Evaluation of the Clinical Outcomes of the Arthroscopic Treatment of Rotator Cuff Tears Using the Modified Suture Bridge Technique.

Objective To evaluate the postoperative clinical outcomes of the arthroscopic repair of rotator cuff injuries using a suture configuration we have developed based on a modification of the Suture Bridge (Arthrex, Naples, FL, United States). Methods A retrospective study with 28 male (41.2%) and 40 female (58.8%) subjects with a mean age of 60 years. All patients underwent rotator cuff repair with the modified Suture Bridge technique and follow-up for a minimum period of 18 months. The clinical assessment was performed using the University of California, Los Angeles (UCLA) Shoulder Score. Results The mean postoperative range of motion was of 134° (range: 110° to 140°) for elevation, 58° (range: 40° to 70°) for lateral rotation, and T10 (range: L4 to T7) for medial rotation. The mean increase was of 15° for elevation, 14° for lateral rotation, and 2 vertebral levels for medial rotation. The outcomes were excellent in 61 (83.6%) cases, good in 8 (10.9%), and regular in 4 cases (5.5%). Conclusion The modified Suture Bridge technique for the arthroscopic repair of rotator cuff injuries led to excellent or good postoperative clinical outcomes in most cases (69; 94.5%).

Evaluation of the Clinical Outcomes of the Arthroscopic Treatment of Rotator Cuff Tears Using the Modified Suture Bridge Technique / Avaliação dos resultados clínicos do tratamento artroscópico de lesões do manguito rotador pela técnica de suture bridge modificada

Abstract Objective To evaluate the postoperative clinical outcomes of the arthroscopic repair of rotator cuff injuries using a suture configuration we have developed based on a modification of the Suture Bridge (Arthrex, Naples, FL, United States). Methods A retrospective study with 28 male (41.2%) and 40 female (58.8%) subjects with a mean age of 60 years. All patients underwent rotator cuff repair with the modified Suture Bridge technique and follow-up for a minimum period of 18 months. The clinical assessment was performed using the University of California, Los Angeles (UCLA) Shoulder Score. Results The mean postoperative range of motion was of 134° (range: 110° to 140°) for elevation, 58° (range: 40° to 70°) for lateral rotation, and T10 (range: L4 to T7) for medial rotation. The mean increase was of 15° for elevation, 14° for lateral rotation, and 2 vertebral levels for medial rotation. The outcomes were excellent in 61 (83.6%) cases, good in 8 (10.9%), and regular in 4 cases (5.5%). Conclusion The modified Suture Bridge technique for the arthroscopic repair of rotator cuff injuries led to excellent or good postoperative clinical outcomes in most cases (69; 94.5%).

Resumo Objetivo Avaliar os resultados clínicos pós-operatórios do reparo artroscópico de lesões do manguito rotador com uma configuração de sutura desenvolvida por nós a partir de modificação do Suture Bridge (Arthrex, Naples, FL, Estados Unidos). Métodos Estudo retrospectivo de 28 pacientes do gênero masculino (41,2%) e 40 do gênero feminino (58,8%), com média de idade de 60 anos. Todos foram submetidos a reparo do manguito rotador com a técnica Suture Bridge modificada e acompanhados por um período mínimo de 18 meses. Os pacientes foram avaliados clinicamente através da Escala de Ombro da University of California, Los Angeles (UCLA). Resultados A amplitude de movimento média no pós-operatório foi elevação de 134 ° (variação: 110° a 140°), rotação lateral de 58° (variação: 40° a 70°), e rotação medial de T10 (variação: L4 a T7). O aumento médio de elevação foi de 15°, o de rotação lateral, de 14°, e o de rotação medial, de 2 níveis vertebrais. Os resultados foram considerados excelentes em 61 casos (83,6%) e bons, em 8 (10,9%). Em 4 casos (5,5%), o resultado foi regular. Conclusão Os resultados clínicos pós-operatórios do reparo artroscópico de lesões do manguito rotador, pela técnica Suture Bridge modificada, foram excelentes e bons na maioria dos casos (69; 94,5%).

Results of Latissimus Dorsi Transfer using a Tendinous Allograft through a Single Deltopectoral Approach for Irreparable Posterosuperior Rotator Cuff Tears.

Objective The primary aim of the present study is to evaluate the functional results of a modification to the latissimus dorsi (LD) transfer around the shoulder for irreparable posterosuperior rotator cuff tears. The secondary aim is to evaluate variables that might influence the outcomes. Surgical Technique Through a single deltopectoral approach, the LD tendon is detached, reinforced, and elongated with a tendinous allograft, transferred around the humerus, and fixed superolaterally to the greater tuberosity and anteriorly to the subscapularis. Methods Retrospective functional evaluation of 16 cases. The average follow-up was 21 months (12-47). The postoperative results (at last follow-up) were compared with the preoperative ones, as well as to other pre, intra, and postoperative variables. Results All (but one) patients were satisfied. Average University of California, Los Angeles (UCLA) score increased from 11.6 (8-16) to 27.3 (17-30) ( p < 0.001). Improvements of shoulder pain, function, and strength achieved statistical significance ( p < 0.001). Nonetheless, normal strength was never restored. Average active range of motion improved as follows: forward elevation, from 106° (60-140°) to 145° (130-160°) ( p < 0.001); external rotation from 30° (0° to 60°) to 54° (40-70°) ( p < 0.001); and internal rotation from L1 (gluteus to T7) to T10 (T12-T3) ( p < 0.05). No complication has occurred. Preoperative pseudoparesis was reverted in all the six cases in which it was present. None of the variables analyzed influenced the outcomes, including pseudoparesis. Conclusions At early follow-up, this technique is safe and effective at recovering from pseudoparesis and at improving shoulder pain, function, and strength.

Results of Latissimus Dorsi Transfer using a Tendinous Allograft through a Single Deltopectoral Approach for Irreparable Posterosuperior Rotator Cuff Tears / Resultados da transferência do grande dorsal alongado com enxerto tendíneo homólogo por via delto-peitoral para lesões póstero-superiores irreparáveis do manguito rotador

Abstract Objective The primary aim of the present study is to evaluate the functional results of a modification to the latissimus dorsi (LD) transfer around the shoulder for irreparable posterosuperior rotator cuff tears. The secondary aim is to evaluate variables that might influence the outcomes. Surgical Technique Through a single deltopectoral approach, the LD tendon is detached, reinforced, and elongated with a tendinous allograft, transferred around the humerus, and fixed superolaterally to the greater tuberosity and anteriorly to the subscapularis. Methods Retrospective functional evaluation of 16 cases. The average follow-up was 21 months (12-47). The postoperative results (at last follow-up) were compared with the preoperative ones, as well as to other pre, intra, and postoperative variables. Results All (but one) patients were satisfied. Average University of California, Los Angeles (UCLA) score increased from 11.6 (8-16) to 27.3 (17-30) (p< 0.001). Improvements of shoulder pain, function, and strength achieved statistical significance (p< 0.001). Nonetheless, normal strength was never restored. Average active range of motion improved as follows: forward elevation, from 106° (60-140°) to 145° (130-160°) (p< 0.001); external rotation from 30° (0° to 60°) to 54° (40-70°) (p< 0.001); and internal rotation from L1 (gluteus to T7) to T10 (T12-T3) (p< 0.05). No complication has occurred. Preoperative pseudoparesis was reverted in all the six cases in which it was present. None of the variables analyzed influenced the outcomes, including pseudoparesis. Conclusions At early follow-up, this technique is safe and effective at recovering from pseudoparesis and at improving shoulder pain, function, and strength.

Resumo Objetivo O objetivo primário do presente trabalho é avaliar os resultados funcionais de uma modificação na transferência do grande dorsal no ombro para o tratamento de lesões póstero-superiores irreparáveis do manguito rotador. O objetivo secundário é avaliar as variáveis que podem influenciar os resultados. Técnica cirúrgica Por meio de uma única abordagem deltopeitoral, o tendão do músculo grande dorsal é desinserido reforçado e alongado com um enxerto tendíneo homólogo, transferido para o úmero e fixado em posição superolateral ao tubérculo maior e anterior ao músculo subescapular. Métodos Avaliação funcional retrospectiva de 16 casos. O período médio de acompanhamento foi de 21 meses (12-47 meses). Os resultados pós-operatórios (no último acompanhamento) foram comparados aos pré-operatórios, bem como a outras variáveis pré, intra e pós-operatórias. Resultados Todos os pacientes ficaram satisfeitos (exceto um). A pontuação média da University of California, Los Angeles (UCLA) aumentou de 11,6 (8-16) para 27,3 (17-30) (p< 0,001). A dor, a função e a força do ombro apresentaram melhora estatisticamente significativa (p< 0,001). A força, porém, não voltou ao valor normal. A amplitude de movimento ativa média apresentou as seguintes melhoras: elevação frontal, de 106° (60-140°) para 145° (130-160°) (p< 0,001); rotação externa, de 30° (0-60°) para 54° (40-70°) (p< 0,001); e rotação interna, de L1 (glúteo a T7) para T10 (T12-T3) (p< 0,05). Nenhuma complicação foi observada. A pseudoparesia pré-operatória foi revertida em todos os seis casos em que foi observada. Nenhuma das variáveis analisadas influenciou os desfechos, nem mesmo a pseudoparesia. Conclusões A curto prazo essa técnica é segura e eficaz na recuperação da pseudoparesia e na melhora da dor, da função e da força do ombro.

Traumatic anterior instability of the shoulder.

The shoulder is the most unstable joint in the human body. Traumatic anterior instability of the shoulder is a common condition, which, especially in young patients, is associated with high recurrence rates. The effectiveness of non-surgical treatments when compared to surgical ones is still controversial. The purpose of this study was to review the literature for current concepts and updates regarding the treatment of this condition.

A articulação do ombro é a mais instável do corpo humano. Sua instabilidade anterior de causa traumática é uma condição comum e com alta taxa de recidiva em pacientes jovens. A eficácia do tratamento conservador comparado com o tratamento cirúrgico, em suas diversas abordagens, ainda é debatida. O propósito deste estudo foi revisar a literatura, rever conceitos e últimas atualizações sobre o tratamento dessa afecção.

Traumatic anterior instability of the shoulder / Instabilidade anterior traumática do ombro

ABSTRACT The shoulder is the most unstable joint in the human body. Traumatic anterior instability of the shoulder is a common condition, which, especially in young patients, is associated with high recurrence rates. The effectiveness of non-surgical treatments when compared to surgical ones is still controversial. The purpose of this study was to review the literature for current concepts and updates regarding the treatment of this condition.

RESUMO A articulação do ombro é a mais instável do corpo humano. Sua instabilidade anterior de causa traumática é uma condição comum e com alta taxa de recidiva em pacientes jovens. A eficácia do tratamento conservador comparado com o tratamento cirúrgico, em suas diversas abordagens, ainda é debatida. O propósito deste estudo foi revisar a literatura, rever conceitos e últimas atualizações sobre o tratamento dessa afecção.

FREQUENCY OF WRIST GROWTH PLATE INJURY IN YOUNG GYMNASTS AT A TRAINING CENTER

ABSTRACT Objective: To assess the frequency of physeal injuries and wrist pain in young competitive gymnasts according to their training characteristics . Methods: This is a cross-sectional study (January-June 2015) of a male gymnastics team in São Paulo, SP, Brazil. Nineteen gymnasts, mean age 13.3 years, were evaluated in three ways: a questionnaire, physical examination and radiographs . Results: On average, they trained since 6 years-old and during hours per week. Eighty-two percent had wrist pain and 65% had wrist physeal injury. The pain was worse in practitioners of (82%) and soil (17%) exercises. A greater frequency of physeal injury was found in those with more years of training and higher weekly working hours, wrist pain was more frequent in those with higher weekly working hours, and a decreased range of motion was observed in those with physeal injury, results statistically significant . Conclusions: We found that 65% of gymnasts had wrist physeal injury and 82% had wrist pain. There were statistically significant relationships between physeal injury and years of training, physeal injury and weekly working hours, pain and weekly working hours, and physeal injury and range of motion. Level of Evidence IV, Case Series.

FREQUENCY OF WRIST GROWTH PLATE INJURY IN YOUNG GYMNASTS AT A TRAINING CENTER.

OBJECTIVE: To assess the frequency of physeal injuries and wrist pain in young competitive gymnasts according to their training characteristics . METHODS: This is a cross-sectional study (January-June 2015) of a male gymnastics team in São Paulo, SP, Brazil. Nineteen gymnasts, mean age 13.3 years, were evaluated in three ways: a questionnaire, physical examination and radiographs . RESULTS: On average, they trained since 6 years-old and during hours per week. Eighty-two percent had wrist pain and 65% had wrist physeal injury. The pain was worse in practitioners of (82%) and soil (17%) exercises. A greater frequency of physeal injury was found in those with more years of training and higher weekly working hours, wrist pain was more frequent in those with higher weekly working hours, and a decreased range of motion was observed in those with physeal injury, results statistically significant . CONCLUSIONS: We found that 65% of gymnasts had wrist physeal injury and 82% had wrist pain. There were statistically significant relationships between physeal injury and years of training, physeal injury and weekly working hours, pain and weekly working hours, and physeal injury and range of motion. Level of Evidence IV, Case Series.

Reavaliação do ombro doloroso em atletas de beisebol após tratamento conservador / Reassessment of painful shoulders among baseball players after conservative treatment

OBJETIVO: O objetivo deste trabalho foi avaliar os resultados da reabilitação nos jogadores de beisebol que possuíam dor e déficit de rotação medial no ombro. MÉTODOS: Dos 55 atletas avaliados no período de abril a junho de 2009, observou-se que 20 atletas tinham dor em algum momento do arremesso. Eles foram orientados a realizar um programa de reabilitação com exercícios para alongamento da cápsula posterior e reforço dos músculos da cintura escapular, especialmente os rotadores laterais. Dezoito pacientes seguiram as orientações, dois perderam o seguimento. Os parâmetros avaliados foram: dor, amplitude de movimento e força pré e pós o término do programa. RESULTADOS: Na avaliação final, em comparação com a inicial, observamos: aumento em média da elevação de 10º (p = 0,001), de três níveis vertebrais da rotação medial (p < 0,001), aumento de 20º da rotação medial a 90º de abdução (p < 0,001) e um aumento de 26º do arco de rotação (p < 0,001). Com relação à força, foi evidente a melhora da força de elevação com aumento de 3kgf (p = 0,002) e da força de rotação lateral com aumento de 1kgf (p = 0,020). Dos 18 atletas estudados, a dor melhorou em 16, dois atletas permaneceram com dor e foram submetidos à ressonância magnética, na qual foram evidenciadas lesões de tratamento cirúrgico. CONCLUSÃO: O programa de reabilitação realizado com os jogadores de beisebol foi efetivo, possibilitando aumento da rotação medial, da elevação, do arco de rotação e das forças de elevação e rotação lateral, consequentemente havendo melhora da dor na maioria dos atletas.

OBJECTIVE: The objective of this study was to evaluate the rehabilitation results among baseball players who presented pain and medial rotation deficit in their shoulders. METHODS: Out of 55 baseball players assessed between April and June 2009, it was observed that 20 presented pain at some instant during throwing movements. They were advised to undergo a rehabilitation program with exercises to stretch the posterior capsule and reinforce the muscles of the scapular belt, especially the lateral rotators. Eighteen patients followed the advice, while two were lost from the follow-up. The parameters evaluated were: pain, range of motion, strength before the program and strength after the end of the program. RESULTS: Comparing the initial and final assessments, we observed mean increases as follows: 10º of elevation (p = 0.001); three vertebral levels of medial rotation (p < 0.001); 20º of medial rotation at 90º abduction (p < 0.001); and 26º of range of motion (p < 0.001). Regarding strength, elevation force increased by 3 kgf (p = 0.002) and lateral rotation force increased by 1 kgf (p = 0.020). Out of the 18 baseball players studied, the pain level improved in 16, while two continued to present pain and underwent magnetic resonance imaging, which showed lesions for surgical treatment. CONCLUSION: The rehabilitation program conducted among the baseball players was effective and enabled increases in medial rotation, elevation, range of motion and strength of elevation and lateral rotation, consequently producing pain improvements in most of the players.

REASSESSMENT OF PAINFUL SHOULDERS AMONG BASEBALL PLAYERS AFTER CONSERVATIVE TREATMENT.

OBJECTIVE: The objective of this study was to evaluate the rehabilitation results among baseball players who presented pain and medial rotation deficit in their shoulders. METHODS: Out of 55 baseball players assessed between April and June 2009, it was observed that 20 presented pain at some instant during throwing movements. They were advised to undergo a rehabilitation program with exercises to stretch the posterior capsule and reinforce the muscles of the scapular belt, especially the lateral rotators. Eighteen patients followed the advice, while two were lost from the follow-up. The parameters evaluated were: pain, range of motion, strength before the program and strength after the end of the program. RESULTS: Comparing the initial and final assessments, we observed mean increases as follows: 10° of elevation (p = 0.001); three vertebral levels of medial rotation (p < 0.001); 20° of medial rotation at 90° abduction (p < 0.001); and 26° of range of motion (p < 0.001). Regarding strength, elevation force increased by 3 kgf (p = 0.002) and lateral rotation force increased by 1 kgf (p = 0.020). Out of the 18 baseball players studied, the pain level improved in 16, while two continued to present pain and underwent magnetic resonance imaging, which showed lesions for surgical treatment. CONCLUSION: The rehabilitation program conducted among the baseball players was effective and enabled increases in medial rotation, elevation, range of motion and strength of elevation and lateral rotation, consequently producing pain improvements in most of the players.

Fluxograma diferencial entre a artrite séptica e sinovite transitória do quadril em crianças / Flowchart distinguishing between septic arthritis and transitory synovitis of the hip in children

O diagnóstico diferencial entre a artrite séptica e a sinovite transitória do quadril não é fácil de ser realizado, pois não há um exame que seja simples, nem satisfatoriamente sensível e específico para diferenciá-las. Sendo assim, é muitas vezes utilizada uma propedêutica armada de exames que demanda maior custo e requer melhor infra-estrutura da instituição de saúde. Perante isso, torna-se evidente a necessidade de uma análise multifatorial dos dados clínicos e laboratoriais envolvidos para a proposição de um fluxograma em que se possa racionalizar exames visando a correta abordagem e evitar a indicação de procedimentos, muitas vezes, desnecessários como a ressonância magnética ou mais invasivos como a artrocentese e a própria drenagem cirúrgica. Realizamos uma ampla revisão da literatura nas bases de dados do Pubmed e Cochrane até maio de 2009 em que foi analisada a importância do exame clínico, dos testes laboratoriais e de imagem para a diferenciação entre as duas afecções. Mediante o cruzamento dos dados foi elaborado um fluxograma para o diagnóstico e conduta na criança e no adolescente, com idade de seis meses a dezoito anos, com sintoma de dor no quadril, na suspeita de quadro inflamatório. Nivel de Evidência III, estudos diagnósticos, investigação de um exame para diagnóstico.

The distinguishing diagnosis between the septic arthritis and the transitory synovitis of a hip is not easy to be carried through; therefore, there is not a simple, nor sensible and satisfactorily specific examination to differentiate them. Thus, the use of a propedeutic set of examinations becomes necessary to demand greater cost and depend on a bigger infrastructure of the health institution. First of all, the necessity of a multifactorial analysis on a flowchart is evident, so it can rationalize the indication of unnecessary or more invasive procedures as artrocentesis, magnetic resonance and the surgical draining. A revision of literature on the databases of Pubmed and Cochrane until May of 2009 was carried through, and the importance of the clinical examination, laboratorial tests and imaging exams was analyzed. By studies on the data, it was elaborated a flowchart for the diagnosis and the conduction of the management on the patient, between the ages of six months and eighteen years old, with complaint of pain on the hip under suspicion of inflammatory picture. Level of Evidence: Level III, diagnostic studies - investigating a diagnostic test.