Spinal accessory nerve neuropathy following neck dissection / Neuropatia do nervo acessório espinhal secundária à cirurgia de esvaziamento cervical

Tthe most common complication of neck dissection is shoulder dysfunction due to manipulation of spinal accessory nerve, resulting in trapezius muscle atrophy mainly in procedures involving the posterior neck triangle. AIM: This study used electromyography to evaluate the injury to the spinal accessory nerve following neck dissection. MATERIALS AND METHODS: Prospective case series of 51 patients submitted to 60 neck dissections followed by physical therapy evaluation of shoulder dysfunction. Nerve integrity was evaluated before and after the surgery by means of surface EMG registering the electric activity of the trapezius muscle during voluntary contraction. The patients were grouped according to the type of neck dissection, presence of shoulder pain, impairment during abduction movement and hypotrophy/atrophy of the trapezius muscle. RESULTS: Action potential had median values of 54.3 microV before surgery and 11.6 microV after it (p<0.001). There was a mean decrease of 70 percent comparing to preoperative values. The median was 12.5 microV after dissection including level IIb, and 8.9 microV after dissection including levels IIb and V (p<0.002). CONCLUSION: Surface EMG is a sensitive and painless method for spinal accessory nerve dysfunction evaluation. The results suggest the usefulness of the trapezius muscle electromyography to confirm diagnosis and early physical therapy intervention in neuropathies of the spinal accessory nerve.

Uma das complicações mais comuns do esvaziamento cervical é a disfunção do ombro devido à manipulação do nervo acessório, que resulta na atrofia do músculo trapézio. OBJETIVO: Avaliar com eletromiografia de superfície (EMGs) a lesão do XI par decorrente do esvaziamento cervical. MATERIAL E MÉTODO: Estudo prospectivo com 51 pacientes (60 esvaziamentos cervicais) tratados de câncer de cabeça e pescoço. A função do nervo acessório foi avaliada no período pré e pós-operatório com registro da atividade elétrica das fibras descendentes do músculo trapézio em contração isométrica voluntária máxima. Os pacientes foram agrupados pelo tipo de esvaziamento e movimento de abdução do braço. RESULTADOS: O potencial de ação apresentou mediana de 54,3 microV no pré-operatório e 11,6 microV no pós-operatório (p<0,001). Os valores registrados no pós-operatório apresentaram decréscimo médio de 70 por cento (20 por cento a 94 por cento) em relação aos valores pré-operatórios. Com relação à extensão do EC, foram observadas medianas de 12,5 microV após o esvaziamento do nível iib e 8,9 microV com o esvaziamento dos níveis iib+V (p=0,002). CONCLUSÃO: A eletromiografia de superfície é um método quantitativo, sensível e indolor para complementar o diagnóstico da disfunção do XI par. Os achados sugerem a utilidade da EMGs do músculo trapézio para confirmar o diagnóstico e orientar a intervenção precoce da fisioterapia.

Tratamiento artroscopico de la compresión del nervio supraescapular por ganglión espinoglenoideo / The compression of the supraescapular nerve by spinoglenoid cyst: arthroscopic treatment

Una de las patologías más comunes en nuestras consultas es el síndrome del hombro doloroso. Tiene diversos factores que pueden originario (tendinopatía del manguito rotador, bíceps, inestabilidad, hernia de disco cervical.). Sin embargo, es importante conocer que existen otras causas menos frecuentes. Presentamos, por su rareza, el caso de un paciente masculino de de 34 años con limitación funcional progresiva a la abducción del miembro superior izquierdo; tratado con analgésicos-antiinflamatorios y rehabilitación sin mejoría clínica. Al realizar resonancia magnética nuclear se descubre ganglión supraglenoideo y SLAP. Se solicita electromiograma que describe el atrapamiento del nervio supraescapular. Su tratamiento fue por artroscopía.

Early Arthroscopic Release in Stiff Shoulder

Purpose: To evaluate the results of early arthroscopic release in the patients of stiff shoulder Methods: Twenty patients of stiff shoulder; who had symptoms for at least three months and failed to improve with steroid injections and physical therapy of 6 weeks duration; underwent arthroscopic release. The average time between onset of symptoms and the time of surgery was 4 months and 2 weeks. The functional outcome was evaluated using ASES and Constant and Murley scoring systems. Results: All the patients showed significant improvement in the range of motion and relief of pain by end of three months following the procedure. At 12 months; mean improvement in ASES score is 38 points and Constant and Murley score is 4O.5 points. All patients returned to work by 3-5 months (average -4.5 months). Conclusion: Early arthroscopic release showed promising results with reliable increase in range of motion; early relief of symptoms and consequent early return to work. So it is highly recommended in properly selected patients. Level of evidence: Level IV

Arthroscopic release of the diabetic persistent frozen shoulder

Sixteen diabetic patients who developed frozen shoulder which failed to respond to conservative treatment were subjected to arthroscopic shoulder release between January 2000 and March 2001. They had persistent pain, stiffness and limited function. They were followed up for an average period of 22 months, ranging between 19 and 24 months and evaluated according to the modified score of UCLAwith an average improvement of 16.25 points; 3 patients scored excellent [18.75%], 12 good [75%] and 1 fair [6.25%] result. In addition, the patients were assessed preoperatively and postoperatively for forward flexion, external rotation, abduction and internal rotation. The study revealed a good measurable increase in the range of motion in all planes. The study also considered arthroscopic release of the diabetic persistent frozen shoulder to be an effective method of treatment

Dolor de hombro: la tendinopatía del manguito de los rotadores

El complejo de tendones y músculos situados alrededor del hombro y conocido como el "manguito rotador" o también, "manguito de los rotadores", suele sufrir lesiones como consecuencia de trauma, ejercicio fuerte y repetido, o más frecuentemente por varios factores al mismo tiempo. Las nuevas técnicas de imágenes facilidan el diagnóstico de estos problemas, pero siguen siendo indispensables la historia clínica detallada y el cuidadoso examen físico del enfermo, para precisar la situación y ordenar el tratamiento más apropiado