Evaluation of isometric strength and fatty infiltration of the subscapularis in latarjet surgery.

OBJECTIVE: To evaluate the function of the subscapularis muscle by means of isometric strength, clinical examination and analysis of fatty infiltration in patients with recurrent anterior dislocation of the shoulder undergoing Latarjet-Patte surgery. METHODS: 38 patients operated from March 2011 to March 2012, with minimum follow-up of two years were evaluated, being 26 males and 12 females, with a mean age of 28.7 years old. Isometric strength was measured using a portable dynamometer and measuring the distance from the back of the hand during the lift-off test. We used the Rowe and Walch-Duplay scores for clinical evaluation. The degree of fatty infiltration of the subscapularis belly was assessed by computed tomography. RESULTS: The mean scores in the Walch-Duplay and Rowe were 84.7 and 89.4, respectively. The mean distance to the back of the hand was 7.34 cm on the operated side and 8.72 cm on the opposite side (p <0.0001). The mean strength measured in the lift-off test was 0.38 kg lower than on the contralateral side (p = 0.001). There was no fatty infiltration of the subscapularis in 16 patients (42.1%). Sixteen patients (42.1%) were classified as Goutallier grade 1 and six (15.8%) as grade 2. We found that the measured isometric strength decreases with increasing the degree of fatty infiltration (p <0.0001). CONCLUSIONS: The decrease in subscapularis strength, albeit of low magnitude (0.38 kg), was directly related to the degree of fatty infiltration and worse clinical outcomes. Level of Evidence III, Therapeutic Study - Investigating the Results of Treatment.

Parsonage-Turner syndrome.

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.

OBJETIVO: Descrever os achados clínicos, eletrofisiológicos e de imagem na síndrome de Parsonage­Turner 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.

COMPARATIVE MACROSCOPIC STUDY OF OSTEOCHONDRAL DEFECTS PRODUCED IN FEMURS OF RABBITS REPAIRED WITH BIOPOLYMER GEL CANE SUGAR.

OBJECTIVE: To study the surface, coloring, consistency, continuity and healing of osteochondral defects produced in the femoral condyles of rabbits and filled with sugar cane biopolymer gel (SCBG), after 90, 120 and 180 days, and in comparison with a control group. METHOD: Sixteen adult New Zealand white rabbits aged 6 to 7 months, weighing between 2 and 2.5 kg and without locomotor system abnormalities were studied. In all the animals, a defect was made in the femoral condyles of the right and left knees, measuring 3.2 mm in diameter and 4 mm in depth, using a trephine. The animals were divided into two groups: study group formed by the right knees, in which the medial and lateral condyles received implants of SCBG; and control group formed by the left knees, in which the medial and lateral condyles were allowed to heal naturally. The knees were assessed 90, 120 and 180 days after the operation. After the animals had been sacrificed, the anatomical specimens were resected and placed in Bouin's solution. They were then photographed with a Nikon Coolpix 5400(®) coupled to a Nikon SM2800(®) stereoscopic loupe, to analyze the surface, coloring, consistency, continuity and healing. RESULTS: The results were evaluated using the chi-square test. There were no significant differences in the macroscopic assessments of healing between the study and control groups. CONCLUSION: With regard to the surface, coloring, consistency, continuity and healing of the defects, the macroscopic appearance of the tissue repaired with SCBG was similar to that of the control group.

Freqüência de malformações congênitas das extremidades em recém-nascidos / Frequency of congenital malformations of the extremities in newborns

As malformações congênitas constituem alterações de estrutura, função ou metabolismo presentes ao nascer, que resultam em anomalias físicas ou mentais, podendo ou não ser simples ou múltiplas e de maior ou menor importância clínica. O objetivo é de analisar a frequência de malformações congênitas das extremidades em maternidades da cidade de Maceió. Realizou-se um estudo de coorte transversal prospectivo em 2500 recém-nascidos no período de julho de 2002 a junho de 2003, junto às maternidades Casa Maternal Santa Mônica, Hospital Memorial Arthur Ramos e Santa Casa de Misericórdia de Maceió. Foram excluídos os recém-nascidos em alto risco e casos de aborto. Cerca de 2,88 por cento dos recém-nascidos estudados apresentaram algum tipo de anomalia do aparelho locomotor. A anomalia maior mais frequente foi o pé torto equinovaro congênito e a anomalia menor de maior incidência foi o pé calcâneo valgo.

Congenital malformations are structural, functional or metabolic alterations present in birth that cause physical or cognitive anomalies; they may be simple or multiple and of major or minor clinical importance. We aimed to analyze the frequency of locomotor apparatus congenital anomalies (extremities) in maternities of the city of Maceió. A prospective cross-sectional cohort study was carried out with 2500 newborns between July 2002 and June 2003 in the maternities Casa Maternal Santa Mônica, Hospital Memorial Arthur Ramos and Santa Casa de Misericórdia de Maceió. Approximately 2.88 percent of the studied newborns presented some type of locomotor apparatus anomaly. The most frequent major anomaly was the equinovarus clubfoot and the most frequent minor anomaly was the valgus calcaneus foot. It is important to note that an early diagnosis improves the quality of life of this population.