Glenohumeral internal rotation deficit in general population with shoulder pain: A descriptive observational study.

Glenohumeral internal rotation deficit (GIRD) is one of the most important factors influencing injury risk in the arm of overhead athletes. Some studies have shown that the GIRD of athletes with shoulder pain was higher than those without shoulder pain, establishing a relation between shoulder pain and GIRD. However, there are no studies that relate to GIRD and shoulder pain or the risk factors that affect GIRD in the population with this ailment. This study aimed to: determine if GIRD could be found clinically and between which values it oscillates in patients with shoulder pain, and explore if there are any potential associations between GIRD and some sociodemographic data, and orthopedic or radiological findings. A descriptive observational study design was adopted to determine if GIRD could be found clinically in patients with shoulder pain and to gain further evidence in the potential associations between GIRD and sociodemographic data, and orthopedic or radiological findings. All those patients without exclusion criteria between October 1,2020 and March 31,2021 were included. Exclusion criteria consisted of being under 18 years old but younger than 80 years old, showing shoulder pain in both shoulders and having a joint prosthesis in at least one of the 2 shoulders, tumor, or infection. A total of 67 patients aged between 25 and 75 years (52.7 ±â€…11.8 years, 36 male and 31 female). More than 82% of patients with shoulder pain showed a GIRD higher than 20º. The mean GIRD was 37.6 ±â€…17.09º. The 95th percentile was 66.22º. From sociodemographic data could be extracted that: patients who have children showed a lower GIRD, patients with right shoulder pain, or whose dominance coincided with a painful shoulder showed a higher GIRD. The orthopedic findings revealed that patients with a positive Jobe test showed a lower GIRD. The linear model considering both sociodemographic and orthopedic findings showed that GIRD was reduced by having children and by BMI. GIRD shows a high incidence in patients with shoulder pain. The descendant, BMI, and positive Jobe test were negatively associated with the GIRD.

Treatment of glenohumeral internal rotation deficit in the general population with shoulder pain: An open single-arm clinical trial.

BACKGROUND: Maladaptation can provoke important alterations in the arthrokinematics such as an internal rotation reduction in the dominant shoulder compared with the nondominant shoulder known as glenohumeral internal rotation deficit (GIRD). Though the number of studies investigating GIRD in athletic population, there are not studies reporting the efficacy of the GIRD treatment in the nonathlete population, a kind of study required to improve our understanding of patient care with this pathology. This study aimed to describe the efficacy of the GIRD treatment in nonathlete population with shoulder pain. METHODS: An open single-arm trial with 35 patients was adopted for evaluating the efficacy of GIRD treatment in patients with shoulder pain. All patients with shoulder pain who attended the consultation, accepted, and agreed to participate in the study between October 2020 and March 2021 were included. A treatment sequence including joint manual therapy techniques and soft tissue release techniques was applied in the consultation. Then, patients were instructed to adapt the daily active biological stimulus at home. The IR before (IR0) and after (IR1) the treatment was considered the outcome measure. The GIRD was calculated as the difference between the IR of the non-painful shoulder and the IR of the painful shoulder before (GIRD0) and after treatment (GIRD1). A paired Student t test was used to compare the GIRD of each patient before and after the treatment. RESULTS: Treatment of the patients significantly increased the IR of the painful shoulder in all the patients (P-value < .0001) So, the mean IR0 was 26.09 ± 14.46º (23.64-28.53), and after the treatment the mean IR1 was 67.98 ± 15.03º (65.48-70.52). The mean difference after the treatment (IR1-IR0) was 41.89 ± 14.74º (39.4-44.39). The treatment also significantly reduced GIRD (P-value < .0001). So, the mean GIRD0 was 42.95 ± 16.26º (40.2-45.7), and after the treatment the mean GIRD1 was -1.05 ± 17.18º (-3.96 to 1.85). CONCLUSIONS: The treatment administrated in this study significantly increased the internal rotation of the treated and painful shoulder and reduced the GIRD from the first consultation. LEVEL OF EVIDENCE: Level 3.

Vertical versus horizontal suture configuration for the repair of isolated type II SLAP lesion through a single anterior portal: a randomized controlled trial.

PURPOSE: To compare the clinical and functional outcomes of the repair of an isolated type II SLAP lesion by 2 different configuration techniques (vertical v horizontal suture) through a single anterior portal. METHODS: We designed a prospective, double-blinded, randomized clinical trial. A junior orthopaedic surgeon, who made the initial diagnosis, used a 10-point visual analog scale for pain and subjective instability and the American Shoulder and Elbow Surgeons (ASES) scoring system and evaluated the range of motion. After a diagnostic arthroscopy that ascertained the presence of an isolated type II SLAP lesion, patients were randomized to receive either vertical suture configuration (group 1) or horizontal suture configuration (group 2), both through a single anterior portal. Thirty-two patients were included in the study. The mean follow-up time was 37 months. RESULTS: The mean postoperative ASES score was 91.9 in group 1 versus 95.8 in group 2 (P > .05). The differences observed from preoperative ASES score for both groups to postoperative ASES score were statistically significant. The differences observed in preoperative range of motion from the contralateral healthy shoulder and the affected shoulder in both groups were all clinically and statistically significant. Comparing the overall range of motion of the affected limb postoperatively with the range of motion of the contralateral healthy shoulder and between both groups, we found no statistically significant differences in forward flexion (P = .067), external rotation (P = .101), or internal rotation (P = .343). CONCLUSIONS: The results of this study suggest that the repair of an isolated type II SLAP lesion through a single anterior portal is clinically and functionally beneficial to patients regardless of the suture configuration performed (vertical or horizontal suture) because no differences were observed between these configurations after repair of an isolated type II SLAP lesion. LEVEL OF EVIDENCE: Level I, randomized controlled trial.

Mediastinitis necrotizante descendente / Descending necrotizing mediasstinitis

Se presenta un niño de 3 años que a consecuencia de una herida punzante en la pared posterior de la faringe, desarrolló un absceso retrofaríngeo, el cual por vía descendente invadió mediatino y ambas cavidades pleurales. A pesar de la antibioticoterapia agresiva, drenaje toráxico bilateral, y drenaje del espacio retrovisceral, el paciente falleció. La mediastinitis Necrotizante Descendente (MND) ocurre como complicacion de un proceso infeccioso localizado en orofaringe, y en esta presentación se discuten problemas etiológicos, fisiopatológicos y terapeúticos (AU)

Mediastinitis necrotizante descendente / Descending necrotizing mediasstinitis

Se presenta un niño de 3 años que a consecuencia de una herida punzante en la pared posterior de la faringe, desarrolló un absceso retrofaríngeo, el cual por vía descendente invadió mediatino y ambas cavidades pleurales. A pesar de la antibioticoterapia agresiva, drenaje toráxico bilateral, y drenaje del espacio retrovisceral, el paciente falleció. La mediastinitis Necrotizante Descendente (MND) ocurre como complicacion de un proceso infeccioso localizado en orofaringe, y en esta presentación se discuten problemas etiológicos, fisiopatológicos y terapeúticos