Bilateral diaphragmatic paralysis and Lyme neuroborreliosis. Ten-years of follow-up / Parálisis diafragmática bilateral y neuroborreliosis de Lyme. Diez años de seguimiento

Abstract Borrelia burgdorferi infection (Lyme disease) is one of the few identifiable causes of neuralgic amyotrophy (AN). Bilateral diaphragmatic paralysis is considered rare in borreliosis, and the pattern of long-term recovery of diaphragm function is also uncertain. Transdiaphragmatic pressure is the gold standard for diagnosing bilateral diaphragmatic paralysis, a study that has been reported on a few occasions. We pres ent a case of AN associated with borrelia infection and bilateral diaphragmatic paralysis that provides a detailed follow-up of the spirometric evolution, the maximum static pressures in the mouth, and the transdiaphragmatic pressure from the onset of symptoms and in the long term. This case allows us to know one of the possible evolutionary profiles of diaphragmatic dysfunction in AN due to borreliosis.

Resumen La infección por Borrelia burgdorferi (enfermedad de Lyme) es una de las pocas causas identificables de amiotrofia neurálgica. La parálisis diafragmática bilateral es considerada rara en la borreliosis y el patrón de recuperación a largo plazo de la función del diafragma también es incierto. La presión transdiafragmática es el patrón de oro para el diagnóstico de parálisis diafragmática bilateral, un estudio que ha sido informado en pocas ocasiones. Se presenta un caso de amiotrofia neurálgica asociado a infección por Borrelia y parálisis diafrag mática bilateral, que aporta un seguimiento detallado de la evolución espirométrica, de las presiones estáticas máximas en la boca y de la presión transdiafragmática desde el inicio de los síntomas y a largo plazo. Este caso permite conocer uno de los posibles perfiles evolutivos de la disfunción diafragmática en la amiotrofia neurálgica por borreliosis.

Daño neurológico perioperatorio. Identificación de factores de riesgo, prevención y estudios relacionados / Perioperative nerve injury. Risk factor identification, prevention and work-up

BACKGROUND: Regional anesthesia techniques can have adverse effects, like peripheral nerve injuries. This can affect the practitioner on the choice of techniques when offering multimodal analgesia. CASE REPORT: We present the case of an arthroscopic rotator cuff repair on a patient with no comorbidities who presented peripheral nerve injury during post-op. Initially thought to have occurred as a consequence of the anesthetic technique, further study of the patient revealed the injuries to have been produced by the arthroscopic surgery. CONCLUSION: There are multiple factors that influence the possibility of peripheral nerve injury associated with nerve blocks. They can be grouped as related to the patient, the anesthetic technique or the surgical technique, the latter being the most relevant. If a patient manifests signs of peripheral nerve injury high-resolution magnetic resonance of the neural tissue must be performed immediately. Sensory nerve conduction study and electromyography must be performed 4 weeks after by an expert neurologist.

INTRODUCCIÓN: La anestesia regional puede producir como efecto adverso lesiones de nervios periféricos, lo que puede hacer desistir al anestesiólogo de realizar técnicas que mejoran la analgesia multimodal. CASO CLÍNICO: Se presenta el caso de un paciente sin comorbilidades que se operó de reparación artroscópica del manguito rotador y presentó daño neurológico postoperatorio. Inicialmente se sospechó que el daño había sido producido durante la técnica anestésica, sin embargo, el estudio adecuado demostró que el daño se relacionaba con la técnica quirúrgica. CONCLUSIÓN: Existen factores que influyen en la posibilidad de daño neurológico asociado a bloqueos de nervios periféricos que pueden ser propios del paciente, de la técnica anestésica o quirúrgicos, siendo estos últimos los más relevantes. En un paciente con clínica compatible debe realizarse resonancia magnética del tejido neural de alta resolución de forma inmediata; estudio de conducción neural sensitiva y electromiografía a las 4 semanas de evolución por un neurólogo experto.

Síndrome de Parsonage-Turner en paciente sometido a cirugía de revascularización miocárdica. caso clínico / Parsonage-Turner syndrome: report of one case

We report a 59-year-old male who, three weeks after a coronary revascularization surgery, reported a sudden intense burning pain in his left upper limb. Two weeks later, he reports a paresis with difficulty to extend his left wrist and fingers. The electromyography showed a severe axonal damage of the radial nerve with distal denervation signs. This clinical picture probably corresponds to a neuralgic amyotrophy, an inflammatory disorder of the brachial plexus known by a number of terms, including Parsonage-Turner syndrome.

Enfermedad de hirayama en un adolescente / Hirayama disease observed in an adolescent

La Enfermedad de Hirayama -o amiotrofia monomélica- es una afección de baja frecuencia y escasamente reportada en la edad pediátrica. Se presenta el caso clínico de un adolescente de 15 años de edad con disminución de la fuerza muscular y pérdida de la masa muscular, que comenzó a los 10 años de edad por la mano izquierda, y le afectó posteriormente el antebrazo. Mantuvo un curso progresivo durante 3 años, para luego mantenerse estable. El electromiograma de aguja arrojó lesión de axones motores o motoneuronas dependientes de los miotomas C7-T1, y en menor grado, C5-C6. En la tomografía axial computarizada con contraste endovenoso en marcada flexión cervical, se observó desde C7-T2 una evidente ectasia venosa posmedular asimétrica, predominantemente del lado izquierdo, por congestión del plexo venoso vertebral posterior interno. En este paciente la enfermedad se detuvo espontáneamente, en otros casos es necesario limitar la motilidad de la columna con el uso de un collar cervical, y solo llegar a la cirugía en los casos más severos de evolución rápida.

Hirayama disease or monomelic amyotrophy is a low frequent, barely reported illness at pediatric ages. Here is the clinical case of 15 years-old boy that presented with reduced muscular strength and loss of muscle mass; this condition began at the age of 10 year in his left hand and then affected the forearm. The illness progressed for three years and then remained stable. The needle electromyogram showed a lesion in C7-T1 myotome-depending motor axons or motoneurons and to less extent in those C5-C6 depending ones. The venous contrast computed tomography on a marked cervical cord flexion position; it was observed an evident asymmetric postmedullary vein ectasia from the C7-T2 myotomes, mainly on the left side, caused by the internal posterior vertebral vein plexus congestion. There was spontaneous remission of the disease in this patient, but it is necessary in other cases to limit the cervical cord motility with the use of a collar and to only perform surgery in the most rapidly evolving and severe cases.

Síndrome del desfiladero torácico neurogénico causado por la arteria escapular descendente: comunicación de un caso / Neurogenic thoracic gland syndrome caused by the descending descending artery: case report

El síndrome del desfiladero torácico es una entidad clínica compleja que abarca varias situaciones donde hay compresión del paquete vásculo-nervioso que suministra las extremidades superiores en el canal cervicotorácico. El síndrome se puede dividir en neurogénico y vascular de acuerdo con la estructura comprometida, siendo la primera la más frecuente. Entre las causas descritas están las costillas cervicales, anomalías de la primera costilla, músculos anómalos o hipertrofiados, traumatismos y tumores de la región. Describimos el caso de una paciente de 47 años que presenta un cuadro de cervicobraquialgia asociado con parestesias y paresia en la mano izquierda compatible con síndrome del desfiladero torácico en que la causa de la compresión era la arteria escapular descendente. Fue realizada una revisión de la literatura siendo encontrado sólo un caso similar.

The thoracic outlet syndrome is a complex clinical entity that encompasses several situations where there is compression of the neurovascular bundle that supplies the upper limbs in the cervicothoracic channel. It can be divided in neurogenic and vascular according to the structure committed, the first being the most frequently found. Among the causes described there are cervical ribs, anomalies of the first rib, anomalous or hypertrophied muscles, trauma and tumors of the region. We report the case of a 47 year old patient who presents with a clinical picture of cervicobrachialgia associated with paresthesia and paresis on the left hand compatible with thoracic outlet syndrome in which the cause of compression was the descending scapular artery.We conducted a literature review and found only one similar case.

Brachioradial pruritus in a patient with cervical disc herniation and Parsonage-Turner syndrome

Abstract Brachioradial pruritus is a chronic sensory neuropathy of unknown etiology which affects the skin of the shoulders, arms and forearms on the insertion of the brachioradialis muscle. We describe the case of a 60-yearold woman recently diagnosed with multiple myeloma who refers paresis, severe pruritus and itching lesions on the right arm with 6 months of evolution. Investigation led to a diagnosis of Brachioradial pruritus consequent to the presence of cervical disc herniation and Parsonage-Turner syndrome. The patient started gabapentin 900mg/day with good control of itching. Corticosteroids and antihistamines are often ineffective in the treatment of BP. Gabapentin has been used with encouraging results. All patients with Brachioradial pruritus should be evaluated for cervical spine injuries.

Síndrome de Parsonage-Turner / Parsonage-Turner syndrome

OBJETIVO: Descrever os achados clínicos, eletrofisiológicos e de imagem na síndrome de Parsonage-Turner e avaliar os resultados do tratamento conservador. MÉTODOS: Foram estudados oito casos entre fevereiro de 2010 e fevereiro de 2012, com seguimento mínimo de um ano (média de 14 meses). Todos os pacientes foram submetidos ao questionário clínico e avaliados funcionalmente com o escore de Constant e Murley. Após a suspeita clínica o exame de eletroneuromiografia foi feito para confirmação diagnóstica. RESULTADOS: Oito pacientes (média de 29 anos) foram avaliados. O lado direito foi acometido em 70% dos casos e era o dominante em 80%. Todos os pacientes relataram um início súbito de dor no ombro, com duração de um a cinco dias em seis casos e de até 15 dias em dois casos. Em três casos foi observada atrofia severa do músculo deltoide. Hipotrofia dos músculos supraespinhal e infraespinhal foi observada em três casos. Escápula alada foi observada em dois casos restantes. A eletromiografia demonstrou envolvimento do nervo torácico longo nesses dois últimos casos e confirmou o envolvimento dos nervos axilar e supraescapular nos seis casos restantes. A pontuação média na escala de Constant e Murley foi de 96 no fim do tratamento conservador com medicamentos anti-inflamatórios não esteroides e fisioterapia. Seis dos oito pacientes apresentaram boa recuperação da força muscular. CONCLUSÃO: Na maioria dos casos a recuperação funcional foi boa, embora a força muscular não tenha sido completamente restaurada em alguns deles.

OBJECTIVE: To describe the clinical, electrophysiological and imaging findings from Parsonage-Turner syndrome and evaluate the results from conservative treatment. METHODS: Eight cases were studied between February 2010 and February 2012, with a minimum follow-up of one year (mean of 14 months). All the patients answered a clinical questionnaire and underwent functional evaluation using the Constant and Murley score. After clinical suspicion was raised, an electromyography examination was performed to confirm the diagnosis. RESULTS: Eight patients (mean age of 29 years) were evaluated. The right side was affected in 70% of the cases, and the dominant side in 80% of the cases. All the patients reported that their shoulder pain had started suddenly, lasting from one to five days in six cases and up to 15 days in two cases. In three cases, severe atrophy of the deltoid muscle was observed. Hypotrophy of the supraspinatus and infraspinatus muscles was observed in three cases. A winged scapula was observed in the two remaining cases. Electromyography demonstrated involvement of the long thoracic nerve in these last two cases and confirmed the involvement of the axillary and suprascapular nerves in the remaining six cases. The mean score on the Constant and Murley scale was 96 at the end of the conservative treatment with non-steroidal anti-inflammatory drugs and physiotherapy. Six of the eight patients presented good recovery of muscle strength. CONCLUSIONS: In the majority of the cases, the functional recovery was good, although muscle strength was not completely restored in some of them.

Cirugía de salvamento de extremidades para paciente con tumor maligno de la cintura escapular. A propósito de un caso / Limb salvage surgery for patient withMalignant tumor of the shoulder girdle. A case report

Previo a los años 70, la amputación interescapulotorácica era el principal tratamiento para los tumores óseos malignos de la cintura escapular. Con la mejor comprensión del comportamiento biológico de éstos y aplicación de terapia adyuvante, 80-90% pueden ser resecados con seguridad, empleando procedimientos de salvamento de extremidades. Se trata de paciente masculino de 34 años de edad quien cursa con aumento de volumen en región escapular derecha, de un año de evolución, acompañado de dolor en articulación acromio-clavicular y limitación para movimientos de abducción y flexión. Radiológicamente, se observó área osteolítica en fosa supraespinosa de escápula derecha; la tomografía reveló lesión destructiva de acromio, cabeza humeral y tercio externo de clavícula, en gammagrama óseo: lesión única en escápula derecha; TAC de tórax sin evidencia de lesiones secundarias. Biopsia incisional reportó sarcoma de alto grado clasificado como estadío IIB de Enneking. Posterior a estudio de Angioresonancia, se decidió y realizó la cirugía de salvamento de extremidad denominada Thikoff Lindbergh tipo IVB, consistente en la resección oncológica de margen amplio de escápula, articulación glenohumeral, 2/3 externos de clavícula y 1/3 proximal de húmero derecho. La histopatología determinó bordes libres de enfermedad y el diagnóstico final fue Osteosarcoma de alto grado. Postoperatorio con excelentes resultados; es referido a oncología clínica y a fisioterapia. Aunque los osteosarcomas de huesos planos son relativamente raros, su aparición en huesos como escapula condicionan situaciones de difícil manejo, ya que la resección adecuada está sujeta a un correcto proceso de estadificación y a una técnica depurada y experimentada(AU)

Prior to the 70s, the forequarter amputation was the primary treatment for malignant bone tumors of the shoulder girdle. With better understanding of the biological behavior of these and application of adjuvant therapy, 80-90% can be safely resected using limb salvage procedures. Male patient is 34-year- old who was studying with increased volume in the right scapular region, a year of evolution, accompanied by pain in acromioclavicular joint and limitation of abduction and flexion movements. Radiologically, there was osteolytic area in right supraspinous fossa of scapula; tomography revealed destructive lesion of acromion, humeral head and the outer third of clavicle, in ganmagrama bone: single lesion in right scapula, CT scan without evidence of secondary lesions. Incisional biopsy reported high grade sarcoma classified as Enneking stage IIB. Angiography after study, it was decided and performed limb salvage surgery called Thikoff Lindbergh type IVB, consisting of oncological resection of scapula wide margin, glenohumeral joint, two thirds collarbone external third right proximal humerus. The histopathology determined disease-free edges and the final diagnosis was highgrade osteosarcoma. Postoperative with excellent results, is referred to physiotherapy and clinical oncology. Although osteosarcoma of flat bones are relatively rare, their occurrence in bone and scapula condition unwieldy situations as adequate resection is subject to proper staging process and a refined technique and experienced(AU)

Extended Neuralgic Amyotrophy Syndrome: voice therapy in one case of vocal fold paralysis / Amiotrofia Nevrálgica Estendida: fonoterapia em um caso de paralisia de prega vocal

Neuralgic Amyotrophy (NA) is a rare disturb of the peripheral nervous system that can include extreme pain, multifocal paresis and atrophy of the muscles of the upper limbs. When the nerves located outside of the brachial plexus are involved, the term Neuralgic Amyotrophy Extended (ANE) is used. Diagnosis of NA is clinical and has a series of inclusion and compatibility criteria established by the European CMT Consortium. On this study the clinical history, multidimensional vocal assessment data and the vocal techniques used in five-weeks voice therapy for one patient, professional voice, with ANE are presented. In this case, sudden and recurrent paralysis of his right vocal fold was the only manifestation of the disease. At the end of the fifth week the patient's voice was normal, the spoken and sung vocal ranges were same as before the current episode of ANE and scores of his vocal self-assessment were appropriate.

A Amiotrofia Nevrálgica (AN) é um distúrbio raro do sistema nervoso periférico que pode incluir dor extrema, paresia multifocal e atrofia dos músculos dos membros superiores. Quando há o envolvimento de nervos localizados fora do plexo braquial, o termo Amiotrofia Nevrálgica Estendida (ANE) é utilizado. O diagnóstico da AN é clínico e possui uma série de critérios de inclusão, bem como critérios de compatibilidade estabelecidos pelo European CMT Consortium. Neste estudo são apresentados a história clínica, os dados da avaliação vocal multidimensional e as técnicas vocais utilizadas na terapia vocal de cinco semanas de um paciente, profissional da voz, com ANE. A paralisia súbita e recorrente da prega vocal direita foi a única manifestação da doença. Ao término da quinta semana, a voz do paciente estava adaptada, as extensões de voz falada e cantada eram as mesmas de antes da lesão e os escores de sua autoavaliação vocal estavam adequados.

Neuralgia amiotrófica posterior a la vacunación contra la leptospirosis humana / Neuralgic amyotrophy following vaccination against human leptospirosis

Introducción: la neuralgia amiotrófica o síndrome de Parsonage-Turner se asocia a vacunaciones en 15 por ciento de los casos. No existen reportes que vinculen esta condición con la vacuna contra la leptospirosis humana. Objetivo: describir las características clínicas de un paciente que presentó una plexopatía braquial aguda posterior a la inmunización contra la leptospirosis humana. Presentación del caso: un varón de 31 años de edad, obrero agrícola en 2008 recibió una dosis de la vacuna cubana contra la leptospirosis humana (vax-Spiral); 3 semanas después presentó dolor intenso localizado en ambos hombros, a la semana siguiente aparece debilidad muscular y posteriormente atrofia del músculo deltoides derecho. La evaluación neurológica era compatible con afección aguda asimétrica de la porción superior del plexo braquial, con mayor intensidad en el lado derecho, en el cual también estaba involucrado el diafragma. Se comprobó el compromiso de la porción superior del plexo braquial con estudios de neuroconducción y electromiografía. El paciente es tratado con analgésicos y fisioterapia, evolucionando de modo favorable. Conclusiones: el evento ocurrido en este caso sugiere que la vacuna cubana contra leptospirosis humana pudiera producir inmunorreactividad cruzada contra antígenos del sistema nervioso periférico

Introduction: neuralgic amyotrophy or Parsonage-Turner syndrome is associated with vaccination in 15 percent of cases. There are no reports linking this condition to the vaccine against human leptospirosis. Objective: describe the clinical characteristics of a patient who developed acute brachial plexopathy after vaccination against human leptospirosis. Case presentation: a male 31 year-old agricultural worker received a dose of the Cuban vaccine against human leptospirosis (vax-SPIRAL) in 2008. Three weeks later he presented intense pain in both shoulders. The following week he had muscular weakness, and then atrophy of the right deltoid muscle. Neurological evaluation showed acute asymmetric damage to the upper brachial plexus, with greater intensity on the right side, and involvement of the diaphragm. Nerve conduction examination and electromyography revealed involvement of the upper brachial plexus. The patient was treated with analgesics and physical therapy, and was found to evolve favorably. Conclusions: the events described suggest that the Cuban vaccine against human leptospirosis might produce immunological cross-reactivity against antigens of the peripheral nervous system

Neurografía por resonancia magnética en 3T: experiencia preliminar / 3T MRI neurography: preliminary experience

Propósito. Presentar las ventajas de la secuencia IDEAL (Iterative Decomposition of water and fat with Echo Asymmetry and Least-squares estimation) en la evaluación de los nervios periféricos y plexos braquial (PB) y lumbosacro (PLS) para el diagnóstico de las neuropatías por atrapamiento o compresión, las neuropatías sin atrapamiento y las condiciones subyacentes. La secuencia IDEAL proporciona 4 tipos de imágenes a partir de una sola adquisición, permitiendo la supresión uniforme de la grasa y el agua, y la obtención de imágenes en fase o fuera de fase de agua, grasa o de la combinación de éstas. Materiales y Métodos. Estudio retrospectivo de enero de 2011 a junio de 2011. Se realizaron 11 neurografías con secuencia IDEAL en resonancia magnética 3T (HDX.3T, GE Healthcare, USA), con bobinas phased array de 8 canales en planos coronal y sagital, cortes de 1,2 - 0 mm, y plano axial 3D spoiled gradient recalled (SPGR) T1, cortes 1 - 0 mm sin y con gadolinio. El campo de visión (FOV) fue variable según el nervio o plexo a explorar. Resultados. Se encontraron 2 schwannomas (plexo braquial, nervio ciático), 1 neuritis (inflamación por compresión del nervio mediano), 2 casos con neurofibromas múltiples (uno en plexo lumbosacro y ciático y otro en plexo braquial), 3 neuromas postraumáticos (ciático poplíteo externo -CPE-), una avulsión con pseudomeningocele (plexo braquial) y 2 casos sin alteraciones (plexo lumbosacro y ciático poplíteo externo). Conclusión. En esta presentación preliminar, la neurografía por resonancia magnética (RM) mostró una excelente diferenciación entre el nervio y las estructuras circundantes y permitió reconocer la estructura del nervio y su señal, determinar variantes anatómicas y causas de neuropatías, así como también se pudieron evaluar los cambios de denervación en los grupos musculares involucrados.

3T MRI neurography: preliminary experience. Purpose. Demonstrate the advantages of the IDEAL(Iterative Decomposition of water and fat with Echo Asymmetry and Least-squares estimation) sequence in the evaluation of peripheral nerves, brachial plexus and lumbar plexus, for the diagnosis of compression or entrapment neuropathies, non-entrapment neuropathies, and the underlying conditions. The IDEAL sequence provides 4 types of images from a single acquisition, allowing uniform fat or water suppression and in phase/out of phase images of water, fat or a combination of both. Materials and Methods. This is a retrospective study, from January 2011 to June 2011. Eleven neurographies were performed on 3T MRI (HDX 3T, GE Healthcare, USA), with 8-channel phased array coils on sagittal and coronal planes, with 1.2-0 mm slices with no gap, axial 3D spoiled gradient recalled (SPGR) T , with 1-0-mm slice thickness with and without gadolinium injection and variable field of view (FOV) according to the nerve or plexus to explore. Results. We found 2 schwannomas (brachial plexus and sciatic nerve), 1 neuritis (compression to median nerve), 2cases of multiple neurofibromas (lumbosacral plexus, sciatic nerve, brachial plexus), 3 traumatic neuromas (peroneal nerve) and 1 pseudomeningocele avulsion (brachial plexus),and 2 with no structural alterations (lumbosacral plexus and peroneal nerve). Conclusion. In this preliminary experience, the use of highresolution sequences in magnetic resonance imaging neurography studies provided excellent signal homogeneity, improving the recognition of the nerve structure and signal,the identification of anatomical variations, and causes of neuropathy, as well as the characterization of denervation changes of the affected muscle groups.

Síndrome de Parsonage-Turner en infancia y adolescencia: Caso clínico / Parsonage-Turner syndrome in childhood and adolescence: Case report

Se presenta el caso de un varón de 17 años con diagnóstico de síndrome de Parsonage-Turner recidivante en brazo derecho. En su historial clínico se diagnosticó neuralgia amiotrófica de miembro superior en tres ocasiones anteriores, con clínica semejante en cada uno de los episodios, aunque alternándose el miembro superior afecto. Estuvo en tratamiento en los Servicios de Rehabilitación de dos centros hospitalarios. A la exploración física en cada recidiva presenta dolor intenso en el hombro y brazo, y pérdida de fuerza en escápula y miembro superior afecto. El objetivo de su tratamiento combina tratamiento del dolor y, junto con fisioterapia, luchar contra la atrofia muscular que presenta. El paciente evolucionó favorablemente en cada uno de los episodios que presentó y, en la actualidad, se muestra asintomático y dado de alta en el servicio de Rehabilitación.

We present the case of a 17-year-old male whose diagnosis is Parsonage-Turner syndrome relapsing in the right arm. In his medical record, he was diagnosed as having amyotrophic neuralgia of the upper limb in three previous occasions. The diagnosis was similar in all episodes, although the affected upper limb was alternating. He was treated in the Rehabilitation Services of two hospitals. At physical examination, in every relapse, he showed acute pain in both, shoulder and arm, and loss of strength in the shoulder blade and the affected upper limb. The aim of his treatment combines the healing of the pain and, together with physiotherapy, fighting against muscular atrophy. The patient evolved favourably in each of the episodes. Nowadays, he does not show any symptom, and he has been discharged from the rehabilitation service.

Polimialgia reumática: estudio descriptivo en Medellín, Colombia / Polymyalgia rheumatica: a descriptive study in Medellin, Colombia

Introducción: la polimialgia reumática (PMR) es una enfermedad inflamatoria que afecta a mayores de 50 años, caracterizada por dolor y rigidez en región cervical, cinturas escapular y pélvica y por una rápida respuesta a los glucocorticoides. Hasta donde sabemos, no hay estudios clínicos sobre PMR en nuestra población. Algunas enfermedades reumatológicas de comienzo tardío como artritis reumatoide (AR), lupus eritematoso sistémico (LES), espondiloartropatías y arteritis de células gigantes (ACG) pueden manifestarse con hallazgos de PMR. Igualmente, neoplasias hematológicas y algunos tumores sólidos pueden presentarse con un síndrome polimiálgico. Objetivo: analizar las características clínicas, de laboratorio y terapéuticas de pacientes de Medellín con PMR entre 1998 y 2011. Métodos: estudio descriptivo transversal. Se revisaron historias clínicas de pacientes con PMR y al menos 1 visita de seguimiento. Se analizaron variables sociales, demográficas, clínicas, de laboratorio y terapéuticas. Resultados: se evaluaron sesenta y nueve pacientes (79,7% mujeres), 68 (98,6%) de los cuales tuvieron dolor y/o rigidez en cintura escapular y 62 (89,8%) en cintura pélvica. La velocidad de sedimentación globular (VSG) fue igual o mayor a 40 mm/h en 43 (62,3%) pacientes y la proteína C reactiva (PCR) igual o mayor a 0,8 mg/dl en 56 (81,2%). El 76.9% de los pacientes recibieron prednisolona en dosis = 15 mg/día; 95,7% respondieron en los 3 primeros meses de tratamiento, 94,2% presentaron remisión (84,6% en los 6 primeros meses) y 39,1% tuvieron recaída (77,8% en el primer año de seguimiento). Los pacientes con VSG elevada tuvieron menor respuesta en el primer mes. Durante el seguimiento, 5 pacientes desarrollaron artritis reumatoide y 2 ACG. Conclusiones: los hallazgos encontrados aportan mayor información sobre las características de los pacientes con PMR en nuestra población y confirman la rápida respuesta al tratamiento con dosis bajas a moderadas de esteroides y menor respuesta inicial en pacientes con VSG elevada. Su diseño y tamaño de muestra son insuficientes para definir asociaciones estadísticamente significativas.

Background: Polymyalgia rheumatic is a syndrome that affects people over 50 years, characterized by pain and stiffness of shoulder and pelvic girdle. Its behavior in our population is unknown. It may be a manifestation of rheumatoid arthritis, systemic lupus erythematous, and neoplasm or could be associated with giant cells arteritis and it is a common indication for steroid usage. Objective: To analyze clinical, laboratory and treatment features of patients with PMR in Medellín between 1998-2011. Methodology: Descriptive cross-sectional study. We reviewed medical records of patients with PMR with at least 1 follow-up visit. We analyzed social, demographic, clinical, laboratory and therapeutic variables. Results: The records of 68 patients were assessed, 79.7% women. Pain and stiffness in shoulder and pelvic girdle were major symptoms. 62.3% had erythrocyte sedimentation rate equal to or greater than 40 mm/h and 81.2% had C reactive protein equal to or greater than 0.8 mg/dl. 76.9% received doses of prednisolone of 15 mg/day or below. 95.7% responded within the first 3 months of treatment, 94.2% showed remission (84.6% within the first 6 months), 39.1% relapsed (most within the first year of monitoring). Those with elevated ESR had a lower response in the first month. Five patients developed rheumatoid arthritis and two patients giant cells arteritis. Conclusions: These findings add more information about the clinical characteristics of patients with PMR. They allow suggesting early responses to treatment with low to moderate doses of steroids and a lower initial response in patients with elevated ESR. Design and sample size are insufficient to identify statistically significant associations.

Avaliação postural e muscular da cintura escapular em adultos jovens, estudantes universitários / Posture and muscular evaluation of scapular waist in yong adults university students

A cintura escapular é uma estrutura anatômica comumente acometida por alterações posturais, visto que é extremamente móvel. O objetivo foi verificar a incidência de alterações posturais da cintura escapular em adultos jovens, universitários do curso de Educação Física, da Universidade Federal de Juiz de Fora. A amostra foi composta por 20 universitários (10 mulheres e 10 homens); a coleta de dados constou de exame postural através de observação clínica subjetiva, registro fotográfico, medidas de referência da escápula e testes de comprimento e de força musculares dos músculos envolvidos nas alterações encontradas durante a observação clínica subjetiva. Os dados foram analisados, quantitativamente, através da análise de freqüência, utilizando-se do software Excell 2007 e qualitativamente através da descrição dos mesmos. 100% dos universitários apresentaram pelo menos uma alteração postural da cintura escapular, sendo as mais comuns a protrusão de ombros (90%), escápula alada (45%) e a escápula elevada (75%). Verificaram-se também alterações das propriedades de força ou comprimento musculares, não sendo detectada alteração apenas para a rotação medial da escápula. Conclusão: A cintura escapular dos indivíduos avaliados se mostrou sujeita a muitas alterações posturais, corroborando com estudos semelhantes encontrados na literatura e confirmando a tendência à instabilidade desta estrutura.

Introduction: The scapular waist is an anatomical structure which is commonly affected by posture alterations, once it is extremely mobile. Objective: Verify the incidence of posture alterations on scapular waist in young adults university students of Bachelor of Physical Education of Federal University of Juiz de Fora – Minas Gerais State, Brazil. Methodology: The sample was composed of 20 students (10 male and 10 female); the data was done by a postural test using subjective clinical observation, photographic records, measures of waist references and length tests and muscular strength of muscles which are related to changes found on subjective clinical observation. The data was analyzed quantitatively by rating analysis, using the Excel 2007 software and analyzed qualitatively by describing them. Results: There was at least one postural alteration of scapular waist in 100% of university students being the most commons shoulder protrusion(90%),flying scapula (45%) and elevated scapula(75%). In addition, it was evaluated the alterations of strength features or muscle length, this alterations were not seen only in medial rotation of scapula. Results: the scapular waist of evaluated individuals was prone to several posture alterations corroborating to similar studies in the literature and confirming a tendency of this structure to be instable.

Avaliação do resultado do tratamento da capsulite adesiva de ombro com bloqueios seriados do nervo supraescapular / Treatment of frozen shoulder by supraescapular nerve block. Outcome evaluation

Objetivo: Avaliar 136 pacientes (144 ombros) com capsulite adesiva tratados no período de junho de 1994 a fevereiro de 2000 pela técnica dos bloqueios seriados do nervo supraescapular. Método: Analisamos os pacientes em relação à faixa etária, sexo, dominância e classificação, sendo os resultados obtidos com o tratamento avaliados de acordo com critérios da UCLA. O seguimento médio foi de 39 meses. Resultados: Obtivemos resultados satisfatórios em 84,0% (121 ombros) e melhora da dor em 91,7% (132 ombros). Avaliamos os pacientes diabéticos com capsulite adesiva, não sendo notada diferença estatisticamente significativa na gravidade de acometimento destes com relação à população geral do nosso trabalho. Conclusão: O tratamento da capsulite adesiva com bloqueios seriados do nervo supraescapular se mostrou eficaz não apenas nos pacientes não diabéticos como também nos diabéticos.

Síndrome de parsonage-turner: relato de caso em paciente HIV soropositivo / Parsonage-turner syndrome: case report of a HIV seropositive patient

A síndrome de Parsonage-Turner é uma doença rara que acomete a musculatura da cintura escapular levando à hipotrofia muscular e grande déficit motor. A etiologia é indeterminada; acredita-se que existam fatores infecciosos e autoimunes envolvidos. O diagnóstico é de exceção, e os principais diagnósticos diferenciais são hérnias discais cervicais, lesões do manguito rotador e doenças reumáticas. Na investigação diagnóstica realizamos exames laboratoriais, radiografias e ressonância magnética dos ombros e da coluna cervical com destaque para a eletroneuromiografia auxiliando no diagnóstico definitivo. Por se tratar de uma doença raramente associada à soropositividade do vírus HIV e pela importância do diagnóstico precoce para o melhor tratamento destes pacientes é que relatamos este caso.

The Parsonage-Turner Syndrome is a rare disease that affects the muscles of the scapular girdle, leading to muscular atrophy and a large motor deficit. The etiology is unknown, but it is believed that infectious and autoimmune factors are involved. The diagnosis is made by exclusion, and the main differential diagnoses are cervical disc hernias, rotator cuff injuries and rheumatic diseases. During diagnostic research, we conducted laboratory tests, radiographs and MRI of the shoulder and cervical spine, with particular reference to electroneuromyography to help generate a definitive diagnosis. This case report is presented because it shows a disease that is rarely associated with HIV seropositivity and the importance of early diagnosis for better treatment of these patients.

Imaging assessment of the scapular girdle elastofibromas / Avaliação por imagem dos elastofibromas da cintura escapular

O elastofibroma dorsal, pseudotumor de partes moles com crescimento lento, tem sido cada vez mais lembrado no diagnóstico diferencial de dor escapular crônica, sendo também diagnosticado incidentalmente em exames de diagnóstico por imagem de rotina. Abordamos aqui o diagnóstico por imagem que pode começar pela radiografia convencional, mas é melhor caracterizado pelo ultrassom e pela ressonância magnética, sendo esta última a modalidade de escolha.

Elastofibroma dorsi, a slow-growing, soft-tissue pseudotumor has been more and more remembered in the differential diagnosis of chronic scapular pain. It has also been incidentally diagnosed in routine diagnostic imaging tests. Our approach here is the imaging diagnosis, which can start with the conventional X-ray, but is better characterized by the ultrasound and the magnetic resonance, the latter being the modality of choice.