Oral steroid therapy for frozen shoulder / Terapia de esteroides orales para el hombro congelado

BACKGROUND: Since frozen shoulder is characterized by spontaneous recovery, no precise treatment strategy exists. Both conservative therapy and arthroscopic surgery is available, but the time required for recovery varies considerably. This study looks at the possible early symptom relief with oral steroid therapy. SUBJECTS AND METHODS: The subjects were 76 patients aged 33 to 73 years at the beginning of the study. The duration of the frozen shoulder was one to 15 months (mean 5.7 months) and hypertension was noted in 13 patients as a complicated disorder. A single course of steroid therapy consisted of a total dose of 105 mg of prednisolone over approximately a three-week period by the dose-tapering method. The number of courses varied with the degree of symptom relief, but the rest period between courses was always approximately four weeks. The results were assessed on the basis of the Japanese Orthopaedic Association (JOA) score, but the principal evaluations were pain and range of motion. RESULTS: The average ranges of motion before treatment were 102.8º of forward flexion 11.3º of external rotation and internal, rotation was at the buttocks. However, after one course of treatment, forward flexion was 136º, external rotation was 33.7º, and internal rotation was limited to the buttocks in only six cases. CONCLUSION: The results of oral steroid therapy for frozen shoulder were highly satisfactory. However, sufficient care is required in explaining the method of administration and the adverse effects such as the osteonecrosis of the femoral head or osteoporosis.

ANTECEDENTES: Como que el hombro congelado se caracteriza por la recuperación espontánea, no existe una estrategia de tratamiento precisa. Tanto la terapia conservadora como la cirugía artroscópica se hallan a disposición, pero el tiempo requerido para la recuperación varía considerablemente. Este estudio echa una ojeada al posible alivio de los síntomas tempranos por medio de la terapia de esteroides orales. SUJETOS Y MÉTODO: Los sujetos fueron 76pacientes en edades de 33 a 73 años al comienzo del estudio. La duración del hombro congelado fue de 1 a 15 meses (promedio 5.7 meses), y se observó hipertensión en 13 pacientes como una condición co-mórbida. Un solo tratamiento con esteroides consistía en una dosis total de 105 mg de prednisolona por un período de aproximadamente tres semanas mediante el método de reducción gradual de la dosis. El número de tratamientos varió de acuerdo con el grado de alivio del síntoma, pero el período de descanso entre tratamientos fue aproximadamente de cuatro semanas. Los resultados fueron evaluados sobre la base de la puntuación establecida por la Asociación Ortopédica del Japón (JOA), y las evaluaciones principales fueron el dolor y el alcance del movimiento. RESULTADOS: El rango promedio del movimiento antes del tratamiento fue 102.8º deflexión delantera, y 11.3º de rotación externa y la rotación interna fue en las nalgas. Sin embargo, luego de un tratamiento, la flexión delantera fue 136º, la rotación externa fue 33.7º, y la rotación interna estuvo limitada a las nalgas en sólo seis casos. CONCLUSIÓN: Los resultados de la terapia de esteroides orales para el hombro congelado, fueron altamente satisfactorias. Sin embargo, se requiere suficiente cuidado al explicar el método de administración y los efectos adversos, tales como la osteonecrosis de la cabeza del fémur o la osteoporosis.

Tradução e adaptação cultural à língua portuguesa do American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) para avaliação da função do ombro / Translation and cultural adaptation to the portuguese language of the American Shoulder and Elbow Surgeons Standardized Shoulder assessment form (ASES) for evaluation of shoulder function

Dores na região do ombro estão presentes em grande parte da população. Um instrumento de medida utilizado para avaliar a função do ombro, independente da enfermidade ou do distúrbio, é o American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES). No entanto, até o presente estudo, o ASES não contava com uma versão em português. O objetivo deste trabalho é realizar a tradução e a adaptação cultural do ASES à língua portuguesa.A versão original do ASES passou pelo processo específico de tradução e adaptação cultural, constituído pelas etapas de tradução inicial, retrotradução, comitê, pré-teste e aprovação do autor da versão original. O pré-teste foi aplicado em vinte pacientes com distúrbios variados na articulação do ombro (9 mulheres; 41,1 ± 13,0 anos de idade; 11,2 ± 8,9 meses de acometimento; 12,5 ± 3,1 anos de escolaridade). A versão definitiva do ASES em português foi estabelecida após os pacientes julgarem todos os seus itens compreensíveis e claros, e o autor do questionário original considerar a versão adequada. O resultado deste trabalho auxiliará os profissionais de reabilitação e os pesquisadores brasileiros, que passam a contar com mais um instrumento de medida a ser aplicado em pacientes com alterações funcionais no ombro.

Shoulder pain affects a significant percentage of the population. The American Shoulder and Elbow Surgeons Standardized Shoulder assessment form (ASES) is an outcome tool used to assess shoulder function, regardless of the disorder. However, at the moment the current study was undertaken, a Portuguese version of the ASES was not available. The objective of this work was to translate and make a cultural validation of the ASES to the Portuguese language. The original version of the ASES underwent the specific process of translation and cultural adaptation, comprising of the initial translation, back translation, committee, pre-test and the approval by the original author. The pre-test was applied in 20 patients with shoulder disorders (9 women, 41.1 ± 13.0 years of age, 11.2 ± 8.9 months with the disorder, and 12.5 ± 3.1 schooling years). The final Portuguese version of the ASES was established after patients considered all items of this tool comprehensible and clear, and the author of the original questionnaire considered it adequate. The results obtained with this study will help Brazilian rehabilitation professionals and researchers, since they have one more outcome measure to be applied in patients with functional disabilities of the shoulder.

Floor activity score.

OBJECTIVE: To propose an instrument to measure the amount of floor activities performed by an individual. MATERIAL AND METHOD: A list of 12 questionnaires relating to floor activities is proposed. A cross-sectional survey of the response to the questionnaires was tried on 3 communities representing rural, urban and metropolitan areas. The total number of enrolled people was 733. The scores of the questionnaires were tested for statistical difference (p< 0.05) among the communities by Chi-square and ANOVA nonparametric tests. RESULTS: The total scores among the three communities were significantly different. The rural civilians achieved the highest score, whereas the metropolitan area had the lowest score. CONCLUSION: The proposed instrument measuring floor activities is able to discriminate the activities of civilians in rural, urban and metropolitan areas.

Intra-articular methylprednisolone acetate in the management of chronic arthritis in children king Hussein medical center experience

Intraarticular steroid injection in Juvenile Idiopathic arthritis [JIA] has been recently introduced into pediatric rheumatology practice. Much of the evidence supporting its use based on open, non-controlled studies. Patients and methods: We prospectively evaluated the impact of a single intraarticular injection of Methylprednisolone acetate on control of inflammatory arthritis of knee joints in a group of 24 children [30 joints] with Juvenile Idiopathic Arthritis who failed to respond satisfactory to Non-Steroidal Anti-inflammatory Drugs[NSAIDs] with or without slow acting anti-inflammatory drugs. Adverse effects were also evaluated. The study was carried out at the pediatric immunology clinic at King Hussein medical Center [KHMC] between December 1999 to June 2003. Patients aged between 1.5 to 10 years with a mean of 3.39 years. The median duration of follow-up was 24 months. We achieved a significant restoration of the extension function of most joints injected. The mean duration of effect was 18 months for oligoarthritis, and 24 months for juvenile psoriatic arthritis and enthesitis related arthritis compared with 6.75 months for other subtypes. All patients with oligoarthritis who were on oral steroid have discontinued this treatment. This effect was partial or not seen in other subtypes. Relapse rate was higher in patients with systemic- and polyarthritis subtypes. The favorable outcome did not correlate with age, sex or disease duration. The beneficial effect of the injections did not correlate with the presence of antinuclear antibodies [ANA] or ESR. Local adverse effects were few and self-limited with no evidence of systemic toxicity. Intraarticular injection of methylprednisolone acetate appears to be effective, rapid and not associated with significant adverse effects in oligoarthritis, Juvenile Psoriatic arthritis and Enthesitis related arthritis subtypes. On contrary it was found to be less effective in systemic and polyarthritis subtypes

Capacidad funcional postoperatoria en pacientes jóvenes con artrosplastía total de cadera no cementada, en el Hospital General de México / Post-operative functional ability in young patients who have non-cemented hip prosthesis in the Mexico City General Hospital

Se incluyeron en el presente estudio todos los pacientes que ingresaron al Servicio de Ortopedia del Hospital General de México, con patología de cadera propuestos para artroplastía total de cadera no cementada, en el periodo de enero de 1993 a julio de 1996, con un total de 42 pacientes con 46 artroplastías, con una edad mínima de 17años, máxima de 59 y promedio de 39.4 años. Las prótesis utilizadas fueron PCA (10), isoelásticas (12), Harris Galante (7), Osteonics (13), AML (2), Lima Litto (2). Se valoraron los pacientes a las 2, 6 y 12 semanas de postoperatorio utilizando la escala de Merle D'Aubigné. A las seis semanas marcha, 26 (61.90 por ciento) escala III, 16 (38.09 por ciento) en a escala IV. Dolor: 16 (38.09 por ciento) en la escala V, 26 (61.90 por ciento) en la escala VI. Movilidad: 42 (100 por ciento) en la escala III. A las 12 semanas, marcha: 28 (66.66 por ciento) escala V, 14 (33.33 por ciento) escala VI. Dolor 42 (100 por ciento) escala VI. Movilidad: 42 (100 por ciento) escala de III, y de acuerdo la satisfacción del paciente; regular 2 (4.76 por ciento), buena 21 (50 por ciento) y excelente 19 (45.23 por ciento). Se concluye que hasta la fecha, gran variedad de prótesis no cementadas han demostrado buena respuesta en un principio, mejorando notablemente la capacidad funcional del paciente

Infección y artritis reactiva: correlación clínico bacteriológica en artropatía seronegativa / Infection and reactive arthritis: clinical bacteriological correlation in seronegative arthropathies

The aim of this study was to search infections that trigger reactive arthritis. Eigthy-six patients with seronegative arthritis (SNA) were studied; 32 had reactive arthritis, 21 ankylosing spondylitis, 7 psoriatic arthritis and 26 undifferentiated seronegative oligoarthritis. As controls, 70 patients with connective tissue diseases (CTD) and 55 healthy volunteers (HV) were studied. Serological evidence for infection with Chlamydia trachomatis was studied with micro immunofluorescence, looking for L2 and BED serotypes and serological evidence for Yersinia infection, using a commercial kit. Stool cultures were done in seven patients with recent diarrhea and endourethral or endocervical cultures in 35 individuals. Serotypes L2 or BED were positive in 23 of 83 patients with SNA, 3 of 39 patients with CTD and 4 of 55 HV (p<0.03). IgG class antibodies against L2 were detected in 17 percent of SNA patients, 2.6 percent of CTD patients and 5.4 percent of HV (p<0.05). IgM class antibodies were detected in 6 SNA patients, 0 CTD patients and 2 HV (NS). 12 of 35 cultures were positive for Chlamydia. As a whole 30 percent of SNA patients has serological or bacteriological evidence for Chlamydia infection. Serology for Yersinia was positive in 39 of 81 SNA patients, 1 of 54 CTD patients and 3 of 51 HV (p<0.01). Rates of infections were similar among male, female, HLA B27 positive and HLA negative subjects. It is concluded that SNA patients have a high prevalence of infections by Chlamydia trachomatis or Yersinia enterocolitica

Restauración de la pronosupinación, en diferentes patologías de la muñeca, por la técnica de Sauve-Kapandji / Restoration of the pronation-supination movement in different sequelae of the wrist joint by the Sauve-Kapandji technique

Se presenta una serie de 18 casos con 19 muñecas, con edad promedio de 40 años, que tenían artrosis de la unión radio-cubital distal, con inestabilidad en 8 casos, incongruencia en 11, artrosis no traumática en 8, artritis traumática en 8, y un caso de polio, de artritis reumatoide juvenil, de deformidad de Madelung y de gota. El tratamiento que se les realizó consistió en sinotosis radio-cubital distal y pseudoartrosis del cúbito, proximal a la sinostosis (Suave-Kapandji). Después de la cirugía la pronación aumentó de 23 a 64 grados en promedio y la supinación aumentó de 29 a 81 grados en promedio. El dolor postoperatorio persistió solamente en 5 casos, de mediana a baja intensidad y de aparición esporádica, ya fuera en la zona de la pseudoartrosis cubital o después de trabajo pesado

Enfermedad de Behcet / Behcet disease

Presentamos un paciente masculino con enfermedad de Behçet mucocutánea. Hacemos hincapié en la dificultad diagnóstica y revisamos brevemente las alternativas terapéuticas

Evaluacion clinica de pacientes con artrosis sometidos a tratamiento con DSMSO, mesoterapia y mucopolisacaridos / Clinical evaluation of patients with arthrosis using DSMSO mesotherapy and treatment with mucopolysacarides

36 pacientes portadores de artrosis de larga evolucion y con antecedentes de tratamientos habituales, con moderada a completa limitacion de las actividades fisicas, fueron sometidas a un tratamiento tri-conjugado utilizando DMSO (Dimepilsulfoxido) mesoterapia y mucopolisacaridos con un periodo de acompanamiento de 24 meses. 33 de los pacientes tratados mostraron una recuperacion clinica importante con su reincorporacion a las actividades normales de su rutina. Los autores revisan los conceptos farmacologicos de los componentes quimicos utilizados, asi como se describe la tecnica empleada. A traves de estos resultados los autores recomiendan una intensa re-evaluacion de nuestros conceptos de tratamiento de los procesos artrosicos, asi como una ampliacion de estudios similares para solidificar los conceptos emitidos.

Neuroartropatía. Reporte de 10 casos / Neuroarthropathy. Report of 10 patients

Se presentan 10 pacientes con neuroartropatía que afecta sus articulaciones de carga, principalente rodilla, tobillo y pie, en quiens el diagnóstico de origen, que dió lugar a la artropatía fue sífilis tardía, diabetes mellitus, lepra y mielomeningocele. Se hace énfasis en la importancia del diagnóstico de neuroartropatía, ya que en un alto porentaje de los enfermos este cuedro pasa inadvertido puesto que se trata de un proceso no doloroso.

Ankylosing spondylitis in females. Similarities and differences with male spondylitics.

Ten female and seventy two male patients suffering from ankylosing spondylitis were studied to evaluate differences between the two sexes. Low lumbar backache and inactivity stiffness were the commonest presenting complaints in females (8/10) as compared to males (34/72). They also had a later age of onset (25.4 + 6.16 yrs) compared to males (20.56 + 6.57 yrs). Females were found to be symptomatically milder with a more benign course of the disease. There were no significant differences in the frequency of extra-articular features and HLA B27 between males and females. A positive family history was more often seen in female ankylosing spondylitis (50%) than male (31.94%) patients.

Reumatismo por microcristales de hidroxiapatita / Rheumatism due to hydroxyapatite microcrystals

El presente trabajo está basado en la selección de 100 pacientes portadores de calcificaciones periarticulares de diferente localización, aunque con gran predominio en la articulación del hombro. Se ubica la afección dentro del gran grupo de artropatías microcristalinas, siendo la que nos ocupa, debido a calcificaciones de hidroxiapatita (HA). Aunque su mecanismo de producción no se conoce analizaremos las teorías más aceptadas. Asimismo, su incidencia en cuanto a frecuencia, edad sexo y localización se comentan algunas historias clínicas más demostrativas, adjuntando las radiografías correspondientes. No hacemos referencia a las manifestaciones de laboratorio o radiológicas porque ellas son analizadas en otro capítulo de esta misma obra. Se comentan directivas terapéuticas y evolución