Bone Integration and Prevalence of Radiolucent Lines around the Pegs of Minimally Cemented Glenoid Components in Total Shoulder Arthroplasty.

Objectives Glenoid component failure is the main cause of total shoulder arthroplasty (TSA) revision, and component design seems to influence the failure rate. The aim of the present study was to clinically and radiographically (through X-rays and computed tomography scan) evaluate the results of TSA using a minimally cemented glenoid component. Methods Total should arthroplasties performed using the minimally cemented Anchor Peg (DuPuy Synthes, Warsaw, IN, USA) glenoid component between 2008 and 2013 were evaluated. University of California at Los Angeles (UCLA) scores were calculated, and standardized plain film and computed tomography images were obtained, at a minimum follow-up of 24 months. The presence of bone between the fins of the central component peg, which indicates its integration, was assessed on the images, as well the presence of radiolucent lines around the glenoid component. Results Nineteen shoulders in 17 patients were available for evaluation. According to the UCLA score, clinical results were satisfactory in 74% of cases and fair in 21% of cases. One patient had a poor result. Component integration was found in 58% of patients (total in 42% and partial in 16%). Radiolucent lines were observed in 52% of cases. No relationship was detected between component integration and clinical results. Conclusion Satisfactory clinical results were achieved in most patients undergoing TSA using a minimally cemented glenoid component. Radiolucent lines around the glenoid component are common, but do not interfere with the clinical results. Level of evidence IV; Case series; Treatment study.

Bone Integration and Prevalence of Radiolucent Lines around the Pegs of Minimally Cemented Glenoid Components in Total Shoulder Arthroplasty / Integração óssea e prevalência de linhas radiotransparentes ao redor dos pinos de componentes glenoidais minimamente cimentados na artroplastia total de ombro

Abstract Objectives Glenoid component failure is the main cause of total shoulder arthroplasty (TSA) revision, and component design seems to influence the failure rate. The aim of the present study was to clinically and radiographically (through X-rays and computed tomography scan) evaluate the results of TSA using a minimally cemented glenoid component. Methods Total should arthroplasties performed using the minimally cemented Anchor Peg (DuPuy Synthes, Warsaw, IN, USA) glenoid component between 2008 and 2013 were evaluated. University of California at Los Angeles (UCLA) scores were calculated, and standardized plain film and computed tomography images were obtained, at a minimum follow-up of 24 months. The presence of bone between the fins of the central component peg, which indicates its integration, was assessed on the images, as well the presence of radiolucent lines around the glenoid component. Results Nineteen shoulders in 17 patients were available for evaluation. According to the UCLA score, clinical results were satisfactory in 74% of cases and fair in 21% of cases. One patient had a poor result. Component integration was found in 58% of patients (total in 42% and partial in 16%). Radiolucent lines were observed in 52% of cases. No relationship was detected between component integration and clinical results. Conclusion Satisfactory clinical results were achieved in most patients undergoing TSA using a minimally cemented glenoid component. Radiolucent lines around the glenoid component are common, but do not interfere with the clinical results. Level of evidence IV; Case series; Treatment study.

Resumo Objetivos A falha do componente glenoidal é a principal causa de revisão da artroplastia total do ombro (ATO) e sua frequência parece ser influenciada pelo design do componente. O objetivo deste estudo foi a avaliação clínica e radiográfica (através de raios X e tomografia computadorizada) dos resultados da ATO com componente glenoidal minimamente cimentado. Métodos O presente trabalho analisou ATOs realizadas com componente glenoidal Anchor Peg (DuPuy Synthes, Warsaw, IN, EUA) minimamente cimentado entre 2008 e 2013. Por um período mínimo de acompanhamento de 24 meses, escores segundo critérios da University of California at Los Angeles (UCLA) e imagens padronizadas de radiografia simples e tomografia computadorizada foram analisadas. A presença de osso entre as aletas do pino do componente central, que é um indicador de sua integração, foi avaliada nas imagens, bem como a presença de linhas radiotransparentes ao redor do componente glenoidal. Resultados Dezenove ombros de 17 pacientes foram avaliados. De acordo com o escore da UCLA, os resultados clínicos foram satisfatórios em 74% dos casos e moderados em 21% dos casos. O resultado foi ruim em um paciente. A integração de componentes foi observada em 58% dos pacientes, sendo total em 42% e parcial em 16% dos casos. Linhas radiotransparentes foram observadas em 52% dos pacientes. Nenhuma relação entre a integração de componentes e os resultados clínicos foi detectada. Conclusão A maioria dos pacientes submetidos à ATO com componente glenoidal minimamente cimentado apresentou resultados clínicos satisfatórios. Linhas radiotransparentes ao redor do componente glenoidal são comuns, mas não interferem nos resultados clínicos Nível de evidência IV; Série de caso; Estudo terapêutico.

Treatment of chronic locked posterior dislocation of the shoulder with the modified McLaughlin procedure.

BACKGROUND: Locked posterior dislocation of the shoulder (LPDS) is a challenging condition for the orthopedic surgeon. The problem with cases of chronic LPDS is that they may result in worse clinical outcomes because the size of the reverse Hill-Sachs lesion and cartilage damage can increase over time. Multiple treatment strategies have been reported in the literature for the treatment of chronic cases. The purpose of this study was to report our experience with the modified McLaughlin technique for the treatment of chronic LPDS and evaluate the mid- and long-term functional outcomes. METHODS: This was a retrospective single-center study including a consecutive series of 10 patients who underwent the modified McLaughlin procedure for the treatment of chronic LPDS. The time between dislocation and treatment ranged from 6 weeks to 14 months (mean, 20.9 weeks). Postoperative imaging and functional evaluation were performed with a minimum of 2 years' follow-up (range, 24-110 months). Functional outcomes were assessed by means of a visual analog scale score for pain and patient satisfaction regarding the operation, the Constant-Murley score, and the University of California, Los Angeles shoulder rating scale. RESULTS: The mean follow-up period was 59.4 months (range, 24-110 months). Range of motion improved significantly after surgery: Mean forward flexion improved from 71° ± 5° to 126°± 37° (P < .001), mean external rotation improved from 7°± 7° to 52° ± 18° (P = .012), and mean internal rotation improved from gluteal region ± 1 vertebral level to L1 ± 4 vertebral levels (P = .001). Functional outcome measures demonstrated significant improvements: The mean Constant-Murley score improved from 22 ± 2.4 (range, 20-26) to 65 ± 21.5 (P < .001); the mean University of California, Los Angeles score improved from 9.8 ± 1.3 (range, 8-12) to 27 ± 9.7 (P < .001); and the mean visual analog scale score improved from 4.6 ± 0.8 (range, 3-6) to 2.4 ± 2.3 (P < .001). Of the patients, 8 (80%) were satisfied with the procedure. The 2 remaining cases had a delay from injury to diagnosis > 6 months and evolved with poor functional outcomes and severe glenohumeral degenerative joint disease. There were no cases of recurrent dislocation, infection, or neurologic injury during the follow-up. CONCLUSION: Our study findings demonstrated that the modified McLaughlin procedure showed good results over a 2-year minimum follow-up period. The clinical outcomes of this procedure are worse when there is a delay from injury to diagnosis > 6 months.

Incidence and Risk Factors of the Complications Related to the Latarjet Surgery.

Objective The Latarjet procedure is a well-accepted treatment of shoulder instability. This technique is associated with a unique set of complications with overall rates of up to 30%. The purpose of the present study was to investigate the incidence and risk factors associated with complications after open Latarjet procedure. Methods We retrospectively reviewed 102 patients submitted to open Latarjet procedure. Complications were divided into three types: clinical; graft-related; and screw-related. All of the patients were submitted to radiography and computed tomography (CT). The risk factors analyzed were gender, age, previous surgery, epilepsy, experience of the surgeon. Results A total of 102 consecutive patients (108 cases) underwent the Latarjet procedure. The mean age was 33.7 years old (18 to 61 years old), with 88 males and 14 females. The overall complication rate was 21.2%, being 12% clinical-related, 7.4% graft-related, and 2.7% screw-related. The most frequent were anterior apprehension (eight cases) and lateral overhang of the graft in six patients. Computed tomography scan at a minimum of 6 months was performed in 79 cases (73%), and graft union occurred in 75 patients (94.9%). There were no cases of instability in the remaining four cases of nonunion. Ten patients (9.2%) required revision surgery. The risk factors associated with complications were epilepsy ( p = 0.0325), experience of the surgeon ( p = 0.0499) and patients ≥ 40 years old at the time of the surgery ( p = 0.0151). There was no correlation with gender and previous surgery. Conclusion The complication rate following the Latarjet procedure was 21.2%, with 9% requiring revision surgery. Epilepsy, age > 40 years old and experience of the surgeon were risk factors.

Incidence and Risk Factors of the Complications Related to the Latarjet Surgery / Incidência e fatores de risco das complicações da cirurgia de Latarjet

Abstract Objective The Latarjet procedure is a well-accepted treatment of shoulder instability. This technique is associated with a unique set of complications with overall rates of up to 30%. The purpose of the present study was to investigate the incidence and risk factors associated with complications after open Latarjet procedure. Methods We retrospectively reviewed 102 patients submitted to open Latarjet procedure. Complications were divided into three types: clinical; graft-related; and screw-related. All of the patients were submitted to radiography and computed tomography (CT). The risk factors analyzed were gender, age, previous surgery, epilepsy, experience of the surgeon. Results A total of 102 consecutive patients (108 cases) underwent the Latarjet procedure. The mean age was 33.7 years old (18 to 61 years old), with 88 males and 14 females. The overall complication rate was 21.2%, being 12% clinical-related, 7.4% graft-related, and 2.7% screw-related. The most frequent were anterior apprehension (eight cases) and lateral overhang of the graft in six patients. Computed tomography scan at a minimum of 6 months was performed in 79 cases (73%), and graft union occurred in 75 patients (94.9%). There were no cases of instability in the remaining four cases of nonunion. Ten patients (9.2%) required revision surgery. The risk factors associated with complications were epilepsy (p = 0.0325), experience of the surgeon (p = 0.0499) and patients ≥ 40 years old at the time of the surgery (p = 0.0151). There was no correlation with gender and previous surgery. Conclusion The complication rate following the Latarjet procedure was 21.2%, with 9% requiring revision surgery. Epilepsy, age ≥ 40 years old and experience of the surgeon were risk factors.

Resumo Objetivo A cirurgia de Latarjet é bem estabelecida para o tratamento da instabilidade anterior do ombro. Apresenta complicações específicas com taxas de até 30%. Nosso objetivo é avaliar a incidência e os fatores de risco associados às complicações após a cirurgia de Latarjet. Métodos Analisamos retrospectivamente 102 pacientes submetidos ao procedimento. Dividimos as complicações em três tipos: clínicas, relacionadas ao enxerto e relacionadas aos implantes. Todos os pacientes foram submetidos a radiografias e tomografia computadorizada (TC). Os fatores de risco analisados foram gênero, idade, cirurgia prévia, epilepsia e experiência do cirurgião. Resultados Um total de 102 pacientes consecutivos (108 casos) foram avaliados. A média de idade foi 33,7 anos (18 a 61 anos), com 88 homens e 14 mulheres. A taxa de complicações foi de 21,2%, sendo 12% clínicas, 7,4% relacionadas ao enxerto e 2,7% relacionadas ao implante. As mais frequentes foram apreensão anterior (oito casos) e posicionamento lateral do enxerto, em seis casos. A TC foi realizada com o mínimo de 6 meses em 79 casos (73%), evidenciando a consolidação do enxerto em 75 pacientes (94.9%). Nenhum caso de não união apresentou instabilidade. Dez pacientes (9.2%) precisaram de cirurgia de revisão. Os fatores de risco relacionados às complicações foram epilepsia (p = 0.0325), experiência do cirurgião (p = 0.0499) e pacientes ≥ 40 anos (p = 0.0151). Não houve correlação com gênero e cirurgia prévia. Conclusão A taxa de complicações após a cirurgia de Latarjet foi de 21,2%, com 9% necessitando de revisão cirúrgica. Epilepsia, idade ≥ 40 anos e experiência do cirurgião foram fatores de risco.

Risk Factors for Coracoid Graft Osteolysis after the Open Latarjet Procedure.

Objective Coracoid osteolysis has been described as a possible complication after the Latarjet procedure. The aim of the present study was to investigate the incidence and risk factors associated to coracoid graft osteolysis and to correlate them with clinical results. Methods A retrospective review of 38 Latarjet procedures was conducted. Computed tomography (CT) scans were obtained from all of the patients before and at least 1 year after the surgery. Coracoid osteolysis was evaluated and correlated to preoperative factors, namely: age, smoking status, and preoperative glenoid bone loss. The patients were divided into 2 groups: A (no or minor bone resorption) and B (major or total bone resorption). The functional outcome was determined by the Rowe score. Results Coracoid graft osteolysis occurred in 22 cases (57.8%). The mean preoperative glenoid defect was 22.8% in group A, and 13.4% in group B ( p = 0.0075). The mean ages of the subjects in both groups were not significantly different. Smoking did not seem to affect the main outcome either, and no correlation was found between graft osteolysis and postoperative range of motion, pain, or Rowe score. There were no cases of recurrent dislocations in our sample, although four patients presented with a positive anterior apprehension sign. Conclusion Bone resorption of the coracoid graft is present in at least 50% of the patients submitted to the Latarjet procedure, and the absence of significant preoperative glenoid bone loss showed to be the only risk factor associated with severe graft osteolysis, even though this did not influence significantly the clinical outcome.

Risk Factors for Coracoid Graft Osteolysis after the Open Latarjet Procedure / Fatores de risco para osteólise do enxerto do coracoide após o procedimento de Latarjet aberto

Abstract Objective Coracoid osteolysis has been described as a possible complication after the Latarjet procedure. The aim of the present study was to investigate the incidence and risk factors associated to coracoid graft osteolysis and to correlate them with clinical results. Methods A retrospective review of 38 Latarjet procedures was conducted. Computed tomography (CT) scans were obtained from all of the patients before and at least 1 year after the surgery. Coracoid osteolysis was evaluated and correlated to preoperative factors, namely: age, smoking status, and preoperative glenoid bone loss. The patients were divided into 2 groups: A (no or minor bone resorption) and B (major or total bone resorption). The functional outcome was determined by the Rowe score. Results Coracoid graft osteolysis occurred in 22 cases (57.8%). The mean preoperative glenoid defect was 22.8% in group A, and 13.4% in group B (p= 0.0075). The mean ages of the subjects in both groups were not significantly different. Smoking did not seem to affect the main outcome either, and no correlation was found between graft osteolysis and postoperative range of motion, pain, or Rowe score. There were no cases of recurrent dislocations in our sample, although four patients presented with a positive anterior apprehension sign. Conclusion Bone resorption of the coracoid graft is present in at least 50% of the patients submitted to the Latarjet procedure, and the absence of significant preoperative glenoid bone loss showed to be the only risk factor associated with severe graft osteolysis, even though this did not influence significantly the clinical outcome.

Resumo Objetivo Osteólise do processo coracoide é descrita como uma possível complicação da cirurgia de Latarjet. O objetivo do presente estudo foi avaliar a incidência e fatores de risco associados à osteólise do enxerto do coracoide e correlacioná-los com resultados clínicos. Métodos Foi realizada uma revisão retrospectiva incluindo 38 casos submetidos ao procedimento de Latarjet. Em todos os casos, foi realizada uma tomografia computadorizada antes e pelo menos 1 ano após a cirurgia. A presença de osteólise do coracoide foi avaliada e correlacionada com os seguintes fatores de risco: idade, tabagismo, e perda óssea pré-operatória da glenóide. Os pacientes foram divididos em dois grupos: A (ausência ou menor reabsorção óssea) e B (maior reabsorção óssea ou total). A avaliação funcional foi determinada através do escore de Rowe. Resultado Osteólise do processo coracoide ocorreu em 22 casos (57,8%). O defeito ósseo médio pré-operatório da glenóide foi de 22,8% no grupo A e de 13,4% no grupo B (p= 0.0075). A média de idade dos casos em ambos os grupos não apresentou diferença estatística. Tabagismo também não esteve relacionado com diferenças no resultado. Não houve correlação entre a presença de osteólise e o arco de movimento, dor ou ao escore de Rowe. Não houve casos de reluxação; entretanto, quatro pacientes apresentaram apreensão anterior no exame físico. Conclusão A reabsorção do processo coracoide ocorreu em pelo menos 50% dos pacientes submetidos à cirurgia de Latarjet, e a ausência pré-operatória de perda óssea significativa da glenóide foi o único fator de risco associado a osteólise mais severa do enxerto, porém sem influência no resultado clínico.

Intra-articular arthroscopic biceps tenodesis with interference screw: clinical and isokinetic evaluation.

BACKGROUND: Although biceps tenodesis has been widely used to treat its pathologies, few studies looked at the objective evaluation of elbow strength after this procedure. The purpose of this study is to clinically evaluate patients submitted to long head of the biceps (LHB) tenodesis with interference screws through an intra-articular approach and analyze the results of an isokinetic test to measure elbow flexion and forearm supination strengths. METHODS: Patients who had biceps tenodesis were included in the study if they had a minimum follow-up of 24 months. Patients were excluded if they had concomitant irreparable cuff tears or previous or current contralateral shoulder pain or weakness. Postoperative evaluation was based on University of California-Los Angeles (UCLA) shoulder score and on measurements of elbow flexion and supination strength, using an isokinetic dynamometer. Tests were conducted in both arms, with velocity set at 60º/s with 5 concentric-concentric repetitions. RESULTS: Thirty-three patients were included and the most common concomitant diagnosis were rotator cuff tear (69%) and superior labrum anterior to posterior (SLAP) lesions (28%). The average UCLA score improved from 15.1 preoperatively to 31.9 in the final follow-up (P < .001). Isokinetic tests showed no difference in peak torque between the upper limbs. One patient had residual pain in the biceps groove. None of the patients had Popeye deformity. UCLA score and follow-up length did not demonstrate correlation with peak torque. CONCLUSION: Arthroscopic proximal biceps tenodesis with interference screw, close to the articular margin, yielded good clinical results. Isokinetic tests revealed no difference to the contralateral side in peak torque for both supination and elbow flexion.

Reverse arthroplasty of the shoulder for treating rotator cuff arthropathy / Artroplastia reversa do ombro no tratamento da artropatia do manguito rotador

OBJECTIVE: to present a retrospective analysis on the clinical-functional results and complications among patients with rotator cuff arthropathy (RCA) who underwent reverse arthroplasty of the shoulder. METHODS: patients with a diagnosis of RCA associated with pseudoparalysis of anterior elevation who underwent reverse arthroplasty of the shoulder with a minimum follow-up of one year were selected. RESULTS: preoperative information was gathered from our shoulder and elbow arthroplasty register, comprising age, sex, laterality, history of previous procedures, Constant's functional scores and the preoperative range of motion as described in the protocol of the American Academy of Shoulder and Elbow Surgery (ASES). After a mean follow-up of 44 months, 17 patients (94%) were satisfied with the result from the procedure. CONCLUSION: reverse arthroplasty for treating RCA in patients with pseudoparalysis of the shoulder was shown to be effective in achieving a statistically significant improvement in range of motion regarding anterior flexion and abduction. However, in this series, there was no improvement in range of motion regarding external and internal rotation. Reverse arthroplasty is a procedure that reestablishes shoulder joint function in patients who previously did not present any therapeutic possibilities...

OBJETIVO: apresentar uma análise retrospectiva dos resultados clínico-funcionais e das complicações dos pacientes com artropatia do manguito rotador (AMR) submetidos à artroplastia reversa do ombro. MÉTODOS: foram selecionados pacientes com diagnóstico de AMR associada à pseudoparalisia da elevação anterior submetidos à artroplastia reversa do ombro com seguimento mínimo de um ano. RESULTADOS: foram coletadas informações pré-operatórias, por meio do nosso Registro de Artroplastias do Ombro e Cotovelo, que consistiam em idade, sexo, lateralidade, história de procedimentos prévios, escores funcionais de Constant, além da amplitude de movimentos pré-operatórios, conforme protocolo da American Academy of Shoulder and Elbow Surgery (Ases). Com seguimento médio de 44 meses, 17 pacientes (94%) estavam satisfeitos com o resultado do procedimento. CONCLUSÃO: a artroplastia reversa no tratamento da AMR em pacientes com pseudoparalisia do ombro demonstrou-se efetiva na melhoria, com significância estatística, da amplitude de movimentos de flexão anterior e abdução. Porém, nesta série não houve melhoria da amplitude dos movimentos de rotação externa e interna. A artroplastia reversa é um procedimento que restabelece a função da articulação do ombro em pacientes que previamente não apresentavam possibilidades terapêuticas...

Recurrent anterior glenohumeral instability: the quantification of glenoid bone loss using magnetic resonance imaging.

OBJECTIVE: To investigate the accuracy of conventional magnetic resonance imaging (MRI) in determining the severity of glenoid bone loss in patients with anterior shoulder dislocation by comparing the results with arthroscopic measurements. SUBJECTS AND METHODS: Institutional review board approval and written consent from all patients were obtained. Thirty-six consecutive patients (29 men, seven women; mean age, 34.5 [range, 18-55] years) with recurrent anterior shoulder dislocation (≥3 dislocations; mean, 37.9; range, 3-200) and suspected glenoid bone loss underwent shoulder MRI before arthroscopy (mean interval, 28.5 [range, 9-73] days). Assessments of glenoid bone loss by MRI (using the best-fit circle area method) and arthroscopy were compared. Inter- and intrareader reproducibility of MRI-derived measurements was evaluated using arthroscopy as a comparative standard. RESULTS: Glenoid bone loss was evident on MRI and during arthroscopy in all patients. Inter- and intrareader correlations of MRI-derived measurements were excellent (intraclass correlation coefficient = 0.80-0.82; r = 0.81-0.86). The first and second observers' measurements showed strong (r = 0.76) and moderate (r = 0.69) interreader correlation, respectively, with arthroscopic measurements. CONCLUSIONS: Conventional MRI can be used to measure glenoid bone loss, particularly when employed by an experienced musculoskeletal radiologist.

Reverse arthroplasty of the shoulder for treating rotator cuff arthropathy.

OBJECTIVE: to present a retrospective analysis on the clinical-functional results and complications among patients with rotator cuff arthropathy (RCA) who underwent reverse arthroplasty of the shoulder. METHODS: patients with a diagnosis of RCA associated with pseudoparalysis of anterior elevation who underwent reverse arthroplasty of the shoulder with a minimum follow-up of one year were selected. RESULTS: preoperative information was gathered from our shoulder and elbow arthroplasty register, comprising age, sex, laterality, history of previous procedures, Constant's functional scores and the preoperative range of motion as described in the protocol of the American Academy of Shoulder and Elbow Surgery (ASES). After a mean follow-up of 44 months, 17 patients (94%) were satisfied with the result from the procedure. CONCLUSION: reverse arthroplasty for treating RCA in patients with pseudoparalysis of the shoulder was shown to be effective in achieving a statistically significant improvement in range of motion regarding anterior flexion and abduction. However, in this series, there was no improvement in range of motion regarding external and internal rotation. Reverse arthroplasty is a procedure that reestablishes shoulder joint function in patients who previously did not present any therapeutic possibilities.

OBJETIVO: apresentar uma análise retrospectiva dos resultados clínico-funcionais e das complicações dos pacientes com artropatia do manguito rotador (AMR) submetidos à artroplastia reversa do ombro. MÉTODOS: foram selecionados pacientes com diagnóstico de AMR associada à pseudoparalisia da elevação anterior submetidos à artroplastia reversa do ombro com seguimento mínimo de um ano. RESULTADOS: foram coletadas informações pré-operatórias, por meio do nosso Registro de Artroplastias do Ombro e Cotovelo, que consistiam em idade, sexo, lateralidade, história de procedimentos prévios, escores funcionais de Constant, além da amplitude de movimentos pré-operatórios, conforme protocolo da American Academy of Shoulder and Elbow Surgery (Ases). Com seguimento médio de 44 meses, 17 pacientes (94%) estavam satisfeitos com o resultado do procedimento. CONCLUSÃO: a artroplastia reversa no tratamento da AMR em pacientes com pseudoparalisia do ombro demonstrou-se efetiva na melhoria, com significância estatística, da amplitude de movimentos de flexão anterior e abdução. Porém, nesta série não houve melhoria da amplitude dos movimentos de rotação externa e interna. A artroplastia reversa é um procedimento que restabelece a função da articulação do ombro em pacientes que previamente não apresentavam possibilidades terapêuticas.

Assessment of the results from arthroscopic surgical treatment of adhesive capsulitis / Avaliacao dos resultados do tratamento cirurgico artroscopico da capsulite adesiva

OBJECTIVE: Describe the outcomes of patients with adhesive capsulitis treated with arthroscopic surgical procedure. METHODS: Between January and September of 2009, 9 patients (10 cases) underwent arthroscopic surgical release. There were 4 male (one bilateral) and 5 female patients. Their mean age was 51 years (27-63). The time from onset of symptoms to the surgical procedure averaged 23.4 months (6-38). Preoperative assessment was based on the UCLA and Constant score. ROM was evaluated with one week and six months of surgery. RESULTS: According to UCLA shoulder score (p < 0.01) it increased from 9.8 preoperatively (6-14) to 31.6 postoperatively (26-35) and the Constant (p < 0.01) from 20 (13-27) to 79.2 (66-91). ROM improved significantly, with mean passive elevation changing from 89° (80-100°) preoperatively to 150° postoperatively with one week and 153° with six months, mean passive external rotation changing from 12.5° (0-30°) preoperatively to 46° (one week) and 56° (six months) postoperatively, and passive internal rotation from L5 (T12-gluteus) to T11 (one week) and T9 (six months). There was not statistical significance of the duration of the disease and the postoperative result. CONCLUSION: This study shows that the surgical treatment of adhesive capsulitis with arthroscopic capsular release and manipulation appears to be a safe procedure that results in pain relief and functional gain.

OBJETIVO: Descrever os resultados dos pacientes com capsulite adesiva submetidos ao tratamento cirúrgico artroscópico. MÉTODOS : Estudo prospectivo com nove pacientes (10 casos) de capsulite adesiva submetidos ao tratamento cirúrgico entre janeiro e setembro de 2009. Cinco pacientes eram do sexo feminino e quatro do masculino (um bilateral), com faixa etária média de 51 anos (27-63). O tempo médio entre o início dos sintomas e a cirurgia foi 23,4 meses (6-38). Foram usados os escores da UCLA e Constant para avaliar os resultados e o ganho do arco de movimento com uma semana e seis meses. RESULTADOS : Houve aumento no escore da UCLA (p < 0,01) de 9,8 no pré-operatório (6-14) para 31,6 no pós-operatório (26-35) e no de Constant (p < 0,01) de 20 (13-27) para 79,2 (66-91). As médias da mobilidade articular passiva no período pré-operatório foram de 89º de flexão anterior (80º-100º), 12,5º de rotação lateral (0º-30º) e L5 de rotação medial (T12-Glúteo), com aumento médio significante estatisticamente na primeira semana para 150º/46º/T11 e para 153º/56º/T9 com seis meses. Não existiu significância estatística com relação ao tempo de evolução da doença e o resultado pós-operatório. CONCLUSÃO : Este estudo demonstrou que o tratamento cirúrgico para capsulite adesiva com liberação capsular artroscópica associada à manipulação é um procedimento seguro e que resulta em alívio da dor e recuperação do arco de movimento.

Electrophysiological correlates of the threshold to detection of passive motion: an investigation in professional volleyball athletes with and without atrophy of the infraspinatus muscle.

The goal of the present study is to compare the electrophysiological correlates of the threshold to detection of passive motion (TTDPM) among three groups: healthy individuals (control group), professional volleyball athletes with atrophy of the infraspinatus muscle on the dominant side, and athletes with no shoulder pathologies. More specifically, the study aims at assessing the effects of infraspinatus muscle atrophy on the cortical representation of the TTDPM. A proprioception testing device (PTD) was used to measure the TTDPM. The device passively moved the shoulder and participants were instructed to respond as soon as movement was detected (TTDPM) by pressing a button switch. Response latency was established as the delay between the stimulus (movement) and the response (button press). Electroencephalographic (EEG) and electromyographic (EMG) activities were recorded simultaneously. An analysis of variance (ANOVA) and subsequent post hoc tests indicated a significant difference in latency between the group of athletes without the atrophy when compared both to the group of athletes with the atrophy and to the control group. Furthermore, distinct patterns of cortical activity were observed in the three experimental groups. The results suggest that systematically trained motor abilities, as well as the atrophy of the infraspinatus muscle, change the cortical representation of the different stages of proprioceptive information processing and, ultimately, the cortical representation of the TTDPM.

Treatment of complex acute proximal humerus fractures using hemiarthroplasty / Tratamento das fraturas complexas agudas da extremidade proximal do úmero com o uso de hemiartroplastia

OBJECTIVE: Evaluate the clinical and radiological results of hemiarthroplasty for treatment of complex proximal humerus fractures. METHODS: Sixty-seven patients were included, with follow-up of 12 to 62 months. Mean age was 65 years (44 to 88), and 47 patients were female (70%). Clinical assessment was performed using the University of California Los Angeles score (UCLA) and measurement of range of motion (ROM) according to the American Academy of Orthopaedic Surgeons criteria. A standardized radiological evaluation was conducted, with special attention to healing and position of tuberosities. Patients were divided into two groups: A (anatomical healing of tuberosities) and B (without anatomical healing of tuberosities). Statistical analyses were performed using the t test. Level of significance was set at p < 0.05. RESULTS: Considering the entire sample, the mean UCLA score was 26 points, with 8 points for pain and 64 patients subjectively satisfied (96%). The mean values for active ROM were 104º of forward flexion and 36º of external rotation. In group A, with 33 patients, we found a mean of 122º forward flexion and 29.5 points on UCLA. In group B the mean forward flexion were 87º and 22.7 points for UCLA. Comparing these parameters in the two groups, we found statistically significant differences for both forward flexion (p < 0.0001) and UCLA. (p < 0.0001). CONCLUSION: We conclude that hemiarthroplasty for treatment of complex proximal humerus fractures has a low incidence of complications and a high subjective satisfaction rate, with favorable results related to pain. A good functional result is less predictable and depends on anatomical reestablishment of proximal humerus anatomy, particularly healing of the greater tuberosity.

OBJETIVO: Avaliar os resultados funcionais e radiográficos dos pacientes submetidos à hemiartroplastia para tratamento das fraturas complexas da extremidade proximal do úmero. MÉTODOS: Foram incluídos 67 pacientes, com seguimento que variou entre 12 e 62 meses. A média de idade foi de 65 anos (44 a 88) e 47 pacientes eram do sexo feminino (70%). Os pacientes foram avaliados clinicamente por meio da avaliação da amplitude de movimentos (ADM) e do escore funcional da University of California Los Angeles (UCLA). A avaliação radiográfica foi feita de forma padronizada com divisão dos pacientes em dois grupos: A (consolidação do tubérculo maior em posição anatômica) e B (ausência de consolidação anatômica do tubérculo maior). Na análise estatística consideramos significativos os achados com p < 0,05. RESULTADOS: A pontuação média do UCLA foi de 26 pontos, com média de oito pontos para dor e 64 pacientes satisfeitos subjetivamente (96%). Na avaliação da amplitude de movimento (ADM) ativa encontramos uma média de 104º de flexão anterior e 36º de rotação lateral. No grupo A, com 33 pacientes, encontramos uma média de 122º de flexão anterior e pontuação média da UCLA de 29,5. No grupo B as médias foram de 87º para flexão anterior e de 22,7 pontos para a UCLA. Comparando esses parâmetros encontramos diferenças estatisticamente significativas tanto para a flexão anterior (p < 0,001) quanto para a UCLA (p < 0,001). CONCLUSÃO: A hemiartroplastia no tratamento das fraturas complexas da extremidade proximal do úmero apresenta alto índice de satisfação subjetiva e um resultado favorável com relação à dor. Um resultado funcional satisfatório é menos previsível e depende do restabelecimento preciso da morfologia da extremidade proximal do úmero, especialmente da consolidação anatômica do tubérculo maior.

Assessment of the results from arthroscopic surgical treatment of adhesive capsulitis.

Objective: Describe the outcomes of patients with adhesive capsulitis treated with arthroscopic surgical procedure. Methods: Between January and September of 2009, 9 patients (10 cases) underwent arthroscopic surgical release. There were 4 male (one bilateral) and 5 female patients. Their mean age was 51 years (27-63). The time from onset of symptoms to the surgical procedure averaged 23.4 months (6-38). Preoperative assessment was based on the UCLA and Constant score. ROM was evaluated with one week and six months of surgery. Results: According to UCLA shoulder score (p < 0.01) it increased from preoperatively (6-14) to 31.6 postoperatively (26-35) and the Constant (p < 0.01) from 20 (13-27) to 79.2 (66-91). ROM improved significantly, with mean passive elevation changing from 89° (80-100°) preoperatively to 150° postoperatively with one week and 153° with six months, mean passive external rotation changing from 12.5° (0-30°) preoperatively to 46° (one week) and 56° (six months) postoperatively, and passive internal rotation from L5 (T12-gluteus) to T11 (one week) and T9 (six months). There was not statistical significance of the duration of the disease and the postoperative result. Conclusion: This study shows that the surgical treatment of adhesive capsulitis with arthroscopic capsular release and manipulation appears to be a safe procedure that results in pain relief and functional gain.

Treatment of complex acute proximal humerus fractures using hemiarthroplasty.

OBJECTIVE: Evaluate the clinical and radiological results of hemiarthroplasty for treatment of complex proximal humerus fractures. METHODS: Sixty-seven patients were included, with follow-up of 12 to 62 months. Mean age was 65 years (44 to 88), and 47 patients were female (70%). Clinical assessment was performed using the University of California Los Angeles score (UCLA) and measurement of range of motion (ROM) according to the American Academy of Orthopaedic Surgeons criteria. A standardized radiological evaluation was conducted, with special attention to healing and position of tuberosities. Patients were divided into two groups: A (anatomical healing of tuberosities) and B (without anatomical healing of tuberosities). Statistical analyses were performed using the t test. Level of significance was set at p < 0.05. RESULTS: Considering the entire sample, the mean UCLA score was 26 points, with 8 points for pain and 64 patients subjectively satisfied (96%). The mean values for active ROM were 104° of forward flexion and 36° of external rotation. In group A, with 33 patients, we found a mean of 122° forward flexion and 29.5 points on UCLA. In group B the mean forward flexion were 87° and 22.7 points for UCLA. Comparing these parameters in the two groups, we found statistically significant differences for both forward flexion (p < 0.0001) and UCLA. (p < 0.0001). CONCLUSION: We conclude that hemiarthroplasty for treatment of complex proximal humerus fractures has a low incidence of complications and a high subjective satisfaction rate, with favorable results related to pain. A good functional result is less predictable and depends on anatomical reestablishment of proximal humerus anatomy, particularly healing of the greater tuberosity.

Análise das lesões intra-articulares na instabilidade anterior do ombro / Analysis of intra-articular lesions in anterior shoulder instability

Introdução: Instabilidade anterior do ombro é uma afecção frequente, na qual uma de suas consequências é o surgimento de lesões labrais, ósseas e do manguito rotador. Estas lesões que, muitas vezes, estão associadas, variam no seu tamanho de acordo com a causa e número de episódios de luxações. Objetivo: Descrever as alterações intra-articulares encontradas nos pacientes submetidos ao tratamento artroscópico para instabilidade anterior do ombro e correlacionar os achados com a causa da luxação e o número de episódios até o tratamento. Material e métodos: Entre agosto de 2006 e julho de 2007, 60 cirurgias para instabilidade anterior do ombro foram realizadas no Instituto Nacional de Traumatologia e Ortopedia (INTO). Protocolo pré-operatório específico identificando-se: idade, sexo, mecanismo do primeiro episódio de luxação (traumática ou atraumática) e número de luxações foi preenchido em todos os casos. Ao final do procedimento cirúrgico foi preenchido um protocolo descrevendo a eventual presença das seguintes lesões: Bankart, Hill-Sachs, SLAP, ALPSA, HAGL, ruptura do manguito rotador e lesão óssea da glenoide. As lesões da glenoide foram divididas em três tipos: lesão condral sem defeito ósseo, lesões com perda óssea menor e maior que 27%. Resultados: Dos 60 pacientes, 42 eram do sexo masculino e 18 do feminino. A média de idade foi de 30 anos (16-54), 45 casos traumáticos e 15 atraumáticos e a média de luxações foi de 20 episódios (1-100). A lesão de Bankart esteve presente em 57 pacientes (95%), Hill-Sachs em 53 (88%), a do manguito rotador em três casos (5%), SLAP em 11 (18%) e a lesão ALPSA em três (5%). Conclusão: Todos os casos traumáticos e a maioria dos atraumáticos apresentaram lesão do labrum anterior. Não houve associação entre o número de luxações e lesão óssea na glenoide ou entre o mecanismo do primeiro episódio e presença de lesão óssea.

Osteossíntese das fraturas da extremidade proximal do úmero com sistema de placa de ângulo fixo com parafusos bloqueados: técnica e resultados / Osteosynthesis of proximal humeral end fractures with fixed angle plate and locking screws: technique and results

OBJETIVO: Descrever os resultados do tratamento cirúrgico das fraturas da extremidade proximal do úmero com a placa de sistema bloqueado Philos. MÉTODOS: Entre março de 2003 e outubro de 2004 foram avaliados, de forma prospectiva, 24 de 26 pacientes com fratura da extremidade proximal do úmero tratados com a placa Philos. A média de seguimento foi de 12 meses e da idade dos pacientes, de 57 anos. Seis pacientes tinham fraturas em quatro partes, 11 em três partes e nove em duas partes. A avaliação clínica foi feita por meio dos critérios da University of California at Los Angeles (UCLA). RESULTADOS: A média do escore da UCLA foi de 30 pontos (17-35). Todas as fraturas consolidaram. Em três pacientes a fratura consolidou em varo. Nesses, o índice da UCLA médio foi de 27 pontos. CONCLUSÃO: A osteossíntese com a placa Philos permite fixação estável com bom resultado funcional.

OBJECTIVE: Describe the results of proximal humeral fractures surgically treated with the Philos locking plate system. METHOD: Between March 2003 and October 2004 we prospectively reviewed 24 of 26 patients with proximal humerus fractures treated with a Philos plate. The mean follow-up time was 12 months and the mean age of patients was 57 years. Six patients had four-part proximal humerus fractures, 11 patients had three-part proximal humerus fractures, and nine patients had two-part proximal humerus fractures. Clinical evaluation was performed using the University of California at Los Angeles (UCLA) criteria. RESULTS: The mean UCLA score was 30 points (17-34). All fractures showed union. Three patients showed fracture union at varus position. The mean UCLA score for these patients was 27 points. CONCLUSION: Osteosynthesis with Philos plate provides a stable fixation method with good functional outcome.

Registro de artroplastias do ombro / Shoulder arthroplasty records

Objetivo: Determinar as características clínico-cirúrgicas referentes a 145 artroplastias do ombro realizadas no período entre julho de 2004 a dezembro de 2006. Métodos: No período de estudo foram realizadas 145 artroplastias de ombro. Através de protocolo prospectivo, informações demográficas, da anamnese, exame físico e exame radiográfico foram armazenadas em umbanco de dados. Os dados coletados foram organizados em três grandes grupos: doenças articulares degenerativas, fraturas e seqüelas traumáticas. Esses dados foram correlacionados a fim de definir o perfil epidemiológico dos pacientes, das lesões e artroplastias. Resultados: Das 145 artroplastias de ombro realizadas37% foram por seqüelas traumáticas, 30% por doença articular degenerativa e 33% com diagnóstico de fratura. Foram 12% artroplastias totais e 88% parciais. Ocorreram cinco complicaçõesno pós-operatório recente. Conclusão: As artroplastias de ombro tornaram-se um procedimento frequente na prática ortopédica. Registros cirúrgicos são importantes a fim de demonstrar essaevolução progressiva e permitir avaliações de resultados clínicos no futuro.

Objective: The study's objective is to evaluate the characteristics and problems of patients who underwent shoulder arthroplasties between July 2004 and November 2006. Methodology: During the period of the study, 145 shoulder arthroplasties were performed. A prospective protocol was used for every patient; demographic,clinical and surgical procedure data were collected. All gathered data were included in the data base. The patients were divided in three major groups: fractures, degenerative diseases and trauma sequels. Information obtained from the data base was correlated in order to determine patients' epidemiologic, injuries, and surgical procedure profiles. Results: Of the 145shoulder arthroplasties performed, 37% presented trauma sequels, 30% degenerative diseases, and 33% proximal humerus fracture. 12% of the cases required total arthroplasties and 88% partial arthroplasties. Five major complications were observed on early postoperative period. Conclusion: Shoulder arthroplasties have become a common procedure in orthopaedic practice. Surgical records are important in evidencing progressive evolution and in enabling future clinical outcomes evaluation.

OSTEOSYNTHESIS OF PROXIMAL HUMERAL END FRACTURES WITH FIXED-ANGLE PLATE AND LOCKING SCREWS: TECHNIQUE AND RESULTS.

UNLABELLED: Describe the results of proximal humeral fractures surgically treated with the Philos locking plate system. METHOD: Between March 2003 and October 2004 we prospectively reviewed 24 of 26 patients with proximal humerus fractures treated with a Philos plate. The mean follow-up time was 12 months and the mean age of patients was 57 years. Six patients had four-part proximal humerus fractures, 11 patients had three-part proximal humerus fractures, and nine patients had two-part proximal humerus fractures. Clinical evaluation was performed using the University of California at Los Angeles (UCLA) criteria. RESULTS: The mean UCLA score was 30 points (17-34). All fractures showed union. Three patients showed fracture union at varus position. The mean UCLA score for these patients was 27 points. CONCLUSION: Osteosynthesis with Philos plate provides a stable fixation method with good functional outcome.