder girdle muscles, essential for suitable kinematics. The objective of this study was to compare the electromyographic activity (EMG) of the muscles from the shoulder complex during external rotation exercises with elastic band. A total of 11 male subjects were evaluated during (1) ER in orthostasis; (2) ER with shoulder abduction; (3) ER with lateral decubitus. The muscles assessed by the EMG were: (a) upper trapezius (UT); (b) middle deltoid (MD); (c) posterior deltoid (PD) and (d) infraspinatus (IS). Resistance was made with a gray elastic band calibrated with a load of 5% body weight. Data analysis was performed using the application software BIOMEC-SAS and statistics for the repeated measures using ANOVA in SPSS version 20.0. The UT and MD muscles were found to have increased EMG activity during ER exercise with shoulder abduction, as well as the PD muscle during ER with shoulder abduction and ER in lateral decubitus, whereas IS had increased EMG activity during an ER in orthostasis and ER in lateral decubitus.


Subject(s)
Humans , Male , Adult , Shoulder Joint/physiology , Rotator Cuff/physiology , Electromyography , Exercise Therapy/methods , Biomechanical Phenomena/physiology , Cross-Sectional Studies , Range of Motion, Articular/physiology , Exercise Therapy/instrumentation , Muscle Strength/physiology , Shoulder Injuries/rehabilitation
19.
Acta ortop. mex ; 33(4): 265-270, jul.-ago. 2019. graf
Article in Spanish | LILACS | ID: biblio-1284952

ABSTRACT

Resumen: Introducción: Las fracturas escapulares comprenden 1% del total de las fracturas en general y de 3 a 5% del hombro, las cuales se presentan por alta energía en pacientes jóvenes. Sólo 10% tiene indicación quirúrgica al tomarse como base la alteración de complejo suspensorio del hombro. El objetivo es valorar el resultado de pacientes con indicación quirúrgica así como una revisión de la literatura. Reporte de casos: Presentamos dos pacientes con fractura del cuerpo escapular derecho Bartonicek D con desplazamiento mediolateral, deformidad angular anteroposterior y alteración del ángulo glenopolar. Se realizó el manejo quirúrgico con osteosíntesis y placas convencionales y anatómicas. Se realizó valoración funcional y seguimiento radiográfico de ambos casos a los seis meses y se obtuvo arcos de movilidad flexión 180o/170o en ambos casos, así como escalas funcionales DASH 22/25, Constant 90/89 y Simple Shoulder Test 11/11 respectivamente; se obtuvo una consolidación ósea grado III-IV de Montoya. Discusión: Se considera importante realizar una adecuada reducción y estabilización del trazo de fractura debido al bajo grado de satisfacción con tratamiento conservador en pacientes con alta demanda funcional, que consiste en dolor residual, pinzamiento y disquinesia escapular. Se recomienda la cirugía para estas fracturas ya que comprometen la cadena cinética del hombro e impactan en el resultado funcional a corto y mediano plazo.


Abstract: Introduction: Scapular fractures comprise 1% of all fractures and 3 to 5% of the shoulder, they occur in young patients by high energy trauma. Only 10% have surgical indication based on the alteration of the shoulder's suspensory complex. The objective is to assess the outcome of patients with surgical indication as well as a review of the literature. Case report: We present two patients with Bartonicek D fracture of the right scapular body with mediolateral displacement, anteroposterior angular deformity and alteration of the glenopolar angle. Surgery was performed on both cases with conventional and special anatomical plates. Functional assessment and radiographic follow-up of both cases were performed at 6 months, obtaining flexion mobility of 180º/170º in both cases, as well as functional scales DASH 22/25, Constant 90/89 and Simple Shoulder Test 11/11 respectively; with bone consolidation grade III-IV of Montoya. Discussion: Due to the low degree of satisfaction with conservative treatment in patients with high functional demand, and multiple complications consisting in residual pain, impingement and scapular dyskinesia; it is important to perform an adequate reduction and stabilization of the fracture. We recommend surgical management for this type of fractures since they compromise the kinetic chain of the shoulder and impact the functional outcome in the short and medium term.


Subject(s)
Humans , Shoulder Fractures/surgery , Shoulder Joint , Fracture Fixation, Internal , Scapula/injuries , Shoulder , Range of Motion, Articular , Treatment Outcome , Shoulder Injuries
20.
Acta ortop. mex ; 33(3): 182-184, may.-jun. 2019. graf
Article in Spanish | LILACS | ID: biblio-1248659

ABSTRACT

Resumen: La lesión del nervio axilar (o circunflejo) aislada es poco frecuente, ésta suele presentarse asociada a una lesión del plexo braquial. En nuestra institución, en un período comprendido entre los años 2015-2017, se ha observado una frecuencia de sólo 0.4% de esta lesión. Con el presente reporte de caso se resalta la relación de la luxación de hombro con lesión del nervio axilar aislada. Caso clínico: Masculino de 31 años de edad, con trauma en hombro derecho, secundario a caída de su propia altura en accidente laboral. Radiografía de ingreso de hombro derecho muestra luxación anteroinferior de articulación glenohumeral, asociada a fractura de troquiter. Es intervenido quirúrgicamente, con reducción cerrada de articulación glenohumeral y osteosíntesis de troquiter. Posterior a ello, el paciente presenta atrofia marcada del deltoides, se ordena electromiografía que evidencia lesión completa del nervio axilar sin reinervación.


Abstract: Isolated lesion of the axillary (or circumflex) nerve is infrequent, this is usually associated with a brachial plexus injury. In our institution, in a period comprised between the years 2015-2017, a frequency of only 0.4% of this injury has been observed. Clinical case: Male patient of 31 years of age, with trauma in the right shoulder, caused by fall of his own height in work accident. The admission graph of the right shoulder shows anterior inferior dislocation of the glenohumeral joint, associated with a greater tubercle fracture. He underwent surgery, with closed reduction of the glenohumeral joint and osteosynthesis of the greater tubercle. The patient later presents marked atrophy of the deltoid, electromyography is ordered that shows complete lesion of the axillary nerve without reinnervation.


Subject(s)
Humans , Male , Adult , Shoulder Dislocation , Shoulder Joint , Brachial Plexus , Brachial Plexus Neuropathies , Shoulder , Shoulder Injuries
SELECTION OF CITATIONS
SEARCH DETAIL