Diminutive Incision Acromioplasty Assisted with Arthroscopy in the Treatment of Chinese Patients with Subacromial Impingement Syndrome / Acromioplastia de Incisión Diminuta Asistida con Artroscopia en el Tratamiento de Pacientes Chinos con Síndrome de Pinzamiento Subacromial

ABSTRACT Background: Many causes can lead to shoulder pain and subacromial impingement syndrome (SIS) is the most frequently recorded disorders. The aim of this study was to evaluate the clinical effects of diminutive incision acromioplasty assisted with arthroscopy for the treatment of Chinese patients with subacromial impingement syndrome. Subject and Methods: Twenty-two patients with 24-painful shoulders subacromial impingement syndrome were enrolled. All painful shoulders were in Grades II (8) and III (16) according to Neer's classification. Detailed physical examination was performed. Conventional radiography and subsequent magnetic resonance imaging (MRI) of the shoulder region of all patients were done. The University of California at Los Angeles Shoulder (UCLA) score system was used for all patients to evaluate their satisfaction after surgery. The preoperative recordings of the UCLA scores were collected and all enrolled cases including 24-painful shoulders were available for follow-up in 1, 3, 6, 12 months after surgery. Results: According to the UCLA scoring system, the symptom of all painful shoulders were improved after one year postoperatively. The average score before surgery from 15.4 points increased to 31.2 points postoperatively, showing a statistical difference (p < 0.05). Conclusions: A diminutive incision acromioplasty assisted with arthroscopy is a reliable approach to treat Chinese patients with subacromial impingement syndrome. All painful shoulders were obviously improved in one year after surgery.

ABSTRACT Antecedentes: Muchas causas pueden provocar dolor de hombro y síndrome de compresión subacromial (SIS) es el trastorno más frecuentemente registrado. El objetivo de este estudio fue evaluar la clínica. Efectos de la acromioplastia con incisión diminuta asistida con artroscopia para el tratamiento de Pacientes chinos con síndrome de pinzamiento subacromial. Sujeto y métodos: Se incluyeron veintidós pacientes con síndrome de afectación subacromial de 24-hombros dolorosos. Todos los hombros dolorosos estaban en Grados II (8) y III (16) de acuerdo con la clasificación de Neer. Se realizó examen físico detallado. Se realizaron radiografías convencionales y, posteriormente, imágenes de resonancia magnética (IRM) de la región del hombro de todos los pacientes. El sistema de puntuación de la Universidad de California en Los Angeles Shoulder (UCLA) se utilizó para que todos los pacientes evaluaran su satisfacción después de la cirugía. Los registros preoperatorios de las puntuaciones de UCLA se recopilaron y todos los casos incluidos, incluidos 24-hombros dolorosos, estaban disponibles para el seguimiento en 1, 3, 6 y 12 meses después de la cirugía. Resultados: De acuerdo con el sistema de puntuación de UCLA, el síntoma de todos los hombros dolorosos mejoró después de un año después de la operación. La puntuación promedio antes de la cirugía de 15.4 puntos aumentó a 31.2 puntos después de la operación, mostrando una diferencia estadística (p < 0.05) Conclusiones: Una acromioplastia de incisión diminuta asistida con artroscopia es un enfoque confiable para tratar a pacientes chinos con síndrome de pinzamiento subacromial. Todas las lesiones dolorosas se mejoraron obviamente en un año después de la cirugía.

The myofascial component of the pain in the painful shoulder of the hemiplegic patient

OBJECTIVES: Poststroke shoulder pain occurs very frequently and compromises function and quality of life. Because treatment depends on a multidisciplinary approach, it is desirable to optimize effectiveness. Myofascial pain syndrome is defined by the presence of trigger points that can also be found in spastic stroke patients. The aim of this study was to evaluate the frequency of myofascial pain in the shoulder girdle muscles in patients with poststroke shoulder pain and to document the clinical and functional results obtained with specific treatment for this condition. METHODS: Spastic stroke hemiplegic patients undergoing rehabilitation at the Rehabilitation Center of the Hospital das Clínicas of the Ribeirão Preto Medical School of the University of São Paulo were evaluated regarding the intensity and characteristics of shoulder pain, previous therapeutic interventions, shoulder goniometry and the presence of trigger points. Patients underwent trigger point blockade by intramuscular infiltration of 1% lidocaine. The evaluation and treatment procedures were repeated in the subsequent 3 weeks as long as the pain intensity was greater than 5 on a visual analog scale (VAS). In the fourth week, the evaluation procedures were repeated. Patients who were in a multiprofessional rehabilitation program were instructed to continue the treatment, and the others received complementary therapeutic advice if necessary to initiate it. The evaluations were performed at 0, 1, and 3 weeks and after 4 months. RESULTS: Twenty-one patients (13 men; age=67.8±10.2 years; right hemiparesis: 11) participated in the study, and there was a reduction in pain assessed by VAS from baseline (7.6±2.7) to the first week (5.8±3.6; p<0.05) through the end of the third week (5.2±3.5; p<0.05), but not at the end of four months (6.6±2.9; p=0.11). Good responders had significantly lower pain levels after the third week and presented with a larger range of motion for passive abduction by the end of 4 months. These results demonstrate that the myofascial component of pain should be considered in poststroke shoulder pain and that its treatment may be a pathway for the rapid and long-lasting relief of symptoms. CONCLUSION: Trigger point blockade with lidocaine can reduce pain perception in spastic hemiplegic shoulder in as much as 50% of stroke survivors for four months.

Resonancia magnética en el atrapamiento del nervio supraescapular por quiste supraglenoideo / Magnetic resonance in nerve entrapment suprascapular supraglenoid cyst

El síndrome de atrapamiento del nervio supraescapular es una causa infrecuente de dolor en el hombro y de difícil diagnóstico clínico. Puede ser consecuencia de traumatismo, infección, compresión extrínseca o estiramiento secundario a movimientos repetitivos. Los quistes supraglenoideos deben considerarse en el diagnóstico diferencial pues son una causa frecuente de compresión del nervio supraescapular que ocurre casi exclusivamente en hombres. Se evaluaron con resonancia magnética (RM) y en forma retrospectiva siete pacientes con diagnóstico de atrapamiento del nervio supraescapular por quiste supraglenoideo. La RM mostró la causa y localización de la compresión nerviosa así como la distribución del edema muscular en todos los casos. Puede evaluar el grado de severidad de la enfermedad y realizar el diagnóstico diferencial con otras causas que provocarían atrapamiento del nervio supraescapular. (AU)

Suprascapular nerve entrapment has been regarded as a relatively uncommon condition that is easily overlooked in the differential diagnosis of shoulder discomfort. The common feature is nerve damage, caused either by trauma, extrinsic compression or by stretching secondary to repeated movements. Ganglion cysts account for the majority of the masses causing entrapment and seem to occur exclusively in men. Seven cases of suprascapular nerve entrapment caused by supraglenoid cyst compression were reviewed with MRI. MRI showed the cause and location of nerve compression as well as the distribution of muscular edema in all cases. MR imaging also allows an evaluation of the severity of the disease. It is also very efficient in excluding several differential diagnoses. (AU)

Absceso subpectoral como diagnóstico diferencial de hombro doloroso: reporte de un caso / Subpectoral abscess as a differential diagnosis of painful shoulder: a case report

Los síndromes dolorosos del hombro son relativamente comunes en la práctica clínica. Habitualmente son causados por un número limitado de patologías. Dentro de los diagnósticos diferenciales, el pinzamiento subacromial, las lesiones aisladas del manguito rotador, capsulitis adhesiva, tendinitis cálcica, patología degenerativa de las articulaciones glenohumeral y acromioclavicular, y la inestabilidad crónica del hombro, son causas comunes. Causas infrecuentes son la rotura del tendón del bíceps, neuralgias, patología infecciosa articular y tumores del hombro. Un absceso subpectoral sin sintomatología infecciosa clara es una causa extremadamente rara de hombro doloroso en el adulto. Presentamos el caso de un paciente de 60 años, que inicia con un cuadro de hombro doloroso cuya causa se identifica como un absceso subpectoral por staphylococcus aureus que se maneja con drenaje quirúrgico y tratamiento antibiótico endovenoso con buenos resultados.

Painful shoulder syndromes are commonly caused by a limited assortment of pathologies. Differential diagnosis include rotator cuff impingement syndrome, rotator cuff tears, adhesive capsulitis, calcific tendonitis, degenerative disease of the joint including acromio-clavicular and gleno-humeral joints and chronic instability. Less common causes are labral tears, biceps tendon rupture, soft tissue infection, neurologic disease, joint infection and shoulder tumors. A subpectoral abscess without infectious clinical features is a very rare cause of shoulder pain in adults. We present the case of a 52 years old male who develops a painful shoulder syndrome caused by a staphylococcus aureus subpectoral abscess, treated by surgical drainage and intravenous antibiotic therapy with good results.

Prevalencia de dolor de hombro y sus factores asociados en lesionados medulares parapléjicos usuarios de silla de ruedas / Shoulder pain prevalence and associated factors in spinal cord-injured paraplegic wheelchair users

INTRODUCCIÓN: la prevalencia de dolor de hombro en pacientes parapléjicos usuarios de silla de ruedas es elevada. existe consenso en que el uso de la silla de ruedas manual es un factor importante en el origen de este dolor. no existen estudios en Chile acerca del tema. OBJETIVO: determinar la prevalencia y factores asociados a dolor de hombro en personas con paraplejia secundaria a lesión medular traumática, usuarios de sillas de ruedas, describiendo también las características del dolor. MATERIALES Y MÉTODOS: estudio descriptivo transversal en personas adultas con paraplejia secundaria a lesión medular traumática, que cumplieron los criterios de inclusión. previo consentimiento informado, se les aplicó un cuestionario ISCIPDS:B, enfocado a dolor de hombro. además de preguntar qué tipo de silla de ruedas utilizan, tiempo de autopropulsión, uso de guantes de propulsión y ocupación previa a la lesión medular. se recuperaron datos de registros en ficha clínica para identificar sexo, edad, fecha del accidente, ASIA impairment scale (AIS) y nivel neurológico de la lesión. RESULTADOS: 59 pacientes cumplieron los criterios de inclusión. de ellos, el 61% de ellos refirió dolor en hombro (s). no hubo una asociación estadísticamente significativa entre el dolor en el hombro y la edad, tiempo de evolución de lesión medular, AIS, nivel de lesión neurológica, tipo de silla de ruedas ni el tiempo de uso de la silla de ruedas manual. hubo una asociación estadísticamente significativa entre uso de guantes de propulsión y el dolor de hombro. la afectación bilateral es más frecuente que unilateral. el dolor promedio fue de NRS 5,6. la duración fue referida principalmente como constante, mayor a 1 hora pero menor a 24 horas. la mayor intensidad de dolor se reportó como vespertina. CONCLUSIONES: la prevalencia de dolor de hombro en pacientes chilenos con paraplejia secundaria a lesión medular traumática es alta. es necesaria mayor investigación para determinar si los hallazgos de este estudio se extrapolan a la población general con lesión medular traumática.

INTRODUCCIÓN: the prevalence of shoulder pain in paraplegic patients using wheelchair is high. there is consensus that the use of manual wheelchair is an important factor in the origin of this pain. there are no studies in Chile about this. OBJECTIVE: to determine the prevalence and factors associated with shoulder pain in paraplegic patients for traumatism with spinal cord injury (SCI) wheelchair users, also describing the characteristics of pain. MATERIALS AND METHODS: descriptive transversal study in adults paraplegic patients for traumatism with SCI, who met inclusion criteria. an ISCIPDS:B questionnaire was previously informed, focused on shoulder pain, also asking what kind of wheelchair is being used, time of propulsion, use of propulsion gloves, and if it was being used before the spinal cord injury. further clinical record data were retrieved to identify gender, age, date of accident, ASIA, and neurological injury level. RESULTS: 59 patients met the inclusion criteria, 61% of them reported shoulder pain. there was no statistically significant association between shoulder pain and age, duration of SCI, ASIA, neurological level of injury, type of wheelchair, nor usage time of the manual wheelchair. there was a statistically significant association between the use of gloves propulsion and shoulder pain. bilateral involvement is more often. the average pain was NRS 5.6. the duration was mainly referred as a constant greater than 1hour but less than 24hours. the greater intensity of pain was reported during the evening. CONCLUSIONS: the prevalence of shoulder pain in chilean paraplegic for spinal cord traumatic injury is high. more research is needed to determine whether the findings of this study are extrapolated to the general population.

Upper limb function and functional independence in patients with shoulder pain after stroke / Função do membro superior e independência funcional em pacientes com ombro doloroso após AVC

ABSTRACT Objective To examine the frequency of shoulder pain following stroke. Methods Stroke patient function was evaluated using the Functional Independence Measure (FIM) and Scale for Upper Limb Function in Stroke (SULFS). Function scores were examined and compared between the shoulder pain group (SPG) and the no shoulder pain group (No-SPG). Results A total of 58 patients, 22 women (37.9%), were included in this study. The mean patient age was 49.2±10.8 years and study evaluations were done 3.52±2.26 months after stroke. A total of 16 patients (27.6%) were in the SPG and 42 patients (72.4%) were in the No-SPG. The SPG scored significantly lower on the FIM (SPG: 91.06±14.65 vs. No-SPG 114.62 ± 2.27; p < 0.01) and SULFS (SPG median: 2 [range: 1-4], No-SPG median: 5 [range: 1-5]; p < 0.01) than the No-SPG. Conclusion Shoulder pain commonly occurs after stroke and is related to the affected upper limb function and functional independence in stroke patients.

RESUMO Objetivo Identificar a frequência de ombro doloroso após acidente vascular cerebral (AVC). Métodos Avaliação funcional de pacientes pós-AVC foi realizada pela Medida de Independência Funcional (MIF) e pela Escala de Função de Membro Superior pós-AVC (EFMSA). As pontuações foram comparadas entre pacientes com ombro doloroso (PcOD) e pacientes sem ombro doloroso (PsOD). Resultados 58 pacientes foram incluídos no estudo, sendo 22 (37,9%) mulheres. A idade média dos pacientes foi 49,2±10,8 anos e a avaliação foi realizada 3,52±2,26 após o AVC. Dezesseis (27,6%) pacientes foram incluídos no grupo PcOD e 42 (72,4%) no grupo PsOD. A MIF foi menor no grupo PcOD (91,06±14,65) quando comparados ao grupo PsOD (114,62 ± 2,27), p < 0.01. A EFMSA também foi menor no grupo PcOD (mediana: 2 [intervalo: 1-4] em comparação ao grupo PsOD (mediana: 5 [intervalo: 1-5], p < 0.01. Conclusão Ombro doloroso é comum após AVC e afeta de forma significativa a função do membro superior e a independência funcional.

Neuroartropatia de Charcot secundária à siringomielia: relato de caso / Charcot neuroarthropathy by syringomyelia: case report

A neuroartropatia de Charcot é uma das complicações da siringomielia, podendo ocasionar deformidades osteoarticulares e incapacidade funcional, com comprometimento das atividades da vida diária. Relatamos um caso de paciente com neuroartropatia de Charcot do ombro associada a siringomielia e malformação de Arnold-Chiari tipo I, acompanhado no Instituto Nacional de Traumatologia e Orto-pedia do Rio de Janeiro, RJ, Brasil.

Charcot neuroartropathy is one of the complications of syringomyelia and can lead to joint deformity and disability, affecting patients in activities of daily living. We report a case of a patient with shoulder Charcot neuroarthropathy associated with syringomyelia and Arnold-Chiari malformation type I, from the National Institute of Traumatology and Orthopedics of Rio de Janeiro, RJ, Brazil.

Resultados funcionales de la aplicación de toxina botulínica tipo A contra antiinflamatorios orales en la rehabilitación de síndrome de hombro doloroso por lesión del mango de los rotadores / Functional results of type a botulinum toxin versus oral antiinflammatory agents in the rehabilitation of painful shoulder syndrome caused by rotator cuff lesion

Las enfermedades del mango de los rotadores se caracterizan por signos inespecíficos, síntomas y alteraciones de la anatomía, su etiología es multifactorial y pueden abarcar desde tendinitis hasta rupturas masivas de espesor completo del tendón del manguito de los rotadores, las cuales comprometen la biomecánica normal del hombro afectado. Normalmente suceden en mayores de 40 años; sin embargo, el asociado a trauma depende del mecanismo de lesión y no tiene relación directa con la edad de aparición de los síntomas. Se han descrito factores vasculares en el daño al tendón del manguito de los rotadores, en patologías que afectan a la microcirculación; sin embargo, estudios recientes no han demostrado que el tendón bajo observación directa presente datos de hipovascularidad. La toxina botulínica tipo A realiza su acción mediante bloqueo de la liberación de acetilcolina en la placa neuromuscular; en las articulaciones provoca liberación de la tensión capsular así como la disminución de factores pro inflamatorios tales como la interleucina-1; aunque existen pocos artículos sobre su utilidad intraarticular, en los grupos musculares y tendinosos, además de tener un efecto miorrelajante existen diversas publicaciones que apoyan su utilidad en el manejo del dolor y su utilidad en la rehabilitación de este grupo de pacientes; en dosis bajas, ha sido ampliamente utilizada. Material y métodos: Se trata de un estudio prospectivo, experimental y longitudinal en el cual se realizó seguimiento a 24 pacientes con diagnóstico de síndrome de hombro doloroso demostrado por pruebas clínicas y de gabinete debido a lesiones del mango de los rotadores, sin criterios de reparación quirúrgica inmediata, o ya reparados, a los cuales a 12 pacientes se les aplicará toxina botulínica tipo A en el espacio subacromial de forma peri-tendón del tendón conjunto del manguito de los rotadores, así como en puntos de dolor y contractura muscular en hombro, con una dosis total de 200 UI de toxina botulínica tipo A, mientras que al grupo control, de 12 pacientes, se le administraron antiinflamatorios vía oral por seis semanas, tipo Cox 2, Celecoxib 100 mg cápsulas una cada 12 horas; a los dos grupos se les sometió a un programa de rehabilitación ya establecido, el cual fue supervisado cada dos semanas y hasta las seis semanas de evolución; se realizaron valoraciones subjetivas y objetivas valorando la presencia de dolor, el nivel funcional y la movilidad posible mediante la escala de valoración funcional de hombro de Constant y la escala visual análoga. Resultados: Grupo de Celecoxib Promedio de escala de Constant inicial fue de 60 puntos, el inmediato a la primera dosis se mantuvo en 60 puntos, a las dos semanas de tratamiento con Celecoxib se encontró un puntaje de Constant promedio de 66 puntos y a las seis semanas el promedio fue de 70.33 puntos, siendo el valor de la p > 0.005. Grupo de toxina botulínica 200 UI máximo en hombro afectado, 50 UI subacromial y 150 en puntos de dolor además de asociarlo a programa de ejercicios de rehabilitación supervisados en consultorio. El promedio de la escala de Constant inicial fue de 58 puntos, el inmediato a la primera dosis se elevó a 70.83 puntos, a las dos semanas posteriores a infiltración y seguimiento de ejercicios en consultorio fue de puntaje Constant promedio de 77.16 puntos y a las seis semanas el promedio fue de 78.5 puntos, siendo el valor de la p < 0.005 (p = 0.00045). En cuanto a la escala visual análoga se observó que en el grupo de Celecoxib existió una disminución de dicha escala a las seis semanas con una p < 0.005.

Rotator cuff conditions are characterized by unspecific signs, as well as anatomic alterations and symptoms. They have a multifactorial etiology and may include everything from tendinitis to massive, full thickness tears of the rotator cuff tendon that compromise the normal biomechanics of the involved shoulder. They usually occur in people over 40 years of age but lesions resulting from trauma may vary according to the mechanism of injury and are not directly related with the age at onset of symptoms. Vascular factors have been described as related with rotator cuff tendon damage in conditions affecting the microcirculation. However, recent studies have not proven that the tendon under direct observation shows hypovascularity. Type A botulinum toxin acts by blocking the release of acetylcholine in the neuromuscular plate; in the joints it releases capsular tension and reduces proinflammatory factors such as interleukin-1 (IL-1). There are only a few papers on its intraarticular benefit; in muscle and tendon groups it not only has a muscle relaxant effect, but several publications support its utility for pain management. It has been widely used in the rehabilitation of this group of patients at low doses. Material and methods: Prospective, investigational and longitudinal study involving the follow-up of 24 patients with a diagnosis of painful shoulder syndrome proven clinically and with imaging tests, and caused by rotator cuff lesions. The patients either did not meet the criteria for immediate surgical repair or had already undergone such a repair. Type A botulinum toxin was applied to 12 patients in the subacromial space around the rotator cuff conjoint tendon, as well as in the painful spots and in the muscle contracture in the shoulder. The total dose of Type A botulinum toxin was 200 IU. The control group, also composed of 12 patients, was given a COX-2 oral antiinflammatory agent for 6 weeks (Celecoxib, 100 mg BID). Both groups followed a pre-established rehabilitation program for a total of 6 weeks and were supervised every 2 weeks. Subjective and objective assessments were made including pain, performance level and possible mobility, using Constant's functional shoulder assessment and the visual analog scale (VAS). Results: Celecoxib group: Mean initial Constant scale score was 60; after the first dose it remained unchanged. After 2 weeks of treatment with Celecoxib the mean Constant score was 66; by 6 weeks it was 70.33, with p > 0.005. The botulinum toxin group received a maximum dose of 200 IU in the affected shoulder, 50 IU were administered subacromially and 150 in the painful spots. This treatment was combined with rehabilitation exercises supervised at the doctor's office. The mean initial Constant scale score was 58; immediately after the first dose it went up to 70.83. Two weeks after the injection and the supervision of rehabilitation exercises at the office, the mean Constant scale score was 77.16; at six weeks it was 78.5, with p < 0.005 (p = 0.00045). The VAS in the Celecoxib group decreased at six weeks with p < 0.005.

Suprascapular neuropathy in collegiate baseball player

Suprascapular neuropathy [SSN] is generally thought of as a diagnosis of exclusion. However, increasing attention is being paid to the diagnosis, treatment and rehabilitation of this pathology to prevent chronic supraspinatus and infraspinatus atrophy in patients. To date, literature has only articulated variable or customized treatment and rehabilitation plans without clear standardized care. This case study provides a detailed description of the diagnosis, treatment, and rehabilitation of a collegiate baseball player's recovery from suprascapular nerve release. A 20 year-old male baseball pitcher with right shoulder pain reported for athletic training evaluation, was treated conservatively, and due to lack of resolution was referred for further imaging and evaluation by an orthopedist. Following inconclusive magnetic resonance imaging findings the patient underwent electrodiagnostic testing which showed decreased nerve conduction velocity of the right suprascapular nerve. The patient elected for surgical intervention. Post-operative rehabilitation followed and the patient was able to pitch in 22 weeks. The patient provided positive subjective feedback and was able to return to unrestricted pitching without pain, loss of velocity, or loss in pitch control. This study demonstrates a need for further investigation into the most appropriate treatment and rehabilitation of suprascapular nerve injury

Eccentric training for shoulder abductors improves pain, function and isokinetic performance in subjects with shoulder impingement syndrome: a case series / Treino excêntrico para abdutores do ombro melhora dor, função e desempenho isocinético em sujeitos com síndrome do impacto: série de casos

BACKGROUND: Conservative treatments have been proposed for people with shoulder impingement syndrome (SIS), such as strengthening of the rotator cuff and scapular muscles and stretching of the soft tissues of the shoulder. However, there is a lack of studies analyzing the effectiveness of eccentric training in the treatment of SIS. OBJECTIVES: To evaluate the effects of eccentric training for shoulder abductors on pain, function, and isokinetic performance during concentric and eccentric abduction of the shoulder in subjects with SIS. METHODS: Twenty subjects (7 females, 34.2 SD 10.2 years, 1.7 SD 0.1 m, 78.0 SD 16.3 kg) with unilateral SIS completed the study protocol. Bilateral isokinetic eccentric training at 60º/s for shoulder abductors was performed for six consecutive weeks, twice a week, on alternate days. For each training day, three sets of 10 repetitions were performed with a 3-minute rest period between the sets for each side. The range of motion trained was 60° (ranging from 80° to 20°). The Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire was used to evaluate functional status and symptoms of the upper limbs. Peak torque, total work and acceleration time were measured during concentric and eccentric abduction of the arm at 60º/s and 180º/s using an isokinetic dynamometer. RESULTS: DASH scores, peak torque, total work and acceleration time improved (p<0.05) after the period of intervention. CONCLUSIONS: This study suggests that isokinetic eccentric training for shoulder abductors improves physical function of the upper limbs in subjects with SIS.

CONTEXTUALIZAÇÃO: Tratamentos conservadores têm sido propostos para pessoas com síndrome do impacto (SI) do ombro, como fortalecimento do manguito rotador e dos músculos escapulares e alongamento dos tecidos moles do ombro. No entanto, são escassos os estudos que analisaram a eficácia do treinamento excêntrico no tratamento da SI. OBJETIVOS: Avaliar os efeitos do treinamento excêntrico para abdutores do ombro na dor, função e desempenho isocinético durante a abdução concêntrica e excêntrica do ombro em indivíduos com SI. MÉTODOS: Vinte indivíduos (sete mulheres, 34,2 DP 10,2 anos, 1,7 DP 0,1 m, 78,0 DP 16,3 kg) com SI unilateral completaram o protocolo do estudo. Realizou-se treinamento isocinético excêntrico bilateral a 60º/s para abdutores do ombro durante seis semanas consecutivas, duas vezes por semana, em dias alternados. Para cada dia de treinamento, foram realizadas três séries de dez repetições, com um período de descanso de 3 minutos entre as séries para cada lado. A amplitude de movimento treinada foi de 60° (de 80° a 20°). O questionário Disabilities of the Arm, Shoulder and Hand (DASH) foi utilizado para avaliar a função e os sintomas dos membros superiores. O pico de torque, o trabalho total e o tempo de aceleração foram avaliados durante a abdução concêntrica e excêntrica do braço a 60º/s e 180º/s por meio de um dinamômetro isocinético. RESULTADOS: As pontuações do DASH, o pico de torque, o trabalho total e o tempo de aceleração melhoraram (p<0,05) após o período de intervenção. CONCLUSÕES: Este estudo sugere que o treinamento isocinético excêntrico para abdutores do ombro melhora a função física dos membros superiores em indivíduos com SI.

What Do the Patients Want and Worry in Korean Patients Who Undergo Arthroscopic Rotator Cuff Surgery?

BACKGROUND: To specify what patients want and worry preoperatively is important in orthopedic practice. The aim of the current study was to analyze the patient characteristics of rotator cuff disease in Korean population who were willing to undergo arthroscopic surgery, and to evaluate the differences in expectations and concerns by age and gender. METHODS: We prospectively enrolled 303 patients who underwent rotator cuff surgery between April 2004 and August 2008. Three questionnaires were completed before surgery: the first one addressing preoperative patient's expectation, the second one focusing on concerns by covering 64 items using a visual analogue scale, and the third one evaluating patient's demographic characteristics. The characteristics of preoperative expectation, concern, and demographic data were evaluated according to gender and age group. RESULTS: Female patients had lower level of sports activity (p = 0.007) and lower levels of information (p = 0.028). Gender specific worries are about a caregiver during hospital stay, operating on the working side, fear about ugly scars, postoperative pain, applying makeup or combing hair. The older group responded that they can't be willing to change activities of daily living (p = 0.001), are not living with a spouse (p = 0.002), had previous shoulder operation history (p = 0.008), and had a lower level of information (p = 0.007). They especially worried about medical bills, worried about the physician being too young and inexperienced, postoperative pain, loss of arm function, and hospital food. CONCLUSIONS: Our data showed what Korean patients wanted and were concerned about prior to rotator cuff surgery. This can empower patients to formulate realistic expectations and make informed decisions. We feel that we can achieve higher levels of postoperative satisfaction by analyzing expectations and concerns in depth and addressing these proactively.

Risk factors and prevalence of musculoskeletal disorders among Jordanian dentists

To investigate the prevalence of Musculoskeletal Disorders [MSDs] symptoms [hand/wrist, neck, shoulder and back pain] among dentists and to identify the risk factors associated with these symptoms. A random sample of 200 dentists [114 males [mean age 40.6 years] and 86 females [mean age 40.1 years] were personally interviewed using a structured questionnaire. The questionnaire assessed age, gender, presence of MSDs, daily working hours, years of experience, working position, participants' knowledge of correct working posture and employment of dental surgeon assistant. Data were processed and analyzed by Chi-square test. P value was set at < 0.05. The majority of participants were general practitioners [87.5%]. 86% of the study sample suffered one or more of the MSDs [back pain [56%], neck pain [47%], shoulder pain [39%] and hand/wrist pain [26%]]. Females reported more shoulder pain and less back pain than males [P=0.001]. Neck, shoulder and back pain were significantly increased among older dentists and dentists with more years of professional experience [P<0.0001]. More than half of the participants were not aware of the correct working postures [62.5%], the more the awareness of healthy postures the less the hand/wrist, neck and back pain [P < 0.05]. Hand/wrist pain was most prevalent among dentists who only worked while standing while least prevalent among dentists mixing between sitting and standing postures [P<0.0001]. MSDs are common among Jordanian dentists. There seems to be a substantial need for further training and continuing education on occupational health among Jordanian dentists

Causes of Shoulder Pain in Women with Breast Cancer-Related Lymphedema: A Pilot Study

PURPOSE: To inform on shoulder pathology and to identify the disabilities and level of quality of life (QOL) associated with shoulder pain in patients with breast cancer-related lymphedema (BCRL). MATERIALS AND METHODS: Using patient history, physical examination, and ultrasound (US), we classified patients with BCRL into the following three groups: no pain with normal ultrasound (US), pain with normal US, and pain with abnormal US. We evaluated shoulder pathology using US, pain intensity using a visual analogue scale (VAS), and functional disability using the Korean version of the Disabilities of Arm, Shoulder, and Hand (DASH) questionnaire. For assessment of QOL, we used the Korean version of the brief form of the World Health Organization Quality of Life Assessment Instrument (WHOQOL-BREF). RESULTS: 28.9% of patients had no pain and normal US, 31.6% had pain with normal US, and 39.5% had pain with abnormal US. The US findings for those with pain and abnormal US revealed the following: 53.3% had a supraspinatus tear, 13.3% had biceps tenosynovitis, 13.3% had acromioclavicular arthritis, 13.3% had subdeltoid bursitis, and 53.3% had adhesive capsulitis. Patients with shoulder pain and abnormal US findings had significantly higher mean DASH and pain scores. Pain scores were positively correlated with DASH scores and negatively correlated with QOL. CONCLUSION: We found that BCRL with shoulder pain and evidence of shoulder pathology on US was associated with reduced QOL and increased disability. Proper diagnosis and treatment of shoulder pain are necessary to improve QOL and decrease disability in patients with BCRL.

Septic arthritis of sternoclavicular joint: a case report of a rare finding in injecting drug users

The sternoclavicular joint is an unusual site for bacterial infection. In this case, we describe a 25-year-old man who presented to the emergency department with fever, chills, limited range of motion in the right upper limb along with complaints of severe pain and tenderness in the right upper chest wall and shoulder. He was admitted to the hospital for further evaluation. This patient admitted to a history of injecting heroin use during the previous three months. The diagnosis of septic arthritis of the right sternoclavicular joint was confirmed by blood culture and MRI of the sternoclavicular joint. This case is, to the best of our knowledge, the 25th recorded staphylococcal septic sternoclavicular arthritis. He received appropriate intravenous antibiotic therapy and subsequently was discharged two weeks later with complete clinical and laboratory recovery

Diagnostic accuracy of high resolution ultrasound in communicating rotator cuff tears

High resolution ultrasound is performed in the investigation of rotator cuff pathology. However, there are various reports in the literature regarding the diagnostic accuracy of ultrasound. The purpose of our study was to compare the diagnostic accuracy of ultrasound with multislice computed tomography arthrography [CT arthrography]. We prospectively studied sixty-four consecutive patients with rotator cuff pathology diagnosed by ultrasound [35 men and 29 women; age range, 35-75] who underwent preoperative multislice CT arthrography of the shoulder from February 2006 to January 2008. Full-thickness and communicating partial-thickness tears of the supraspinatus, infraspinatus, subscapularis tendons as well as the abnormalities of the long head of the biceps tendon were assessed. The right shoulder was involved in 44 patients. The supraspinatus tendon was the most frequently involved either by full-thickness [n=50] or partial-thickness [n=29] tears. Ultrasound correctly identified full-thickness rotator cuff tears in 84% of cases with a good positive predictive value [83%]. The sensitivity and specificity of ultrasound in the detection of partial-thickness tears were 76% and 46%, respectively. These percentages significantly increased with the presence of joint effusion [77% vs 70%] and joint and subacromial/subdeltoid bursal effusion [80% vs 67%]. Ultrasound allows an accurate diagnosis of full-thickness tears. The diagnostic performance of ultrasound in the assessment of partial-thickness tears increases when a joint effusion or double effusion is present

La ultrasonografía en el estudio de síndrome de hombro doloroso / Musculoskeletal ultrasound in the evaluation of the painful shoulder

El síndrome de hombro doloroso es una causa frecuente de consulta en la práctica clínica diaria. Su origen puede ser traumático, inflamatorio, degenerativo, infeccioso o tumoral. El abordaje diagnóstico implica un amplio conocimiento de la anatomía regional y la aplicación de maniobras clínicas y técnicas de imagen que conduzcan a un diagnóstico certero para la aplicación de un tratamiento óptimo en cada paciente. En los años recientes, el ultrasonido musculoesquelético ha demostrado ser una herramienta complementaria de altísima utilidad en el examen complementario de los pacientes con hombro doloroso, especialmente en el contexto de la práctica reumatológica. Revisaremos los principales hallazgos patológicos evaluados por esta técnica.

Painful shoulder syndrome is a frequent cause of daily clinical consultation. Its origin can be traumatic, inflammatory, degenerative, infectious or tumor like. The boarding diagnosis implies an ample knowledge of the regional anatomy and the application of clinical and technical maneuvers of image that leads to an accurate diagnosis for the application of an optimal treatment in each patient. In the recent years, the musculoskeletal ultrasound has demonstrated to be a complementary tool of highest utility in the complementary examination of the patients with painful shoulder, especially in the context of the rheumatological practice. We will review the main pathological findings evaluated by this technique.

Associação entre discinesia escapular e dor no ombro de praticantes de natação / Association between scapular dyskinesia and shoulder pain in swimmers

A escápula possui funções essenciais no ombro do atleta de arremesso. Qualquer desequilíbrio presente entre as estruturas responsáveis pela sua estabilidade originará uma condição denominada discinesia escapular, a qual é comumente acompanhada de dor no ombro. Este estudo tem o objetivo de verificar se há associação entre a discinesia escapular e a dor no ombro de praticantes de natação. Foi realizado um estudo analítico observacional de corte transversal, incluindo 36 praticantes de natação do sexo masculino, com idade de 18 a 36 anos. Como métodos diagnósticos sugestivos de discinesia escapular foram utilizados o Slide Lateral Scapular Test e a filmagem proposta por Kibler. A existência de proporções significativas entre as variáveis nominais foi comprovada pelo teste do qui-quadrado ou pelo teste exato de Fisher. Para identificar associações entre as variáveis contínuas e os grupos de estudo foi utilizado o teste t de Student. Um p < 0,05 foi considerado estatisticamente significante. O grau de concordância interexaminador (Kappa; p < 0,0001) foi considerado substancial, correspondendo a 86,1 por cento (0,7656) no ombro direito e 83,3 por cento (0,6412) no esquerdo. Constatou-se que a grande maioria (80 por cento) dos indivíduos que apresentaram positividade no Slide Lateral Scapular Test relatou dor no ombro. Dentre os nadadores que apresentaram discinesia escapular durante a filmagem, em 70,8 por cento também foi constatada a presença dessa condição no teste estático. Este é um estudo original no que diz respeito à abordagem da discinesia escapular em nadadores e em relacioná-la com a presença de dor no ombro. Porém, a hipótese inicial de que haveria uma associação significante não foi correspondida.

The scapula plays an essential role in the throwing motion performed by athletes. Scapular dyskinesia is a condition characterized by imbalance in the structures responsible for the joint stability, which is often accompanied by shoulder pain. The main objective of this study is to assess the relationship between scapular dyskinesia and shoulder pain in swimmers. A total of 36 male swimmers aged between 18 and 36 years were diagnosed for scapular dyskinesia utilizing two different methods: the Lateral Slide Scapular Test and the video recording method suggested by Kibler. Statistical analysis was performed using the Chi-square test or Fisher's exact test. Comparisons between groups were performed using the t-test. The degree of p< 0.05 was considered statistically significant. Significance was set at á=0.05. There was a high inter-rate reliability concerning the video analysis (Kappa; p<0.0001), corresponding to 86.1 percent (0.7656) on the right shoulder and 83.3 percent (0.6412) on the left shoulder. The majority of the individuals that had positive diagnosis assessed by the Lateral Slide Scapular Test (80 percent) reported pain on the shoulder. Furthermore, 70.8 percent of the subjects who had positive diagnosis by the video recording also had positive diagnosis in the static test. Although a significant association between scapular dyskinesia and shoulder pain was not found, this is an important study to approach these conditions in swimmers.

Percutaneous Radiofrequency Ablation for the Hepatocellular Carcinoma Abutting the Diaphragm: Assessment of Safety and Therapeutic Efficacy

OBJECTIVE: To assess the safety and therapeutic efficacy of a percutaneous radiofrequency (RF) ablation for the hepatocellular carcinoma (HCC) abutting the diaphragm. MATERIALS AND METHODS: We retrospectively assessed 80 patients who underwent a percutaneous RF ablation for a single nodular (< 4 cm) HCC over the last four years. Each patient underwent an ultrasound-guided RF ablation using internally cooled electrodes for the first-line treatment. We divided patients into two subgroups based on whether the index tumor was abutting (less than 5 mm) the diaphragm or not: group A (abutting; n = 31) versus group B (non-abutting; n = 49). We compared the two subgroups for complications and therapeutic efficacy using image and the review of medical records. The statistical assessment included an independent t-test, Fisher's exact test, and chi-square test. RESULTS: The assessment of the diaphragmatic swelling at CT immediately following the procedure was more severe in group A than group B (mean thickness change:1.44 vs. 0.46 mm, p = 0.00). Further, right shoulder pain was more common in group A than B (p = 0.01). Although minor complications (hemothorax 1 case, pleural effusion 1 case) were noted only in group A, no major thoracic complication occurred in either group. The technical success rate was lower in group A than group B (84% vs. 98%, p = 0.03). As well, the primary and secondary technique effectiveness rates in group A and group B were 90% versus 98% (p = 0.29) and 79% versus 91% (p = 0.25), respectively. The local tumor progression rate was higher in group A than in group B (29% vs. 6%, p = 0.02). CONCLUSION: We found that the percutaneous RF ablation for the HCC abutting the diaphragm is a safe procedure without major complications. However, it is less effective with regard to technical success and local tumor control.

Avaliação dos efeitos a longo prazo da acupuntura e exercícios terapêuticos em ombro congelado de pacientes com acidente cerebral vascular / Evaluation of long term effects of acupuncture and therapeutic exercises on frozen shoulder in stroke patients

Objetivo do estudo: Determinar como a acupuntura e a terapia com exercícios afetam a função motora e espasmodicidade das mãos de pacientes com acidente cerebral vascular 6 meses após eles terem recebido este tipo de terapia. Métodos: Estudo clínico prospectivo, aleatório e cego de 20 pacientes, com idades entre 60-70 anos, na fase crônica de 6 meses após o AVC. Os sujeitos do estudo foram divididos em dois grupos: Grupo A, o qual foi tratado com acupuntura e terapia de exercícios (AP-ET) 6 meses atrás e Grupo B, o qual foi tratado apenas com terapia de exercícios (ET) 6 meses atrás. A avaliação incluiu uma entrevista ampla e a administração dos estágios de Brunnstrom, a Medida de Independência Funcional (MIF), a Escala Modificada de Ashworth (MAS), o Teste de Funcionalidade das Extremidades Superiores (UEFT), o Registro de Atividade Motora (MAL), a Série de Movimentos ativos e passivos (ROM, pROM), o teste de FUGL-Meyer da função da extremidade superior (FMA), o Questionário de Croft sobre Incapacidade do Ombro (CSDQ) e a Escala Analógica Visual (VAS) de dor. O Teste-t de Gosset foi usado para uma análise estatística. Resultados: As análises mostraram uma diferença estatisticamente significativa nos SCORES do pós-tratamento em comparação com 6 meses após o tratamento com cada grupo de estudo, para todos os parâmetros examinados (p<0.01 em todos os casos) exceto pelo MAS.

Aim of the study: To determine how acupuncture and exercise therapy affect motor function and spasticity on the hands of stroke patients 6 months after they had received this kind of therapy. Methods: Prospective, randomized, single blind clinical study of 20 patients, age 60-70 years, in the chronic phase 6 months after stroke. Subjects were divided into two groups: Group A, which was treated with acupuncture and exercise therapy (AP-ET) 6 months ago and Group B, which was treated with exercise therapy (ET) alone 6 months ago. the assessment included a comprehensive interview and administration of the Brunnstrom?s stages, Functional Independence Measure (FIM), Modified Ashworth Scale (MAS), Upper Extremity Function Test (UEFT), Motor Activity Log (MAL), active and passive Range of Motion (aROM, pROM), Fugl-Meyer test of upper extremity function (FMA), Croft Shoulder Disability Questionnaire (CSDQ) and Visual Analogue Scale (VAS) of pain. The Gosset t-Test was used for the statistical analysis. Results: Analyses showed a statistically significant difference in the post-treatment SCORES as compared to 6 months after treatment within each study group for all parameters examined (p<0.01 in all cases) except for MAS. Analyses showed a statistically significant difference in some parameters in the ET group as compared to the AP-ET group with greater mean values recorded in the AP-ET group for MAS and CSDQ. All other parameters showed no statistical differences between the two different therapy groups 6 months after the therapy. Conclusion: The results confirm the hypothesis that acupuncture and exercise therapy are useful in the treatment of frozen shoulder in stroke patients and that their effects are still present after 6 months of therapy, however, given the small patient population, further studies are needed to verify these results.