Glenoid Bone Loss - A Retrospective Evaluation of Functional Outcomes after Bone Block Surgery for Anterior Shoulder Instability in High-demand Athletes / Falha óssea na glenoide - Uma avaliação retrospectiva dos desfechos funcionais após cirurgia de bloqueio ósseo para instabilidade anterior do ombro em atletas de alta demanda

Abstract Objective This study assesses the relationship between the glenoid bone loss size and range of motion, functional outcomes, and complications in high-performance athletes undergoing bone block surgery for anterior shoulder instability. Methods This retrospective study evaluated postoperative outcomes in athletes submitted to bone block surgery for anterior shoulder instability. In 5 years, 41 shoulders underwent the procedure; 20 had bone losses up to 15%, and 21 shoulders presented bone losses ranging from 15% and 25%. Results There was no statistically significant difference regarding postoperative complications, new dislocations, and the rate of return to sports. In addition, the quantitative criteria evaluated, i.e., ranges of motion and functional scores, showed no statistically significant difference between groups. Conclusion The size of the bone loss per se does not seem to affect functional outcomes and complications from these procedures, which are safe techniques for small and large bone losses.

Resumo Objetivo Avaliar a relação do tamanho do defeito ósseo da glenoide no arco de movimento, nos resultados funcionais e nas complicações em pacientes atletas de alta performance submetidos a cirurgia de bloqueio ósseo para instabilidade anterior do ombro. Método Estudo retrospectivo no qual foram avaliados os resultados pós-operatórios de atletas submetidos a cirurgia de bloqueio ósseo para instabilidade anterior do ombro. Em 5 anos foram 41 ombros operados, sendo 20 deles com até 15% de defeito ósseo e 21 com defeitos entre 15% e 25%. Resultados Não houve diferença estatisticamente significativa com relação a complicações pós-operatórias, novas luxações, e na taxa de retorno ao esporte. Os critérios quantitativos avaliados - arcos de movimento e escores funcionais - também não apresentaram diferença estatisticamente significativa entre os grupos. Conclusão O tamanho do defeito ósseo por si só não parece afetar os resultados funcionais e as complicações desses procedimentos, sendo uma técnica segura tanto para defeitos pequenos, quanto para os maiores.

Incidence and Risk Factors of the Complications Related to the Latarjet Surgery / Incidência e fatores de risco das complicações da cirurgia de Latarjet

Abstract Objective The Latarjet procedure is a well-accepted treatment of shoulder instability. This technique is associated with a unique set of complications with overall rates of up to 30%. The purpose of the present study was to investigate the incidence and risk factors associated with complications after open Latarjet procedure. Methods We retrospectively reviewed 102 patients submitted to open Latarjet procedure. Complications were divided into three types: clinical; graft-related; and screw-related. All of the patients were submitted to radiography and computed tomography (CT). The risk factors analyzed were gender, age, previous surgery, epilepsy, experience of the surgeon. Results A total of 102 consecutive patients (108 cases) underwent the Latarjet procedure. The mean age was 33.7 years old (18 to 61 years old), with 88 males and 14 females. The overall complication rate was 21.2%, being 12% clinical-related, 7.4% graft-related, and 2.7% screw-related. The most frequent were anterior apprehension (eight cases) and lateral overhang of the graft in six patients. Computed tomography scan at a minimum of 6 months was performed in 79 cases (73%), and graft union occurred in 75 patients (94.9%). There were no cases of instability in the remaining four cases of nonunion. Ten patients (9.2%) required revision surgery. The risk factors associated with complications were epilepsy (p = 0.0325), experience of the surgeon (p = 0.0499) and patients ≥ 40 years old at the time of the surgery (p = 0.0151). There was no correlation with gender and previous surgery. Conclusion The complication rate following the Latarjet procedure was 21.2%, with 9% requiring revision surgery. Epilepsy, age ≥ 40 years old and experience of the surgeon were risk factors.

Resumo Objetivo A cirurgia de Latarjet é bem estabelecida para o tratamento da instabilidade anterior do ombro. Apresenta complicações específicas com taxas de até 30%. Nosso objetivo é avaliar a incidência e os fatores de risco associados às complicações após a cirurgia de Latarjet. Métodos Analisamos retrospectivamente 102 pacientes submetidos ao procedimento. Dividimos as complicações em três tipos: clínicas, relacionadas ao enxerto e relacionadas aos implantes. Todos os pacientes foram submetidos a radiografias e tomografia computadorizada (TC). Os fatores de risco analisados foram gênero, idade, cirurgia prévia, epilepsia e experiência do cirurgião. Resultados Um total de 102 pacientes consecutivos (108 casos) foram avaliados. A média de idade foi 33,7 anos (18 a 61 anos), com 88 homens e 14 mulheres. A taxa de complicações foi de 21,2%, sendo 12% clínicas, 7,4% relacionadas ao enxerto e 2,7% relacionadas ao implante. As mais frequentes foram apreensão anterior (oito casos) e posicionamento lateral do enxerto, em seis casos. A TC foi realizada com o mínimo de 6 meses em 79 casos (73%), evidenciando a consolidação do enxerto em 75 pacientes (94.9%). Nenhum caso de não união apresentou instabilidade. Dez pacientes (9.2%) precisaram de cirurgia de revisão. Os fatores de risco relacionados às complicações foram epilepsia (p = 0.0325), experiência do cirurgião (p = 0.0499) e pacientes ≥ 40 anos (p = 0.0151). Não houve correlação com gênero e cirurgia prévia. Conclusão A taxa de complicações após a cirurgia de Latarjet foi de 21,2%, com 9% necessitando de revisão cirúrgica. Epilepsia, idade ≥ 40 anos e experiência do cirurgião foram fatores de risco.

Signos y síntomas en niños y adolescentes con hipermovilidad articular: un estudio transversal cuantitativo observacional / Signs and symptoms in children and adolescents with joint hypermobility: an observational, quantitative cross-sectional study

Contexto y Objetivo: La hipermovilidad articular (HA) puede representar el ex-tremo del rango normal de movimiento o condición para un grupo de trastornos hereditarios del tejido conectivo, con una variación de 2-64.6% en diferentes poblaciones. El objetivo fue caracterizar la asociación entre HA con las manifestaciones en forma de signos y síntomas.Tipo de Estudio y Ajuste: Estudio transversal cuantitativo observacional en un hospital universitario público.Métodos: Estudio con niños y adolescentes entre 5 y 16 años, de ambos sexos, en asistencia multiprofesional en la clínica ambulatoria de HA y SED en el Hospital Base de São José do Rio Preto y en la Unidad del Proyecto "Gato de Botas", en colaboración con FAMERP. Se utilizó un cuestionario para registrar datos y análisis realizados en base a cálculos de medidas de tendencia central, dispersión y conteos de frecuencia.Resultados: El puntaje 4 obtuvo la frecuencia más alta (45,61%), seguido del puntaje 6 (21,05%). Las manifestaciones musculoesqueléticas y extraesqueléticas fueron frecuentes. La variable de hiperextensión del quinto dedo >90º fue la variable con mayor incidencia, seguida de la aposición del pulgar al tocar la región flexora del antebrazo.Conclusiones: Entre los niños y adolescentes con HA, la mitad o más presentaron manifestaciones musculoesqueléticas o extraesqueléticas.

Background and Aim: Joint hypermobility (JH) may be the extreme of the normal range of motion or a condition for a group of hereditary connective tissue disorders, with a prevalence rate of 2 to 64.6% in different populations. The aim of the present study was to characterize the association between JH and manifestations in the form of signs and symptoms. Study Type and Setting: An observational, quantitative, cross-sectional study was conducted at a public hospital. Methods: This study involved the participation of male and female children and adolescents aged five to 16 years under multidisciplinary care at the JH and Ehlers-Danlos syndrome clinic of the São José do Rio Preto Base Hospital and the "Gato de Botas" Project Unit in partnership with the São José do Rio Preto School of Medicine. A questionnaire was administered for the recording of the data, which were analyzed descriptively, with the calculation of central tendency and dispersion measures as well as the determination of frequencies.Results: Beighton score 4 was the most frequent (45.61%), followed by score 6 (21.05%). Musculoskeletal and extraskeletal manifestations were frequent. Hyperextension of the 5th finger > 90º had a higher occurrence, followed by the thumb touching the flexor region of the forearm. Conclusions: Among children and adolescents with hypermobility, half or more had musculoskeletal or extraskeletal manifestations.

Síndrome de Ehlers-Danlos hipermóvel: um relato de caso / Hypermobile Ehlers-Danlos syndrome: a case report

A síndrome de Ehlers-Danlos é estabelecida por distúrbios hereditários do tecido conjuntivo que tem como manifestações principais a hipermobilidade articular, a hiperextensibilidade da pele e a fragilidade de tecidos, como articulações, ligamentos, pele, vasos sanguíneos e órgãos internos. São reconhecidos 13 subtipos, de acordo com Classificação Internacional de 2017. Dentre estes, abordamos o hipermóvel, cujo diagnóstico é eminentemente clínico, com manifestações sistêmicas distintas. Esse artigo refere-se ao caso de uma paciente diagnosticada com síndrome de Ehlers-Danlos hipermóvel, tendo como intuito a atualização acerca dos novos critérios diagnósticos, assim como o diagnóstico precoce de tal raropatia.

Ehlers-Danlos syndrome is established through hereditary disorders of connective tissue, and has as its manifestations: joint hypermobility, skin hyperextensibility, and fragility of tissues such as joints, ligaments, skin, blood vessels, and internal organs. Thirteen subtypes have been recognized according to the 2017 International Classification. Among these, the hypermobile type, the diagnosis of which is eminently clinical, with distinct systemic manifestations, will be addressed. This article refers to the case of a patient diagnosed with hypermobile Ehlers-Danlos syndrome, with the objective of updating the new diagnostic criteria, as well as the early diagnosis of such a rare disease.

Influência da hipermobilidade articular generalizada sobre a articulação temporomandibular e a oclusão dentária: estudo transversal / Influence of generalized joint hypermobility on temporomandibular joint and dental occlusion: a cross-sectional study

RESUMO Objetivo Avaliar a oclusão dentária e a articulação temporomandibular de mulheres com e sem hipermobilidade articular generalizada. Método A hipermobilidade foi avaliada pelo Escore de Beighton, e as voluntárias foram distribuídas, conforme o escore obtido, em dois grupos: com e sem hipermobilidade. A articulação temporomandibular foi avaliada por meio do instrumento Critérios de Diagnóstico para Pesquisa de Desordens Temporomandibulares, e a avaliação oclusal compreendeu a classificação de Angle, presença de sobremordida, sobressaliência e mordida cruzada, padrão de desoclusão e interferências oclusais. Resultados 43 mulheres participaram voluntariamente da pesquisa, 17 no grupo com hipermobilidade e 26 no grupo sem hipermobilidade. A frequência de ruídos articulares e de desvio na abertura da boca foi maior no grupo com hipermobilidade (52,9% versus 38,5% e 76,5% versus 50%, respectivamente), sem diferença significante. Quanto à oclusão, nenhuma voluntária apresentou uma oclusão ideal e não se verificou diferença significativa na Classe de Angle entre os grupos. As alterações na oclusão obtiveram percentual maior no grupo com hipermobilidade (29,4% de sobremordida, 47,1% de sobressaliência e 17,6% de mordida cruzada), sendo que a mordida cruzada apresentou diferença estatística entre os grupos. Conclusão A hipermobilidade não influenciou a oclusão e as amplitudes de movimentos mandibulares nas mulheres avaliadas. Contudo, o maior percentual de ruídos articulares e de desvio não corrigido apresentado pelo grupo com hipermobilidade, mesmo sem diferença entre os grupos, pode constituir um indício de relação entre hipermobilidade e disfunção temporomandibular.

ABSTRACT Purpose To evaluate the dental occlusion and temporomandibular joint in women with and without generalized joint hypermobility. Methods Generalized joint hypermobility was assessed by the Beighton score. Individuals were divided into two groups: with and without hypermobility. The Research Diagnostic Criteria for Temporomandibular Disorders was used to evaluate the temporomandibular joint. Dental occlusion was assessed according to Angle classification, overjet and overbite measures, presence of open bite or crossbite, pattern of disocclusion, and occlusal interference. Results Forty-three women participated voluntarily in the study: 17 in the group with hypermobility and 26 in the group without hypermobility. The frequencies of joint noise and deviation during mouth opening were greater in the hypermobility group (52.9% vs. 38.5% and 76.5% vs. 50%, respectively), but without statistical significance. None of the volunteers presented ideal occlusion and no significant difference was found in Angle Class between the groups. The hypermobility group presented a higher percentage of changes in occlusion (29.4% of overbite, 47.1% of overjet, and 17.6% of crossbite), with crossbite showing statistical difference between the groups. Conclusion Hypermobility does not influence occlusion and range of mandibular motion in the women assessed. Nevertheless, the higher percentage of articular noise and uncorrected deviation during mouth opening shown by the group with hypermobility, even without statistical difference, may constitute evidence of correlation between hypermobility and temporomandibular disorder.

Síndrome de Ehlers-Danlos vascular: complicaciones vasculares graves en enfermos con hipermovilidad articular / Vascular Ehlers-Danlos syndrome: severe vascular complications in patients with articular hypermobility

El Síndrome de Ehlers-Danlos Vascular es una de las Alteraciones Hereditarias del Tejido Conectivo. Es poco frecuente, pero es de alta morbilidad y mortalidad. Se debe a una mutación del gen COL3A1, que da debilidad del tejido colágeno, por lo que se pueden producir complicaciones graves afectando a la piel, tubo digestivo, hígado, pulmón y sistema vascular. Se pueden producir rupturas intestinales, neumotórax espontáneo, dilatación o ruptura aortica y anuerismas, lo que puede llevar a la muerte súbita del paciente.

The Vascular Ehlers-Danlos is one of Hereditary Diseases of Connective Tissue. Has low prevalence, but high morbidity and mortality. It is due to a COL3A1 gene mutation, producing tissue fragility, which can produce serious complications in the skin, digestive tract, liver, lungs and in the vascular system. It is frequently associated to intestinal ruptures, spontaneous pneumothorax, dilation or rupture of the aorta anuerism, which can lead to sudden death.

Unstable Simple Elbow Dislocation Treated with the Repair of Lateral Collateral Ligament Complex

BACKGROUND: Unstable simple elbow dislocation (USED) repair is challenged by the maintenance of joint reduction; hence, primary repair or reconstruction of disrupted ligaments is required to maintain the congruency and allow early motion of the elbow. We evaluated the effectiveness and the outcome of lateral collateral ligament (LCL) complex repair with additional medial collateral ligament (MCL) repair in cases of USED. METHODS: We retrospectively reviewed 21 cases of diagnosed USED without fractures around the elbow that were treated with primary ligament repair. In all cases, anatomical repair of LCL complex with or without common extensor origin was performed using suture anchor and the bone tunnel method. Next, the instability and congruency of elbow for a full range of motion were evaluated under the image intensifier. MCL was repaired only if unstable or incongruent elbow was observed. Clinical outcomes were evaluated using the Mayo elbow performance score (MEPS) and radiographic outcomes on last follow-up images. RESULTS: All cases achieved a stable elbow on radiographic and clinical results. LCL complex repair alone was sufficient to obtain the stable elbow in 17 of 21 cases. Four cases required additional MCL repair after restoration of the LCL complex. The overall mean MEPS was 91 (range, 70 to 100): excellent in 12 cases, good in 7 cases, and fair in 2 cases. All 17 cases with LCL complex repair only and 2 of 4 cases with additional MCL repair had excellent or good results by MEPS. CONCLUSIONS: USED requires surgical treatment to achieve a congruent and stable joint. If the repair of lateral stabilizer such as LCL complex acquires enough joint stability to maintain a full range of motion, it may not be necessary to repair the medial stabilizer in all cases of USED.

Síndrome de hipermovilidad articular benigna: manifestaciones musculoesqueléticas en pie y tobillo / Benign joint hypermobility syndrome: musculoskeletal manifestations in foot and ankle

The hypermobility syndrome benign joint (SHAB) is an inherited disorder that refers to the presence of a greater range of joint mobility associated with musculoskeletal symptoms, such as joint pain, muscle pain, soft tissue injury and non-inflammatory limb pain without coexistence of other systemic rheumatic disease. For the identification of joint hypermobility 1973 Beighton criteria used and the criteria for Brighton SHAB 1998. The joints most commonly affected are knees (87 percent), hip (77 percent), ankle (74 percent) and feet (72 percent). The latter two regions have received little attention. The foot problems include pain in the Achilles tendon, plantar fasciitis, tenosynovitis of the posterior tibial or peroneal, flexor and extensor tendinopathy, bursitis and hallux valgus. For diagnosis, the physical exam and ancillary studies such as ultrasound and MRI to detect changes that are not evident in the observation is used...

El síndrome de hipermovilidad articular benigna (SHAB) es un trastorno hereditario que se refiere a la presencia de un mayor rango de movilidad articular asociado a síntomas musculoesqueléticos, como son artralgias, dolor muscular, lesión de tejidos blandos y dolor no inflamatorio de extremidades, sin coexistencia de otra enfermedad reumática sistémica. Para la identificación de hipermovilidad articular se utilizan los criterios de Beighton 1973, y para SHAB, los criterios de Brighton 1998. Las articulaciones con mayor afección son rodillas (87 por ciento), cadera (77 por ciento), tobillo (74 por ciento) y pies (72 por ciento). Los problemas en el pie incluyen dolor en el tendón de Aquiles, fascitis plantar, tenosinovitis del tibial posterior o peroneos, tendinopatía de flexores y extensores, bursitis y hallux valgus. Para su diagnóstico se emplean el examen físico y estudios complementarios como ultrasonido y resonancia magnética que permitan detectar cambios que no son evidentes en la observación...

Temporomandibular disorder and generalized joint hypermobility: application of diagnostic criteria / Disfunção têmporo-mandibular e hipermobilidade articular generalizada: aplicação de critérios diagnósticos

Generalized joint hypermobility (GJH) has been considered a predisposing factor for the development of temporomandibular disorder (TMD). AIM: To evaluate clinical and psychosocial aspects in individuals diagnosed with TMD with or without GJH. MATERIALS AND METHODS: Clinical and experimental study, which enrolled 34 women, from 18 to 35 years of age with TMD diagnosed by RDC/TMD. The GJH was assessed by the Beighton score and volunteers were broken down into 2 groups: with GJH (n = 22) and without GJH (n = 12). RESULTS: We found a high percentage of GJH (64. 71 percent). All participants had myofascial pain; 79. 41 percent had arthralgia and 41 percent had disk displacement. There was a correlation between higher GJH scores and higher passive mouth opening amplitude (p=0. 0034), with pain (p=0. 0029) and without pain (p=0. 0081). Greater mandibular range of motion was observed in the group with GJH, except for protrusion. Painful mouth opening was statistically higher in the GJH group (p=0. 0279). CONCLUSIONS: Individuals with TMD associated or not to GJH do not differ significantly regarding clinical and psychosocial aspects, except in the mandibular opening range of motion, which if kept at physiological levels can lead to a late diagnosis of TMD in these individuals.

A hipermobilidade articular generalizada (HAG) é uma condição sistêmica considerada como fator contribuinte para o desenvolvimento de sinais e sintomas da disfunção têmporo-mandibular (DTM). OBJETIVO: Avaliar aspectos clínicos e psicossociais de indivíduos com DTM associada ou não à HAG. Material e Método: Consistiu de um estudo clínico e experimental do qual participaram 34 mulheres, com idades entre 18 e 35 anos, diagnosticadas com DTM pelos Critérios diagnósticos para pesquisa em DTM (RDC/TMD). A HAG foi avaliada pelo Escore de Beighton e os voluntários divididos em 2 grupos: com HAG (n=22) e sem HAG (n=12). RESULTADOS: Verificou-se elevado percentual de HAG (64,71 por cento). Todos os participantes apresentaram dor miofascial, 79. 41 por cento artralgia e 41 por cento desordens discais. Houve correlação entre maiores escores de HAG e maior amplitude de abertura bucal passiva (p=0,0034), com (p=0,0029) e sem dor (p=0,0081). Observaram-se maiores amplitudes de movimento mandibular no grupo com HAG, exceto para a protrusão. A abertura com dor foi significativamente maior no grupo hipermóvel (p=0,0279). CONCLUSÕES: Indivíduos com DTM associada ou não à HAG não diferem significativamente quanto aos aspectos clínicos e psicossociais avaliados, exceto quanto à amplitude de abertura mandibular, cuja manutenção em níveis fisiológicos pode levar ao diagnóstico tardio de DTM nestes indivíduos.

Prevalência das lesões associadas na luxação recidivante traumática do ombro / Prevalence of lesions associated with traumatic recurrent shoulder dislocation

OBJETIVO: Avaliar a prevalência das lesões associadas à instabilidade anterior traumática do ombro e a relação entre o número de episódios e o tempo do início dos sintomas com a prevalência destas lesões. MÉTODO: Foram selecionados 57 pacientes com instabilidade anterior traumática do ombro, entre 18 e 40 anos, com mais de um episódio de luxação do ombro e com no mínimo, seis meses da primeira luxação, que necessitaram de cirurgia para tratamento da instabilidade. Foi realizada inspeção artroscópica em todos os pacientes para avaliação das lesões associadas. RESULTADOS: Foi avaliada a prevalência das lesões, sendo a lesão de Bankart a mais prevalente seguida pela lesão de Hill-Sachs e as lesões do manguito rotador as menos prevalentes. Não houve correlação comparando o número de episódios de luxação com a prevalência de lesões associadas. Já em relação ao tempo de sintomas, os pacientes com maior tempo de sintomas tiveram menos lesão de Hill-Sachs. CONCLUSÃO: Não foi possível afirmar que, em pacientes com instabilidade crônica do ombro, as lesões associadas aumentam com o tempo de sintomas ou com o número de episódios de luxação.

OBJECTIVE: To evaluate the prevalence of lesions associated with traumatic anterior shoulder instability and the relationships between the prevalence of these lesions and the number of episodes and time since symptoms started. METHOD: Fifty-seven patients aged 18 to 40 years, with traumatic anterior shoulder instability, more than one episode of shoulder dislocation and at least six months since the first dislocation, who required surgery to treat the instability, were selected. Arthroscopic inspection was performed on all the patients to assess any associated lesions. RESULTS: The prevalence of lesions was assessed, and Bankert lesions were the most prevalent, followed by Hill-Sachs lesions, while rotator cuff injuries were the least prevalent. There was no correlation from comparison between the number of episodes of dislocation and the prevalence of associated lesions. On the other hand, in relation to the time since symptoms started, the patients who had had symptoms for longer times had fewer Hill-Sachs lesions. CONCLUSION: It was not possible to affirm that, in patients with chronic shoulder instability, the numbers of associated lesions increased with the time since symptoms started, or with the number of episodes of dislocation.

Anterior Cruciate Ligament Reconstruction in Patients with Generalized Joint Laxity

Generalized joint laxity is a genetically determined component of overall joint flexibility. The incidence of joint laxity in the overall population is approximately 5% to 20%, and its prevalence is higher in females. Recently it was noticed that individuals with generalized joint laxity are not only prone to anterior cruciate ligament injuries but also have inferior results after a reconstruction. Therefore, an anterior cruciate ligament reconstruction in patients with generalized laxity should be undertaken with caution due to the higher expected failure rate from the complexity of problems associated with this condition. It is also necessary to identify the risk factors for the injury as well as for the post operative outcome in this population. A criterion that includes all the associated components is necessary for the proper screening of individuals for generalized joint laxity. Graft selection for an anterior cruciate reconstruction in patients with ligament laxity is a challenge. According to the senior author, a hamstring autograft is an inferior choice and a double bundle reconstruction with a quadriceps tendon-bone autograft yields better results than a single bundle bone-patella tendon-bone autograft. Future studies comparing the different grafts available might be needed to determine the preferred graft for this subset of patients. Improved results after an anterior cruciate ligament reconstruction can be achieved by proper planning and careful attention to each step beginning from the clinical examination to the postoperative rehabilitation.

Multidirectional Instability Accompanying an Inferior Labral Cyst

Paralabral cyst of the shoulder joint can be observed in 2% to 4% of the general population, particularly in men during the third and fourth decade. On average, these cysts measure 10 mm to 20 mm in diameter and are located preferentially on the postero-superior aspect of the glenoid. The MRI has increased the frequency of the diagnosis of paralabral cysts of the shoulder joint. Paralabral cysts of the shoulder joint usually develop in the proximity of the labrum. The relationship between shoulder instability and labral tears is well known, however, the association of shoulder instability with a paralabral cyst is rare. Shoulder instability may cause labral injury or labral injury may cause shoulder instability, and then injured tear develops paralabral cyst. In our patient, the inferior paralabral cyst may be associated with inferior labral tears and instability MRI.

Reliability of MRI Findings of Peroneal Tendinopathy in Patients with Lateral Chronic Ankle Instability

BACKGROUND: Patients with chronic lateral ankle instability also have peroneal tendinopathy often. However, preoperative MRIs of these patients are vague in many cases. Our study was performed to see the reliability of MRI findings of peroneal tendinopathy in patients with chronic lateral ankle instability. METHODS: MRI images for 82 patients who had chronic lateral ankle instability, and had received surgical treatment between March 2006 and November 2009 were compared with impressions from operating rooms. The mean age of patients was 36.4 years (range, 15 to 64 years), 82 ankles were studied, and patients with rheumatoid diseases were excluded from the study. RESULTS: Of the 82 cases, 26 were true positives, 38 true negatives, 13 false positives and 5 false negatives. Of 39 cases of peroneal tendinopathy diagnosed from MRI, 14 had peroneal tendon partial tears, 15 tenosynovitis, 3 dislocations, 17 low-lying muscle bellies, and 6 peroneus quartus muscles. Of 31 cases of peroneal tendinopathy observed in surgery 11 had peroneal tendon partial tears, 4 tenosynovitis, 5 dislocations, 12 low-lying muscle belliess, and 1 peroneus quartus muscle. Sensitivity and specificity of peroneal tendinopathy were 83.9% and 74.5%, respectively. Positive predictive value was 66.7%. Negative predictive value was 88.4%. Accuracy rate was 78.0%. CONCLUSIONS: MRI is a useful diagnostic tool for detecting peroneal tendinopathy in patients with chronic lateral ankle instability. However, MRI is vague in many cases. Therefore, a thorough delicate physical examination and careful observation is needed.

Etiopathogenesis of disk displacement of the temporomandibular joint: A review of the mechanisms.

Disk displacement of the temporomandibular joint (TMJ) is a clinically important condition, showing a high prevalence in both patient and non-patient populations. Despite its clinical importance, there is incomplete understanding of the etiopathogenic mechanisms leading to disk displacement. A number of possible risk factors have been identified. This article analyzes the etiopathogenesis from both the clinical and the biomechanical viewpoints and also reviews the literature on the association between disk displacement and the main risk factors (i.e., trauma, altered disk shape and/or dynamic properties, occlusal abnormalities, steepness of the articular eminence, hyperactivity of the lateral pterygoid muscle, joint hypermobility, etc.). According to our interpretation of available data, an impairment of joint lubrication may be a common finding in cases of disk displacement, thus suggesting the need for future studies addressing both local and systemic neuroendocrine aspects influencing the friction coefficient of the TMJ. A full comprehension of the etiopathogenesis of disk displacement is far from being achieved, and clinicians must take into account this consideration when treating patients with temporomandibular disorders.

Prevalência de sinais e sintomas de desordens temporomandibulares esuas associações em jovens universitários / Prevalence of signs and symptoms of temporomandibular disorders and their association with young university students

Objetivo: Verificar a prevalência de sinais e sintomas de desordem temporomandibular e sua associação com ruídos articulares, hipermobilidade articular, interferências oclusais, tratamento ortodôntico e bruxismo em uma população específica, composta por jovens universitários. Métodos: Foram selecionados 117 voluntários (média de 22 anos de idade) do curso de graduação em Odontologia, da Faculdade de Odontologia do Centro Universitário Hermínio Ometto (Araras, São Paulo, Brasil). Os voluntários responderam a um questionário e foram submetidos a exame clínico e eletrovibratografia. Posteriormente, os voluntários foram classificados como portadores ou não portadores de desordem temporomandibular, considerando a presença de sensibilidade dolorosa na articulação temporomandibular e/ou presença de ruídos articulares. A prevalência dos fatores estudados foi calculada juntamente com a associação entre cada fator e a presença de desordem temporomandibular foi analisada pelo teste do qui-quadrado. Resultados: A prevalência de desordem temporomandibular na amostra avaliada foi de 42,9% e associação significante foi encontrada entre desordem temporomandibular e ruídos articulares (p<0,05); e entre desordem temporomandibular e bruxismo (p<0,05). Conclusão: Os resultados sugerem que pacientes com presença de bruxismo e ruídos articulares precisamente diagnosticados devem ser monitorados quanto ao aparecimento de sinais e sintomas de desordem temporomandibular.

Objective: To verify the prevalence of signs and symptoms of temporomandibular disorder and their association with joint noise, joint hypermobility, occlusal interference, orthodontic treatment and bruxism in a specific population composed of young university students. Methods: One hundred and seventeen (117) volunteers (mean age of 22 years) were selected from the undergraduate course in Dentistry at the School of Dentistry of the "Centro Universitário Hermínio Ometto" (Araras, São Paulo, Brazil). The volunteers answered a questionnaire and were submitted to clinical and electrovibratography exams. Afterwards, the volunteers were classified as either having temporomandibular disorder or not, considering the presence of painful sensitivity in the temporomandibular joint and/or presence of joint noise. The prevalence of the studied factors was calculated together with the association between each factor, and the presence of temporomandibular disorder was analyzed by the Chi-square test. Results: The prevalence of temporomandibular disorder in the evaluated sample was 42.9% and significant association was found between temporomandibular disorder and joint noise (p<0.05); and between temporomandibular disorder and bruxism (p<0.05). Conclusion: The results suggest that patients with presence of precisely diagnosed bruxism and joint noise should be monitored with regard to the appearance of signs and symptoms of temporomandibular disorder.

Síndrome de Brown bilateral associada com hipermobilidade articular benigna: relato de caso / Bilateral Brown's syndrome associated with benign joint hypermobility: a case report

A síndrome de Brown é caracterizada por grande limitação de elevação em adução, elevação ligeiramente diminuída ou normal na abdução, anisotropia em "Y" ou "V", intorção do olho em supraversão e ducção forçada positiva. Sua causa se deve à inelastibilidade do músculo oblíquo superior ou por sua contenção em sua própria bainha. A hipermobilidade articular benigna é doença hereditária do tecido conectivo caracterizada por aumento da mobilidade em diversas articulações. Sua prevalência é muito variável em relação à idade, sexo e etnia, variando de 2 a 35 por cento em homens e de 5 a 57 por cento e mulheres. Neste relato os autores descrevem um caso de síndrome de Brown associada com hipermobilidade articular benigna e atentam para a associação pouco referida na literatura. J.C.S, masculino, 6 anos de idade, pardo, estudante, foi encaminhado à Universidade de Santo Amaro com queixa de exotropia há dois anos que aumentava na supraversão. Paciente com o diagnóstico de síndrome de Brown bilateral teve o diagnóstico de hipermobilidade articular benigna pelo Reumatologista. O paciente com hipermobilidade articular benigna pode desenvolver sintomas articulares como artralgia devido a uma inflamação articular. Acreditamos na possibilidade de que síndrome de Brown possa ter ocorrido devido a processo inflamatório na tróclea que teve início devido a hipermobilidade articular benigna.

Brown's syndrome is characterized by a limitation of elevation in adduction, slight or normal limitation of elevation in abduction, divergence in straight upgaze (V-pattern), intorsion in upgaze and positive forced duction. It is caused by a tight or inelastic superior oblique tendon. Benign joint hypermobility is a hereditary disease of the connective tissue characterized by an increase of mobility in diverse joints. Its prevalence is very changeable regarding age range, sex and ethnicity, varying from 2 to 35 percent in men and 5 to 57 percent in women. In this case the authors describe a case of Brown's syndrome associated with Benign joint hipermobility and call attention to a little described association in the literature. J.C.S, male, 6 years old, mulatto, student, was referred to the University of Santo Amaro with complaint of exotropia for 2 years that it increased in supraversion. The patient with the diagnosis of bilateral Brown's syndrome, was diagnosed as having benign joint hipermobility by the reumatologist. The patient with benign joint hipermobility can develop symptoms such as arthralgia caused by a joint inflammation. We believe in the possibility that Brown syndrome has occurred, caused by an inflammatory process in the trochlea that started because of the benign joint hypermobility.

One-year Outcome Evaluation after Interspinous Implantation for Degenerative Spinal Stenosis with Segmental Instability

The authors hypothesized that the placement of the interspinous implant would show a similar clinical outcome to the posterior lumbar interbody fusion (PLIF) in patients having spinal stenosis with mild segmental instability and that this method would be superior to PLIF without significantly affecting degeneration at the adjacent segments. Forty two adult patients having degenerative spinal stenosis with mild segmental instabilit who underwent implantation of Coflex(TM) (Spine motion, Germany) or PLIF at L4-5 between January 2000 and December 2003 were consecutively selected and studied for one-year clinical outcome. At 12 months after surgery, both groups showed a significant improvement in the visual analogue scale score and Oswestry disability index score for both lower extremity pain and low back pain. However, the range of motion at the upper adjacent segments (L3-4) increased significantly after surgery in the PLIF group, which was not manifested in the Coflex(TM) group during the follow-up. The authors assumed that interspinous implantation can be an alternative treatment for the spinal stenosis with segmental instability in selected conditions posing less stress on the superior adjacent level than PLIF.

Artrodesis sacroiliaca en secuelas post-traumáticas de fractura de pelvis inestable / Sacroiliac arthrodesis in post traumatic sequela of unstable pelvic fractures

Post-traumatic sacroiliac joint osteoarthritis and pseudarthrosis are rare. They generally appear as a complication of unstable pelvic fracture. The goal of this study is to describe the functional and radiographic outcome of sacroiliac joint arthrodesis (SJA) in post-traumatic sequela of unstable pelvic fractures. We perform a retrospective review of patients who underwent sacroiliac joint arthrodesis between 1984 and 2005 at the Hospital del Trabajador de Santiago with a minimum of 1 year follow up. From a total of 235 patients with the diagnosis of unstable pelvic fracture within this period, 11 presented chronic sacroiliac pain refractary to conservative treatment that required SJA. There were 9 men and 2 women with an average age of 42 years old (range 24-58). At the time of SJA, 7 patients had post-traumatic osteoarthritis and 4 posttraumatic pseudarthrosis. Time between the accident and SJA was 15.8 months in average (range 6-55). The SJA was performed using a posterior sacroiliac approach followed by curettage of the articular cartilage and bone grafting. The joint is then stabilized with the use of screws and/or plate except in 1 patient. All the patients were evaluated radiographically in the postoperative period. Functional outcome was evaluated using Majeed`s grading score. The mean follow up was 8 years (with a minimum of 1 year). Nine of the11 patients achieved solid fusion. Five of 11 had excellent and good functional results and 6 of 11 had fair or poor. The SJA is thought to be the last procedure in posttraumatic disorders of the sacroiliac joint. In this group of patient the functional outcome is less satisfactory than other sacroiliac disorders 3.

Tanto la artrosis como la pseudoartrosis sacroilica postraumática son entidades poco frecuentes. Se presentan generalmente como complicación del tratamiento de las fracturas de pelvis inestables y su incidencia no supera el 10 por ciento. El objetivo de este trabajo es describir los resultados funcionales y radiográficos de la artrodesis sacroiliaca (ASI) en pacientes con secuelas de fractura de pelvis inestables. Se realizó una revisión retrospectiva de pacientes con fracturas inestables de pelvis tratados por artrosis o pseudoartrosis postraumática con ASI durante el período de 1984 a 2005 en el Hospital del Trabajador de Santiago. De un total de 235 pacientes con fractura inestable de pelvis, 11 presentaron dolor crónico de origen sacroiliaco refractario a tratamiento no quirúrgico que requirió ASI. Nueve fueron hombres y 2 mujeres, el promedio de edad fue de 42 años (rango de 24 a 58). Al momento de la cirugía 7 presentaban artrosis y 4pseudoartrosis postraumática. El tiempo entre el accidente y la ASI fue de 15,8meses en promedio (rango de 6-55). La ASI fue realizada usando el abordaje sacroiliaco posterior, seguido de curetaje articular y aporte de injerto óseo. La fijación se realizó con tornillos canulados y/o placa en todos los pacientes excepto uno. Se realizó una evaluación radiográfica seriada y se utilizó la escala de Majeed para analizar el resultado funcional. El seguimiento promedio fue de 8 años (con un mínimo de un año). Nueve de 11 pacientes lograron fusión sólida. Cinco de 11obtuvieron resultados funcionales excelentes y buenos y 6 de 11 regulares y malos. La ASI se presenta como última alternativa para el manejo dolor sacroiliaco crónico. En este grupo de pacientes, los resultados funcionales logrados son menos satisfactorios que en pacientes con otros desordenes sacroiliacos.