Correlation of Physical Examination with Arthroscopic Findings in the Treatment of Rotator Cuff Tear.

Objective To compare clinical data from the physical examination with arthroscopic findings in rotator cuff rupture. Methods A total of 177 patients submitted to arthroscopic treatment of rotator cuff rupture were selected, and arthroscopic findings were compared with physical examination. Results The impingement tests showed high sensitivity for rotator cuff rupture. Among the strength tests, the most sensitive was the Patte test (85.7%), and the one with the highest positive predictive value (PPV) was the Jobe test (95%). The Drop Sign test showed higher specificity and negative predictive value (NPV) (98.7 and 95.9%, respectively). Patients with a history of trauma were 3.5 times more likely to have a positive Lift Off test. Conclusion The impingement tests had high sensitivity for rotator cuff ruptures. The Jobe test showed similar sensitivity among patients who had partial or total supraspinal injury. For complete lesions of the subscapularis, The Lift Off and Belly Press tests showed high sensitivity and specificity.

Correlation of Physical Examination with Arthroscopic Findings in the Treatment of Rotator Cuff Tear / Correlação do exame físico com achados artroscópicos no tratamento da ruptura do manguito rotador

Abstract Objective To compare clinical data from the physical examination with arthroscopic findings in rotator cuff rupture. Methods A total of 177 patients submitted to arthroscopic treatment of rotator cuff rupture were selected, and arthroscopic findings were compared with physical examination. Results The impingement tests showed high sensitivity for rotator cuff rupture. Among the strength tests, the most sensitive was the Patte test (85.7%), and the one with the highest positive predictive value (PPV) was the Jobe test (95%). The Drop Sign test showed higher specificity and negative predictive value (NPV) (98.7 and 95.9%, respectively). Patients with a history of trauma were 3.5 times more likely to have a positive Lift Off test. Conclusion The impingement tests had high sensitivity for rotator cuff ruptures. The Jobe test showed similar sensitivity among patients who had partial or total supraspinal injury. For complete lesions of the subscapularis, The Lift Off and Belly Press tests showed high sensitivity and specificity.

Resumo Objetivo Comparar dados clínicos do exame físico com os achados artroscópicos na ruptura do manguito rotador. Métodos Foram selecionados 177 pacientes submetidos ao tratamento artroscópico de ruptura do manguito rotador e foram comparados os achados artroscópicos com o exame físico. Resultados Os testes irritativos de impacto apresentaram alta sensibilidade para ruptura do manguito rotador. Dentre os testes de força, o de maior sensibilidade foi o teste de Patte (85,7%) e o de maior valor preditivo positivo (VPP) foi o teste de Jobe (95%). O teste Drop Sign apresentou maior especificidade e valor preditivo negativo (VPN) (98,7 e 95,9%, respectivamente). Pacientes com história de trauma possuíam 3,5 vezes mais chances de apresentarem o teste Lift Off positivo. Conclusão Os testes irritativos tiveram alta sensibilidade para rupturas do manguito rotador. O teste de Jobe apresentou sensibilidade semelhante entre os pacientes que tinham lesão parcial ou total do supraespinhal. Para as lesões completas do subescapular, as testes Lift Off e Belly Press apresentaram alta sensibilidade e especificidade.

Evaluation of the Glenoid Track Tomographic Method in Magnetic Resonance Imaging/Arthro-MRI.

Objective To evaluate and compare the glenoid track method in 3D-reconstructed computed tomography (3D-CT) scans with magnetic resonance imaging (MRI) and/or arthro-MRI. Methods Forty-four shoulders with clinical and radiographic diagnosis of traumatic anterior instability were assessed using 3D-CT, MRI, and/or arthro-MRI scans. Glenoid track (GT), Hill-Sachs interval (HSI), and glenoid bone loss (GBL) were determined by a radiologist using 3D-CT images, and classified as on-track/off-track. Three surgeons, blinded to the radiologist's evaluation, performed the same determinations using MRI/arthro-MRI. Descriptive analysis, variance analysis, results disagreement analysis, and receiver operating characteristic (ROC) curves were performed. Results Results from the 4 examiners were fully consistent in 61.4% of the cases. Magnetic resonance imaging/arthro-MRI diagnosed off-track injuries with 35 to 65% sensitivity and on-track injuries, with 91.67 to 95.83% specificity. Accuracy ranged from 68.1 to 79.5%. The greatest data divergence occurred for off-track injuries diagnosed by MRI/arthro-MRI. The greatest data variability referred to HSI calculation. Higher HSI and GBL values were associated with greater disagreement among examiners. Hill-Sachs interval values were lower at MRI/arthro-MRI when compared to 3D-CT. Agreement between CT and MRI/arthro-MRI for the GT method was only moderate (kappa value, 0.325-0.579). Conclusion Magnetic resonance imaging/arthro-MRI showed low accuracy and moderate agreement for the GT method; as such, it should be used with caution by surgeons.

Evaluation of the Glenoid Track Tomographic Method in Magnetic Resonance Imaging/Arthro-MRI / A avaliação do método tomográfico glenoid track na ressonância magnética/artro RM

Abstract Objective To evaluate and compare the glenoid track method in 3D-reconstructed computed tomography (3D-CT) scans with magnetic resonance imaging (MRI) and/or arthro-MRI. Methods Forty-four shoulders with clinical and radiographic diagnosis of traumatic anterior instability were assessed using 3D-CT, MRI, and/or arthro-MRI scans. Glenoid track (GT), Hill-Sachs interval (HSI), and glenoid bone loss (GBL) were determined by a radiologist using 3D-CT images, and classified as on-track/off-track. Three surgeons, blinded to the radiologist's evaluation, performed the same determinations using MRI/arthro-MRI. Descriptive analysis, variance analysis, results disagreement analysis, and receiver operating characteristic (ROC) curves were performed. Results Results from the 4 examiners were fully consistent in 61.4% of the cases. Magnetic resonance imaging/arthro-MRI diagnosed off-track injuries with 35 to 65% sensitivity and on-track injuries, with 91.67 to 95.83% specificity. Accuracy ranged from 68.1 to 79.5%. The greatest data divergence occurred for off-track injuries diagnosed by MRI/arthro-MRI. The greatest data variability referred to HSI calculation. Higher HSI and GBL values were associated with greater disagreement among examiners. Hill-Sachs interval values were lower at MRI/arthro-MRI when compared to 3D-CT. Agreement between CT and MRI/arthro-MRI for the GT method was only moderate (kappa value, 0.325-0.579). Conclusion Magnetic resonance imaging/arthro-MRI showed low accuracy and moderate agreement for the GT method; as such, it should be used with caution by surgeons.

Resumo Objetivo Comparar a avaliação do método glenoid-track (GT) em exames de tomografia computadorizada com reconstrução 3-D (TC-3D) com a avaliação realizada em exames de ressonância magnética (RM) e/ou artro-ressonância magnética (ARM). Métodos Quarenta e quatro ombros com diagnóstico clínico e radiográfico de instabilidade anterior traumática foram avaliados por meio de exames de TC-3D, RM e/ou ARM. As variáveis GT, intervalo de Hill-Sachs (IHS) e a perda óssea da glenoide (POG) foram realizadas por um médico radiologista, utilizando imagens de TC-3D, e classificadas em on-track/off-track. Três cirurgiões cegos à avaliação do radiologista realizaram o mesmo método utilizando RM/ARM. O estudo realizou análise descritiva, de variância, de associação da discordância de resultados, de concordância e curva característica de operação do receptor. Resultados Os resultados dos 4 examinadores foram totalmente concordantes em 61,4%. A RM/ARM diagnosticou lesões off-track com a sensibilidade variando de 35 a 65%, e lesões on-track com a especificidade variando de 91,67 a 95,83%. A acurácia variou de 68,1 a 79,5%. A maior divergência de dados ocorreu para o diagnóstico por RM/ARM de lesões off-track. A maior variabilidade dos dados ocorreu para o cálculo do IHS. Valores maiores de IHS e de POG foram associados a maior discordância entre os examinadores. A RM/ARM apresentou menor medida de valores de IHS quando comparado com a TC-3D. Ocorreu apenas moderada concordância no método GT entre a TC e a RM/ARM (Kappa 0,325-0,579). Conclusão A RM/ARM apresentou baixa acurácia e moderada concordância para o método GT, devendo ser utilizada com cautela por cirurgiões.

Protocol of BRICS: Brazilian multicentric pragmatic randomised trial of surgical interventions for displaced diaphyseal clavicle fracture study: MIPO versus ORIF for the treatment of displaced midshaft clavicle fractures.

INTRODUCTION: Fractures of the diaphysis of the clavicle are common; however, treatment guidelines for this condition are lacking. Surgery is associated with a lower risk of non-union and better functional outcomes but a higher risk of complications. Open reduction and internal fixation with plates and screws are the most commonly performed techniques, but they are associated with paraesthesia in the areas of incisions, extensive surgical exposure and high rates of implant removal. Minimally invasive techniques for treating these fractures have a lower rate of complications. The aim of this study is to evaluate which surgical treatment option (minimally invasive osteosynthesis or open reduction and internal fixation) has better prognosis in terms of complications and reoperations. METHODS AND ANALYSIS: The study proposed is a multicentric, pragmatic, randomised, open-label, superiority clinical trial between minimally invasive osteosynthesis and open reduction and internal fixation for surgical treatment of patients with displaced fractures of the clavicle shaft. In the proposed study, 190 individuals with displaced midshaft clavicle fractures, who require surgery as treatment, will be randomised. The assessment will occur at 2, 6, 12, 24 and 48 weeks, respectively. The primary outcome of the study will be the number of complications and reoperations. For sample size calculation, a moderate effective size between the techniques was considered in a two-tailed test, with 95% confidence and 90% power. Complications include cases of infection, hypertrophic scarring, non-union, refracture, implant failure, hypoesthesia, skin irritation and shoulder pain. Reoperations are defined as the number of surgeries for pseudoarthrosis, implant failure, infection and elective removal of the implant. ETHICS AND DISSEMINATION: Study approved by the institutional ethics committee (number 34249120.9.0000.5505-V.3). The results will be disseminated by publications in peer-reviewed journals and presentations in medical meetings. TRIAL REGISTRATION NUMBER: RBR-3czz68)/UTN U1111-1257-8953.

Captured Rotator Cuff: A Poor Prognostic Factor in Rotator Cuff Repair.

Objective To describe a new presentation of tears and retears of the rotator cuff, which we denominate captured rotator cuff (CRC). We also aim to evaluate it clinically and through images. Methods We assessed retrospectively 16 patients with intraoperative diagnosis of CRC between March 2005 and September 2017; by means of imaging (radiography and magnetic resonance imaging [MRI]) and functional scores (UCLA and Constant & Murley). In images we analyzed the evolution for rotator cuff arthropathy and presence of retears. Functionally, we compared the affected side with the contralateral side and extensive lesions with nonextensive. Results Five (31.25%) patients presented with rotator cuff arthropathy, and 10 (62.5%) with retears. Three (75%) patients with nonextensive lesions had good/excellent UCLA and Constant & Murley scores. In patients with extensive lesions, when the Constant & Murley score was evaluated, 6 (50%) presented good/excellent results, and in the UCLA score, 7 (58.3%). Comparing the affected side (Constant 74.72 points; UCLA 20 points) with the contralateral side (Constant 96.96 points; UCLA 25.63 points), there were worse functional results with statistical significance. Conclusion The diagnosis of CRC is suspected by characteristic findings on MRI and confirmed in arthroscopy. The affected shoulders present worse functional postoperative scores.

Captured Rotator Cuff: A Poor Prognostic Factor in Rotator Cuff Repair / Manguito capturado: Um fator de mau prognóstico no reparo do manguito rotador

Abstract Objective To describe a new presentation of tears and retears of the rotator cuff, which we denominate captured rotator cuff (CRC). We also aim to evaluate it clinically and through images. Methods We assessed retrospectively 16 patients with intraoperative diagnosis of CRC between March 2005 and September 2017; by means of imaging (radiography and magnetic resonance imaging [MRI]) and functional scores (UCLA and Constant & Murley). In images we analyzed the evolution for rotator cuff arthropathy and presence of retears. Functionally, we compared the affected side with the contralateral side and extensive lesions with nonextensive. Results Five (31.25%) patients presented with rotator cuff arthropathy, and 10 (62.5%) with retears. Three (75%) patients with nonextensive lesions had good/excellent UCLA and Constant & Murley scores. In patients with extensive lesions, when the Constant & Murley score was evaluated, 6 (50%) presented good/excellent results, and in the UCLA score, 7 (58.3%). Comparing the affected side (Constant 74.72 points; UCLA 20 points) with the contralateral side (Constant 96.96 points; UCLA 25.63 points), there were worse functional results with statistical significance. Conclusion The diagnosis of CRC is suspected by characteristic findings on MRI and confirmed in arthroscopy. The affected shoulders present worse functional postoperative scores.

Resumo Objetivo Descrever uma nova apresentação de ruptura e rerruptura do manguito rotador (MR), a qual denominamos manguito capturado (MC). Objetivamos também avaliá-la clinicamente e por meio de imagens. Métodos Foram avaliados retrospectivamente 16 pacientes com diagnóstico intraoperatório de MC no período de março de 2005 a setembro de 2017; por meio de exames de imagem (radiografia e ressonância magnética [RM]) e escores funcionais (UCLA e Constant & Murley). Nas imagens, analisamos a evolução para artropatia do manguito rotador e presença de rerrupturas. Funcionalmente, comparamos o lado afetado com o contralateral e as lesões extensas com nãoextensas. Resultados Cinco (31,25%) pacientes evoluíram com artropatia do manguito rotador e 10 (62,5%) tiveram rerrupturas. Três (75%) pacientes com lesões não extensas tiveram UCLA e Constant & Murley bons/excelentes. Nos pacientes com lesões extensas, quando avaliado Constant & Murley, 6 (50%) apresentaram resultados bons/excelentes, e no escore UCLA, 7 (58,3%). Comparando o lado acometido (Constant 74,72 pontos; UCLA 20 pontos) com o contralateral (Constant 96,96 pontos; UCLA 25,63 pontos), houve pior resultado funcional com significância estatística. Conclusão O diagnóstico de MC é suspeitado por achados característicos na RM e confirmado na artroscopia. Os ombros acometidos apresentam piores escores funcionais pós-operatórios.

Shoulder Arthroplasty: Tenotomy of the Subscapularis Tendon versus the Lesser Tuberosity Osteotomy.

Objective To evaluate and compare subscapular muscle function among patients undergoing subscapular tenotomy (Group A) and lesser tuberosity osteotomy (Group B), in patients treated with total and partial anatomic shoulder arthroplasty for primary osteoarthrosis. Methods Retrospective study of patients with primary glenohumeral osteoarthrosis surgically undergoing total or partial anatomic shoulder prosthesis implant, evaluated by clinical examination, imaging exams, analogue pain scale and Constant and Murley functional score. A total of 28 patients were evaluated, totalizing a sample of 32 operated shoulders. The minimum follow-up was of 12 months (mean 47.45 months). Results Among patients submitted to subscapularis tendon tenotomy, 10 had an ultrasound with total rupture of its thickness (56%). All of the patients of the group B showed lesser tuberosity healing. There was no difference between groups comparing strength evaluated by Belly press and Bear hug tests as well as clinical outcome, through the Constant and Murley score. Conclusions We did not find differences between Groups A and B evidenciated by comparing strength in the Lift-off test, in the Belly press and Bear hug tests and through he Constant and Murley score.

Shoulder Arthroplasty: Tenotomy of the Subscapularis Tendon versus the Lesser Tuberosity Osteotomy / Artroplastia de ombro: tenotomia do subescapular versus osteotomia do tubérculo menor

Abstract Objective To evaluate and compare subscapular muscle function among patients undergoing subscapular tenotomy (Group A) and lesser tuberosity osteotomy (Group B), in patients treated with total and partial anatomic shoulder arthroplasty for primary osteoarthrosis. Methods Retrospective study of patients with primary glenohumeral osteoarthrosis surgically undergoing total or partial anatomic shoulder prosthesis implant, evaluated by clinical examination, imaging exams, analogue pain scale and Constant and Murley functional score. A total of 28 patients were evaluated, totalizing a sample of 32 operated shoulders. The minimum follow-up was of 12 months (mean 47.45 months). Results Among patients submitted to subscapularis tendon tenotomy, 10 had an ultrasound with total rupture of its thickness (56%). All of the patients of the group B showed lesser tuberosity healing. There was no difference between groups comparing strength evaluated by Belly press and Bear hug tests as well as clinical outcome, through the Constant and Murley score. Conclusions We did not find differences between Groups A and B evidenciated by comparing strength in the Lift-off test, in the Belly press and Bear hug tests and through he Constant and Murley score.

Resumo Objetivo Avaliar e comparar a função do músculo subescapular entre os grupos submetidos a tenotomia do subescapular (Grupo A) e osteotomia do tubérculo menor (Grupo B), em pacientes tratados por artroplastia anatômica total e parcial de ombros apresentando osteoartrose primária. Métodos Estudo retrospectivo de pacientes portadores de osteoartrose primária glenoumeral tratados cirurgicamente com prótese anatômica total ou parcial de ombro, avaliados por exame clínico, exames de imagens, escala visual analógica de dor e escore funcional de Constant e Murley. Foram avaliados 28 pacientes, totalizando uma amostra de 32 ombros operados. O seguimento mínimo foi de 12 meses (média 47,45 meses). Resultados Nos pacientes submetidos à tenotomia do tendão subescapular, dez obtiveram resultado ultrassonográfico com ruptura de sua espessura total (56%). A consolidação ocorreu em todos pacientes submetidos a osteotomia do tubérculo menor. Não houve diferença entre os grupos na comparação do teste Lift Off, da força nos testes Belly Press e Bear hug, e no escore de Constant e Murley. Conclusões Não encontramos diferença entre os grupos A e B na comparação do teste Lift Off, da força nos testes Belly Press e Bear hug, e no escore de Constant e Murley.

Clinical and Image Outcomes of the Hill-Sachs Injury Approach by the Remplissage Technique on the Anterior Shoulder Instability.

OBJECTIVE: To evaluate the functional outcome of the remplissage technique, the healing of the capsulotenodesis of the infraspinatus tendon in Hill-Sachs lesion, and the degree of fatty infiltration of the infraspinatus muscle and its postoperative strength. METHODS: Twenty-five patients with recurrent anterior dislocation of the shoulder and Hill-Sachs lesion with a Hardy index > 20% who underwent the remplissage arthroscopic technique were evaluated with a minimum follow-up of 1 year. Patients underwent a clinical evaluation (Carter-Rowe and Walch-Duplay functional scores, measurement of range of motion and strength) and a magnetic resonance imaging (MRI) exam on the operated shoulder. RESULTS: Eighty-eight percent and 92% of the patients had good or excellent scores in the functional assessments of the Carter-Rowe and Walch-Duplay scores, respectively. A mean difference of - 1 kg in the strength of the operated limb was observed when compared with the contralateral limb ( p < 0.001), as well as a mean difference of 10° in external rotation 1 and 2 ( p < 0.001), also compared with the contralateral side. All of the patients who underwent an MRI exam presented high-grade filling of the Hill-Sachs lesion by capsulotenodesis, as well as absence of or minimal fatty infiltration in the infraspinatus muscle. CONCLUSION: The remplissage technique had good/excellent functional score results, despite the discrete, albeit statistically significant, loss of strength and of external rotation amplitude. Successful capsulotenodesis healing and filling of the Hill-Sachs defect were demonstrated.

Clinical and Image Outcomes of the Hill-Sachs Injury Approach by the Remplissage Technique on the Anterior Shoulder Instability / Resultados clínicos e de imagem da abordagem da lesão de Hill-Sachs pela técnica de remplissage na instabilidade anterior do ombro

Abstract Objective To evaluate the functional outcome of the remplissage technique, the healing of the capsulotenodesis of the infraspinatus tendon in Hill-Sachs lesion, and the degree of fatty infiltration of the infraspinatus muscle and its postoperative strength. Methods Twenty-five patients with recurrent anterior dislocation of the shoulder and Hill-Sachs lesion with a Hardy index > 20% who underwent the remplissage arthroscopic technique were evaluated with a minimum follow-up of 1 year. Patients underwent a clinical evaluation (Carter-Rowe and Walch-Duplay functional scores, measurement of range of motion and strength) and a magnetic resonance imaging (MRI) exam on the operated shoulder. Results Eighty-eight percent and 92% of the patients had good or excellent scores in the functional assessments of the Carter-Rowe andWalch-Duplay scores, respectively. Amean difference of - 1 kg in the strength of the operated limbwas observedwhen compared with the contralateral limb (p < 0.001), as well as amean difference of 10° in external rotation 1 and 2 (p < 0.001), also compared with the contralateral side. All of the patients who underwent an MRI exam presented high-grade filling of the Hill-Sachs lesion by capsulotenodesis, as well as absence of or minimal fatty infiltration in the infraspinatus muscle. Conclusion The remplissage technique had good/excellent functional score results, despite the discrete, albeit statistically significant, loss of strength and of external rotation amplitude. Successful capsulotenodesis healing and filling of the Hill-Sachs defect were demonstrated.

Resumo Objetivos Avaliar o resultado funcional da técnica de remplissage, a cicatrização da capsulotenodese do tendão infraespinal no defeito de Hill-Sachs, o grau de infiltração gordurosa do músculo infraespinal e sua força de rotação lateral no pós-operatório. Método Foram avaliados 25 pacientes comluxação anterior recidivante do ombro e lesão de Hill-Sachs comíndice de Hardy maior do que 20%, submetidos à técnica artroscópica de remplissage com seguimento mínimo de um ano. Os pacientes foram submetidos a avaliação clínica (escores funcionais deCarter-RoweeWalch-Duplay,medição de amplitude de movimento e força) e exame de ressonância magnética no ombro operado. Resultados Dos pacientes, 88% e 92% apresentaram resultados bons ou excelentes nas avaliações funcionais pelos escores de Carter-Rowe e Walch-Duplay, respectivamente. Identificou-se diferença média de 1 kg a menos de força do membro operado em relação ao contralateral (p < 0,001) e diferença média de 10° em rotação lateral 1 e 2 (p < 0,001), novamente com o uso como referência do lado contralateral. Todos os pacientes submetidos a ressonância magnética apresentaram preenchimento de alto grau da lesão de Hill-Sachs pela capsulotenodese, assim como ausência ou mínima infiltração gordurosa no músculo infraespinal. Conclusão A técnica de remplissage apresentou resultados bons/excelentes nos escores funcionais, apesar da perda discreta de força e amplitude de rotação lateral com significância estatística. Foram observados resultados excelentes quanto à cicatrização da capsulotenodese e ao preenchimento do defeito de Hill-Sachs.

Clinical and functional evaluation of patients submitted to reverse arthroplasty with minimum one year of follow-up / Avaliação clínica e funcional de pacientes submetidos a artroplastia reversa com seguimento mínimo de um ano

ABSTRACT Objective: To assess the clinical and functional results of patients submitted to reverse arthroplasty with a minimum follow-up of one year. Methods: Twenty-two patients submitted to shoulder reverse arthroplasty by the Surgery and Shoulder Rehabilitation Group were retrospectively evaluated with pre and postoperative imaging analysis, analog pain scale, range of motion, and ASES functional score. Results: Out of 19 (86.3%) patients with preoperative ASES classified as poor/bad, 11 (57.9%) progress to good/excellent after intervention, showing improvement of function, ranging from a mean preoperative ASES score of 22 (± 18.8) to a postoperative mean of 64.8 (± 27.7) (p = 0.031). Regarding the pain, there was an improvement in analog pain scale, presenting a preoperative mean of 7.64 (1-10) and a postoperative mean of 2.09 (0-7; p < 0.001). Regarding mobility, of 22 patients, 15 (68.2%) had preoperative pseudoparalysis and, of these, ten (66.7%) had an active anterior elevation greater than 90° after reverse arthroplasty. In turn, patients without pseudoparalysis had no significant gain in range of motion (p = 0.002). The authors observed active anterior elevation gain, with a preoperative mean of 76° (0-160°) and a postoperative mean of 111° (0-160°; p = 0.002). Conclusion: Despite being a relatively new procedure in Brazil, reverse shoulder arthroplasty can be used effectively and safely in patients who were previously without treatment options such as rotator cuff arthropathy and revisions providing pain relief, improvement of function, and mobility of the upper limb.

RESUMO Objetivo: Avaliar os resultados clínicos e funcionais de pacientes submetidos a artroplastia reversa com seguimento mínimo de um ano. Métodos: Foram avaliados retrospectivamente 22 pacientes submetidos a artroplastia reversa de ombro pelo grupo de cirurgia e reabilitação de ombro da nossa instituição com análise pré e pós-operatória de exames de imagem, escala analógica da dor, amplitude de movimento e escala funcional ASES. Resultados: Dos 19 (86,3%) pacientes que apresentavam ASES pré-operatória classificada como péssimo/ruim, 11 (57,9%) evoluíram para bom/excelente após a intervenção, apresentaram melhoria da função, saíram de uma escala ASES pré-operatória média de 22 (±18,8) para uma pós-operatória de 64,8 (± 27,7; p = 0,031). Quanto à dor, observou-se melhoria da escala analógica da dor, apresentaram média pré-operatória de 7,64 (1-10) e pós-operatória de 2,09 (0-7; p < 0,001). Em relação à mobilidade, dos 22 pacientes, 15 (68,2%) apresentavam pseudoparalisia pré-operatória; desses, dez (66,7%) passaram a apresentar elevação anterior ativa superior a 90° após artroplastia reversa. Por outro lado, os pacientes sem pseudoparalisia não apresentaram ganho significativo de amplitude de movimento (p = 0,002). Foi observado ganho de elevação anterior ativa, com média pré-operatória de 76° (0-160°) e pós-operatória de 111° (0-160°; p = 0,002). Conclusão: Apesar de ser um procedimento relativamente novo no Brasil, a artroplastia reversa de ombro pode ser usada com eficácia e segurança em pacientes que previamente apresentavam-se sem opções terapêuticas como artropatia do manguito rotador e revisões que proporcionam alívio de dor, melhoria da função e mobilidade do membro superior.

Clinical and functional evaluation of patients submitted to reverse arthroplasty with minimum one year of follow-up.

OBJECTIVE: To assess the clinical and functional results of patients submitted to reverse arthroplasty with a minimum follow-up of one year. METHODS: Twenty-two patients submitted to shoulder reverse arthroplasty by the Surgery and Shoulder Rehabilitation Group were retrospectively evaluated with pre and postoperative imaging analysis, analog pain scale, range of motion, and ASES functional score. RESULTS: Out of 19 (86.3%) patients with preoperative ASES classified as poor/bad, 11 (57.9%) progress to good/excellent after intervention, showing improvement of function, ranging from a mean preoperative ASES score of 22 (± 18.8) to a postoperative mean of 64.8 (± 27.7) (p = 0.031). Regarding the pain, there was an improvement in analog pain scale, presenting a preoperative mean of 7.64 (1-10) and a postoperative mean of 2.09 (0-7; p < 0.001). Regarding mobility, of 22 patients, 15 (68.2%) had preoperative pseudoparalysis and, of these, ten (66.7%) had an active anterior elevation greater than 90° after reverse arthroplasty. In turn, patients without pseudoparalysis had no significant gain in range of motion (p = 0.002). The authors observed active anterior elevation gain, with a preoperative mean of 76° (0-160°) and a postoperative mean of 111° (0-160°; p = 0.002). CONCLUSION: Despite being a relatively new procedure in Brazil, reverse shoulder arthroplasty can be used effectively and safely in patients who were previously without treatment options such as rotator cuff arthropathy and revisions providing pain relief, improvement of function, and mobility of the upper limb.

OBJETIVO: Avaliar os resultados clínicos e funcionais de pacientes submetidos a artroplastia reversa com seguimento mínimo de um ano. MÉTODOS: Foram avaliados retrospectivamente 22 pacientes submetidos a artroplastia reversa de ombro pelo grupo de cirurgia e reabilitação de ombro da nossa instituição com análise pré e pós-operatória de exames de imagem, escala analógica da dor, amplitude de movimento e escala funcional ASES. RESULTADOS: Dos 19 (86,3%) pacientes que apresentavam ASES pré-operatória classificada como péssimo/ruim, 11 (57,9%) evoluíram para bom/excelente após a intervenção, apresentaram melhoria da função, saíram de uma escala ASES pré-operatória média de 22 (±18,8) para uma pós-operatória de 64,8 (± 27,7; p = 0,031). Quanto à dor, observou-se melhoria da escala analógica da dor, apresentaram média pré-operatória de 7,64 (1-10) e pós-operatória de 2,09 (0-7; p < 0,001). Em relação à mobilidade, dos 22 pacientes, 15 (68,2%) apresentavam pseudoparalisia pré-operatória; desses, dez (66,7%) passaram a apresentar elevação anterior ativa superior a 90° após artroplastia reversa. Por outro lado, os pacientes sem pseudoparalisia não apresentaram ganho significativo de amplitude de movimento (p = 0,002). Foi observado ganho de elevação anterior ativa, com média pré-operatória de 76° (0-160°) e pós-operatória de 111° (0-160°; p = 0,002). CONCLUSÃO: Apesar de ser um procedimento relativamente novo no Brasil, a artroplastia reversa de ombro pode ser usada com eficácia e segurança em pacientes que previamente apresentavam-se sem opções terapêuticas como artropatia do manguito rotador e revisões que proporcionam alívio de dor, melhoria da função e mobilidade do membro superior.

New quantitative method to measure the Hill-Sachs lesion: validation of Hardy's radiographic method for MRI/AMRI / Novo método quantitativo para medida da lesão de Hill-Sachs: validação do método radiográfico de Hardy para ressonância magnética/artro-RNM

ABSTRACT Objective: To validate Hardy's radiographic method for magnetic resonance imaging/magnetic resonance arthrography (MRI/MRA) in the assessment of Hill-Sachs lesion (HSL) involvement in patients with a history of anterior shoulder instability. Methods: This study retrospectively evaluated 53 shoulder radiographs and MRI/MRA to compare the measurements of HSL through Hardy's radiographic method. Imaging exams used in the study were conducted between the March 2013 AND September 2015. The data obtained from these exams were carried out during 2015. Inclusion criteria were previous history of anterior instability of the shoulder, presence of LHS, and radiographs at 70° medial rotation. Results: MRI/MRA had a sensitivity of 100% and specificity of 100% when using the Hardy's radiographic method 20% cutoff point to measure the HSL. Conclusion: MRI/MRA can be used to assess the degree of HSL involvement with the same reliability as Hardy's radiographic method.

RESUMO Objetivo: Validar o índice radiográfico de Hardy para ressonância magnética/artrorressonância magnética (RM/ARM) na avaliação do grau de acometimento da lesão de Hill-Sachs (LHS) em pacientes com histórico de instabilidade anterior do ombro. Métodos: Foram avaliados retrospectivamente 53 exames radiográficos e de RM/ARM do ombro para comparação das medidas da LHS por meio do índice radiográfico de Hardy. Os exames de imagem usados no estudo foram feitos entre março de 2013 e setembro de 2015. A coleta dos dados desses exames foi feita durante 2015. Os critérios de inclusão foram: história de instabilidade anterior do ombro, presença de LHS e radiografias em rotação medial com 70°. Resultados: A RM/ARM apresentou sensibilidade de 100% e especificidade de 100% quando usado o ponto de corte de 20% do índice de Hardy para mensuração da LHS. Conclusão: A RM/ARM pode ser usada para avaliação do grau de acometimento da LHS com a mesma confiabilidade da avaliação radiográfica pelo índice de Hardy.

New quantitative method to measure the Hill-Sachs lesion: validation of Hardy's radiographic method for MRI/AMRI.

OBJECTIVE: To validate Hardy's radiographic method for magnetic resonance imaging/magnetic resonance arthrography (MRI/MRA) in the assessment of Hill-Sachs lesion (HSL) involvement in patients with a history of anterior shoulder instability. METHODS: This study retrospectively evaluated 53 shoulder radiographs and MRI/MRA to compare the measurements of HSL through Hardy's radiographic method. Imaging exams used in the study were conducted between the March 2013 AND September 2015. The data obtained from these exams were carried out during 2015. Inclusion criteria were previous history of anterior instability of the shoulder, presence of LHS, and radiographs at 70° medial rotation. RESULTS: MRI/MRA had a sensitivity of 100% and specificity of 100% when using the Hardy's radiographic method 20% cutoff point to measure the HSL. CONCLUSION: MRI/MRA can be used to assess the degree of HSL involvement with the same reliability as Hardy's radiographic method.

OBJETIVO: Validar o índice radiográfico de Hardy para ressonância magnética/artrorressonância magnética (RM/ARM) na avaliação do grau de acometimento da lesão de Hill-Sachs (LHS) em pacientes com histórico de instabilidade anterior do ombro. MÉTODOS: Foram avaliados retrospectivamente 53 exames radiográficos e de RM/ARM do ombro para comparação das medidas da LHS por meio do índice radiográfico de Hardy. Os exames de imagem usados no estudo foram feitos entre março de 2013 e setembro de 2015. A coleta dos dados desses exames foi feita durante 2015. Os critérios de inclusão foram: história de instabilidade anterior do ombro, presença de LHS e radiografias em rotação medial com 70°. RESULTADOS: A RM/ARM apresentou sensibilidade de 100% e especificidade de 100% quando usado o ponto de corte de 20% do índice de Hardy para mensuração da LHS. CONCLUSÃO: A RM/ARM pode ser usada para avaliação do grau de acometimento da LHS com a mesma confiabilidade da avaliação radiográfica pelo índice de Hardy.

Avaliação dos níveis de metais pesados no pantanal dos Marimbus, Bahia, Brasil / Evaluation of heavy metals in levels of wetland Marimbus, Bahia, Brazil

RESUMO A concentração de metais pesados zinco (Zn), chumbo (Pb), cromo (Cr), níquel (Ni), cobre (Cu) e cádmio (Cd) tem aumentado nos últimos anos nos compartimentos aquáticos em função do uso indiscriminado de fertilizantes na agricultura, da falta de saneamento e do descarte de resíduos industriais não tratados. O objetivo deste trabalho foi investigar a disponibilidade dos metais pesados nas águas e em Salvinia auriculata Aubl. das áreas alagadas dos Marimbus, Bahia. As amostras foram submetidas à digestão ácida (HNO3; HClO4) e as análises dos metais pesados utilizaram um aparelho de absorção atômica de chama ar-acetileno. Nas águas, foram detectados teores de chumbo e zinco com valores dentro dos limites permissíveis para águas de classe 1, conforme Resolução CONAMA nº 357/2005 (BRASIL, 2005). Em S. auriculata, observou-se acumulação de concentração de metais na seguinte ordem Zn>Cr>Pb>Ni>Cu. Conclui-se que a presença da S. auriculata nos corpos hídricos funciona como importante removedor de metais pesados e sua presença nos ambientes aquáticos é extremamente relevante para permitir os diversos usos que esse espaço proporciona.

ABSTRACT In recent years, concentration of heavy metals like zinc (Zn), lead (Pb), chromium (Cr), nickel (Ni), copper (Cu) and cadmium (Cd) has increased over the past years in water bodies due to indiscriminate use of fertilizers in agriculture, lack of sanitation and irregular disposal of untreated industrial waste. The main goal of this study was to investigate the presence of heavy metals in the water and in the Salvinia auriculata Aubl. found in flooded areas of Marimbus, Bahia. The samples were subjected to acid digestion (HNO3, HClO4) and the analyses of heavy metals used an air-acetylene flame atomic absorption spectrometer. The detected levels of lead and zinc found in the water samples were within the limits set for water class 01 by CONAMA no. 357/2005 (BRASIL, 2005). An accumulation of metal concentration in the order of Zn>Cr>Pb>Ni>Cu was observed in S. auriculata. Thus, the presence of S. auriculata in water bodies serves as an important remover of heavy metals and their presence in aquatic environments is extremely important to allow the various uses such environments may provide.

Functional outcome after arthroscopic repair of triple shoulder instability.

OBJECTIVE: To evaluate the functional outcomes of patients submitted to arthroscopic repair of triple labral lesion. METHODS: This was an analytical retrospective study of patients who underwent arthroscopic treatment of triple labral lesion from March 2005 to December 2014. Patients with at least one year of postoperative follow-up were included. A total of nine patients were evaluated. The mean age was 32.3 years and the dominant side was affected in five patients. Patients were functionally assessed regarding the range of motion (ROM) in elevation, external rotation with the arm close to the body the arm in abduction of 90°, and internal rotation, and by the Carter-Rowe score. The degree of satisfaction was assessed at the end of the follow-up period. RESULTS: Three patients had less than five episodes of instability, four patients had between five and ten episodes, and two patients had more than ten episodes. Seven patients had positive O'Brien test for SLAP lesions and positive apprehension test in abduction and external rotation, and only one patient had apprehension in adduction and internal rotation. Three patients persisted with positive O'Brien test and one with apprehension in abduction and external rotation at the end of follow-up. The range of motion was complete in all cases. The median Carter-Rowe score increased from 40 preoperatively to 90 (p = 0.008). CONCLUSION: The arthroscopic repair of triple labral lesions allows for the restoration of the stability of the glenohumeral joint, achieving excellent functional results.

OBJETIVO: Avaliar os resultados funcionais dos pacientes submetidos a reparo artroscópico da tríplice lesão labral do ombro. MÉTODOS: Estudo analítico retrospectivo de pacientes com tríplice lesão labral do ombro, submetidos a tratamento artroscópico de março de 2005 a dezembro de 2014. Foram incluídos pacientes com pelo menos um ano de seguimento pós-operatório. Nove pacientes foram avaliados. A média foi de 32,3 anos e o lado dominante foi afetado em cinco pacientes. Os pacientes foram avaliados funcionalmente por meio da amplitude de movimento em elevação, rotação externa com o braço junto ao corpo e com o braço em abdução de 90°, rotação interna e por meio do escore de Carter-Rowe. O grau de satisfação foi avaliado no fim do seguimento. RESULTADOS: Três pacientes tiveram menos de cinco episódios de instabilidade, quatro entre cinco e dez e dois mais de dez. Sete pacientes tiveram teste de O'Brien positivo para lesão do lábio superior de anterior para posterior (Slap, do inglês superior labrum anterior to posterior lesion) e apreensão em abdução e rotação externa positiva; apenas um apresentou apreensão em adução e rotação interna. Três pacientes persistiram com teste de O'Brien positivo e um com apreensão em abdução e rotação externa no fim do seguimento. A amplitude de movimento esteve completa em todos os casos na última avaliação. A média do escore de Carter-Rowe aumentou de 40 no pré-operatório para 90 (p = 0,008). CONCLUSÃO: O reparo artroscópico da tríplice lesão labral permite restaurar a estabilidade da articulação glenoumeral e alcança excelentes resultados funcionais.

Functional outcome after arthroscopic repair of triple shoulder instability / Resultado funcional após reparo artroscópico da tríplice instabilidade do ombro

ABSTRACT OBJECTIVE: To evaluate the functional outcomes of patients submitted to arthroscopic repair of triple labral lesion. METHODS: This was an analytical retrospective study of patients who underwent arthroscopic treatment of triple labral lesion from March 2005 to December 2014. Patients with at least one year of postoperative follow-up were included. A total of nine patients were evaluated. The mean age was 32.3 years and the dominant side was affected in five patients. Patients were functionally assessed regarding the range of motion (ROM) in elevation, external rotation with the arm close to the body the arm in abduction of 90°, and internal rotation, and by the Carter-Rowe score. The degree of satisfaction was assessed at the end of the follow-up period. RESULTS: Three patients had less than five episodes of instability, four patients had between five and ten episodes, and two patients had more than ten episodes. Seven patients had positive O'Brien test for SLAP lesions and positive apprehension test in abduction and external rotation, and only one patient had apprehension in adduction and internal rotation. Three patients persisted with positive O'Brien test and one with apprehension in abduction and external rotation at the end of follow-up. The range of motion was complete in all cases. The median Carter-Rowe score increased from 40 preoperatively to 90 (p = 0.008). CONCLUSION: The arthroscopic repair of triple labral lesions allows for the restoration of the stability of the glenohumeral joint, achieving excellent functional results.

RESUMO OBJETIVO: Avaliar os resultados funcionais dos pacientes submetidos a reparo artroscópico da tríplice lesão labral do ombro. MÉTODOS: Estudo analítico retrospectivo de pacientes com tríplice lesão labral do ombro, submetidos a tratamento artroscópico de março de 2005 a dezembro de 2014. Foram incluídos pacientes com pelo menos um ano de seguimento pós-operatório. Nove pacientes foram avaliados. A média foi de 32,3 anos e o lado dominante foi afetado em cinco pacientes. Os pacientes foram avaliados funcionalmente por meio da amplitude de movimento em elevação, rotação externa com o braço junto ao corpo e com o braço em abdução de 90°, rotação interna e por meio do escore de Carter-Rowe. O grau de satisfação foi avaliado no fim do seguimento. RESULTADOS: Três pacientes tiveram menos de cinco episódios de instabilidade, quatro entre cinco e dez e dois mais de dez. Sete pacientes tiveram teste de O'Brien positivo para lesão do lábio superior de anterior para posterior (Slap, do inglês superior labrum anterior to posterior lesion) e apreensão em abdução e rotação externa positiva; apenas um apresentou apreensão em adução e rotação interna. Três pacientes persistiram com teste de O'Brien positivo e um com apreensão em abdução e rotação externa no fim do seguimento. A amplitude de movimento esteve completa em todos os casos na última avaliação. A média do escore de Carter-Rowe aumentou de 40 no pré-operatório para 90 (p = 0,008) . CONCLUSÃO: O reparo artroscópico da tríplice lesão labral permite restaurar a estabilidade da articulação glenoumeral e alcança excelentes resultados funcionais.

Medicinal uses of plant species in background pasture areas in Northeast Brazil / Usos medicinales de las especies de plantas en áreas de fondo de pastoreo en el noreste de Brasil

This study aimed to identify grazing background areas in the communities of St. Benedict (SB) and Patamuté (PT) in the municipality of Curaçá, Brazil which medicinal plants most used by the population, the amount and type of use, proposing to low importance value index (IVI) for reforestation. Interviews were conducted semi-structured form. For location and collection of plants, not probabilistic intentional sampling was performed. For the calculation of the IVI was carried out phytosociological sampling. The most used plants were Myracrodruon urundeuva (aroeira) in SB and Libidibia ferrea (pau-ferro) in PT. The maximum use values obtained were 1.33 and 0.77 aroeira in SB pau-ferro in PT. Both species have medicinal use in inflammatory conditions. The species M. urundeuva is among the smallest IVI, being proposed to integrate reforestation projects in the areas of savanna studied.

Este estudio tuvo como objetivo identificar las plantas medicinales utilizadas por las personas que viven cerca de las áreas de fondo de pastoreo de las comunidades de São Bento (SB) y Patamuté (PT) en el municipio Curaçá (Bahia, Brasil). Entrevistas acerca de la ubicación y la recolección de plantas se llevaron a cabo en una forma semi-estructurada. Para el cálculo de la IVI se llevó a cabo el muestreo fitosociológico. Se entrevistó a un total de 25 personas. Los informantes identificaron los usos para 38 especies en SB y 25 especies en PT, que pertenecían a 15 familias botánicas. Las plantas más utilizadas fueron Myracrodruon urundeuva (aroeira) en SB y Libidibia ferrea (pau - ferro) en PT. Los valores máximos de uso obtenidos fueron 1,33 de aroeira en SB y 0,77 de pau ferro en PT. Ambas especies tienen uso medicinal en condiciones inflamatorias. La especie M. urundeuva se encuentra entre el IVI más pequeño, que se propone integrar los proyectos de reforestación en las áreas de savana (caatinga) estudiados.

Evaluation of functional results from shoulders after arthroscopic repair of complete rotator cuff tears associated with traumatic anterior dislocation.

OBJECTIVE: To evaluate the clinical outcome of arthroscopic rotator cuff fixation and, when present, simultaneous repair of the Bankart lesion caused by traumatic dislocation; and to assess whether the size of the rotator cuff injury caused by traumatic dislocation has any influence on the postoperative clinical outcomes. METHODS: Thirty-three patients with traumatic shoulder dislocation and complete rotator cuff injury, with at least two years of follow up, were retrospectively evaluated. For analysis purposes, the patients were divided into groups: presence of fixed Bankart lesion or absence of this lesion, and rotator cuff lesions smaller than 3.0 cm (group A) or greater than or equal to 3.0 cm (group B). All the patients underwent arthroscopic repair of the lesions and were evaluated postoperatively by means of the UCLA (University of California at Los Angeles) score and strength measurements. RESULTS: The group with Bankart lesion repair had a postoperative UCLA score of 33.96, while the score of the group without Bankart lesion was 33.7, without statistical significance (p = 0.743). Group A had a postoperative UCLA score of 34.35 and group B, 33.15, without statistical significance (p = 0.416). CONCLUSION: The functional outcomes of the patients who only presented complete rotator cuff tearing after traumatic shoulder dislocation, which underwent arthroscopic repair, were similar to the outcomes of those who presented an associated with a Bankart lesion that was corrected simultaneously with the rotator cuff injury. The extent of the original rotator cuff injury did not alter the functional results in the postoperative evaluation.

OBJETIVO: Avaliar o desfecho clínico da fixação artroscópica do manguito rotador (MR) e, quando presente, a correção simultânea da lesão de Bankart, causadas por luxação traumática. Avaliar se a dimensão da lesão do MR causada por luxação traumática influenciou nos resultados clínicos pós-operatórios. MÉTODOS: Foram avaliados retrospectivamente 33 pacientes com luxação traumática do ombro e lesão completa do manguito rotador e seguimento mínimo de dois anos. Para fins de análise, os pacientes foram divididos em grupos: presença de lesão de Bankart fixada ou ausência da lesão e lesões do MR menores do que 3 cm (grupo A) ou iguais a ou maiores do que 3 cm (grupo B). Todos foram submetidos a reparo artroscópico das lesões e avaliados, pós-operatoriamente, pelo escore da UCLA (University of California at Los Angeles) e medida da força. RESULTADOS: O grupo em que houve o reparo da lesão de Bankart apresentou UCLA pós-operatório de 33,96, em relação ao grupo em que essa lesão não estava presente 33,7, sem significância estatística (p = 0,743). O grupo A apresentou resultado de UCLA pós-operatório de 34,35 e grupo B 33,15, sem significância estatística (p = 0,416). CONCLUSÃO: Os resultados funcionais dos pacientes que apresentaram apenas rotura completa do manguito rotador após luxação traumática do ombro, submetidos ao reparo artroscópico, mostrou-se semelhante àqueles que apresentaram associação da lesão de Bankart, corrigida simultaneamente com a lesão do manguito rotador. A extensão da lesão inicial do manguito rotador não alterou os resultados funcionais na avaliação pós-operatória.