Non-operative management of shoulder osteoarthritis: Current concepts.

Glenohumeral osteoarthritis (OA) is one of the most common causes of shoulder pain. Conservative treatment options include physical therapy, pharmacological therapy, and biological therapy. Patients with glenohumeral OA present shoulder pain and decreased shoulder range of motion (ROM). Abnormal scapular motion is also seen in patients as adaptation to the restricted glenohumeral motion. Physical therapy is performed to (1) decrease pain, (2) increase shoulder ROM, and (3) protect the glenohumeral joint. To decrease pain, it should be assessed whether the pain appears at rest or during shoulder motion. Physical therapy may be effective for motion pain rather than rest pain. To increase shoulder ROM, the soft tissues responsible for the ROM loss need to be identified and targeted for intervention. To protect the glenohumeral joint, rotator cuff strengthening exercises are recommended. Administration of pharmacological agents is the major part next to physical therapy in the conservative treatment. The main aim of pharmacological treatment is the reduction of pain and diminution of inflammation in the joint. To achieve this aim, non-steroidal anti-inflammatory drugs are recommended as first-line therapy. Additionally, the supplementation of oral vitamin C and vitamin D can help to slow down cartilage degeneration. Depending on the individual comorbidities and contraindications, sufficient medication with good pain reduction is thus possible for each patient. This interrupts the chronic inflammatory state in the joint and, in turn, enables pain-free physical therapy. Biologics such as platelet-rich plasma, bone marrow aspirate concentrate, and mesenchymal stem cells have gathered increased attention. Good clinical outcomes have been reported, but we need to be aware that these options are helpful in decreasing shoulder pain but neither stopping the progression nor improving OA. Further evidence of biologics needs to be obtained to determine their effectiveness. In athletes, a combined approach of activity modification and physical therapy can be effective. Oral medications can provide patients with transient pain relief. Intra-articular corticosteroid injection, which provides longer-term effects, must be used cautiously in athletes. There is mixed evidence for the efficacy of hyaluronic acid injections. There is still limited evidence regarding the use of biologics.

Panorama of Infiltration for Painful Shoulder Among Shoulder Specialists / Panorama da infiltração para ombro doloroso entre especialistas em ombro

Abstract Objective To assess how shoulder specialists have used infiltration in their daily practice. Methods A survey study in which shoulder and elbow specialists answered a questionnaire on the use of infiltration in painful shoulders. Results Most of the doctors (45.9%) have > 10 years of experience in the area and have carried out up to 10 infiltrations in the last 12 months. The main indications for glenohumeral and subacromial infiltration are glenohumeral arthrosis and rotator cuff tendinopathy, respectively. The most used portals are the posterior (52.2%) for glenohumeral infiltration and the lateral (57.5%) for subacromial infiltration. The majority of the doctors (752%) infiltrate in an outpatient setting without imaging methods, and the most commonly used drug is the combination of corticoid and anesthetic. The main contraindication cited is the presence of diabetes, and the most common complication is pain after infiltration. Conclusion Subacromial infiltrations are indicated especially for the treatment of rotator cuff tendinopathies and bursitis, performed by the lateral portal, in an outpatient setting, with low index of long-term complications. Glenohumeral infiltrations are indicated especially for glenohumeral arthrosis, with a combination of a corticoid and anesthetic, performed mostly in an outpatient setting.

Resumo Objetivo Avaliar como especialistas de ombro têm utilizado a infiltração na sua prática diária. Métodos Estudo tipo survey interseccional em tempo único, no qual especialistas em ombro e cotovelo responderam a um questionário sobre o uso de infiltrações no ombro doloroso. Resultados A maior parte (45,9%) dos entrevistados possui experiência > 10 anos na área e realizaram até 10 infiltrações nos últimos 12 meses. As principais indicações para infiltração glenoumeral e subacromial são artrose glenoumeral e tendinopatia do manguito rotador, respectivamente. Os portais mais utilizados são o posterior (52,2%) para infiltração glenoumeral e o lateral (57,5%) na subacromial. A maioria (75,2%) dos entrevistados realiza a infiltração ambulatorialmente sem auxílio de métodos de imagem, e a droga mais utilizada é a combinação de corticoide e anestésico. A principal contraindicação citada é a presença de diabetes, e a complicação mais comum é a dor após a infiltração. Conclusão Infiltrações subacromiais são indicadas especialmente para tratamento de tendinopatias do manguito e bursites, realizadas pelo portal lateral, em ambiente ambulatorial, com baixo índice de complicações em longo prazo. As infiltrações glenoumerais são indicadas especialmente para artrose glenoumeral, com combinação de corticoide e anestésico, realizadas, em sua maioria, ambulatorialmente.

Tratamento por ondas de choque extracorpórea na síndrome do estresse tibial: uma revisão da literatura / Treatment of medial tibial stress syndrome with extracorporeal shockwave treatment: a literature review

A síndrome do estresse tibial medial é uma lesão comum devido a sobrecarga mecânica, principalmente em atletas, devido a inflamação local e estresse ósseo. A terapia de ondas de choque (TOC) vem sendo utilizada como tratamento para esta patologia por seus efeitos analgésicos e anti-inflamatórios. Objetivo: Avaliar a eficácia da TOC no tratamento analgésico da síndrome do estresse tibial medial e medidas de funcionalidade. Métodos: Foi realizada uma revisão da literatura, sendo incluídos estudos clínicos em humanos. Resultados: 3 artigos preencheram os critérios de inclusão, incluindo 166 pacientes. Os trabalhos trouxeram uma ampla variedade de intervenções, tipos de aparelhos, frequência e energia utilizada, além de diferenças nas quantidades de sessões e tipos de ondas de choque utilizado no tratamento. Conclusão: Ainda não há evidências consistentes quanto ao uso da TOC no tratamento conservador da síndrome do estresse tibial medial, com estudos pequenos, de qualidade metodológica baixa. Os estudos inclusos no trabalho não relataram efeitos colaterais significativos

Medial tibial stress syndrome is a common injury due to mechanical overload, especially in athletes due to local inflammation and bone stress. Shockwave therapy (ESWT) has been used as a treatment for this pathology due to its analgesic and anti-inflammatory effects. Objective: To evaluate the effectiveness of ESWT in the analgesic treatment of medial tibial stress syndrome and measures of functionality. Methods: A review of the literature was conducted, with clinical studies in humans included. Results: 3 articles fulfilled the inclusion criteria, including 166 patients. The trials involved a wide variety of interventions, types of devices, frequency and energy used, as well as differences in the number of sessions and types of shock waves used in treatment. Conclusion: There is still no consistent evidence regarding the use of ESWT in the conservative treatment of medial tibial stress syndrome, with small studies of low methodological quality. Studies included in this review did not report significant side effects

Twin athlete brothers with open physes operated for ACL reconstruction on the same day, but with different elapsed times after injury: a 5-year follow-up.

We present the case of twin brothers with open physes who practiced judo to a high level and were operated on the same day for anterior cruciate ligament reconstruction. One of them was injured a year before surgery, and the other was injured a month before the procedure. The brother who chose to undergo a conservative treatment sustained meniscus injury afterwards and showed lower objective results when evaluated 5 years after surgery.

Evolución clinica y radiografica de la meniscectomia lateral parcial artroscopica / Partial lateral arthroscopic meniscectomy

Entre 1984 y 1993, los autores estudiaron retrospectivamente 89 pacientes con meniscectomia lateral parcial artroscopica. Fueron seleccionados segun criterios de ausencia de lesion de ligamento asociada y de signos de degeneracion articular confirmados cuando fue realizada la artroscopia. Treinta y siete (42 por ciento) fueron evaluados segun cuestionario y los 52 (58 por ciento) restantes, ademas del cuestionario, fueron examinados clinica y radiograficamente. Se comparo la evolucion clinica de cada paciente con el tipo de lesion meniscal. Se encontro una peor evolucion clinica de los casos donde la meniscectomia era mas agresiva, principalmente en la region del tendon popliteo hasta el cuerno posterior y en las lesiones longitudinales con reseccion de mas del tercio del menisco. El estudio radiografico mostro señales incipientes de artrosis lateral, principalmente en los pacientes con mayor seguimiento y mayor actividad fisica. Los autores concluyeron que la meniscectomia lateral parcial puede presentar evolucion precozmente sintomatica, principalmente en las lesiones longitudinales posteriores y extensas, en deportistas con gran actividad, pudiendo empeorar a lo largo del tiempo

Evolución clinica y radiografica de la meniscectomia lateral parcial artroscopica / Partial lateral arthroscopic meniscectomy

Entre 1984 y 1993, los autores estudiaron retrospectivamente 89 pacientes con meniscectomia lateral parcial artroscopica. Fueron seleccionados segun criterios de ausencia de lesion de ligamento asociada y de signos de degeneracion articular confirmados cuando fue realizada la artroscopia. Treinta y siete (42 por ciento) fueron evaluados segun cuestionario y los 52 (58 por ciento) restantes, ademas del cuestionario, fueron examinados clinica y radiograficamente. Se comparo la evolucion clinica de cada paciente con el tipo de lesion meniscal. Se encontro una peor evolucion clinica de los casos donde la meniscectomia era mas agresiva, principalmente en la region del tendon popliteo hasta el cuerno posterior y en las lesiones longitudinales con reseccion de mas del tercio del menisco. El estudio radiografico mostro señales incipientes de artrosis lateral, principalmente en los pacientes con mayor seguimiento y mayor actividad fisica. Los autores concluyeron que la meniscectomia lateral parcial puede presentar evolucion precozmente sintomatica, principalmente en las lesiones longitudinales posteriores y extensas, en deportistas con gran actividad, pudiendo empeorar a lo largo del tiempo