Intra- and inter-rater reliability, agreement, and minimal detectable change of the handheld dynamometer in individuals with symptomatic hip osteoarthritis.

INTRODUCTION: The handheld dynamometer has been validated to measure muscle strength in different muscle groups. However, to date, it has not been tested in individuals who experience pain induced by hip osteoarthritis. The current study aimed to evaluate the intra- and inter-rater reliability, agreement, and minimal detectable change of the Lafayette handheld dynamometer, model 1165, to assess the peak force (Pk) and average peak force (Af) of hip muscles in individuals with symptomatic hip osteoarthritis. METHODS: Twenty participants with hip osteoarthritis (mean ± SD age: 58.7±15.3 years; body mass index: 28.8±4.2 kg/m2) and pain intensity on the Visual Analogue Scale ≥ 4 (8.05±1.2) were recruited to participate in this study. Pk and Af of hip flexors (seated position), abductors and adductors (supine position), and extensors (prone position) were collected in a single day by two independent raters, each one obtaining test and retest in randomly ordered separate sessions. RESULTS: The intra-rater intraclass correlation coefficient (ICC) was classified as good (>0.75) or excellent (≥0.90) for all muscle groups and all inter-rater ICCs were classified as excellent. Rater A had a lower standard error of measurement compared to rater B, ranging from 0.15 to 0.58 kilogram-force (Kgf) compared with 0.34 to 1.25 kg, respectively. However, the inter-rater comparison showed a minimal detectable change (MDC) of < 10% for all Pk and Af measures for hip adductors and extensors. Finally, the inter-rater Bland-Altman analysis demonstrated good agreement for abductors, adductors, and extensors. CONCLUSION: Despite pain and dysfunction related to hip osteoarthritis, the mean of two measures using a handheld dynamometer was shown to be a reliable tool to assess hip muscle strength, with good to excellent intra- and inter-rater ICCs, satisfactory agreement, and small values for MDC.

Radiographic evaluation of the glenohumeral joint space in patients undergoing arthroscopic shoulder surgery in the beach-chair position.

BACKGROUND: Shoulder arthroscopy can be performed with the patient in the lateral decubitus or beach-chair position, but in both cases, glenohumeral (GH) joint spaces must be increased to improve visualization and allow access of the optical instrument. The aim of this study was to determine the effects of limb setup and longitudinal traction on the opening of the GH space with patients placed in the beach-chair (dorsal decubitus) position. METHODS: GH spaces at 3 test points corresponding to the anatomic locations of Bankart lesions were determined indirectly from radiographic images obtained from 67 patients presenting shoulder pathology with an indication for arthroscopic surgery. Measurements were made with the operative limb in neutral rotation and positioned in relation to the coronal plane in adduction, 45° of abduction, or adduction with an axillary spacer, in each case with and without longitudinal traction. RESULTS: GH spaces were optimized at 2 of 3 test points when the operative limb was positioned in adduction or neutral rotation and manual longitudinal traction was applied with or without a polystyrene spacer placed under the axilla, but use of the spacer was essential to maximize the GH space at all 3 locations. In contrast, 45° of abduction proved to be the least appropriate position because it afforded the smallest GH space values with or without traction. CONCLUSION: Appropriate positioning of the patient on the operating table is a critical aspect of shoulder arthroscopy. Radiographic images revealed that adducted upper-limb traction with the use of an axillary spacer in patients in the beach-chair position generates a significant increase in the GH space in the lower half of the glenoid cavity, thereby facilitating visualization and access of the optical equipment to the GH compartments.

Cirurgia para controle de danos: breve revisão / Damage control surgery: a brief review

A cirurgia de controle de dano é processo de preservação do paciente politraumatizado. É concebida como método cirúrgico que surgiu com a necessidade de restaurar a fisiologia normal do paciente vítima de múltiplos traumas e o objetivo de reduzir a mortalidade relacionada ao tratamento cirúrgico definitivo. A "tríade da morte", caracterizada por hipotermia, acidose metabólica e coagulopatia, é a perturbação fisiológica temida na abordagem cirúrgica de politraumatizados. A melhora nas taxas de sobrevida após o advento da cirurgia de controle de danos, entretanto, ainda convive com taxas de mortalidade, em torno de 50%. É procedimento dispendioso e que exige preparação dos centros e equipes que irão receber esses pacientes. Dessa maneira, muitos estudos têm especulado a possibilidade de predizer a evolução de pacientes candidatos a esse tipo de intervenção, a fim de evitar a aplicação de procedimento tão dispendioso em pacientes sem chances de sobreviver. (AU)

The Damage Control Surgery is a process for the preservation of the polytraumatized patient. It was developed due to the need for restore the physiology of such patients back to their normal condition, in order to reduce the mortality rates related to the definitive surgical approach. The "triad of death" hypothermia, acidosis and coagulopathy is a major threat concerning the surgical approach for the trauma patients. Despite the improvements on the survival rates following the introduction of the Damage Control Surgery, the published data show mortality rates circa 50%. Moreover, it is a costly intervention which demands well-prepared teams and trauma centers. Thus, many studies have sought the capacity of predicting the outcome of patients candidates to this procedure, in order to avoid excessive spending with patients who have no chance of survival. (AU)