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The two main causes of rotator-cuff injuries are trauma and degeneration. Modern medical sciences recommend operative reconstruction surgery for ruptured injuries of the rotator cuff. But the outcome of surgery often leads to restrictions on movement. In this case, supraspinatus tendon tears with degenerative causes were satisfactorily managed with ayurvedic conservative management alone. A 68-year-old patient was admitted to the Kayachikitsa inpatient department of Vaidyaratnam ayurveda college, Ollur, on September 21, 2023, with right shoulder pain and restricted shoulder movements. In an MRI, the case was diagnosed as a partial tear of the anterior fibres of the supraspinatus tendon of the rotator cuff with sub-coracoid bursitis of the right shoulder joint. On examination of the right shoulder joint, all shoulder movements were restricted due to pain. Hawkins抯 impingement test, Neer抯 test, and the painful arc test were found to be positive. She underwent a treatment protocol of Vatavyadhi Chikitsa incorporated with Bhagna Chikitsa. Internal and external medications, along with Upanaham, Abhyanga, Thaila pichu, bandage, and active shoulder exercises, were the treatments followed in this case. After the treatment, patient got relief from pain (VAS scale: 7 to 4) and considerable improvement in range of motion (ROM) for the right shoulder joint. This case study highlighted that within one month, the chronic rotator cuff injury got partial functional restoration (SPADI-56 to 30) by conservative ayurvedic management.
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Rotator cuff tears are very common in middle-aged and older adults and are the leading cause of shoulder surgery in the population. Some patients have rotator cuff tears that are classified as irreparable tears due to the large size of the tear and severe muscle atrophy. The treatment of irreparable rotator cuff tears presents great challenges. How to reconstruct the function of the shoulder joint is the key point. In this review article, authors will focus on partial repair of irreparable rotator cuff tears and tendon transfer for rotator cuff reconstruction, paying attention to its scope of application, efficacy, advantages and disadvantages, and providing reference for clinical diagnosis and treatment.
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Objective To analyze the factors associated with pain after arthroscopic rotator cuff bridge suture.Methods According to the inclusion and exclusion criteria,the data of 112 patients with unilateral rotator cuff injury who received arthroscopic bridge suture in our department were collected and were investigated in the form of telephone follow-up.In this study,SPSS 23.0 was used to input data and conduct statistical analysis.Logistic regression analysis was used to analyze the correlation between the above influencing factors and postoperative pain.Results A total of 112 patients were included for statistical analysis,single factor analysis revealed,including course of disease,smoking history,preoperative University of California,Los Angeles(UCLA)score,Constant score,numeric rating scale(NRS),size of rotator cuff tear,whether it was full-thickness tear and degree of tendon retraction might be related to postoperative pain(P<0.05).The age,gender,body mass index(BMI),drinking history,diabetes and hypertension were not related to postoperative pain(P>0.05).Multiple linear regression analysis concluded that there were four factors related to postoperative pain,and the correlation degree was preoperative NRS,preoperative UCLA score,tear size and smoking history.Conclusion The causes of postoperative pain after arthroscopic rotator cauff repair are complex and diverse.Analyzing the cause of postoperative pain can effectively reduce the pain of patients and promote the recovery of shoulder joint function.
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Objective To investigate the optimal display orientation of rotator cuff space(RI)structures on magnetic resonance(MR)scanning and arthrography.Methods A total of 80 patients who underwent MR scanning and arthrography in our hospital from January 2021 to March 2023 were selected and all of them were confirmed to have normal RI by shoulder arthroscopy.The RI and the superior glenohumeral ligament(SGHL),the long head of biceps tendon(LHBT),and the coracohumeral ligament(CHL)in the transverse axial,oblique sagittal,and oblique coronal positions were counted in the transverse axial,oblique sagittal,and oblique coronal positions on MR scanning and arthrography.Results The display rate of RI structure by oblique sagittal scan was 17.50%higher than that by horizontal scan,0.00%and oblique coronal scan,5.00%(4/80)(χ2 = 18.739,P<0.001).The display of SGHL,LHBT and CHL in RI by MR Oblique sagittal scan was better than that in transverse axis and oblique coronal scan(χ2 = 26.036,P<0.001).MR oblique sagittal arthrography showed a higher rate of RI structures 57.50%than transverse axial 5.00%and oblique coronal 17.50%(χ2 = 61.534,P<0.001);MR oblique sagittal arthrography showed better display of SGHL,LHBT,and CHL structures in RI than transverse axial and oblique coronal(χ2 = 64.569,P<0.001);MR oblique sagittal arthrography had a significantly higher rate of complete visualization of RI structures in 57.50%than MR oblique sagittal plain scanning in 17.50%(χ2 = 27.307,P<0.05).Conclusion Oblique sagittal position is the optimal display orientation for MR scanning and arthrography to show RI structures.
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BACKGROUND:The shoulder joint,as a non-weight-bearing joint of the human upper limb,is considered a perfect compromise between flexibility and stability.The traditional experimental mechanics research of shoulder joints has some limitations due to the complexity of internal structure,measurement techniques and ethical issues.The finite element analysis method is applied to the research of shoulder joints,which provides valuable reference conclusions for the discussion of shoulder joint diseases and the decision of surgical methods. OBJECTIVE:To review the status of finite element research in the field of the shoulder joint,and to put forward the prospect of future research. METHODS:The finite element analysis method was used to search the literature on shoulder joint complex-related diseases in PubMed,Web of Science,WanFang and CNKI databases by computer.Chinese search terms were"shoulder joint,finite element analysis,rotator cuff injury,glenoid labrum,shoulder joint replacement".English search terms were"FE,should joint,glenohumeral joint,rotator cuff tears,glenoid labrum,shoulder arthroplasty".The search period was mainly from January 2010 to January 2023.Some important documents were also tracked,retrieved and read. RESULTS AND CONCLUSION:(1)With the open network of model data and the establishment of relevant model databases,finite element research has become more and more standardized and reproducible.(2)The widely validated finite element model of the shoulder joint deepens our understanding of the shoulder field to enable more efficient clinical decision-making.(3)With the continuous development of computer technology and software development,future finite element research is bound to become an indispensable practical tool for clinical scientific research.
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BACKGROUND:In recent years,some scholars in the field of tendon bone injury have attached stromal cell-derived factor 1 to tissue engineering scaffolds to promote tendon bone healing,and achieved good results.However,whether stromal cell-derived factor 1 promotes tendon bone healing mechanisms and participates in the repair of natural healing has not yet been defined. OBJECTIVE:To study the expression of stroma-cell derived factor 1 during tendon bone healing after rupture of the whole supraspinatus muscle of the rabbit rotator cuff and its migration effect and optimal in vitro migration promoting concentration on stem cells during tendon bone injury. METHODS:Totally 18 adult New Zealand rabbits were randomly selected to establish rotator cuff injury models,and an additional 3 rabbits were selected as blank controls.At 3,5,7,14,21,and 28 days after modeling,three rabbits were executed separately and the rabbits in the blank group were sacrificed.The tissues of tendon bone junction were taken and stored in a-80℃refrigerator.The expression of stromal cell-derived factor 1 was detected by ELISA at each time point after injury.Mesenchymal stem cells were isolated from the bone marrow of young rabbit femur,cultured,and identified.Transwell assay was performed to verify the migration-promoting effect of stromal cell-derived factor 1 on stem cells and the optimal migration-promoting concentration in vitro.The stem cells cultured to P3 were co-cultured with BrdU and injected into the rabbit ear marginal vein,and immunohistochemical staining was used to verify whether the stem cells migrated to the injury site. RESULTS AND CONCLUSION:(1)Stromal cell-derived factor 1 gene expression was bimodal during rotator cuff tendon bone healing.Stromal cell-derived factor 1 gene expression increased significantly at 3 days post-injury(P<0.01)and then decreased,reaching a minimum at 5 days post-injury.It increased again and reached a peak 14 days after injury(P<0.01)and then decreased.(2)Cell immunohistochemical staining displayed that stem cells labeled with BrdU did migrate to the injury site.(3)The results of the transwell experiment exhibited that 60-80 ng/mL stromal cell-derived factor 1 had the best effect on promoting migration of stem cells,while a concentration of 200 ng/mL inhibited migration.(4)Stromal cell-derived factor 1 is involved in the healing of rotator cuff tendon bone during the inflammatory response phase and the proliferation phase.The mechanism of action may be to promote the migration of stem cells to the injury and their differentiation into various types of cells to promote repair.In addition,the pro-migration effect of stromal cell-derived factor 1 exists at a range of concentrations,beyond which it may act as an inhibitor.
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BACKGROUND:Sarcopenia is a chronic condition that leads to strength loss and functional decline,increasing the risk of frailty,disability,falls,and death in older adults.Blood flow restriction training can be effective in the treatment of sarcopenia,but a comprehensive review of its advantages,disadvantages,biological mechanisms,and application options is lacking. OBJECTIVE:To review the advantages,limitations,and biological mechanisms of blood flow restriction training interventions for sarcopenia and to give recommendations for application protocols based on current published evidence. METHODS:A search of major databases was conducted for literature published in the time frame up to February 2023.The search terms were"blood flow restriction training,KAATSU,elderly,sarcopenia,muscle"in English and Chinese.Finally,82 included papers were compiled and analyzed. RESULTS AND CONCLUSION:Blood flow restriction training as an intervention for sarcopenia has been effective in peripheral muscle groups,but there are limitations in its application.Blood flow restriction training is highly operational and safe.This training can improve muscle strength and physical performance,but there are potential risks,including adverse events on skeletal muscle,cardiovascular and endothelial cells.Therefore,blood flow restriction training needs to be performed under scientific guidance and further studies are needed to verify its efficacy in patients with sarcopenia.The biological mechanisms of blood flow restriction training intervention in sarcopenia may include:increasing muscle hypertrophy due to reactive muscle congestion,improving muscle protein synthesis capacity,inducing metabolic stress adaptation,promoting skeletal muscle growth and repair,activating vascular endothelial growth factor signaling pathway to promote angiogenesis,and promoting satellite cell proliferation.However,these specific roles and combined effects of these mechanisms need to be determined by more in-depth studies.Blood flow restriction training interventions for sarcopenia are mainly influenced by training and cuffs.To avoid adverse events,it is recommended that 20%to 50%1RM,20 to 75 repetitions,2 to 3 times per week,30-60 seconds interval between sessions,smaller size cuffs with a pressurization value≤140 mmHg for upper limb training,and larger size cuffs with a pressurization value≤180 mmHg for lower limb training,usually 50%to 80%of the pressure value in the completely occluded artery.However,more research is needed on the training frequency and interval between sessions in older adults,and further research is needed on the optimal choice of cuff pressurization values.
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BACKGROUND:Rotator cuff muscle degeneration(muscle atrophy,fibrosis and fatty infiltration)is a common condition after rotator cuff tears,which seriously affects shoulder function and surgical outcomes.Ginsenoside Rg1 has biological effects such as anti-oxidation,anti-apoptosis and lipid-lowering.However,the effect of ginsenoside Rg1 on muscle degeneration after rotator cuff tear has not been reported. OBJECTIVE:To investigate the effect of ginsenoside Rg1 on muscle degeneration after massive rotator cuff tear in mice. METHODS:Sixty C57BL/6J mice were randomly divided into sham group,model group,ginsenoside Rg1 low dose group and ginsenoside Rg1 high dose group,with 15 mice in each group.The skin of the right shoulder of mice in the sham group was cut and sutured.Massive rotator cuff tear mouse models of the right shoulder were established in the other three groups.Supraspinatus tendon and suprascapular nerve compression were administrated.Mice in the sham and model groups were intraperitoneally injected with 0.5 mL of saline after operation,while those in the ginsenoside Rg1 low and high dose groups were intraperitoneally injected with ginsenoside Rg1 30 and 60 mg/kg respectively,once a day,for 6 weeks.Mice were assessed for limb function by gait analysis the day after the last injection.After euthanasia,the supraspinatus muscle on the operated side was taken to measure the muscle atrophy rate and muscle contractility.Muscle tissue was stained with oil red O and Masson.RT-PCR was used to detect the expression of atrophy,fibrosis,and fatty infiltration related genes. RESULTS AND CONCLUSION:Compared with the model group,low-and high-dose ginsenoside Rg1 significantly increased paw print area and step length(P<0.05).Compared with the model group,low-and high-dose ginsenoside Rg1 significantly increased myofiber cross-sectional area and supraspinatus contractility(P<0.05),and significantly decreased wet muscle mass reduction ratio,fatty infiltration area ratio,and collagen fiber area ratio(P<0.05).Compared with the model group,low-and high-dose ginsenoside Rg1 significantly decreased the expression of atrophy,fibrosis,and fatty infiltration related genes(P<0.05).There was no significant difference in paw print area,supraspinatus muscle contractility,and myofiber cross-sectional area between ginsenoside Rg1 low and high dose groups(P>0.05),and all other indexes were better in the ginsenoside Rg1 high dose group than in the ginsenoside Rg1 low dose group(P<0.05).To conclude,ginsenoside Rg1 could significantly reduce muscle atrophy,fibrosis and fatty infiltration following massive rotator cuff tear in mice,which is beneficial to improve muscle strength and limb function.
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BACKGROUND:Transposition of the long head of biceps tendon is a commonly surgical method for massive rotator cuff tears.Currently,there are a few reports on the clinical efficacy of the transposition of the long head of biceps tendon and there is no consensus on the influencing factors for retearing. OBJECTIVE:To observe the outcome of arthroscopic long head of the biceps tendon in the treatment of massive rotator cuff tear. METHODS:The clinical data of 28 patients with massive rotator cuff tears,aged(61.79±10.50)years,admitted at Jiangsu Province Hospital of Chinese Medicine from March 2019 to May 2022 were retrospectively analyzed.All patients underwent arthroscopic long head of the biceps tendon.Patients were assessed for visual analog scale scores,University of California at Los Angeles scores,American Shoulder and Elbow Surgeons scores,Constant-Murley scores,and shoulder range of motion before and 1 year after operation.MRI of the shoulder joint was performed for observing the integrity of the repaired structure at 1 year after operation.Twenty-three patients(5 of 28 lost to follow-up)were categorized into the intact tendon group(n=18)and the tendon retear group(n=5)according to the Sugaya typing at 1 year after operation;the patients were divided into the normal group(n=8),the degeneration group(n=9),and the partial tear group(n=6)according to the intraoperative quality of the long head of the biceps tendon.Differences in the above indexes were compared between groups. RESULTS AND CONCLUSION:When followed up at 1 year after surgery,the range of motion,visual analog scale scores,University of California at Los Angeles scores,American Shoulder and Elbow Surgeons scores,Constant-Murley scores of the shoulder were significantly improved compared with preoperative data(P＜0.05).There was a significant difference in Goutellier grading between intact tendon and tendon retear groups(P＜0.05),while no significant difference was observed in the other influencing factors(P＞0.05).There were no significant differences in visual analog scale scores,University of California at Los Angeles scores,American Shoulder and Elbow Surgeons scores,Constant-Murley scores,and shoulder range of motion at 1 year after operation among the normal,degeneration,and partial tear groups(P＞0.05).MRI findings indicated that the sutured tendon healed well in 18 patients,with a healing rate of 78%.Arthroscopic long head of the biceps tendon for augmented repair can provide a reliable repair for massive rotator cuff tear that is refractory,significantly alleviate the pain of the shoulder joint,and restore the function of the shoulder joint.
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BACKGROUND:Acromion morphology is the most important external factor of degenerative rotator cuff tear,and studies on acromion morphology and acromion coverage have been continuing. OBJECTIVE:To investigate the coverage of acromion on rotator cuff tissue in three-dimensional space,measure coronal and sagittal parameters,and explore the relationship of acromial overhang,acromioglenoid angle and acromial coverage angle with degenerative full-thickness rotator cuff tears. METHODS:A total of 56 patients diagnosed with full-thickness rotator cuff tears by shoulder arthroscopic surgery or MRI in the Affiliated Hospital of Xuzhou Medical University from January 2022 to June 2023 were retrospectively collected as the tear group,while 48 patients with non-rotator cuff tear were included as the control group.Clinical data and chest CT data of the patients of the two groups were collected,and the shoulder blades of the patients were reconstructed using Mimics software.Acromial overhang,acromioglenoid angle and acromial coverage angle were measured in 3-matic software.The differences between the measurement parameters were compared between the two groups.Binary Logistic regression analysis and receiver operating characteristic curve analysis were performed to evaluate the ability of the measurement parameters to predict rotator cuff tear.It is generally believed that the parameter had good diagnostic value when the area under the receiver operating characteristic curve was greater than 0.8. RESULTS AND CONCLUSION:(1)The mean acromial overhang in patients with rotator cuff tears was greater than that in controls(P<0.001).The mean acromial coverage angle was also greater in patients with rotator cuff tears than in controls(P<0.001).There was no significant difference in the acromioglenoid angle between the two groups(P>0.05).(2)Binary Logistic regression analysis showed that acromial overhang and acromial coverage angle were both risk factors for rotator cuff tear(P<0.05).(3)Receiver operating characteristic curve analysis indicated that the areas under the curve of acromial overhang and acromial coverage angle were 0.725 and 0.865,respectively,and the optimal cutoff values were 36.15 mm and 60.65°.(4)The results showed that the acromial overhang and acromial coverage angle were greater in patients with rotator cuff tears than in patients without rotator cuff tears.Both were associated with degenerative full-thickness rotator cuff tears,and they could be used to predict rotator cuff tears,and the acromial coverage angle was more effective in predicting rotator cuff tears.
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OBJECTIVE@#To explore the effect of chitosan (CS) hydrogel loaded with tendon-derived stem cells (TDSCs; hereinafter referred to as TDSCs/CS hydrogel) on tendon-to-bone healing after rotator cuff repair in rabbits.@*METHODS@#TDSCs were isolated from the rotator cuff tissue of 3 adult New Zealand white rabbits by Henderson step-by-step enzymatic digestion method and identified by multidirectional differentiation and flow cytometry. The 3rd generation TDSCs were encapsulated in CS to construct TDSCs/CS hydrogel. The cell counting kit 8 (CCK-8) assay was used to detect the proliferation of TDSCs in the hydrogel after 1-5 days of culture in vitro, and cell compatibility of TDSCs/CS hydrogel was evaluated by using TDSCs alone as control. Another 36 adult New Zealand white rabbits were randomly divided into 3 groups ( n=12): rotator cuff repair group (control group), rotator cuff repair+CS hydrogel injection group (CS group), and rotator cuff repair+TDSCs/CS hydrogel injection group (TDSCs/CS group). After establishing the rotator cuff repair models, the corresponding hydrogel was injected into the tendon-to-bone interface in the CS group and TDSCs/CS group, and no other treatment was performed in the control group. The general condition of the animals was observed after operation. At 4 and 8 weeks, real-time quantitative PCR (qPCR) was used to detect the relative expressions of tendon forming related genes (tenomodulin, scleraxis), chondrogenesis related genes (aggrecan, sex determining region Y-related high mobility group-box gene 9), and osteogenesis related genes (alkaline phosphatase, Runt-related transcription factor 2) at the tendon-to-bone interface. At 8 weeks, HE and Masson staining were used to observe the histological changes, and the biomechanical test was used to evaluate the ultimate load and the failure site of the repaired rotator cuff to evaluate the tendon-to-bone healing and biomechanical properties.@*RESULTS@#CCK-8 assay showed that the CS hydrogel could promote the proliferation of TDSCs ( P<0.05). qPCR results showed that the expressions of tendon-to-bone interface related genes were significantly higher in the TDSCs/CS group than in the CS group and control group at 4 and 8 weeks after operation ( P<0.05). Moreover, the expressions of tendon-to-bone interface related genes at 8 weeks after operation were significantly higher than those at 4 weeks after operation in the TDSCs/CS group ( P<0.05). Histological staining showed the clear cartilage tissue and dense and orderly collagen formation at the tendon-to-bone interface in the TDSCs/CS group. The results of semi-quantitative analysis showed that compared with the control group, the number of cells, the proportion of collagen fiber orientation, and the histological score in the TDSCs/CS group increased, the vascularity decreased, showing significant differences ( P<0.05); compared with the CS group, the proportion of collagen fiber orientation and the histological score in the TDSCs/CS group significantly increased ( P<0.05), while there was no significant difference in the number of cells and vascularity ( P>0.05). All samples in biomechanical testing failed at the repair site during the testing process. The ultimate load of the TDSCs/CS group was significantly higher than that of the control group ( P<0.05), but there was no significant difference compared to the CS group ( P>0.05).@*CONCLUSION@#TDSCs/CS hydrogel can induce cartilage regeneration to promote rotator cuff tendon-to-bone healing.
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Conejos , Animales , Manguito de los Rotadores/cirugía , Quitosano , Hidrogeles , Lesiones del Manguito de los Rotadores/cirugía , Cicatrización de Heridas , Tendones/cirugía , Colágeno , Células Madre , Fenómenos BiomecánicosRESUMEN
Objective To evaluate the short-term clinical effect of arthroscopic repair of rotator cuff injury with all-suture anchor using a prospective and single-cohort clinical trial.Methods Twenty-five patients with rotator cuff injuries(1.5 cm<tear size<6 cm)and admitted to the Department of Sports Medicine and Ambulatory Surgery Centre of Jiangsu Provincial Subei People's Hospital between July and September 2022 were used as the study subjects.Two cases were excluded for not meeting the in-clusion criteria,while another one was withdrawn halfway due to inconvenience of follow-up.Finally,22 patients were included in the study,consisting of 8 males and 14 females,with the average age of 59.1±10.9 years and rotator cuff tear size of 3.2±1.2 cm of 10 left and 12 right shoulders.Be-fore as well as 3 and 6 months after operation,all patients were evaluated using the pain visual ana-logue scale(VAS),the American Shoulder and Elbow Surgeons(ASES)score,Constant-Murley Shoul-der Functional(Constant)Score,Simple Shoulder Test(SST),bilateral shoulder abduction muscle strength ratio(affected/healthy),and mobility of the affected shoulder joint.Six months after operation,the healing of rotator cuff and the formation of cyst around the all-suture anchor were evaluated by us-ing the magnetic resonance imaging(MRI).According to whether there was cysts around the all-suture anchor,the patients were divided into the cyst group and the cyst-free group.Their age,sex,the side affected,trauma history,course time,tear size and operation time of the two groups were com-pared and analyzed to find the correlated factors.The average VAS,ASES and Constant scores,and the range of motion of the affected shoulder joint and the healing grade of rotator cuff were compared between the two groups 6 months after operation.Results Twenty-two patients were granted 6.2±0.3 months of follow-up after surgery.Three and six months after the operation,their average VAS scores(1.3±1.2 and 0.7±0.4),ASES scores(79.7±12.3 and 88.9±6.5),Constant scores(65.4±12.4 and 73.7±9.6),SST scores(7.6±0.2 and 10.5±0.2)and bilateral shoulder abductor muscle strength ratio(affected side/healthy side)(71.3±9.6 and 90.3±5.9)were significantly higher than the values before the opration(4.2±1.1,51.5±11.2,46.2±12.8,3.5±0.3 and 21.9±15.8),respec-tively(P<0.05).There were also significant differences in the range of motion of shoulder joint 3 months and 6 months after surgery(P<0.05).Postoperative MRI revealed 1 patient with rotator cuff re-tear.There was significant difference in age between the cyst group and the cyst free group(P<0.05).However,there was no significant difference in VAS score,ASES score,Constant score,range of mo-tion of shoulder joint and healing grade of rotator cuff between the two groups 6 months after surgery(P>0.05).Conclusion Arthroscopic rotator cuff repair with all-suture anchor is feasible and safe,and has good short-term clinical effect.
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Abstract Rotator cuff tear is a common source of pain and disfunction in shoulder, with prevalence increasing with age. Nonsurgical treatment is adequate for many patients; however, for those for whom surgical treatment is indicated, rotator cuff repair provides reliable pain relief and good functional results. However, massive and irreparable tears due to tear size, tendon retraction, muscle atrophy, fatty infiltration are a significant challenge for surgeons. Whenever irreparable tears coexist with cartilage degeneration/arthritis (rotator cuff arthropathy), the indication of reverse shoulder arthroplasty is the golden standard. However, in young patients without arthritis, joint preserving procedures, from debridement to muscle transfers, are preferred. Choosing the most appropriate treatment is not quite established in literature, each treatment modality present particular indications, advantages and disadvantages.
Resumo A lesão do manguito rotador é uma fonte frequente de dor e incapacidade funcional na população em geral, e sua prevalência aumenta com o envelhecimento. O tratamento não cirúrgico é adequado para muitos pacientes, e, quando necessário, o reparo cirúrgico resulta em alívio da dor e bons resultados funcionais. Entretanto, lesões extensas e não reparáveis devido ao tamanho da lesão, grau de retração, atrofia muscular e substituição gordurosa apresentam desafios ao tratamento. Nos casos de lesões irreparáveis que coexistem com degeneração articular/osteoartrite (artropatia do manguito rotador), a indicação de artroplastia reversa é o padrão ouro. Porém, nos casos de pacientes mais jovens e sem osteoartrite, as indicações que preservam a articulação, desde o debridamento até as transferências tendinosas, são preferíveis. A escolha do tratamento mais apropriado não está claramente estratificado na literatura e cada modalidade tem suas indicações, vantagens e desvantagens.
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Abstract Objective: To evaluate the influence of radiographic values on clinical and functional results in patients treated with reverse arthroplasty for rotator cuff arthropathy (RCA) using a lateralized design. Methods: A retrospective analysis was performed. Patient demographics were recorded, as well as preoperative and postoperative range of motion. Function was calculated using the Constant-Murley score both before and after the procedure. Pre and postoperative anteroposterior and axial radiographs of the affected shoulder were analysed. In the preoperative images, the following was calculated: acromiohumeral distance (AHD) and lateral humeral offset (LHO). Postoperative measurements included: AHD, LHO, distalization shoulder angle (DSA) and lateralisation shoulder angle (LSA). Linear regression and quadratic regression analysis was performed to determine their degree of association with final functional outcomes. By applying a quadratic regression analysis and ROC curves, the cut-off values were determined with respect to the above-mentioned angles and the VPP was calculated. Results: The greater anterior elevation (AE) ranges were found with DSA between 40-45° and LSA among 80°- 90°, while better ABD was observed with LSA of 90-100°. Preoperative AHD was correlated to RE (rs:0.47; p:0.049). Postoperative AHD was found to be in a directly proportional relationship with AE (rs:0.49; p:0.03). Postoperative ABD showed an inverse linear regression with preoperative AHD (rs: -0.44, p:0.047). LSA and DSA were inversely related. Conclusion: We found that a DSA between 40-45° and a LSA of 80-100° could lead to better range of motion regarding AE and ABD in patients with rotator cuff arthropathy treated with RSA.
Resumo Objetivo: Avaliar a influência dos valores radiográficos nos resultados clínicos e funcionais em pacientes tratados com artroplastia reversa para artropatia do manguito rotador utilizando um desenho lateralizado. Métodos: Foi realizada uma análise retrospectiva. Foram registradas as demografias dos pacientes, bem como o intervalo de movimento pré-operatório e pós-operatório. A função foi calculada usando a pontuação Constant-Murley tanto antes como depois do procedimento. Radiografias pré e pós-operatórias anteroposteriores e axiais do ombro afetado foram analisadas. Nas imagens pré-operatórias, foram calculados a distância acromioumeral (DAU)e offset lateral umeral (OLU). As medidas pós-operatórias incluídas foram DAU, OLU, ângulo de distalização do ombro (ADO) e ângulo de lateralização do ombro (ALO). Foi realizada uma análise de regressão linear e regressão quadrática para determinar seu grau de associação com os resultados funcionais finais. Aplicando uma análise de regressão quadrática e curvas ROC, os valores de corte foram determinados em relação aos ângulos acima mencionados e o valor preditivo positivo foi calculado. Resultados: As maiores faixas de elevação anterior (EA) foram encontradas com ADO entre 40 e 45° e ALO entre 80 e 90°, enquanto a melhor abdução (ABD) foi observada com ALO de 90 e 100°. A DAU pré-operatória foi correlacionada com a rotação externa (RE) (rs: 0,47; p: 0,049). A DAU pós-operatória apresentou uma relação diretamente proporcional com a EA (rs: 0,49; p: 0,03). A ABD pós-operatória mostrou uma regressão linear inversa com a DAU pré-operatória (rs: -0,44, p: 0,047). O ALO e o ADO estavam inversamente relacionados. Conclusão: Determinamos que um ADO entre 40 e 45° e um ALO de 80 e 100° poderia levar a uma melhor amplitude de movimento em relação à EA e ABD em pacientes com artropatia do manguito rotador tratados com artroplastia reversa de ombro.
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Humanos , Hombro/cirugía , Manguito de los Rotadores/cirugía , Artroplastía de Reemplazo de HombroRESUMEN
Abstract Objective The objectives of this study are to compare absolute values of acromial index (AI) and critical shoulder angle (CSA) obtained in both radiographs and magnetic resonance image (MRI) of the shoulder; and to compare the interobserver and intra-observer agreement for AI and CSA values measured in these image modalities. Methods Patients who had medical indication of investigating shoulders conditions through radiographs and MRI were included. Images were taken to two fellowship-trained shoulder surgeons, which conducted measurements of AI and CSA in radiographs and in MRI. Twelve weeks after the first evaluation, a second evaluation was conducted. Inter- and intra-observer reliability was presented as an Intraclass Correlation Coefficient (ICC) and agreement was classified according to Landis & Koch criteria. The differences between two measurements were evaluated using Bland-Altman plots. Results 134 shoulders in 124 subjects were included. Mean intra-observer ICC for CSA in X-rays and in MRI were 0.936 and 0.940, respectively; for AI, 0.908 and 0.022. Mean inter-observer ICC for CSA were 0.892 and 0.752 in X-rays and MRI respectively; for AI, ICC values were 0.849 and 0.685. All individual analysis reached statistical power (p< 0.001). Mean difference for AI values measured in X-rays and in MRI was 0.01 and 0.03 for observers 1 and 2, respectively. Mean difference for CSA values obtained in X-rays and MRI was 0.16 and 0.58 for observers 1 and 2, respectively. Conclusion Both MRI and X-rays provided high intra- and interobserver agreement for measurement of AI and CSA. Absolute values found for AI and CSA were highly correlated in both image modalities. These findings suggest that MRI is a suitable method to measure AI and CSA. Level of Evidence II, Diagnostic Study.
Resumo Objetivo Os objetivos deste estudo foram comparar os valores absolutos do índice acromial (IA) e do ângulo crítico do ombro (ACO) obtidos em radiografias e ressonâncias magnéticas (RM) do ombro e comparar a concordância interobservador e intraobservador dos valores de IA e ACO medidos nessas modalidades de imagem. Métodos Pacientes com indicação médica de investigação de doenças dos ombros por meio de radiografias e RM foram incluídos no estudo. As imagens foram levadas para dois cirurgiões de ombro treinados que realizaram medidas de IA e ACO em radiografias e RM. Doze semanas após a primeira avaliação, uma segunda avaliação foi realizada. A confiabilidade inter e intraobservador foi apresentada como coeficiente de correlação intraclasse (CCI) e a concordância foi classificada segundo os critérios de Landis e Koch. As diferenças entre duas medidas foram avaliadas por meio de gráficos de Bland-Altman. Resultados Cento e trinta e quatro ombros de 124 indivíduos foram incluídos no estudo. O CCI intraobservador médio para ACO em radiografias e RM foi 0,936 e 0,940, respectivamente; para IA, foi 0,908 e 0,022. O CCI interobservador médio para ACO foi 0,892 e 0,752 em radiografias e RM, respectivamente; para IA, os valores de CCI foram 0,849 e 0,685. Todas as análises individuais apresentaram poder estatístico (p < 0,001). A diferença média dos valores de IA em radiografias e RM foi 0,01 e 0,03 para os observadores 1 e 2, respectivamente. A diferença média dos valores de ACO em radiografias e RM foi 0,16 e 0,58 para os observadores 1 e 2, respectivamente. Conclusão Tanto a RM quanto as radiografias tiveram alta concordância intra e interobservador para medida de IA e ACO. Os valores absolutos de IA e ACO foram altamente correlacionados em ambas as modalidades de imagem. Esses achados sugerem que a RM é um método adequado para determinação de IA e ACO. Nível de Evidência II, Estudo Diagnóstico.
Asunto(s)
Humanos , Acromion , Imagen por Resonancia Magnética , Síndrome de Abducción Dolorosa del Hombro , Lesiones del Manguito de los RotadoresRESUMEN
La lesión del manguito rotador es una causa importante de dolor y disfunción del hombro. El tratamiento de las roturas masivas e irreparables del manguito rotador sigue siendo un gran reto para los ortopedistas por su complejidad y severidad. Una de las alternativas prometedoras para su manejo es el uso del balón subacromial. Presentamos el caso de una mujer de 67 años con diagnóstico de rotura masiva e irreparable del manguito rotador en el hombro derecho (grado III de Patte, grado IV Goutallier y grado II de Hamada) sin artrosis glenohumeral, tenosinovitis del bíceps y subescapular íntegro. La escala de constant preoperatorio fue de 40 puntos. Se realizó una reparación parcial artroscópica del tendón supraespinoso e infraespinoso asociado a una tenodesis suprapectoral del bíceps y la colocación del balón subacromial. La paciente realizó rehabilitación con mejoría de los arcos de movilidad, disminución del dolor e incremento de la fuerza del hombro derecho. La escala de constant postoperatorio fue de 80 puntos a la semana doce. El balón subacromial es una buena alternativa de tratamiento para las lesiones irreparables del manguito rotador con resultados óptimos a corto plazo en cuanto a dolor y función.
The rotator cuff injury is a significant cause of shoulder pain and dysfunction. Treating massive and irreparable rotator cuff tears remains a major challenge for orthopedists due to their complexity and severity. One promising alternative for managing these cases is the use of subacromial balloons. In this study, we present the case of a 67-year-old woman diagnosed with a massive and irreparable rotator cuff tear in her right shoulder (Grade III Patte, Grade IV Goutallier, and Grade II Hamada), without glenohumeral arthritis, intact biceps tenosynovitis, and subscapularis. The preoperative Constant score was 40 points. The patient underwent partial arthroscopic repair of the supraspinatus and infraspinatus tendons, along with a suprapectoral biceps tenodesis and subacromial balloon placement. Postoperative rehabilitation led to improved range of motion, reduced pain, and increased strength in the right shoulder. The postoperative Constant score reached 80 points at the twelve-week mark. The subacromial balloon proves to be a promising treatment alternative for irreparable rotator cuff injuries, providing optimal short-term results in terms of pain relief and functionality.
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Resumen: Introducción: es bien conocida la conexión existente entre un ángulo crítico del hombro (ACH) mayor a 35o y las lesiones del manguito rotador (LMR). Sin embargo, se desconoce si existe una asociación entre los valores más elevados de ACH y la presencia de LMR de mayor severidad. Material y métodos: estudio de corte transversal, descriptivo, observacional, prospectivo y analítico, en el que a los pacientes con LMR se les evaluó por imagen el ACH y mediante artroscopía el grado de lesión. Se formaron cuatro grupos (sin lesión; lesión parcial; lesión completa; lesión masiva) y se compararon mediante la estadística paramétrica ANOVA. Se estudió la asociación entre LMR y ACH por medio del coeficiente rho de Spearman. Resultados: se estudiaron 71 pacientes, 15 sin LMR (ACH de 34.13 ± 0.98), 17 con lesión parcial (ACH de 36.00 ± 1.15), 22 con lesión completa (ACH de 40.77 ± 0.69) y 17 con lesión masiva (ACH de 41.53 ± 0.68). No se encontró diferencia significativa entre el ACH de los grupos sin lesión y lesión parcial (p = 0.486; 35o), pero sí existió diferencia entre los grupos de lesión completa y lesión masiva (p = 0.000 y p = 0.001; 35o). Se encontró una asociación positiva significativa entre ACH y LMR (rho = 0.605, p = 0.000). Conclusiones: un ACH por arriba de 35o se asocia con LMR de tipo completas y masivas y funciona como factor predictivo de severidad para estas lesiones.
Abstract: Introduction: the connection between a critical shoulder angle (CSA) greater than 35o and the presence rotator cuff tears (RCT) is well known. However, it remains unidentified if there is an association between a higher CSA value and the presence of more severity RCT. Material and methods: cross-sectional, descriptive, observational, prospective and analytical study in which patients with RCT had their CSA evaluated by imaging and the degree of the RCT by arthroscopy. Four groups were formed (without lesion; partial lesion; complete lesion; massive lesion) and were compared using ANOVA parametric statistics. The association between RCT and CSA was studied by rho Spearman coefficient. Results: 71 patients were studied, 15 without RCT (CSA of 34.13 ± 0.98), 17 with partial lesion (CSA of 36.00 ± 1.15), 22 with complete lesion (CSA of 40.77 ± 0.69) and 17 with massive lesion (CSA of 41.53 ± 0.68). No significant statistical difference was found between the CSA of the groups without lesion and partial lesion (p = 0.486; 35o) but there was a difference between the groups with complete and massive lesion (p = 0.000 and p = 0.001; 35o). A significant positive association was found between CSA and RCT (rho = 0.605, p = 0.000). Conclusions: an CSA above 35o is associated to complete and massive RCT and it works as a predictor of severity for these lesions.
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Resumen: Introducción: el acromion es una pequeña porción de la escápula que se extiende hacia la región anterior desde la espina de la escápula. Tradicionalmente se clasifica al acromion por la forma de su superficie inferior en un plano sagital. Se ha encontrado que la morfología acromial está rela-cionada con la lesión del manguito rotador. Objetivo: determinar la asociación entre el tipo de acromion con una mayor incidencia de ruptura de manguito rotador. Población de estudio: pacientes que acudan al Servicio de Traumatología y Ortopedia de un hospital privado de tercer nivel en la ciudad de Monterrey por hombro doloroso y a los cuales se les haya realizado una resonancia magnética simple de hombro. Material y métodos: se realizó un estudio de tipo transversal, retrospectivo y descriptivo, en el cual se revisaron 273 estudios de resonancia magnética en pacientes que cumplieran los criterios de inclusión. Se reportó el tipo de acromion según la clasificación morfológica en tipo I a IV y el estado del manguito rotador: sin ruptura, ruptura parcial o ruptura completa, haciendo una comparación entre hombro derecho e izquierdo. Resultados: se obtuvo un valor de p = 0.473 por lo que se concluye que no existe una asociación entre el tipo de acromion y el estado del manguito rotador. Conclusión: en el presente estudio, a diferencia de lo publicado en la literatura, se obtuvo que el acromion tipo II fue al que se asoció la mayoría de los casos con ruptura del manguito rotador.
Abstract: Introduction: the acromion is a small portion of the scapula that extends towards the anterior region from the spine of the scapula. Traditionally, the acromion is classified by the shape of its inferior surface in a sagittal plane. Acromial morphology has been found to be related to rotator cuff injury. Objective: to determine the association between the type of acromion with a higher incidence of rotator cuff rupture. Study population: patients who come to the Traumatology and Orthopedics Service of a third level hospital at Monterrey, Mexico, due to a painful shoulder and who have undergone a simple magnetic resonance of the shoulder. Material and methods: a cross-sectional, retrospective and descriptive study was carried out, in which 273 magnetic resonance studies were reviewed in patients who met the inclusion criteria. The type of acromion was reported according to the morphological classification in type I to IV and the state of the rotator cuff: without rupture, partial rupture or complete rupture, making a comparison between right and left shoulder. Results: in this study we found a value of p = 0.473 which concludes that there is no relation between the type of acromion and the injury of the rotator cuff. Conclusion: in the present study, unlike what has been published in the literature, it was found that type II acromion was the one that was associated in most cases with a rotator cuff tear.
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Introdução: o ombro do jogador de voleibol é suscetível a lesões resultantes de sobrecargas biomecânicas e movimentos repetitivos. As frequentes queixas de dor nessa articulação evidenciam o elevado volume de ações motoras unilaterais em alta velocidade acima da cabeça, atingindo o manguito rotador (MR) e gerando limitação funcional na prática desportiva. As tendinopatias do MR, formado pelos músculos subescapular, redondo menor, infraespinhal e supraespinhal, atingem comumente os tendões do supraespinhal e do infraespinhal. Objetivo: descrever as condutas cinesioterapêuticas utilizadas no tratamento das tendinopatias do MR em atletas de voleibol de quadra. Metodologia: pesquisaram-se as bases de dados MEDLINE, SciELO e BVS. Descritores: lesões do ombro, manguito rotador, atletas, voleibol e Terapia por Exercício (pesquisados em inglês), associados dois a dois ou três a três, dentre os quais o termo atletas ou voleibol sempre foi mantido. Foram incluídos artigos de revisão, artigos originais, ensaios clínicos e estudos de coorte publicados em português e inglês, entre os anos de 2009 e 2019. Resultados: inicialmente a busca resultou em 480 artigos. Após o processo de seleção, seis estudos foram revisados na íntegra e incluídos na síntese qualitativa. Conclusão: as principais condutas cinesioterapêuticas descritas foram: fortalecimento dos rotadores externos, dos músculos do tronco, da coluna e periescapulares, alongamento da região posterior do ombro e mobilizações articulares.
Introduction: the volleyball player's shoulder is susceptible to injuries resulting from biomechanical overloads and repetitive movements. The frequent complaints of pain in this joint highlight the high volume of unilateral motor actions at high speed above the head, reaching the rotator cuff (RC) and generating functional limitation in sports. RC tendinopathies, formed by the subscapularis, teres minor, infraspinatus and supraspinatus muscles, commonly affect the supraspinatus and infraspinatus tendons. Objective: to describe the kinesiotherapeutic conducts used in the treatment of RC tendinopathies in indoor volleyball athletes. Methodology: MEDLINE, SciELO and VHL databases were searched. Descriptors: shoulder injuries, rotator cuff, athletes, volleyball and Exercise Therapy (searched in English), associated two by two or three by three, among which the term athletes or volleyball was always maintained. Review articles, original articles, clinical trials and cohort studies published in Portuguese and English between 2009 and 2019 were included. Results: initially the search resulted in 480 articles. After the selection process, six studies were fully reviewed and included in the qualitative synthesis. Conclusion: the main kinesiotherapeutic procedures described were strengthening of the external rotators, trunk, spine and periscapular muscles, stretching of the posterior region of the shoulder and joint mobilizations.
Asunto(s)
Humanos , Masculino , Femenino , Manguito de los Rotadores , Voleibol , Atletas , Lesiones del HombroRESUMEN
Resumen Introducción: Existe falta de información en la litera tura sobre los resultados de la reparación artroscópica del manguito rotador en pacientes mayores de 80 años. El objetivo de este estudio fue evaluar una serie conse cutiva de pacientes con rupturas del manguito rotador a los que se les realizó la reparación artroscópica del mismo. Métodos: Análisis retrospectivo de pacientes mayores de 80 años a quienes se les realizó reparación artroscó pica de manguito rotador entre junio de 2004 y enero de 2016. El seguimiento mínimo fue de 2 años. Para la evaluación funcional y del dolor se utilizaron las escalas Constant, Dash, UCLA y Escala Visual Análoga (EVA). Resultados: El seguimiento promedio fue de 8.4 años. Se obtuvieron mejoras significativas en la valoración del rango de movilidad y la evaluación de las escalas de Constant, Dash y UCLA, y EVA. No se registraron complicaciones mayores y solo 4 pacientes requirieron una re-operación. Conclusión: Los principales hallazgos obtenidos fue ron la mejoría funcional y del dolor en los pacientes mayores de 80 años operados por una ruptura completa del manguito rotador en forma artroscópica.
Abstract Introduction: There is a lack of information in the literature on the results of arthroscopic rotator cuff re pair in patients older than 80 years. The purpose of this study was to evaluate a consecutive series of patients with rotator cuff tears who underwent arthroscopic rotator cuff repair. Methods: Retrospective analysis of patients older than 80 years who underwent arthroscopic rotator cuff repair between June 2004 and January 2016. The mini mum follow-up was 2 years. For functional and pain assessment, the Constant, Dash, UCLA scale and Visual Analogue Scale (VAS) for pain were used. Results: The average follow-up was 8.4 years. Signifi cant improvements were obtained in the assessment of the range of motion and the evaluation of the Constant, Dash and UCLA scales, as well as in the VAS. No major complications were recorded and only 4 patients re quired a reoperation. Conclusion: The main findings obtained were func tional and pain improvement in patients over 80 years of age operated on for a complete arthroscopic rotator cuff tear.