Analgesia na entorse de tornozelo: estudo com etoricoxibe / Analgesia in ankle sprain: study with etoricoxib

JUSTIFICATIVA E OBJETIVOS: A torção de tornozelo é uma das doenças mais frequentes nas emergências ortopédicas. Normalmente prescrevem-se analgésicos e anti-inflamatórios. O objetivo deste estudo foi avaliar se o etoricoxibe na dose diária de 60 mg é tão efetivo quanto à dose de 90 mg no tratamento da dor e inflamação em pacientes com torções de tornozelo graus I e II. MÉTODO: Estudo clínico aleatório, duplamente encoberto e controlado foram estudados 43 pacientes com diagnóstico de entorse de tornozelo graus I e II, com idade média de 32 anos. Os pacientes foram divididos em dois grupos aleatoriamente: grupo I, constituído por 23 pacientes tratados com 90 mg de etoricoxibe em dose única diária, e grupo I, constituído por 20 pacientes em uso de 60 mg em dose única diária. As avaliações pela escala analógica visual (EAV) e avaliação funcional foram feitas após 7 e 15 dias de tratamento. RESULTADOS: Observou-se diminuição significativa da dor entre as visitas pré e pós o uso do medicamento, com uma média de 4,1 pontos na EAV (p < 0,001), porém a diminuição da intensidade da dor não dependeu do esquema terapêutico utilizado. Um paciente teve a medicação suspensa, devido à tolerabilidade, que foi considerada boa em 90,7% dos pacientes. CONCLUSÃO: As doses de 60 e 960 mg de etoricoxibe foram efetivas e bem toleradas para o controle da dor aguda em pacientes com entorse do tornozelo.

BACKGROUND AND OBJECTIVES: Ankle sprain is one of the most frequent diseases in orthopedic emergencies. In general, analgesics and anti-inflammatory drugs are prescribed. This study aimed at evaluating whether 60 mg daily etoricoxib is as effective as 90 mg daily etoricoxib to treat pain and inflammation in patients with ankle sprain grades I and II. METHOD: This is a clinic, randomized, double-blind and controlled study which has evaluated 43 patients with ankle sprain grades I and II, with mean age of 32 years. Patients were randomly distributed in two groups: group I, made up of 23 patients treated with 90 mg daily bolus etoricoxib, and group II, made up of 20 patients under 60 mg daily bolus dose. Patients were evaluated by the visual analog scale (VAS) and by functional evaluation after 7 and 15 days of treatment. RESULTS: There has been significant pain improvement between visits before and after using the drug, with a mean of 4.1 VAS score (p < 0.001), however pain intensity improvement did not depend on therapeutic schedule. Drug was withdrawn from one patient due to tolerability, which was considered good for 90.7% of patients CONCLUSION: Both 60 mg and 90 mg etoricoxib doses were effective and well tolerated to control acute pain in ankle sprain patients.

Shoulder functional ratio in elite junior tennis players.

OBJECTIVE: To evaluate shoulder rotation strength and compare the functional ratio between shoulders of elite junior tennis players. DESIGN: This cross-sectional study evaluated muscular rotation performance of 40 junior tennis players (26 male and 14 female) with an isokinetic dynamometer. MAIN OUTCOME MEASURES: Strength variables of external (ER) and internal rotators (IR) in concentric and eccentric modes were considered. For the peak torque functional ratio, the eccentric strength of the ER and the concentric strength of the IR were calculated. RESULTS: All variables related to IR were significantly higher on the dominant compared to the non-dominant side in males and females (p<0.05), but only boys exhibited this dominance effect in ER (p<0.05 and p<0.001). Regarding functional ratios, they were significantly lower for the dominant shoulder (p<0.001) and below 1.00 for both groups, indicating that the eccentric strength of the ER was not greater than the concentric strength of the IR. CONCLUSION: Elite junior tennis players without shoulder injury have shoulder rotation muscle strength imbalances that alter the normal functional ratio between rotator cuff muscles. Although these differences do not seem to affect the athletic performance, detection and prevention with exercise programs at an early age are recommended.

SPORTS INJURIES OF THE UPPER LIMBS.

Sports injuries of the upper limbs are very common in physical activities and therefore, they need to be studied in detail, taking into consideration specific aspects of the types of sports practiced. Special attention should be paid to the dynamics of the shoulder girdle and the entire scapular belt, since the most appropriate treatment for athletes can only be provided in this manner. This can also help to prevent recurrences, which can occur in some cases because athletes always seek to return to their pre-injury level of sports activity. This article will focus primarily on the management of upper-limb tendon injuries, from the physiopathology through to the new methods of injury treatment that are more prevalent in sports practice in Brazil.

Lesões do membro superior no esporte / Sports injuries of the upper limb

As lesões esportivas do membro superior são muito comuns da prática de atividades físicas e, por isso, devem ser estudadas detalhadamente, levando-se em consideração aspectos específicos da modalidades esportiva praticada. Especial atenção deve ser dada à dinâmica da articulação do ombro e toda cintura escapular, pois somente assim poderemos tratar de forma mais adequada os atletas, atuando também na prevenção das recidivas, que podem ocorrer em alguns casos devido ao fato de o atleta procurar sempre o retorno ao mesmo nível esportivo anterior à lesão. Este artigo vai focar principalmente o manejo das lesões tendíneas do membro superior, da fisiopatologia até os novos métodos de tratamento das lesões de maior prevalência na prática esportiva em nosso país.

Sports injuries of the upper limbs are very common in physical activities, and need to be studied in detail, taking into consideration specific aspects of the types of sports practiced. Special attention should be paid to the dynamics of the shoulder girdle and scapular belt, as this will enable us to treat athletes more adequately, also helping prevent recurrences that can occur in some cases, due to the fact that the athlete always attempts to return to their pre-injury level of sport. This review focuses primarily on the management of upper limb tendon sports injuries, from the physiopathology through to the more common new methods of treatment in sports practice in our country.

Stress reaction of the humerus in tennis players.

BACKGROUND: Overuse injuries are a frequent occurrence among competitive athletes. When analysing the incidence of overuse injuries in tennis players, it has been determined that a significant number of these injures occur in the upper limb area. In this study, we describe five cases of a stress-induced injury to the middle and distal humerus occurring mainly due to repetitive serving. METHODS: Athletes studied were competitive tennis players and elite junior players, two of whom played at international level. Four of the five were male. In all cases, diagnosis was confirmed by magnetic resonance imaging examination. The treatment of middle and distal humeral stress reactions consisted of physical therapy, which focused on analgesia and muscle strengthening. In addition, we analysed each tennis player's strokes in order to identify modifications that would decrease the amount of stress that the upper limbs were subjected to during the service motion. RESULTS: The players in our study missed on average 3 weeks of play and at follow-up after 1 year were able to play symptom free. CONCLUSIONS: Our study highlights the need for coaches, physicians and players to be aware of distal humeral pain and understand treatment options in order to prevent further injury, including stress fractures.

An anatomic study of the iliotibial tract.

PURPOSE: To identify the structure of the iliotibial tract at knee level, as well as its insertions, layer arrangement, and relationship with other structures of the lateral region of the knee and to compare the findings with available literature. METHODS: Ten detailed anatomic dissections were performed by using incisions as recommended by the literature in fresh cadaver knees identifying the iliotibial tract components. RESULTS: The authors observed an iliotibial tract arrangement in superficial, deep, and capsular-osseous layers. Insertions have been described as follows: at linea aspera, at the upper border of the lateral epicondyle, at the patella, and at Gerdy's tibial tuberculum and across the capsular-osseous layer. CONCLUSIONS: The iliotibial tract (ITT) has important interconnections to the femur, the patella, and the lateral tibia; the iliopatellar band joins the ITT to the patella through the superficial oblique retinaculum and the lateral femoropatellar ligament, and the ITT capsular-osseous layer presents differentiated fibers in an arched arrangement that borders the femoral condyle and inserts laterally to the Gerdy's tubercle. CLINICAL RELEVANCE: The iliotibial tract can be considered as an anterolateral knee stabilizer, particularly its capsular-osseous layer, which, together with the anterior cruciate ligament, constitutes a functional unit forming a spatial "horseshoe" form. The detailed description of the structures forming iliotibial tract plays an important role in the study of knee instabilities. Its important tibial, femoral, and patellar connections are described so that better understanding of tibial femoral instability on the lateral side as well as patellofemoral instability can be achieved and mechanisms of repair can be conceived.

Descriptive profile of hip rotation range of motion in elite tennis players and professional baseball pitchers.

BACKGROUND: Repetitive loading to the hip joint in athletes has been reported as a factor in the development of degenerative joint disease and intra-articular injury. Little information is available on the bilateral symmetry of hip rotational measures in unilaterally dominant upper extremity athletes. HYPOTHESIS: Side-to-side differences in hip joint range of motion may be present because of asymmetrical loading in the lower extremities of elite tennis players and professional baseball pitchers. STUDY DESIGN: Cohort (cross-sectional) study (prevalence); Level of evidence, 1. METHODS: Descriptive measures of hip internal and external rotation active range of motion were taken in the prone position of 64 male and 83 female elite tennis players and 101 male professional baseball pitchers using digital photos and computerized angle calculation software. Bilateral differences in active range of motion between the dominant and nondominant hip were compared using paired t tests and Bonferroni correction for hip internal, external, and total rotation range of motion. A Pearson correlation test was used to test the relationship between years of competition and hip rotation active range of motion. RESULTS: No significant bilateral difference (P > .005) was measured for mean hip internal or external rotation for the elite tennis players or the professional baseball pitchers. An analysis of the number of subjects in each group with a bilateral difference in hip rotation greater than 10 degrees identified 17% of the professional baseball pitchers with internal rotation differences and 42% with external rotation differences. Differences in the elite male tennis players occurred in only 15% of the players for internal rotation and 9% in external rotation. Female subjects had differences in 8% and 12% of the players for internal and external rotation, respectively. Statistical differences were found between the mean total arc of hip range of internal and external rotation in the elite tennis players with the dominant side being greater by a clinically insignificant mean value of 2.5 degrees. Significantly less (P < .005) dominant hip internal rotation and less dominant and nondominant hip total rotation range of motion were found in the professional baseball pitchers compared with the elite male tennis players. CONCLUSION: This study established typical range of motion patterns and identified bilaterally symmetric hip active range of motion rotation values in elite tennis players and professional baseball pitchers. Asymmetric hip joint rotational active range of motion encountered during clinical examination and screening may indicate abnormalities and would indicate the application of flexibility training, rehabilitation, and further evaluation.

Avaliação das lesões ortopédicas em tenistas amadores competitivos / Assessment of orthopedic injuries in competitive amateur tennis players

Estudar a incidência de lesões ortopédicas, em tenistas competitivos. Material e métodos: Por meio da análise retrospectiva, 160 tenistas amadores, mas competitivos, do Estado de São Paulo foram estudados. Destes, 64 (40 por cento) eram do sexo feminino e 96 (60 por cento) do masculino. A idade variou de nove a 78 anos, com média de 27,6 anos. Para a análise do material com relação ao número de lesões e ao tipo de lesão apresentada, empregaram-se os critérios da NAIRS (National Athletic Injury Report System) e, para a análise estatística dos dados, utilizou-se o teste t de Student para amostras pareadas, estabelecendo como valor de significância o índice de probabilidade (p) menor do que 0,05. Resultado: Foram relatadas 244 lesões em 122 atletas. Somente 38 (23,8 por cento) tenistas não referiram nenhum tipo de lesão durante a sua vida competitiva. Com relação à região do corpo acometida, a lesão mais freqüente foi a muscular, relatada por 58 (23,8 por cento) tenistas. Logo a seguir foram relatadas as lesões do pé e tornozelo (48-19,7por cento tenistas) e cotovelo (41 - 16,8 por cento - atletas). As patologias específicas mais freqüentemente relatadas foram a epicondilite lateral do cotovelo (epicondilite), relatada por 38 atletas, e as torções do tornozelo (36 relatos). Em média, os tenistas afastaram-se dos treinos e jogos por cinco semanas e quatro dias, porém, este afastamento variou de acordo com o local do organismo acometido pela lesão. As lesões que determinaram maior afastamento das quadras foram as intra-articulares do joelho. Dos atletas que tiveram lesão no joelho, 53,8 por cento submeteram-se a cirurgia e se afastaram do esporte pelo menos por três meses. Conclusões: No tênis, as lesões musculares foram as mais freqüentes, porém, as lesões traumáticas do joelho se mostraram as mais graves e determinaram maior tempo de afastamento das quadras. Não houve diferença estatisticamente significante entre o maior número de torneios disputados ao ano e a maior incidência de lesões. Com relação à epicondilite, na população estudada, não houve diferença estatística entre maior tensão utilizada nas cordas da raquete com a maior incidência da lesão, porém, observou-se que tempo maior de prática do esporte predispõe à lesão. Técnica correta de movimentos básicos parece ser o melhor fator preventivo da epicondilite

The arthroscopic treatment of osteochondritis dissecans of the knee with autologous bone sticks.

PURPOSE: To present a new surgical technique for the fixation of partial dislocated osteochondral fragments in athletes with osteochondritis dissecans (OCD) of the knee. TYPE OF STUDY: Retrospective case series. METHODS: Autologous bone sticks were taken from the ipsilateral tibial metaphysis and used in the arthroscopic fixation of unilateral osteochondritis dissecans of the knee in 11 patients (5 female and 6 male). Patient age ranged from 11 to 20 years (mean, 16 years). Fixation of the partially dislocated fragments of the OCD of the knee was performed following a modified arthroscopic procedure and autologous bone graft. RESULTS: Follow-up ranged from 15 to 108 months (mean, 48 months). Based on modified criteria of Hughston et al., results were satisfactory in 90.9% and unsatisfactory in 9.1% of the cases. CONCLUSIONS: Arthroscopic fixation of OCD of the knee with autologous bone sticks is technically simple and nonaggressive and provides satisfactory results in most cases.

Estudo anatomico do trato iliotibial: revisão crítica de sua importância na estabilidade do joelho / Anatomic study of the iliotibial tract: critical revision of its importance for knee stability

Os autores realizaram 10 dissecões anatomicas pormenorizadas em joelhos de cadáveres a fresco identificando os componentes do trato iliotibial e observaram sua disposição em camadas superficial, profunda e cápsulo-ossea. Foram observadas também suas inserçäes na linha áspera, na margem superior do epicondilo lateral, na patela, no tubérculo de Gerdy e através da camada cápsulo-¢ssea. Ap¢s a descrição desses componentes, relacionando com a literatura, os autores estabeleceram a importância do trato iliotibial como estabilizador ântero-lateral do joelho, especialmente da camada cápsulo-ossea, que, juntamente com o ligamento cruzado anterior, constitui uma unidade funcional formando uma figura espacial em ferradura. Este estudo permitiu maior compreensão da estabilização ântero-lateral do joelho, a gênese do sinal do ressalto e a contenção lateral da patela.

Tratamento artroscópico da osteocondrite dissecante do joelho (OCDJ0) por meio de "palitos ósseos" autólogos / Arthroscopic treatment of osteochondritis dissecans of the knee with autologous bone pegs

A técnica realizada consiste na retirada de "palitos ósseos" da metáfise proximal da tíbia ipsolateral para fixaçäo, por via artroscópica, da osteocondrite dissecante do joelho (OCDJ) unilateral em 11 pacientes (11 joelhos), 5 do sexo feminino e 6 do masculino. A idade variou de 11 a 20 anos (média de 16 anos). Com base nos critérios de avaliaçäo de Hughston et al. (1984) modificados, o resultado obtido foi satisfatório em 90 por cento dos casos e insatisfatório em 10 por cento. A fixaçäo artroscópica da OCDJ com "palitos ósseos" autólogos mostrou-se tecnicamente simples, pouco agressiva cirurgicamente e com resultados satisfatórios na maioria dos casos.

Altura patelar nas reconstruçöes intra-articulares do ligamento cruzado anterior usando o terço médio do tendäo patelar. Via abera x via artrocópica / Patellar hheight in intra-articular reconstruction of the anterior cruciate ligament using the mid-third of the patellar tendon. Open surgery x arthroscopic surgery

O trabalho tem como objetivo medir a altura patelar em pacientes submetidos à reconstruçao intra-articular do ligamento cruzado anterior do joelho (LCA), utilizando o terço médio do tendao patelar através de duas técnicas diferentes - cirurgia aberta e cirurgia artroscópica - a fim de determinar a possibilidade de desenvolvimento de patela baixa. Foram comparados 40 pacientes divididos em dois grupos (cirurgia artroscópica x cirurgia aberta), utilizando o exame ultra-sonográfico para a realizaçao das medidas. Nao foi encontrada diferença estatisticamente significante entre os dois grupos, porém chamou a atençao dos autores o fato de que, estatisticamente, os tendoes patelares operados mostraram aumento em sua medida quando comparados com o lado nao operado.

Análise ultra-sonografia do comprimento do tendäo patelar doador em pacientes submetidos à reconstruçäo intra-articular do ligamento cruzado anterior do joelho / Patellar tendon length changes after intra-articular ACL reconstruction: an ultrasound analysis

Sao analisadas, retrospectivamente, através de exame ultra-sonográfico, as alteraçoes no comprimento do tendao patelar de 30 pacientes submetidos à reconstruçao intra-articular do ligamento cruzado anterior do joelho usando este tendao como enxerto livre. Foram selecionados somente pacientes que nao se queixavam de dor no joelho operado e que nao apresentaram nenhuma complicaçao pós-operatória. Observou-se que em 50 por cento dos casos houve aumento no comprimento do tendao e que em dois (6,6 por cento) pacientes ele foi maior do que 10 por cento. Em relaçao à outra metade, em cinco (16,7 por cento) pacientes nao houve variaçao no tamanho do tendao patelar em comparaçao com o lado nao operado, enquanto nos outros dez (33,3 por cento) houve diminuiçao, com nenhuma variaçao superior a 10 por cento. Na análise dos dados, nenhuma diferença citada foi estatisticamente significante.