Reparación sistemática del manguito rotador: Clasificación de la Fundación Santa Fe de Bogotá / Standardized rotator cuff repair. Classification of Fundación Santa Fe de Bogotá

La cirugía de manguito rotador se ha popularizado en los últimos años y pasó de realizarse mediante una técnica abierta, en la mayoría de los casos, a la reparación artroscópica. Se han descrito múltiples técnicas para la fijación del hueso, pero no se han estandarizado el orden y los pasos para llevar a cabo esta reparación, lo que generó inconsistencias y heterogeneidad en los resultados de la reparación. En este artículo, se propone una nueva clasificación de las lesiones del manguito rotador que les permitirá a los cirujanos tomar decisiones durante la cirugía de reparación artroscópica del manguito rotador. Nivel de Evidencia: IV

Rotator cuff surgery has become more popular in recent years, transitioning from an open technique to arthroscopic surgery. Although multiple techniques for bone fixation have been described, the steps to perform this repair have not been standardized, leading to inconsistencies and heterogeneity in the outcomes. This article proposes a new classification of rotator cuff injuries that will help surgeons make decisions during arthroscopic rotator cuff repair surgery. Level of Evidence: IV

Comparative Study between Multi-slice Computed Tomographic Arthrography and Arthroscopy in the Evaluation of Rotator Cuff Tears / Estudo comparativo entre artrotomografia computadorizada multi-slice e artroscopia na avaliação das lesões do manguito rotador

Abstract Objective To compare the imaging findings of anatomical alterations using multi-slice computed tomographic arthrography in the evaluation of rotator cuff tears in the shoulder, correlating them with the arthroscopy (the gold standard diagnostic test) findings. Materials and Methods A longitudinal, prospective, comparative study of diagnostic accuracy performed in the period between June 2016 and June 2017 in patients of both sexes, aged between 40 and 70 years, with shoulder rotator cuff tendon tears and therapeutic need to undergo shoulder arthroscopy. Patients with contraindication to magnetic resonance imaging were included. After multi-slice computed tomographic arthrography, all patients underwent arthroscopy. Results To obtain the results, the following parameters were determined: sensitivity, specificity, accuracy, positive predictive value, negative predictive value, and Kappa coefficient, and contrast between the imaging method and arthroscopy. Conclusion In the impossibility of performing magnetic resonance imaging (the gold standard imaging technique), multi-slice computed tomographic arthrography is an imaging examination capable of evaluating/diagnosing rotator cuff tears.

Resumo Objetivo Comparar os achados por imagem das alterações anatômicas da artrotomografia computadorizada multi-slice na avaliação das lesões do manguito rotador do ombro e correlacioná-los com os achados da artroscopia (exame diagnóstico padrão-ouro). Materiais e Métodos Estudo longitudinal, prospectivo, comparativo de acurácia diagnóstica, feito de junho de 2016 a junho de 2017, em pacientes de ambos os sexos, com idades entre 40 e 70 anos, com lesão dos tendões do manguito rotador do ombro, e que tinham necessidade terapêutica de fazer artroscopia do ombro. Foram incluídos pacientes com contraindicação à realização de ressonância magnética. Após a artrotomografia computadorizada multi-slice, todos os pacientes foram submetidos a artroscopia. Resultados Para a obtenção dos resultados, os seguintes parâmetros foram considerados: sensibilidade, especificidade, acurácia, valor preditivo positivo, valor preditivo negativo, coeficiente Kappa, e contraposição do método de imagem com a artroscopia. Conclusão Na impossibilidade da realização da ressonância magnética (exame de imagem padrão-ouro), a artrotomografia computadorizada multi-slice se mostra um exame de imagem capaz de avaliar/diagnosticar as lesões do manguito rotador.

Reliability of a Smartphone Compared With an Inertial Sensor to Measure Shoulder Mobility: Cross-Sectional Study.

BACKGROUND: The shoulder is one of the joints with the greatest mobility within the human body and its evaluation is complex. An assessment can be conducted using questionnaires or functional tests, and goniometry can complement the information obtained in this assessment. However, there are now validated devices that can provide more information on the realization of movement, such as inertial sensors. The cost of these devices is usually high and they are not available to all clinicians, but there are also inertial sensors that are implemented in mobile phones which are cheaper and widely available. Results from the inertial sensors integrated into mobile devices can have the same reliability as those from dedicated sensors. OBJECTIVE: This study aimed to validate the use of the Nexus 4 smartphone as a measuring tool for the mobility of the humerus during shoulder movement compared with a dedicated InertiaCube3 (Intersense) sensor. METHODS: A total of 43 subjects, 27 affected by shoulder pathologies and 16 asymptomatic, participated in the study. Shoulder flexion, abduction, and scaption were measured using an InertiaCube3 and a Nexus 4 smartphone, which were attached to the participants to record the results simultaneously. The interclass correlation coefficient (ICC) was calculated based on the 3 movements performed. RESULTS: The smartphone reliably recorded the velocity values and simultaneously recorded them alongside the inertial sensor. The ICCs of the 3 gestures and for each of the axes of movement were analyzed with a 95% CI. In the abduction movement, the devices demonstrated excellent interclass reliability for the abduction humeral movement axis (Cronbach alpha=.98). The axis of abduction of the humeral showed excellent reliability for the movements of flexion (Cronbach alpha=.93) and scaption (Cronbach alpha=.98). CONCLUSIONS: Compared with the InertiaCube3, the Nexus 4 smartphone is a reliable and valid tool for recording the velocity produced in the shoulder.

Validity and reliability study of the Turkish version of the Hand20 questionnaire

Background/aim: This study aimed to translate and validate the Turkish version of the Hand20 questionnaire. Materials and methods: Patients who had upper extremity involvement and stable symptoms for the previous 4 weeks in their upper extremities were included in the study. Patients who were illiterate or used a splint during the day were excluded from the study. Participants completed the Turkish version of the Disabilities of the Arm, Shoulder, and Hand (DASH-T) questionnaire once and the final version of the Hand20 questionnaire twice in a 7-day interval. Internal consistency and reliability of the questionnaire was assessed. Moreover, correlations between Hand20 and DASH-T scores were analyzed using Spearman's correlation coefficient. Results: A total of 104 patients participated in the study. The Turkish version of the Hand20 met the set criteria of reliability and validity. Internal consistency (Cronbach's alpha = 0.93) and test-retest reliability were excellent (r = 0.82). Hand20 showed a positive and statistically significant correlation with DASH-T (r = 0.76, P < 0.001). Conclusion: The results showed that the Turkish version of the Hand20 had excellent test-retest reliability and validity. As a result of this study, it was determined that Hand20 was a valid and reliable instrument to measure the upper extremity disabilities of Turkish-speaking patients.

[A video-based analysis to classify shoulder injuries during the Handball World Championships 2015]. / Eine videobasierte Analyse zur Klassifizierung von Schulterverletzungen während der Handball-Weltmeisterschaft 2015.

Injuries play a major role in high-performance sports and occur in training and competition. Handball is a team sport with high physical demands, and the measurement of specific loads has the potential to identify risk factors for injuries. Few studies have identified this in handball during a World Cup. This study aims to record shoulder injuries that occurred during the 88 games of the 2015 Men's World Cup and to discuss position-specific differences. Players from 24 national teams were analysed using a camera system and special software (Prozone Handball V. 1.2, Prozone, Leeds, UK). In total, nine shoulder injuries were recorded. Three out of these nine injuries were non-contact injuries. The number of passes and throws is position-dependent, and the highest load was documented for the back players. The two back players who suffered a non-contact injury have an increased play time and an increased number of throws compared to their peers. To reduce the risk of injury, the load should be monitored (during training and tournament), and a targeted injury prevention should be performed to prepare the players for the requirements of the game/tournament.

Low prevalence of relevant associated articular lesions in patients with acute III-VI acromioclavicular joint injuries.

PURPOSE: To define the prevalence of associated articular injuries in patients with severe (Rockwood's III-VI) acute acromioclavicular joint injuries and to find out how many of these were associated with the traumatic event and required surgical treatment. METHODS: Retrospective observational multicentric study performed in ten centres included patients who required surgery for acute acromioclavicular joint injuries between 2010 and 2017. The inclusion criteria were: presence of an acute acromioclavicular joint injury (grades III-IV-V-VI) and surgical treatment within 3 weeks of injury that included a full arthroscopic evaluation of the shoulder. Basic epidemiological data, severity of the original injury, prelesional sport level and prelesional work site requirements were recorded. The presence of intraarticular glenohumeral lesions and information of their characteristics, treatment, and whether each lesion was considered acute or pre-existing was also recorded. RESULTS: Two-hundred one subjects [mean (SD) age 36.7 (11.7) years] with acute acromioclavicular joint injuries (110 Rockwood type III, 34 type IV, 56 type V and 1 type VI) fulfilled the inclusion criteria. A total of 28 (13.9%) associated articular lesions were found. These lesions were more often found in grade IV injuries (26.5% in grade IV vs 11.4% in grade III, p = 0.037) and presented in males (18.7% in males vs 4% in females, p = 0.015). Age, laterality, sport level or work requirements did not affect the prevalence of associated lesions. Twelve were rotator cuff tears (6 PASTA lesions, 3 partial supscapularis tears, 2 bursal supraspinatus tears and 1 full-thickness supraspinatus tear), 16 were labral tears (9 anterior, 1 posteroinferior and 6 SLAP). Only 14 (50% of lesions, 7% of total subjects) were considered acute and all but one (an SLAP type 2 tear) required further surgical attention. Most pre-existing lesions were left untreated (n = 7) or managed with minimal debridement (n = 6), and only two required further surgery. The prevalence of associated lesions that required surgical management was 7.46%. CONCLUSIONS: The prevalence of relevant associated lesions in subjects with acute grade III to VI ACJI is relatively low. Only 14% of subjects have an associated lesion and only half of these required further surgical attention. LEVEL OF EVIDENCE: Retrospective case series, level IV.

SLAP Lesions: Trends in Treatment.

PURPOSE: To determine the trends in SLAP repairs over time, including patient age, and percentage of SLAP repairs versus other common shoulder arthroscopic procedures. METHODS: The records of 4 sports or shoulder/elbow fellowship trained orthopaedic surgeons were used to identify the total number of common shoulder arthroscopic cases performed between 2004 and 2014 using current procedural terminology codes (CPT): 29822, 29823, 29826, 29827, 29806, 29807, 29825, and 29828. The number of SLAP repairs (CPT code 29807) as a combined or isolated procedure were recorded, and the classification of SLAP type was undertaken using operative reports. Patient age was recorded. Linear regression was used to determine statistical significance. RESULTS: There were 9,765 patients who underwent arthroscopic shoulder procedures using the defined CPT codes between 2004 and 2014 by our 4 orthopaedic surgeons. Of these, 619 underwent a SLAP repair (6.3%); average age 31.2 ± 11.9. The age of patients undergoing SLAP repair significantly decreased over time (P < .001, R(2) = 0.794). Most SLAP repairs were performed on type II SLAP tears (P = .015, R(2) = 0.503). The percentage of SLAP repairs compared with the total number of shoulder arthroscopic surgeries and total number of patients who underwent SLAP repair significantly decreased over time (P < .001, R(2) = 0.832 and P = .002, R(2) = 0.674, respectively). Conversely, the number and percentage of biceps tenodeses are increasing over time (P = .0024 and P = .0099, respectively). CONCLUSIONS: Over the past 10 years, the total number of biceps tenodeses has increased, whereas the number and relative percentage of SLAP repairs within our practice have decreased. The average age of patients undergoing SLAP repair is decreasing, and most SLAP repairs are performed for type II SLAP tears. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

Epidemiology of shoulder injuries in young baseball players and grading of radiologic findings of Little Leaguer's shoulder.

Relatively few epidemiological studies have examined shoulder injuries. This study aimed to investigate the epidemiology of such injuries in young baseball players. A total of 2,055 players aged 9-12 years who participated in a regional championship between 1983 and 1985 were the subjects of this investigation. They were assessed by questionnaire and radiographic examination. Prevalence of shoulder pain was determined according to position, years of baseball playing experience, and training hours per week. Radiographic examination was recommended to all players who complained of shoulder pain. Of the 2,055 subjects, 275 (13.4%) reported episodes of pain in the throwing shoulder. Years of baseball experience, but not player position or training hours per week, was significantly associated with shoulder pain. Forty-one of the 275 subjects reporting shoulder pain agreed to undergo radiography and 15 exhibited findings of Little Leaguer's shoulder. Their lesions could be classified into three distinct grades based on radiographic findings: grade I, widening of the epiphyseal plate in the lateral area (n=9); grade II, widening at all areas of the epiphyseal plate and demineralization of the metaphysis (n=5); and grade III, a slipped epiphysis (n=1). J. Med. Invest. 62: 123-125, August, 2015.