Asimetría escapular por agenesia congénita de trapecio unilateral: a propósito de un caso / Case report: Scapular asymmetry caused by congenital unilateral absence of trapezius

La agenesia completa unilateral de trapecio es una afección infrecuente, reportada anteriormente en la literatura tras su hallazgo en muestras cadavéricas. Afecta a la estática, biomecánica y funcionalidad de la cintura escapular, por lo que es especialmente importante realizar una exhaustiva exploración física del paciente en consulta para descartarla o sospecharla. Presentamos el caso de un niño de 8 años con asimetría de la cintura escapular y escápula alada, remitido a la consulta de Rehabilitación por sospecha de distrofia facioescapulohumeral. La RM confirmó la agenesia de músculo trapecio derecho. No había alteración de la funcionalidad en el paciente. No se encontraron otras anomalías congénitas.(AU)

Congenital unilateral absence of trapezius is a rare condition, previously reported in cadaveric specimens. It can cause static shoulder asymmetry and affects the scapular biomechanics and functionality, so complete physical examination of the patient becomes important in order to dimiss or suspect an anomaly.We present a case of a 8 years old boy with asymmetry and scapular winging, who was referred to rehabilitation, suspected facioscapulohumeral dystrophy. An MRI scan of cervical spine and shoulder confirmed the absence of the right trapezius muscle. There were no functional disabilities. No other significant congenital anomalies were found.(AU)

Scapular winging in surgical treatment of breast cancer, prospective study to optimize the follow-up protocol

Introduction One of the most common complications of the surgical treatment of breast cancer is limited range-of-motion in the shoulder. Scapular winging is one of the most underdiagnosed shoulder mobility impairments. Objective The main objective of this study was to determine the incidence of scapular winging in patients who underwent breast cancer surgery as the basis for expanding the protocol to patients who have had a sentinel lymph node biopsy. The secondary objective was to determine the risk factors that lead to the development of a winged scapula presented after breast cancer treatment in our sample. Methods This was a prospective, observational, and multidisciplinary study. Between 2013 and 2018, 214 consecutive patients who had been diagnosed with breast cancer and treated for it surgically were followed by Rehabilitation Department for 3 years. The patients were evaluated in the 1st, 6th, 12th, 18th, 24th and 36th months following surgery. Scapular winging was evaluated at each visit by means of static and dynamic tests. Results The cumulative incidence of scapular winging was 3.6% and seven cases of winged scapula were diagnosed. All the cases were diagnosed at the first visit, 1 month after the intervention. In the univariate analysis, the axillary lymph node dissection technique was a more significant risk factor for a winged scapula than sentinel lymph node biopsy. Conclusions The axillary lymph node dissection technique is a risk factor for developing a winged scapula. No evidence was found for any other significant risk factor (AU)

Applied anatomy of the suprascapular nerve: a cadaveric study

The suprascapular nerve plays a very important role in the shoulder. Characterization of anatomy is essential to assist surgeons in shoulder surgery. Objectives: This study is to determine further the anatomical characteristics of the SSN regarding origin, pathway, branching and correlations of SSN with some neighboring structures. Thirty specimens taken from 15 fresh cadavers (9 males and 6 females) were dissected and data were recorded. The presences of the motor branches, sensitive branches, some neighboring structures and the correlation between them and the SSN were de-scribed. The distances from the SSN at the suprascapular notch and spinoglenoid notch to some neighboring structures were measured. The SSN arises from the upper trunk of the brachial plexus. The nerve has two motor branches for supraspinatus and infraspinatus muscles and two sensory branches, the superior articular branch for acromioclavicular joint and coracohumeral ligament about 73.3%, the inferior articular branch for the posterior joint capsule about 100%. The average distance from the nerve at the suprascapular notch to the acromion lateral border is 61.4 mm, to the tip of coracoid is 49.5 mm, and to the superior rim of the glenoid is 31.7 mm. The average distance from the nerve at the spinoglenoid notch to the posterior rim of the glenoid is 19.9 mm. This circles the safe distances for shoulder surgeries. This study deter-mines the anatomical characteristics of the SSN and defines the safe zone on the shoulder. It al-lows surgeons to avoid causing the nerve injury and to approach it easily

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Unusual case of absence of suprascapular notch and foramen

Identification of anatomical variations is essential to understand and perfectly manage the correlated clinical disorders. One of such disorders is shoulder pain that might result from entrapment of suprascapular nerve at the narrow supracondylar foramen. In this article, we report a rare case of absence of such foramen. With absence of the foramen, there is an increasing potentiality of nerve entrapment beneath the superior scapular transverse ligament. Therefore, investigation of such anatomical variation is suggested for proper management of cases of shoulder pain and dysfunction

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Cuando los árboles no dejan ver el bosque / When We Can't See the Forest for the Trees

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Síndrome RS3PE con factor reumatoide positivo / RS3PE syndrome with positive rheumatoid factor

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Tumoraciones con distribución lineal en la región escapular de un varón joven / Tumors Distributed Linearly Near the Scapula in a Young Man

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Chimeric scapular tip flap for the reconstruction of extensive defects of the midface / Colgajo quimérico de punta escapular para la reconstrucción del tercio medio facial

AIM: The main aim of the present report was to show the potential utility of scapular tip flap for maxillary reconstruction. MATERIALS AND METHODS: The medical records of 4 patients that had undergone maxillary reconstruction by using a microvascular scapular tip flap in our department were retrospectively reviewed to identify the possible advantages and disadvantages of this type of flap. Aesthetic and functional outcomes were also analyzed. RESULTS: No evidence was found for failures, partial failures, or infection in our series. Scapular tip flap allowed for great aesthetic and functional outcomes. All anastomoses were performed with the facial vessels and there was no need to use arterial or vein graft. No major complications were observed at the donor site during follow-up. CONCLUSION: Scapular tip flap may be extremely useful in the reconstruction of extensive defect of the midface. Pedicle length, versatility and reliability represent the major advantages of this type of free flap. Moreover, the resistance of the scapular vascular system to atherosclerosis may be helpful in patients showing contraindications to free fibula flaps

OBJETIVO: El principal objetivo de este estudio es demostrar la potencial utilidad del colgajo libre de ángulo escapular para la reconstrucción maxilar. MATERIAL Y MÉTODO: Las historias clínicas de cuatro pacientes sometidos a reconstrucción de maxilar superior mediante el colgajo libre de ángulo escapular fueron analizadas cuidadosamente con el objetivo de evidenciar las potenciales ventajas de este recurso reconstructivo. RESULTADOS: No se evidenciaron fracasos totales o parciales. Este tipo de colgajo permitió resultados estéticos y funcionales altamente favorables. Todas las anastomosis se realizaron con los vasos faciales, sin necesidad de injertos arteriales o venosos. No se evidenciaron complicaciones de importancia a nivel de la zona donante. CONCLUSIÓN: El colgajo microvascularizado de ángulo escapular podría ser muy útil para la reconstrucción del maxilar superior. Longitud de pedículo, versatilidad y reproducibilidad son las principales ventajas de este colgajo. Además, debido a la resistencia del sistema vascular escapular a la aterosclerosis, podría ser muy útil cuando el colgajo de peroné esté contraindicado

Síndrome de Parsonage-Turner: desconocido pero no infrecuente. A propósito de 6 casos / Parsonage-Turner syndrome: unknown but not infrequent. Apropos of 6 cases

El hombro doloroso es un motivo de consulta habitual en Urgencias, Atención Primaria y algunas especialidades. El síndrome de Parsonage-Turner debe formar parte del diagnóstico diferencial de la omalgia aguda. Conocer sus características clínicas y electrofisiológicas nos permitirá evitar iatrogenia. Presentamos 6 casos de síndrome de Parsonage-Turner: un síndrome de etiología desconocida con un cuadro clínico muy característico. Todos comenzaron de forma aguda, con dolor muy intenso de hombro de unas 3 semanas de duración. Tras la resolución de esta primera fase, se evidencia una debilidad marcada del miembro superior con atrofia de los músculos afectados por la neuropatía. Una constante en todos fue el hallazgo de escápula alada. Un caso presentó alteración sensitiva y otro, parálisis hemidiafragmática. Tras la sospecha clínica y la exploración física completa, fueron sometidos a una exploración electromiográfica que confirmó el diagnóstico. Se pautó tratamiento analgésico y rehabilitador

Shoulder pain is a common reason for seeking emergency, primary and specialist care. Parsonage-Turner syndrome should form part of the differential diagnosis of shoulder pain. Familiarity with the clinical and electrophysiological characteristics of this syndrome could help prevent iatrogenic disease. We present 6 cases of Parsonage-Turner syndrome, a syndrome of unknown etiology with a typical clinical picture. All patients had acute onset of the syndrome with intense shoulder pain of approximately 3 weeks' duration. After this phase ended, there was noticeable weakness of the affected arm, causing muscular atrophy depending on the muscles affected by the neuropathy. Winged scapula was present in all patients. One patient showed alteration of sensitivity and another showed hemidiaphragmatic paralysis. After a complete physical examination, the patients underwent electromyographic study that confirmed the diagnosis. Analgesic treatment and rehabilitation were prescribed

Morphometry of suprascapular notch in Egyptian dry scapulae and its correlation with measurements of suprascapular nerve safe zone for clinical consideration

The suprascapular notch is bridged by a superior transverse scapular ligament (STSL) and serves as a passage for the suprascapular nerve. The purpose of this study was to group suprascapular notches (SSN) and provide data on the association of the safe zone distances of the suprascapular nerve. Sixty-five Egyptian dried scapulae were classified into five groups; measurement of dimensions of SSN and measurement of safe zone for the suprascapular nerve were taken. The collected data were analyzed and the correlated parameters in the prevalent types of notches were done.Scapulae were classified into five groups of which the most prevalent groups were Type III (47.63%) followed by Type I (40%). The mean measurements of 'safe zone' distances vary according to the type of notch and correlate with notch dimensions. The present work displayed the anatomical variants of SSN and analyzed the measurement of safe zone distances to help the clinicians to manage different pathological conditions of the shoulder, in order to avoid iatrogenic injury

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Quiste intraneural del nervio supraescapular: causa atípica de síndrome de atrapamiento de nervio periférico. Presentación de un caso y revisión de la literatura / Intraneural cyst of the supraescapular nerve: Atypical cause of peripheral nerve entrapment syndrome. Case report and literature review

Objetivo: Los quistes intraneurales son lesiones benignas de contenido mucinoso que se ubican dentro del epineuro de algunos nervios periféricos, de etiopatogenia controvertida. La mayoría se localizan a nivel de los miembros inferiores. Cuando aparece en los miembros superiores, el nervio más frecuentemente afectado es el cubital. De extraordinaria infrecuencia es el síndrome de atrapamiento del nervio supraescapular debido a la formación de un quiste intraneural del mismo. Con este artículo, aportamos un nuevo caso y realizamos una revisión de la literatura de los quistes intraneurales localizados en el nervio supraescapular. Métodos: Presentamos el caso de una paciente de 49 años con dolor en región lateral del hombro de varios meses de evolución. Se realizó RM plexo braquial donde se objetivó una tumoración de aproximadamente 2×1,5cm, de aspecto quístico, en relación al tronco superior del plexo braquial derecho. Resultados: Fue intervenida bajo control neurofisiológico, mediante un abordaje supra-infraclavicular. La tumoración quística afectaba a la extensión del nervio supraescapular. Tras localizar una zona en la superficie libre de fascículo nervioso se procedió a la disección, vaciamiento del quiste con contenido gelatinoso xantocrómico y resección parcial de la capsula. El examen anatomopatológico confirmó el diagnóstico de quiste intraneural (ganglión). Conclusión: El nervio supraescapular es un nervio mixto que procede del tronco superior. Proporciona las ramas motoras al músculo supraespinoso e infraespinoso, y puede derivar, resultado de la compresión, en una atrofia de los mismos. Es importante conocer esta entidad que, aún de extraordinaria infrecuencia, es uno de los diagnósticos diferenciales que deben ser tenidos en cuenta al estudiar un paciente con dolor irradiado al hombro, y su tratamiento correcto redunda muchas veces en la remisión completa de la sintomatología

Objective: Intraneural cysts are benign lesions located within the epineurium of some peripheral nerves and their aetiopathogenesis is controversial. Most are located at the level of the lower limbs. In the upper limbs, the most frequently affected nerve is the ulnar nerve. Suprascapular nerve entrapment syndrome due to the formation of an intraneural cyst is rare. In this article, we show a new case and perform a literature review of intraneural cysts located in the suprascapular nerve. Methods: We present a 49-year-old woman with pain in the lateral shoulder region of several months’ evolution. A brachial plexus MR showed a tumour of approximately 2×1.5cm, with a cystic appearance, in relation to the upper trunk of the right brachial plexus. Results: We used a supra-infraclavicular approach. The cystic tumour affected the suprascapular nerve. After locating a zone on the surface without nervous fascicles, we performed a partial resection of the capsule and emptying of the cyst, with a xanthochromic gelatinous content. The anatomopathological examination confirmed the diagnosis of intraneural cyst. Conclusion: The suprascapular nerve is a mixed nerve, coming from the upper trunk. It provides the motor branches to the supraspinatus and infraspinatus muscle. Compression of the suprascapular nerve leads to atrophy of these muscles. This entity is one of the differential diagnoses in a patient with pain irradiating to the shoulder, and its correct treatment often results in complete remission of symptoms

Anatomical variation of suprascapular notch amongst the dissected cadavers in anatomy department, Bayero University Kano, Nigeria

The majority of medical students may not have witnessed the absence of the suprascapular notch throughout their dissection period in their medical schools due to its rarity. This absence is very important to the physicians and to the surgeons, as it can cause suprascapular nerve entrapment neuropathy. The aim of this paper is to report the incidence of the total absence of suprascapular notch amongst the past and the presently dissected cadavers in the department. The Anatomy Department had procured averagely 90 human cadavers within thirty years of its establishment. Each formalin-embalmed cadaver was fully dissected by either 200 or 300 level medical or para-medical students. Since the inception of the department, any morphological anomalies of the soft or hard tissues and variations in terms of shape, size, position, or absence were always recorded and published. The human scapulae from those previously dissected cadavers were always examined just like any other bone in the human body to determine any variations or anomalies. Our previous records did not indicate any absence of the suprascapular notch except in one cadaver that was recently dissected and macerated in early 2017.Thus, it can be said that the incidence of absence of the suprascapular notch in Nigeria is 2:180 (90 cadavers: 90 left side, 90 right side scapulae), which is 1.1%. In summary, the absence of the suprascapular notch in our environment is also rare. Notwithstanding, physicians and surgeons should bear in mind the rare absence of the suprascapular notch and its possible involvement in the development of neuropathy due to the entrapment of the suprascapular nerve

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3D computed tomographic mapping of ossified transverse scapular ligaments and their relationship to coracoid, glenoid and acromion: Landmarks assisting safe release for suprascapular nerve decompression

Operative treatment of suprascapular nerve (SSN) entrapment consists of decompression of the nerve by surgical release of superior transverse scapular ligament (STSL) and spinoglenoid ligament (SGL). The surgical explorations rely on the relationship of anatomic landmarks such as coracoid, glenoid and acromion to these ligaments. Anatomical data for the relationship of bony landmarks to ossified STSL and ossified SGL are deficient. The aim of our study was to quantify the radio-anatomic distances from ossified STSL and ossified SGL to bony landmarks. Multidetector CT (128-slice) scans of dry scapulae having ossified superior transverse scapular ligament (STSL) and ossified spinoglenoid ligament (SGL) were acquired. 3D volume rendered reconstruction of ossified suprascapular ligaments, and their distances from Coracoid, Glenoid and Acromion were recorded. In addition, morphometric parameters of unusual bony tunnels in the supraspinous fossa were documented. Twenty-seven dry scapulae having ossified transverse scapular ligaments and two scapulae having bony tunnels were evaluated. The length of ossified ligaments was 1.31-2.31 cm and width was 0.3-0.9 cm. The distances from lateral edge of ossified ligaments to Coracoid was 3.92-4.42cm, to Glenoid was 1.37-3.01cm and to Acromion was 4.43-5.92cm. Knowledge of the 3D morphometry of ossified transverse scapular ligaments described in this study will be helpful in planning their safe endoscopic and open resection. This study uniquely quantifies a rare variant of SGL and bony tunnels in supraspinous fossa

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Efectos de la técnica de liberación por presión del punto gatillo miofascial latente del musculo trapecio superior: ensayo clínico aleatorio controlado / No disponible

Introducción: Los puntos gatillo miofasciales latentes (PGML) son responsables de dolor intenso y espontáneo. La cervicalgia mecánica no traumática se caracteriza por la presencia de hiperalgesia a la presión en la columna cervical, la cual afecta de igual manera a los músculos cervicales, como trapecios superiores, puesto que estos músculos reciben su inervación de los niveles C2-C4. Objetivo: Conocer los efectos inmediatos de la técnica de liberación por presión del PGML del trapecio superior en el umbral de dolor a la presión (UDP) de este músculo, así como del músculo angular del omoplato, del nervio occipital mayor (NOM), del nervio supra-orbitario (V1) y de las apófisis articulares de C3-C4 bilateralmente, y en la amplitud del movimiento activo cervical (AMAC). Material y métodos: Sesenta sujetos diagnosticados de PGML en las fibras más antero-superiores del músculo trapecio superior fueron incluidos en el estudio. Los valores del UDP se midieron bilateralmente en trapecio superior angular del omoplato, NOM, V1 y apófisis articulares de C3-C4 mediante un algómetro digital. La AMAC en flexión, extensión, latero-flexión homolateral, latero-flexión contralateral, rotación homolateral y rotación contralateral se midieron con un inclinómetro de burbuja. Al grupo intervención se le aplicó la técnica de liberación del PGM, y al grupo control se le aplicó una técnica placebo con ultra-sonidos sin intensidad. Resultados: Los resultados obtenidos demuestran que la técnica de liberación por presión del PGML del trapecio superior es efectiva en el aumento del UDP en este músculo inmediatamente después de su aplicación (p<0,01). Se verificó, además, que el aumento del UDP en el trapecio superior, tras la liberación del PGML, fue acompañado de un aumento simultáneo del UDP en el trapecio superior contralateral, así como en el músculo angular del omoplato bilateralmente, NOM bilateralmente, apófisis articulares de C3-C4 bilateralmente y V1 homolateral. En ambos grupos se verificó un incremento significativo de la AMAC (p<0,01). Sin embargo, en el grupo de intervención este aumento fue significativamente superior, lo que del punto de vista clínico puede ser bastante relevante. Conclusiones: La técnica de liberación por presión en el PGML del trapecio superior es una técnica útil en osteopatía, siendo efectiva en el aumento del UDP y de la AMAC inmediatamente después de su aplicación

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Suprascapular ligament ossification and nerve entrapment in a modern skeleton from the central coast of Patagonia, Southern South America

Modification of the suprascapular notch into a foramen as a consequence of the ossification of the suprascapular transverse ligament is a well-known anatomical change. However, it was rarely considered by research in skeletal and cadaveric remains as a possible cause of Suprascapular Nerve Entrapment, a neuropathy that usually produces pain and weakness of the affected shoulder. This paper has the aim to present and to discuss a case of ossification of the suprascapular transverse ligament in a modern-era, possible archaeological male skeleton of 30-45 years old from the central coast of Patagonia, and a possible development of suprascapular nerve entrapment. Complete bilateral ossification of the superior transverse scapular ligament was identified. As no other morphological, traumatic or neoplastic lesions were found in the scapulae, physical activity is suggested as the cause of the ligament ossification in the skeleton, although epigenetic origin cannot be completely rejected

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Evaluación de resultados funcionales y Notching tras el tratamiento de fracturas de húmero mediante artroplastia total invertida a medio plazo / Treatment of proximal humeral fractures by reverse shoulder arthroplasty: mid-term evaluation of functional results and Notching

Objetivo. Evaluar la relación entre el Notching y los resultados clínico-funcionales y radiológicos tras el tratamiento de las fracturas de húmero proximal con prótesis invertida de hombro (PTHi). Material y métodos. Estudio retrospectivo de 37 pacientes con fracturas de húmero proximal tratadas mediante PTHi con seguimiento medio de 24 meses. Se evaluó: tipo de fractura, rango de movilidad postoperatoria (antepulsión [AP], abducción [ABD], rotación externa [RE] y rotación interna [RI]), complicaciones y grado de satisfacción del paciente mediante la escala de Constant (CS). Se constató desarrollo de Notching según la clasificación de Nerot. Análisis estadístico de la relación Notching-posición de la glenosfera y resultados funcionales. Resultados. Los rangos medios de movilidad fueron AP 106,22°, ABD 104,46°, RE 46,08° y RI 40,27°. Se produjo Notching en el 29% de los pacientes al año de seguimiento. El valor medio del CS fue de 63 a los 18 meses post-IQ. Fueron estadísticamente no significativas las relaciones: Notching - balance articular final, Notching - CS, Notching - ángulo del cuello de la escápula, Notching - ángulo de la glena, Notching - distancia del bulón al borde inferior de la glena. Se encontró significación estadística entre la edad y el desarrollo de Notching y el Notching y el Tilt glenoideo. Conclusiones. La PTHi es una opción en pacientes con osteoporosis y artropatía del manguito rotador que presentan fractura humeral proximal. Permite alivio rápido del dolor y una funcionalidad aceptable. No está exenta de complicaciones: son necesarios estudios a largo plazo para determinar la relevancia del Notching (AU)

Objective. An analysis was made on relationship between Notching and functional and radiographic parameters after treatment of acute proximal humeral fractures with reverse total shoulder arthroplasty. Methods. A retrospective evaluation was performed on 37 patients with acute proximal humeral fracture treated by reversed shoulder arthroplasty. The mean follow-up was 24 months. Range of motion, intraoperative and postoperative complications were recorded. Nerot's classification was used to evaluate Notching. Patient satisfaction was evaluated with the Constant Score (CS). Statistical analysis was performed to evaluate the relationship between Notching and glenosphere position, or functional outcomes. Results. Mean range of elevation, abduction, external and internal rotation were 106.22°, 104.46°, 46.08° and 40.27°, respectively. Mean CS was 63. Notching was present at 12 months in 29% of patients. Statistical analysis showed significance differences between age and CS, age and notching development, and tilt with notching. No statistical significance differences were found between elevation, abduction, internal and external rotation and CS either with scapular or glenosphere-neck angle. Conclusion. Reverse shoulder arthroplasty is a valuable option for acute humeral fractures in patients with osteoporosis and cuff-tear arthropathy. It leads to early pain relief and shoulder motion. Nevertheless, it is not exempt from complications, and long-term studies are needed to determine the importance of notching (AU)

Masa de tejido blando. Una presentación singular de un carcinoma pulmonar de células escamosas metastásico / Soft-Tissue Mass. An Unusual Presentation of Metastatic Squamous Cell Lung Carcinoma

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Fracturas de estrés de la escápula tras artroplastia invertida en artropatía de manguito: ¿cuál es su repercusión funcional? / Scapula insufficiency fractures after reverse total shoulder arthroplasty in rotator cuff arthropathy: What is their functional impact?

Introducción-objetivos. Describir la incidencia, factores etiológicos, repercusión funcional y actitud terapéutica de las fracturas de acromion y espina de la escápula tras artroplastia invertida por artropatía de manguito rotador. Material y método. Análisis retrospectivo de 126 artroplastias inversas entre los años 2009-2011. Se identificaron 4 fracturas que se compararon con un grupo control de 40 pacientes. Se analizan variables relacionadas con el proceso quirúrgico, funcionales y de calidad de vida (escala Constant, EQ-5D). Resultados. La incidencia de la fractura fue 3,28% (4 pacientes), edad media 74,7 años y tiempo medio hasta el diagnóstico 11,9 meses. El Constant preoperatorio del grupo control fue de 37,3% y de los pacientes con fractura 34,7% (p > 0,05); el postoperatorio 81,2% y 66,5%, respectivamente (p < 0,001). La anteversión y abducción en los pacientes con fractura descendieron en 39° (p = 0,02) y 34° (p = 0,057) respectivamente con respecto al grupo control. La calidad de vida percibida (EQ-VAS) es inferior en el grupo de fractura (60 vs 76) (p = 0,002). En ninguno de los casos de fractura se observó inestabilidad, no precisando cirugías de revisión. La tasa de consolidación fue de un 50% tras un seguimiento medio de 39,6 meses. Conclusiones. La fractura de escápula tras artroplastia invertida es una complicación poco frecuente. A pesar de su aparición los resultados funcionales y de calidad de vida de estos pacientes son superiores a los presentes preoperatoriamente, sin embargo, resultan inferiores a los de los pacientes intervenidos en los que no se encuentra dicha complicación. Son necesarios más estudios prospectivos que nos ayuden a definir las pautas de actuación terapéutica ante esta complicación (AU)

Introduction-objectives. To describe the incidence, etiological factors, functional impairment and therapeutic management of scapular fractures after reverse shoulder arthroplasty (RSA) in rotator cuff arthropathy. Material and method. A retrospective study was conducted on 126 RSA between 2009 and 2011, in which 4 fractures were identified that were compared with a control group of 40 patients. An analysis was performed on the variables related to the surgical technique, functional results, and quality of life (Constant scale, EQ-5D). Results. The fracture incidence was 3.28% with a mean age of 74.7 years. The mean time until diagnosis was 11.9 months. The preoperative Constant score in the control group was 37.3%, and 34.7% in the fracture group (P > .05); postoperative Constant score: 81.2 and 66.5%, respectively (P > .001). Forward elevation and abduction in fracture patients decreased by 39° (P = .02), and 34° (P = .057) respectively. The perceived quality of life (EQ-VAS) was lower in the fracture group (60 vs. 76) (P = .002). There were no instability cases, and no revision surgery was required. The union rate was 50% after a mean follow-up 39.6 months. Conclusions. Scapular fracture after RSA is a rare complication. Despite its presence, the functional outcomes and quality of life of these patients are higher than preoperatively; however, they are lower than that obtained in patients with RSA without this complication. More prospective studies are needed to define guidelines for therapeutic action against this complication (AU)

Test de Distensión en Rotación Externa Pasiva (TDREP): validación de una nueva prueba clínica para el diagnóstico precoz de la capsulitis adhesiva de hombro / Distension test in passive external rotation: Validation of a new clinical test for the early diagnosis of shoulder adhesive capsulitis

Objetivo. El propósito de este estudio es evaluar la validez interna de una prueba clínica descrita para el diagnóstico precoz de la capsulitis adhesiva de hombro: el Test de Distensión en Rotación Externa Pasiva (TDREP). Material y método. El TDREP se realiza con el paciente de pie, el brazo adducido y el codo flexionado a 90°. Desde esta posición, se inicia un movimiento suave de rotación externa pasiva, sosteniendo el brazo afectado con una mano del examinador en la muñeca y otra manteniendo el codo abducido hasta que se alcanza el punto máximo de rotación indolora. Desde este punto de máxima rotación externa con el brazo en aducción y sin dolor, se realiza un movimiento brusco de distensión, incrementando la rotación externa, causando dolor en el hombro si la prueba es positiva. Es test se realizó en un grupo de 155 pacientes con dolor de hombro de múltiples orígenes para analizar los valores predictivos, la sensibilidad, especificidad y razón de verosimilitud. Resultados. El TDREP mostró una sensibilidad de 100% (IC 95%, de 91,8 a 100%) y una especificidad del 90% (IC 95%, de 82,4 a 94,8%). El valor predictivo positivo fue de 0,62 y la razón de verosimilitud de 10,22 (IC 95%: 5,5 a 19,01). Los falsos positivos se encontraron solo en enfermos con tendinopatías del subescapular o con artrosis glenohumeral. Discusión. El TDREP tiene una alta sensibilidad para diagnosticar CA y cuando es negativo prácticamente la excluye. Los falsos positivos se pueden identificar fácilmente si existe una rotación externa sin limitación (tendinopatía subescapular) o con una radiografía simple de hombro (artrosis glenohumeral) (AU)

Objective. The aim of this study is to evaluate the internal validity of a clinical test for the early diagnosis of shoulder adhesive capsulitis, called the Distension Test in Passive External Rotation (DTPER). Material and method. The DTPER is performed with the patient standing up, the arm adducted, and the elbow bent at 90°. From this position, a smooth passive external rotation is started, the affected arm being supporting at the wrist with one hand of the examiner and the other maintaining the adducted elbow until the maximum painless point of the rotation is reached. From this point of maximum external rotation with the arm in adduction and with no pain, an abrupt distension movement is made, increasing the external rotation, causing pain in the shoulder if the test is positive. This term was performed on a group of patients with shoulder pain of many origins, in order to analyse the predictive values, sensitivity, specificity, and the likelihood ratio. Results. The DTPER showed a sensitivity of 100% (95% CI; 91.8 to 100%) and a specificity of 90% (95% CI; 82.4 to 94.8%). The positive predictive value was 0.62 and a likelihood ratio of 10.22 (95% CI; 5.5 to 19.01). False positives were only found in patients with subscapular tendinopathies or glenohumeral arthrosis. Discussion. The DTPER has a high sensitivity for the diagnosis of adhesive capsulitis, and is excluded when it is practically negative. False positives can easily be identified if there is external rotation with no limits (subscapular tendinopathy) or with a simple shoulder X-ray (glenohumeral arthrosis) (AU)

Presencia de puntos gatillo miofasciales y discinesia escapular en nadadores de competición con y sin dolor de hombro: estudio piloto transversal / Presence of myofascial trigger points and scapular dyskinesis in competitive swimmers with and without shoulder pain: a cross-sectional pilot study

Objetivos: Valorar, en nadadores de competición con y sin dolor de hombro, tanto la presencia de discinesia escapular como la de puntos gatillo miofasciales, activos y latentes, en 19 músculos en los que su presencia puede generar dolor de hombro o discinesia escapular. Material y métodos: Quince nadadores varones de competición (5 con dolor de hombro y 10 sin dolor) participaron en un estudio transversal en el que se valoró la presencia de discinesia escapular mediante el Scapular Dyskinesis Test y de puntos gatillo miofasciales activos y latentes en músculos de la cintura escapular y del miembro superior según los criterios diagnósticos de Simons, Travell & Simons. Resultados: Dos nadadores con dolor de hombro y 3 sin dolor mostraron discinesia escapular obvia. Treinta y seis de los 95 músculos explorados en los nadadores con dolor mostraron puntos gatillo miofasciales activos, más frecuentemente en los músculos subescapular (4/5), pectoral mayor, redondo mayor, redondo menor, cabeza larga del tríceps braquial y trapecio superior (3/5). Cincuenta y uno de los 190 músculos explorados en nadadores sin dolor mostraron puntos gatillo miofasciales latentes, más frecuentemente en los músculos trapecio superior, pectoral mayor, infraespinoso y redondo mayor. Conclusiones: La discinesia escapular está presente en nadadores con dolor de hombro y en nadadores sin dolor. En los nadadores con dolor existe una elevada frecuencia de puntos gatillo miofasciales activos, principalmente en músculos implicados en la fase propulsiva de la brazada

Objectives: To assess the presence of scapular dyskinesis and that of active and latent myofascial trigger points in 19 muscles that can lead to shoulder pain or scapular dyskinesis in competitive swimmers with and without shoulder pain. Material and methods: Fifteen male competitive swimmers (5 with pain and 10 without pain) participated in a cross-sectional study in which scapular dyskinesis was measured by Scapular Dyskinesis Test. Muscles of shoulder girdle and upper extremity were explored to detect active and latent myofascial trigger points following the Simons, Travell & Simons diagnostic criteria. Results: Two swimmers with shoulder pain and 3 swimmers without shoulder pain showed obvious scapular dyskinesis. Active myofascial trigger points were found in 36 out of the 95 muscles explored in swimmers with shoulder pain, more frequently in the following muscles: subscapularis (4/5), pectoralis major, teres major, teres minor, long head of triceps brachialis and upper trapezius (3/5). A total of 51 out of 190 muscles explored in swimmers without shoulder pain showed latent myofascial trigger points, more frequently in upper trapezius, pectoralis major, infraspinatus, and teres major. Conclusions: Scapular dyskinesis is present in swimmers with and without shoulder pain. Active myofascial trigger points are frequently present in swimmers with shoulder pain, mainly in muscles involved in propulsive phase of the stroke