RESUMO
BACKGROUND: Treatment options for irreparable cuff tears include synthetic interposition grafts, but whether such grafts can maintain acceptable shoulder function and prevent cuff tear arthropathy in the long-term is unknown. METHOD: This was a retrospective case series of 13 consecutive patients treated with a synthetic interposition graft made of Dacron (DuPont, Wilmington, DE, USA). Patients were examined with bilateral ultrasonography, bilateral x-ray imaging, Constant-Murley score, and Western Ontario Rotator Cuff score. RESULTS: After a mean of 18 years (range, 17-20 years), 1 patient had died, and 12 were available for x-ray imaging and 10 also for ultrasonography and clinical scores. Cuff tear arthropathy (Hamada grade ≥2) had developed in 9 of 12 (75%; 95% confidence interval, 43%-95%), including 3 patients operated on with arthroplasty in the follow-up period. The mean absolute Constant-Murley score was 46 (standard deviation, 26), and the mean Western Ontario Rotator Cuff score was 59 (standard deviation, 20). In 7 of 10 patients (70%) with available ultrasonography, the graft was interpreted as not intact. All patients had a contralateral full-thickness tear, and 7 of 12 patients (58 %; 95% confidence interval, 28%-85%) had contralateral cuff tear arthropathy. The number of patients with cuff tear arthropathy was not significantly different between the shoulder repaired with a Dacron graft and the contralateral shoulder (P = .667). CONCLUSION: These results indicate that a synthetic interposition graft with screw fixation could not prevent cuff tear arthropathy and preserve cuff integrity in a long-term perspective.
Assuntos
Artroplastia/instrumentação , Polietilenotereftalatos , Complicações Pós-Operatórias/epidemiologia , Lesões do Manguito Rotador/cirurgia , Artropatia de Ruptura do Manguito Rotador/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Artroplastia/efeitos adversos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico por imagem , Radiografia , Estudos Retrospectivos , Lesões do Manguito Rotador/diagnóstico por imagem , Artropatia de Ruptura do Manguito Rotador/diagnóstico por imagem , Articulação do Ombro/cirurgia , Resultado do Tratamento , UltrassonografiaRESUMO
BACKGROUND: Long-term results regarding tear progression, arthropathy, and clinical scores of unrepaired rotator cuff tears are largely unknown. This study investigated whether the condition of the glenohumeral joint and rotator cuff had deteriorated at a minimum of 20 years after an acromioplasty without cuff repair and assessed the clinical results. METHODS: A retrospective analysis was conducted of a consecutive series of patients treated between 1989 and 1993 with acromioplasty without cuff repair due to subacromial pain and cuff tear. At follow-up results of x-ray, ultrasonography, and clinical scores were recorded. RESULTS: At a mean of 22 years (range, 21-25 years), 69 patients were available for follow-up with Western Ontario Rotator Cuff Index, Constant-Murley (CM) score, x-ray, and ultrasonography. Mean age at operation was 49 years (range, 19-69 years). There were 45 partial-thickness tears (PTT) and 24 full-thickness tears (FTT). Of 23 patients with FTT, 17 (74% with x-ray) had developed cuff tear arthropathy (Hamada ≥2) and 20 (87% with ultrasonography) had progressed in tear size. Mean relative CM in patients with FTT and cuff tear arthropathy was 62 (standard deviation [SD], 27), and the mean WORC was 58% (SD, 26%). In the 43 PTT patients, 3 (7% with x-ray) had developed cuff tear arthropathy and 16 (42% with ultrasonography) had tear progression. With PTT at follow-up, the mean relative CM was 101 (SD, 22), and the mean WORC was 81% (SD, 20%). CONCLUSIONS: After an acromioplasty, most unrepaired full-thickness tears will, in long-term, increase in size and be accompanied by cuff tear arthropathy changes. Most partial thickness tears remain unchanged; cuff tear arthropathy is rare, and clinical scores generally good.
Assuntos
Acrômio/cirurgia , Lesões do Manguito Rotador/diagnóstico por imagem , Artropatia de Ruptura do Manguito Rotador/diagnóstico por imagem , Articulação do Ombro/fisiopatologia , Dor de Ombro/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Progressão da Doença , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia , Estudos Retrospectivos , Lesões do Manguito Rotador/complicações , Lesões do Manguito Rotador/fisiopatologia , Artropatia de Ruptura do Manguito Rotador/etiologia , Artropatia de Ruptura do Manguito Rotador/fisiopatologia , Articulação do Ombro/diagnóstico por imagem , Fatores de Tempo , Ultrassonografia , Adulto JovemRESUMO
BACKGROUND AND PURPOSE: Few authors have considered the outcome after acute traumatic rotator cuff tears in previously asymptomatic patients. We investigated whether delay of surgery, age at repair, and the number of cuff tendons involved affect the structural and clinical outcome. PATIENTS AND METHODS: 42 patients with pseudoparalysis after trauma and no previous history of shoulder symptoms were included. A full-thickness tear in at least 1 of the rotator cuff tendons was diagnosed in all patients. Mean time to surgery was 38 (6-91) days. Follow-up at a mean of 39 (12-108) months after surgery included ultrasound, plain radiographs, Constant-Murley score, DASH score, and western Ontario rotator cuff (WORC) score. RESULTS: At follow-up, 4 patients had a full-thickness tear and 9 had a partial-thickness tear in the repaired shoulder. No correlation between the structural or clinical outcome and the time to repair within 3 months was found. The patients with a tendon defect at follow-up had a statistically significantly lower Constant-Murley score and WORC index in the injured shoulder and were significantly older than those with intact tendons. The outcomes were similar irrespective of the number of tendons repaired. INTERPRETATION: A delay of 3 months to repair had no effect on outcome. The patients with cuff defects at follow-up were older and they had a worse clinical outcome. Multi-tendon injury did not generate worse outcomes than single-tendon tears at follow-up.
Assuntos
Lesões do Manguito Rotador , Doença Aguda , Adulto , Fatores Etários , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Ortopédicos/métodos , Procedimentos Ortopédicos/reabilitação , Modalidades de Fisioterapia , Amplitude de Movimento Articular/fisiologia , Estudos Retrospectivos , Manguito Rotador/patologia , Manguito Rotador/cirurgia , Fatores de Tempo , Resultado do TratamentoRESUMO
BACKGROUND: A successful clinical result is reported in 75% to 85% of impingement patients after arthroscopic subacromial decompression. The result is maintained over time, but few studies have investigated the integrity of the rotator cuff in these patients. MATERIALS AND METHODS: Using ultrasonography, we examined the integrity of the rotator cuff in 70 patients 15 years after arthroscopic subacromial decompression. All patients had an intact rotator cuff at the index procedure. RESULTS: Tendons were still intact in 57 patients (82%), 10 (14%) had partial-thickness tears, and 3 (4%) had full-thickness tears. DISCUSSION: The total number of 18% tears (partial and full thickness) in this study, including patients clinically diagnosed with subacromial impingement at a mean age of 60 years, is unexpectedly low compared with 40% degenerative tears reported in asymptomatic adults of the same age. CONCLUSION: Arthroscopic subacromial decompression seems to reduce the prevalence of rotator cuff tears in impingement patients. This appears attributable to elimination of extrinsic factors such as mechanical wear and bursitis. The potential effect of surgery on intrinsic cuff degeneration is unknown, but intrinsic factors may explain tears still developing despite decompression. LEVEL OF EVIDENCE: Level III, therapeutic study.
Assuntos
Artroscopia/métodos , Descompressão Cirúrgica/métodos , Lesões do Manguito Rotador , Síndrome de Colisão do Ombro/cirurgia , Traumatismos dos Tendões/epidemiologia , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Estudos de Coortes , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Probabilidade , Estudos Retrospectivos , Medição de Risco , Manguito Rotador/diagnóstico por imagem , Distribuição por Sexo , Síndrome de Colisão do Ombro/diagnóstico por imagem , Traumatismos dos Tendões/prevenção & controle , UltrassonografiaRESUMO
INTRODUCTION: Pain management in patients with hip fractures is a major challenge for emergency care. The objective of this study was to evaluate whether the supplementation of pre-operative analgesia with low-dose fascia iliaca compartment block (FICB) compared with placebo would improve pain relief in patients with hip fractures. METHODS: A double-blind, randomized, controlled trial was conducted on 127 patients. At hospital admission, a low-dose FICB was administered to patients with hip fractures as a supplement to regular pre-operative analgesia. Patients with and without cognitive impairment were included. The instruments used were a visual analogue scale (VAS), a numerical rating scale and a tool for behavior related pain assessment. The primary endpoint was the change in reported pain on movement from hospital admission to two hours after FICB. RESULTS: The intervention group showed improved pain management by mean VAS score for pain on movement compared with the control group (p = 0.002). CONCLUSIONS: Our results support the use of low-dose FICB as a pain-relieving adjuvant to other analgesics when administered to patients with a hip fracture.
Assuntos
Fraturas do Quadril/cirurgia , Dor/prevenção & controle , Idoso , Analgésicos/administração & dosagem , Método Duplo-Cego , Serviços Médicos de Emergência , Feminino , Fraturas do Quadril/enfermagem , Humanos , Masculino , Bloqueio Nervoso , Enfermagem Ortopédica , Dor/enfermagem , Medição da Dor , Período Pré-Operatório , Estudos Prospectivos , Resultado do TratamentoRESUMO
A consecutive series of 181 patients with clinical signs of subacromial impingement underwent arthroscopic subacromial decompression (ASD). All patients had the same surgical procedure, and all pathological findings at the arthroscopy were recorded. Ten to 13 years (mean, 11.2) after the procedure, 162 patients (91%) were available for follow-up consisting of clinical examination and the Constant-Murley and DASH scores. The overall mean value of the age correlated Constant score was 77 points. Men had significantly better Constant score than women. The state of the rotator cuff at the index procedure was found to affect the outcome significantly. Patients with isolated full-thickness supraspinatus tears had the best results, followed by those with partial tears, intact cuffs, or large tears involving more than 1 tendon. ASD in the treatment of subacromial impingement yields good long-term results. Small full-thickness supraspinatus tears had the best results, indicating that the ASD might prevent further cuff deterioration and that repair of these lesions may be unnecessary.
Assuntos
Artroscopia , Descompressão Cirúrgica , Manguito Rotador/cirurgia , Síndrome de Colisão do Ombro/cirurgia , Adulto , Idoso , Feminino , Seguimentos , Humanos , Artropatias/cirurgia , Masculino , Pessoa de Meia-Idade , Lesões do Manguito RotadorRESUMO
This study was designed to investigate human surgical specimens from patients with impingement (n = 16), ruptured supraspinatus tendons (n = 7), frozen shoulder (n = 2) and controls (n = 9) with respect to histological changes and the presence of fibronectin and Matrix metalloprotease-1 (MMP-1). The biopsy of the middle part of the supraspinatus tendons was analyzed microscopically after staining with hematoxyline eosin, Van Giesons hematoxyline and Phospho Tungstic Acid Hematoxyline for visualization of fibrin. Immunofluorescent stainings for fibronectin and MMP-1 were performed. Histology and immunofluorescence were assessed blindly. Necrotic tendinous tissue and fibrin were found only in some specimens from ruptures. The staining for fibronectin was significantly increased among patients with a rupture. MMP-1 was, however, only infrequently found in specimens from patients with impingement and ruptures. Fibrosis and thinning of fascicles seemed to be a more non-specific finding, appearing in control, impingement and rupture specimens. In conclusion, necrotic tendinous tissue, fibrin and fibronectin appear to be signs of tendon degeneration, whereas fibrosis and thinning of fascicles were found also in controls.
Assuntos
Fibronectinas/análise , Metaloproteinase 1 da Matriz/análise , Manguito Rotador/química , Manguito Rotador/patologia , Síndrome de Colisão do Ombro/patologia , Adulto , Biópsia , Fibrose , Imunofluorescência , Humanos , Necrose , Ruptura Espontânea/patologiaRESUMO
The purpose of this study was to investigate the incidence and prevalence of injuries among elite weight lifters and power lifters, with a special focus on shoulder injuries and possible injury-provoking exercises. In 1995, a questionnaire was administered to 110 male and female elite lifters to evaluate injuries and training characteristics. A follow-up of the athletes from 1995 was conducted in 2000, and a new 2000 elite group was also queried. In 1995 and again in 2000, the athletes sustained, on average, 2.6 injuries per 1000 hours of activity. Most common in 1995 were low back injuries, with an injury rate of 0.43 per 1000 hours, and shoulder injuries, with a rate of 0.42 per 1000 hours. Shoulder injuries dominated in 2000, with an injury rate of 0.51 per 1000 hours of activity. There was a difference in injury pattern between weight lifters, who mostly sustained low back and knee injuries, and power lifters, in whom shoulder injuries were most common. No correlation was found between shoulder injuries and any specific exercise. Although the total injury rate was the same during the two periods of study, the rate of shoulder injuries had increased.
Assuntos
Levantamento de Peso/lesões , Adulto , Traumatismos em Atletas/epidemiologia , Estudos Transversais , Feminino , Humanos , Incidência , Masculino , Prevalência , Suécia/epidemiologiaRESUMO
PURPOSE: The purpose of this study was 2-fold: to document the accuracy of a new measuring device and to intraoperatively compare the subacromial distance between controls and patients with impingement syndrome before and after arthroscopic subacromial decompression (ASD). TYPE OF STUDY: Clinical study. METHODS: When performing an ASD, it is important that bone resection is adequate. Today the correct subacromial distance after bone resection is only assessed by eye, directly or indirectly. The subacromial distance was measured between the anterolateral corner of the acromion and the supraspinatus tendon in the lateral decubitus position. The device was inserted 2 to 3 cm below the anterolateral acromion. There was no subacromial pathology among the controls (n = 15, mean age, 28 years). In 30 patients with impingement syndrome (average age, 53 years) an ASD was performed. The subacromial distance was measured after bursectomy and then after bone resection. Intraindividual and interindividual assessment was performed. RESULTS: The mean value of the subacromial distance in controls was 16 mm, the 95% confidence limits between 14 and 18 mm. The mean value in the group of patients with impingement syndrome was 8 mm before and 16 mm after the decompression. Due to the pressure within the subacromial space, the subacromial distance increased 1 mm. Intraindividual measurements never varied more than 1 mm (n = 5). The correlation coefficient between the measurements by both authors was 0.99. CONCLUSIONS: In this study, we assessed and described the use of a measuring device that enables the surgeon to quantify the subacromial distance before and after bone resection. After bone resection, the mean value of the subacromial distance was well within the control values. The amount of bone resected varied from 5 to 13 mm. This new device enables documentation in clinical work as well as in research.
Assuntos
Articulação Acromioclavicular/cirurgia , Acrômio/anatomia & histologia , Artroscopia/métodos , Descompressão Cirúrgica/métodos , Monitorização Intraoperatória , Manguito Rotador/anatomia & histologia , Síndrome de Colisão do Ombro/cirurgia , Articulação Acromioclavicular/anatomia & histologia , Adulto , Pesos e Medidas Corporais/instrumentação , Pesos e Medidas Corporais/métodos , Feminino , Humanos , Masculino , Síndrome de Colisão do Ombro/patologia , Instrumentos CirúrgicosRESUMO
BACKGROUND AND AIM: Hip fracture is a leading cause of mortality, morbidity, and disability in older people. The aim of the present study was to prospectively assess the development of physical performance in patients with hip fracture after surgery. SETTING: Prospective, observational study in a Swedish university hospital. METHODS: Assessment of 102 consecutive patients (65 females), with a mean age of 82 years (range 35-98) without specific inclusion or exclusion criteria. Seven physical functions were assessed using the following 4 measuring methods and 3 rating scales at baseline 7 to 10 days after surgery and follow-up after 4 months (F4): 10-m habitual walking speed (HWS), timed up and go (TUG), 30-second chair stand test (CST), handgrip strength (HGS), Berg balance scale (BBS), functional ambulation category (FAC), and general mobility. RESULTS: The 47% dropout patients were significantly older and more often lived alone or in nursing homes and used indoor walking aids. At baseline, the mean HWS was 0.4/0.5 (females/males) m/s; TUG 53/30 s; CST 4/5 kg, and HGS 17.4/31.2 kg. The medians of BBS and FAC were 20/20 and 4/4, respectively. There were significant mean improvements at F4 for all 4 measured functions, except for HGS in males but for neither of the rating scales. There was a large heterogeneity in all assessed variables, both at baseline and regarding change at 4 months. Therefore, the mean/median results are depicted in figures, showing all individual results at baseline and F4, compared to reference values and discussed in relation to degree of improvement. CONCLUSION: The observed large heterogeneity at baseline as well as F4 makes it essentially meaningless to report means and median data of functional assessment of patients with hip fracture. There is a strong need for individualization in both health analysis and how the treatment program is targeted, carried through, and evaluated over time in patients with hip fracture.
RESUMO
BACKGROUND: Hip surgery is associated with the risk of postoperative urinary retention. To avoid urinary retention hip surgery patients undergo urinary catheterisation. Urinary catheterisation, however, is associated with increased risk for urinary tract infection (UTI). At present, there is limited evidence for whether intermittent or indwelling urinary catheterisation is the preferred choice for short-term bladder drainage in patients undergoing hip surgery. OBJECTIVES: The aim of the study was to investigate differences between intermittent and indwelling urinary catheterisation in hip surgery patients in relation to nosocomial UTI and cost-effectiveness. DESIGN: Randomised controlled trial with cost-effectiveness analysis. SETTING: The study was carried out at an orthopaedic department at a Swedish University Hospital. METHODS: One hundred and seventy hip surgery patients (patients with fractures or with osteoarthritis) were randomly allocated to either intermittent or indwelling urinary catheterisation. Data collection took place at four time points: during stay in hospital, at discharge and at 4 weeks and 4 months after discharge. RESULTS: Eighteen patients contracted nosocomial UTIs, 8 in the intermittent catheterisation group and 10 in the indwelling catheterisation group (absolute difference 2.4%, 95% CI -6.9-11.6%) The patients in the intermittent catheterisation group were more often catheterised (p<0.001) and required more bladder scans (p<0.001) but regained normal bladder function sooner than the patients in the indwelling catheterisation group (p<0.001). Fourteen percent of the patients in the intermittent group did not need any catheterisation. Cost-effectiveness was similar between the indwelling and intermittent urinary catheterisation methods. CONCLUSIONS: Both indwelling and intermittent methods could be appropriate in clinical practice. Both methods have advantages and disadvantages but by not using routine indwelling catheterisation, unnecessary catheterisations might be avoided in this patient group.
Assuntos
Análise Custo-Benefício , Quadril/cirurgia , Cateterismo Urinário/métodos , Humanos , Anos de Vida Ajustados por Qualidade de Vida , Suécia , Resultado do Tratamento , Cateterismo Urinário/efeitos adversos , Cateterismo Urinário/economia , Infecções Urinárias/epidemiologia , Infecções Urinárias/prevenção & controleRESUMO
BACKGROUND: The diagnosis of Sever's injury (apophysitis calcanei) has previously been partly based on radiographic findings in the calcaneal apophysis. Sclerosis and fragmentation have been supposed to represent signs of inflammation due to tractions from the Achilles tendon. The clinical findings, diagnostic criteria, and studied population are often poorly defined. We sought to define diagnostic criteria by analyzing clinical and radiographic characteristics in a population with Sever's injury and to compare the findings with those of a control group of matched, symptom-free children. METHODS: We assessed 30 consecutive children with Sever's injury with high levels of pain but high physical activity levels in sports activities and 15 pain-free matched controls. RESULTS: One-leg heel standing showed 100% sensitivity; the squeeze test, 97%; and the palpation test, 80%. All three tests showed 100% specificity. All of the patients and controls showed increased density of the apophysis. Half of the pain-free controls showed fragmentation versus almost 90% of children with heel pain. CONCLUSIONS: The diagnosis of Sever's injury is clinical, not radiologic. Radiologic findings of increased density and fragmentation are found also in pain-free controls with high levels of physical activity and may, therefore, represent normal growth and development. We suggest that the diagnosis of Sever's injury should be based on patient history and the results of two specific clinical tests.
Assuntos
Calcâneo/lesões , Esporão do Calcâneo/diagnóstico por imagem , Calcâneo/diagnóstico por imagem , Criança , Diagnóstico Diferencial , Feminino , Esporão do Calcâneo/fisiopatologia , Humanos , Masculino , Atividade Motora , RadiografiaRESUMO
6 patients with symptomatic nonunion of midshaft clavicular fractures were treated by internal fixation with an intramedullary cancellous screw and autologous cancellous bone grafting. At follow-up after median 21 (12-72) months, all nonunions had healed. The Constant score was median 98 (57-100) points. 1 patient, with shortening of the clavicle, had poor function.