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1.
Bone Joint J ; 102-B(3): 365-370, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32114820

RESUMEN

AIMS: Patient-specific instrumentation has been shown to increase a surgeon's precision and accuracy in placing the glenoid component in shoulder arthroplasty. There is, however, little available information about the use of patient-specific planning (PSP) tools for this operation. It is not known how these tools alter the decision-making patterns of shoulder surgeons. The aim of this study was to investigate whether PSP, when compared with the use of plain radiographs or select static CT images, influences the understanding of glenoid pathology and surgical planning. METHODS: A case-based survey presented surgeons with a patient's history, physical examination, and, sequentially, radiographs, select static CT images, and PSP with a 3D imaging program. For each imaging modality, the surgeons were asked to identify the Walch classification of the glenoid and to propose the surgical treatment. The participating surgeons were grouped according to the annual volume of shoulder arthroplasties that they undertook, and responses were compared with the recommendations of two experts. RESULTS: A total of 59 surgeons completed the survey. For all surgeons, the use of the PSP significantly increased agreement with the experts in glenoid classification (x2 = 8.54; p = 0.014) and surgical planning (x2 = 37.91; p < 0.001). The additional information provided by the PSP also showed a significantly higher impact on surgical decision-making for surgeons who undertake fewer than ten shoulder arthroplasties annually (p = 0.017). CONCLUSIONS: The information provided by PSP has the greatest impact on the surgical decision-making of low volume surgeons (those who perform fewer than ten shoulder arthroplasties annually), and PSP brings all surgeons in to closer agreement with the recommendations of experts for glenoid classification and surgical planning. Cite this article: Bone Joint J 2020;102-B(3):365-370.


Asunto(s)
Artroplastía de Reemplazo de Hombro/métodos , Toma de Decisiones , Imagen Tridimensional , Osteoartritis/cirugía , Articulación del Hombro/cirugía , Cirugía Asistida por Computador/métodos , Tomografía Computarizada por Rayos X/métodos , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Osteoartritis/diagnóstico , Articulación del Hombro/diagnóstico por imagen
2.
Orthop Clin North Am ; 51(2): 241-258, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32138862

RESUMEN

The glenohumeral joint is prone to instability. Patients with instability should have a physical examination. Imaging studies can provide additional information. Classification schemes that into account soft tissue pathology, neuromuscular control, bone loss, and activity level. An arthroscopic Bankart repair is the mainstay for unidirectional instability. Bone block procedures are indicated for patients with bone loss or a failed attempt at stabilization surgery. The arthroscopic Latarjet is a promising option for these patients. For patients with multidirectional instability, prolonged rehabilitation is indicated, followed by capsular plication or inferior capsular shift if instability is unresponsive to physical therapy.


Asunto(s)
Inestabilidad de la Articulación/cirugía , Luxación del Hombro/cirugía , Articulación del Hombro/cirugía , Artroscopía , Toma de Decisiones , Humanos , Internacionalidad , Inestabilidad de la Articulación/clasificación , Inestabilidad de la Articulación/diagnóstico , Examen Físico , Luxación del Hombro/clasificación , Luxación del Hombro/diagnóstico , Articulación del Hombro/anatomía & histología
3.
Orthop Clin North Am ; 51(2): 259-264, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32138863

RESUMEN

The relationship between obesity and glenohumeral osteoarthritis is relatively understudied. The purpose of this study was to better define this relationship by age- and gender-matching 596,874 patients across six body mass index (BMI) cohorts and determining the prevalence of glenohumeral osteoarthritis and the standardized rate of glenohumeral arthroplasty in each cohort. Individuals with a BMI over 24 were found to be at increased odds for developing glenohumeral osteoarthritis, compared to the normal BMI cohort, and individuals with a BMI over 30 were additionally found to be at increased odds for undergoing glenohumeral arthroplasty.


Asunto(s)
Artroplastía de Reemplazo de Hombro , Obesidad/epidemiología , Osteoartritis/epidemiología , Articulación del Hombro/cirugía , Índice de Masa Corporal , Estudios de Cohortes , Humanos , Obesidad/complicaciones , Osteoartritis/cirugía , Prevalencia , Estudios Retrospectivos
4.
Instr Course Lect ; 69: 255-272, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32017732

RESUMEN

Compared with other joints in the body, examination of the shoulder continues to be a challenge for practitioners, whether they be trainers, physical therapists, primary care physicians, or orthopedic surgeons. There are many reasons for this challenge, the primary being the highly complex architecture of bony and soft-tissue anatomy which allows for the greatest range of motion of any joint of the body. As a result, the clinical examination as Ralph Hertel, MD, has commented "perhaps it is just not easy." His comment reflects that one cannot just expect to understand how to interpret the examination unless the observer has some knowledge of how the shoulder complex works, how to perform the basics of the examination, how to interpret radiographs, and how to integrate these variables into a diagnosis. This chapter will attempt to delineate the principles which make the shoulder examination more attainable, plus highlight the areas where a combination of factors is necessary to arrive at a diagnosis.


Asunto(s)
Articulación del Hombro , Hombro , Humanos , Examen Físico , Radiografía , Rango del Movimiento Articular
5.
Instr Course Lect ; 69: 583-594, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32017753

RESUMEN

The glenoid is considered a weak link in total shoulder arthroplasty because failure on the glenoid side is one of the most common reasons for revision of total shoulder arthroplasty. Glenoid wear is commonly seen in glenohumeral arthritis and compromises glenoid bone stock and also alters the native version and inclination of the glenoid. It is critical to recognize glenoid wear and correct it intraoperatively to avoid component malposition, which can negatively affect the survivorship of the glenoid implant. The end point of correction for the glenoid wear in shoulder arthroplasty is controversial, but anatomic glenoid component positioning is likely to improve long-term survivorship of the total shoulder arthroplasty. Preoperative three-dimensional (3-D) computer planning software, based on CT, is commercially available. It allows the surgeon to plan implant type (anatomic versus reverse), size, and position on the glenoid, and also allows for templating deformity correction using bone graft and/or augments. Guidance technology in the form of computer-assisted surgery (CAS) and patient-specific instrumentation (PSI) allows the surgeon to execute the preoperative plan during surgery with a greater degree of accuracy and precision and has shown superiority to standard instrumentation. However, the proposed benefits of this technology including improved glenoid survivorship, reduced revision arthroplasty rate and cost-effectiveness have not yet been demonstrated clinically. In this review, we present the current evidence regarding PSI and CAS in managing glenoid deformity in total shoulder arthroplasty.


Asunto(s)
Artroplastía de Reemplazo de Hombro , Cavidad Glenoidea , Articulación del Hombro , Cirugía Asistida por Computador , Artroplastia , Humanos , Imagen Tridimensional
6.
Bone Joint J ; 102-B(2): 246-253, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32009423

RESUMEN

AIMS: To describe and analyze the mid-term functional outcomes of a large series of patients who underwent the Hoffer procedure for brachial plexus birth palsy (BPBP). METHODS: All patients who underwent the Hoffer procedure with minimum two-year follow-up were retrospectively reviewed. Active shoulder range of movement (ROM), aggregate modified Mallet classification scores, Hospital for Sick Children Active Movement Scale (AMS) scores, and/or Toronto Test Scores were used to assess functional outcomes. Subgroup analysis based on age and level of injury was performed. Risk factors for subsequent humeral derotational osteotomy and other complications were also assessed. A total of 107 patients, average age 3.9 years (1.6 to 13) and 59% female, were included in the study with mean 68 months (24 to 194) follow-up. RESULTS: All patients demonstrated statistically significant improvement in all functional outcomes and active shoulder abduction and external rotation ROM (p < 0.001). Patients < 2.5 years of age had higher postoperative AMS, abduction ROM and strength scores, and aggregate postoperative Toronto scores (p ≤ 0.035) compared to patients ≥ 2.5 years old. There were 17 patients (16%) who required a subsequent humeral derotational osteotomy; lower preoperative AMS external rotation scores and external rotation ROM were predictive risk factors (p ≤ 0.016). CONCLUSION: Patients with BPBP who underwent the Hoffer procedure demonstrated significant improvement in postoperative ROM, strength, and functional outcome scores at mid-term follow-up. Patients younger than 2.5 years at the time of surgery generally had better functional outcomes. Limited preoperative external rotation strength and ROM were significantly associated with requirement for subsequent humeral derotational osteotomy. In our chort significant improvements in shoulder function were obtained after the Hoffer procedure for BPBP. Cite this article: Bone Joint J 2020;102-B(2):246-253.


Asunto(s)
Plexo Braquial/cirugía , Parálisis Neonatal del Plexo Braquial/cirugía , Transferencia Tendinosa/métodos , Adolescente , Plexo Braquial/lesiones , Niño , Preescolar , Femenino , Estudios de Seguimiento , Humanos , Lactante , Masculino , Parálisis Neonatal del Plexo Braquial/rehabilitación , Rango del Movimiento Articular , Recuperación de la Función , Estudios Retrospectivos , Articulación del Hombro/fisiopatología , Transferencia Tendinosa/rehabilitación , Resultado del Tratamiento
7.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 34(2): 179-183, 2020 Feb 15.
Artículo en Chino | MEDLINE | ID: mdl-32030948

RESUMEN

Objective: To evaluate the effectiveness of total scapular arthroplasty after total scapulectomy for scapular tumors. Methods: A clinical data of 17 patients with scapular tumors treated with total scapulectomy and total scapular arthroplasty between January 2010 and December 2017 were retrospectively reviewed. There were 9 males and 8 females with an average age of 34.4 years (range, 13-64 years). Seven patients were diagnosed with chondrosarcoma, 3 with osteosarcoma, 2 with Ewing's sarcoma, 1 with high-grade sarcoma, 1 with polymorphic dedifferentiated sarcoma, 1 with fibrosarcoma, 1 with plasmacytoma, and 1 with bone giant cell tumor. According to the surgical staging system described by Enneking et al, 1 patient was rated as stage 3, 8 as stageⅠB, 8 as stageⅡB. According to the classifications of shoulder girdle resections of Malawer et al, 11 patients were type ⅢB, 5 were type ⅣB, 1 was type ⅥB. The disease duration ranged from 0.5 to 8.0 months (mean, 3.2 months) and tumor size ranged from 11.0 cm×7.5 cm×6.0 cm to 18.5 cm×18.0 cm×12.5 cm. The 1993 Musculoskeletal Tumor Society (MSTS) upper limb function scoring system and shoulder mobility were used to evaluate postoperative shoulder joint function. Tumor recurrence and metastases were monitored by radiograph. Results: Poor superficial incision healing occurred in 1 patient, the rest incisions achieved healing by first intention. All patients were followed up 20-72 months (mean, 45.4 months). Two of the 17 patients died of multiple organ dysfunction syndrome caused by tumor metastases; 3 patients suffered from pulmonary metastases and were alive with disease. No local recurrence occurred in all patients. The overall survival rate was 88.2% (15/17) and the disease-free survival rate was 70.6% (12/17). Rib fracture after trauma, aseptic loosening, and atrophy of the deltoid muscle occurred in 1, 1, and 1 case, respectively. The other related complication was not observed. At last follow-up, the MSTS score was 26.1±1.4, and the flexion, extension, and abduction range of motion of shoulder joint were (70.0±7.5), (31.2±11.3), and (54.4 ±12.5) °, respectively. Conclusion: Reconstruction with total scapular arthroplasty after total scapulectomy can obtain a satisfactory shoulder contour and an acceptable functional outcomes in patients with scapular tumors.


Asunto(s)
Artroplastia , Neoplasias Óseas , Articulación del Hombro , Adolescente , Adulto , Neoplasias Óseas/cirugía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia , Estudios Retrospectivos , Escápula , Resultado del Tratamiento , Adulto Joven
8.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 34(2): 184-189, 2020 Feb 15.
Artículo en Chino | MEDLINE | ID: mdl-32030949

RESUMEN

Objective: To summarize the effectiveness of two-stage reverse total shoulder arthroplasty for treating postoperative deep infection after internal fixation of the proximal humeral fracture. Methods: Between June 2014 and January 2018, 17 patients with deep infection and humeral head necrosis or bone nonunion after internal fixation of proximal humeral fractures were treated. There were 8 males and 9 females, aged from 52 to 78 years (mean, 63.8 years). The infection occurred at 19-66 months after the initial internal fixation (mean, 34.8 months). Microbial culture of joint fluid was positive in 14 cases and negative in 3 cases. The preoperative Constant score, American shoulder and elbow surgeons (ASES) score, and visual analogue scale (VAS) score were 36.41±8.65, 31.06±7.43, and 7.29±0.99, respectively. The preoperative ranges of forward flexion, abduction, external rotation were (45.88±12.46), (42.18±12.31), and (16.76±4.92)°, respectively. The preoperative range of internal rotation was buttock in 9 cases, lumbosacral joint in 3 cases, L 3 in 5 cases. At the first-stage surgery, the thorough debridement was done and the antibiotic-impregnated bone cement spacer was placed after the removal of internal fixation. After the infections disappeared, the two-stage reverse total shoulder arthroplasty was performed. The mean interval between the two procedures was 4.2 months (range, 3.0-6.5 months). Results: All the incisions healed primarily and no complications such as recurrent infection or vascular nerve injury occurred. All patients were followed up 15-32 months (mean, 22.0 months). At last follow-up, the ranges of forward flexion, abduction, and external rotation were (109.00±23.66), (98.53±16.92), (41.41±6.82)°, respectively; and the range of internal rotation was lumbosacral joint in 5 cases, L 3 in 8 cases, T 12 in 4 cases. The range of motion of shoulder joints at last follow-up was significant improved when compared with the preoperative range of motion ( P<0.05). The Constant score (64.88±8.70), ASES score (65.18±8.10), and VAS score (2.94±1.25) were significantly superior to the preoperative scores ( P<0.05). X-ray films showed that no prosthesis loosening occurred. Conclusion: Two-stage reverse total shoulder arthroplasty is an effective treatment for the postoperative deep infection after internal fixation of the proximal humeral fracture, which has advantages of low risk of infection recurrence, good shoulder function, and satisfactory short-term effectiveness.


Asunto(s)
Artroplastía de Reemplazo de Hombro , Complicaciones Posoperatorias , Fracturas del Hombro , Articulación del Hombro , Anciano , Artroplastía de Reemplazo de Hombro/efectos adversos , Femenino , Fijación Interna de Fracturas , Humanos , Masculino , Persona de Mediana Edad , Rango del Movimiento Articular , Estudios Retrospectivos , Fracturas del Hombro/cirugía , Resultado del Tratamiento
9.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 34(2): 266-269, 2020 Feb 15.
Artículo en Chino | MEDLINE | ID: mdl-32030962

RESUMEN

Objective: To summarize the research progress of the greater tubercle fixation and the rotator cuff repair in humeral head replacement. Methods: The literature about proximal humerus fracture and humeral head replacement in recent years was extensively consulted and analyzed. Results: The greater tubercle fixation and the attached rotator cuff repair have great influence on the function of shoulder joint after humeral head replacement. It is difficult to make an objective comparison because of lack of direct comparison between various methods, unified standards of grading, and limited number of cases. Conclusion: It is an important factor of reduction and fixation of greater tubercle to obtain better effectiveness in humeral head replacement. However, one-stage repair of rotator cuff is more important than greater tubercle fixation for functional recovery of shoulder joint.


Asunto(s)
Cabeza Humeral , Manguito de los Rotadores , Humanos , Lesiones del Manguito de los Rotadores , Fracturas del Hombro , Articulación del Hombro
10.
Br J Radiol ; 93(1106): 20190886, 2020 Feb 01.
Artículo en Inglés | MEDLINE | ID: mdl-31912757

RESUMEN

OBJECTIVE: To describe the posterior labral lesions and labrocapsular abnormalities of the shoulder on sonoarthrography and to compare these findings with MR arthrography results. METHODS: 82 shoulders were initially evaluated with ultrasonography and MRI and then were examined with sonoarthrography and MR arthrography following intraarticular injection of diluted gadolinium solution. The ultrasonography images were prospectively evaluated for the presence of posterior labral tear, sublabral cleft, and posterior capsular abnormalities by two radiologists. The diagnostic accuracy of sonoarthrography in the detection of posterior labral tears and posterior labrocapsular variants was compared with that of MR arthrography. RESULTS: In sonoarthrographic examinations of 82 shoulders, 5 and 6 posterior labral tears were identified by Observer 1 and 2, respectively. Moreover, 6 and 7 posterior sublabral clefts, and 2 and 3 posterior synovial folds were identified by Observer 1 and 2, respectively. All the 82 patients were examined with MR arthrography; however, only 14 patients underwent arthroscopic examination. No significant difference was found among the 82 patients with regard to age, gender, and the prevalence of posterior labral tear, posterior labral cleft, and posterior synovial fold (p > 0.05). Interobserver variability showed substantial agreement between the sonoarthrographic and MR arthrographic results of the posterior labrocapsular structures (κ = 0.71, p < 0.05). CONCLUSION: Posterior labral tears and posterior synovial folds of the shoulder joint can be evaluated non-invasively by sonoarthrography. ADVANCES IN KNOWLEDGE: Variations and pathologies of posterior labrocapsular structures of the glenohumeral joint are relatively uncommon.Direct (MR) arthrography is the gold-standard imaging modality to evaluate of posterior labrocapsular abnormalities of the glenohumeral joint.Sonoarthrography of the glenohumeral joint may be utilized in clinical practice in patients with contraindications to (MRI).


Asunto(s)
Artrografía/métodos , Lesiones del Hombro/diagnóstico , Adolescente , Adulto , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Imagen Multimodal/métodos , Estudios Prospectivos , Rotura Espontánea , Luxación del Hombro/diagnóstico , Articulación del Hombro , Ultrasonografía , Adulto Joven
11.
J Surg Oncol ; 121(4): 612-619, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-31919856

RESUMEN

BACKGROUND AND OBJECTIVES: We aimed to identify the overall survival (OS), surgical complications, survival of reconstruction, and functional outcome of patients who underwent extra-articular resection of the shoulder joint for primary bone sarcomas. The OS and local recurrence rates in patients who underwent an amputation were also evaluated for comparison. METHODS: Thirty-two patients treated between 1988 and 2017 were studied. The tumours were located in the humerus in 22 (69%) and scapula in 10 patients (31%). The resection types were Malawer type IV in 6 (19%), type V in 21 (66%), and type VI in 5 patients (15%). Reconstruction was performed with endoprosthesis in 23 patients (72%) while excision arthroplasty with the suspension of the humerus to the clavicle was performed in 9 patients (28%). Surgical margins were wide in 16, marginal in 8, intralesional in 3, and not available in 5 patients. During the study period, 40 patients underwent a forequarter amputation and 11 patients underwent a shoulder disarticulation. RESULTS: The 5-year OS for patients who underwent extra-articular resection of the shoulder joint was 42% which was not statistically different compared with that of patients who underwent amputation (5-year OS = 30%; P = .091). The 5-year survival of the reconstruction was 94%, similar for endoprosthesis and excision arthroplasty. Local recurrence and complications developed in 6 (19%) and 10 patients (31%), respectively. Failures of the reconstruction requiring revision surgery occurred in two patients (6%). Limb salvage was achieved in 30 patients (94%). The median Musculoskeletal Tumour Society functional score was 61% (interquartile range, 57%-70%) and was similar in the endoprosthesis and excision arthroplasty group. CONCLUSIONS: Extra-articular resection of the shoulder joint for bone sarcomas is an effective limb-salvage method. However, local recurrence remains a principal concern.


Asunto(s)
Neoplasias Óseas/cirugía , Recuperación del Miembro/métodos , Osteosarcoma/cirugía , Articulación del Hombro/cirugía , Adolescente , Adulto , Amputación/efectos adversos , Amputación/métodos , Amputación/mortalidad , Neoplasias Óseas/mortalidad , Neoplasias Óseas/patología , Desarticulación/efectos adversos , Desarticulación/métodos , Desarticulación/mortalidad , Femenino , Humanos , Estimación de Kaplan-Meier , Recuperación del Miembro/efectos adversos , Recuperación del Miembro/mortalidad , Masculino , Persona de Mediana Edad , Osteosarcoma/mortalidad , Osteosarcoma/patología , Prótesis e Implantes , Procedimientos Quirúrgicos Reconstructivos/efectos adversos , Procedimientos Quirúrgicos Reconstructivos/métodos , Procedimientos Quirúrgicos Reconstructivos/mortalidad , Estudios Retrospectivos , Articulación del Hombro/patología , Adulto Joven
12.
Int J Sports Med ; 41(1): 59-64, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31752027

RESUMEN

The purpose of this study was to compare measures of bilateral shoulder and hip range of motion (ROM) between youth softball pitchers and position players. Fifty-two youth softball athletes (12.7±2.1 yrs.; 160.28±10.98 cm; 59.31±15.07 kg) participated. Bilateral hip and shoulder ROM were measured among pitchers (n=29) and position players (n=23). A 2 (pitcher/position player) × 2 (dominant/non-dominant) ANOVA was performed for both internal and external rotation ROM for the shoulder and hip. Paired sample t-tests were also conducted to examine side-to-side differences in total ROM. Data revealed a significant interaction between position and side dominance. Specifically, position players have significantly more non-dominant shoulder external rotation ROM (106.92°± 9.14°) than pitchers (100.12°± 11.21°). There were no significant differences between throwing and non-throwing sides. It is important that coaches and clinicians are aware of these adaptations between overhand and underhand throwing in order to properly develop conditioning and rehabilitation programs to alleviate injury susceptibility and cater to position-specific demands. Additionally, the current data suggest many of the functional adaptations seen within older populations are not fully developed until after youth.


Asunto(s)
Béisbol/fisiología , Articulación de la Cadera/fisiología , Articulación del Hombro/fisiología , Adaptación Fisiológica , Adolescente , Factores de Edad , Béisbol/lesiones , Niño , Femenino , Humanos , Rango del Movimiento Articular , Factores de Riesgo , Rotación
13.
Sports Biomech ; 19(2): 212-226, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-29768090

RESUMEN

The topspin tennis forehand drive has become a feature of modern game; yet, as compared to the serve, there has been little research analysing its kinematics. This is surprising given that there is considerably more variation in the execution of the topspin forehand. Our study is the first to examine the amplitude of upper limb joint rotations that produce topspin in the forehand drives of 14 male competitive tennis players using video-based motion analysis. Humerothoracic abduction (-)/adduction (+), extension (-) /flexion (+), and external (-)/internal (+) rotation, elbow extension (-) /flexion (+) and forearm supination (-)/pronation (+), wrist extension (-)/flexion (+) and ulnar (-)/radial (-) deviation were computed. Our findings revealed that the generation of topspin demanded more humeral extension and forearm pronation but less humeral internal rotation angular displacement during the forwardswing. The follow-through phase of the topspin shot was characterised by greater humeral internal rotation and forearm pronation, and reduced humeral horizontal adduction when compared to the flat shot. This study provides practitioners with a better understanding of the upper limb kinematics associated with the topspin tennis forehand drive production to help guide skill acquisition interventions and physical training.


Asunto(s)
Articulación del Codo/fisiología , Destreza Motora/fisiología , Articulación del Hombro/fisiología , Tenis/fisiología , Articulación de la Muñeca/fisiología , Adulto , Fenómenos Biomecánicos , Conducta Competitiva/fisiología , Antebrazo/fisiología , Humanos , Masculino , Pronación/fisiología , Estudios de Tiempo y Movimiento , Grabación en Video
14.
J Shoulder Elbow Surg ; 29(1): 68-78, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31378683

RESUMEN

BACKGROUND: Pathologic activation pattern of muscles can cause shoulder instability. We propose to call this pathology functional shoulder instability (FSI). The purpose of this prospective study was to provide an in-detail description of the characteristics of FSI. METHODS: In the year 2017, a total of 36 consecutive cases of FSI presenting to our outpatient clinic were prospectively collected. Diagnostic investigation included a pathology-specific questionnaire, standardized clinical scores, clinical examination, psychological evaluation, video and dynamic fluoroscopy documentation of the instability mechanism, as well as magnetic resonance imaging (MRI). In a final reviewing process, the material from all collected cases was evaluated and, according to the observed pattern, different subtypes of FSI were determined and compared. RESULTS: Based on the pathomechanism, positional FSI (78%) was distinguished from nonpositional FSI (22%). Controllable positional FSI was observed in 6% of all cases and noncontrollable positional FSI in 72%, whereas controllable and noncontrollable nonpositional FSI were each detected in 11% of the cases. The different subtypes of FSI showed significant differences in all clinical scores (Western Ontario Shoulder Instability Index: P = .002, Rowe Score: P = .001, Subjective Shoulder Value: P = .001) and regarding functional impairment (shoulder stability: P < .001, daily activities: P = .001, sports activities: P < .001). Seventy-eight percent had posterior, 17% anterior, and 6% multidirectional instability. Although several patients showed constitutional glenoid shape alterations or soft tissue hyperlaxity, only few patients with acquired minor structural defects were observed. CONCLUSION: FSI can be classified into 4 subtypes based on pathomechanism and volitional control. Depending on the subtype, patients show different degrees of functional impairment. The majority of patients suffer from unidirectional posterior FSI.


Asunto(s)
Inestabilidad de la Articulación/diagnóstico por imagen , Inestabilidad de la Articulación/fisiopatología , Articulación del Hombro/diagnóstico por imagen , Articulación del Hombro/fisiopatología , Hombro/diagnóstico por imagen , Adolescente , Adulto , Femenino , Fluoroscopía , Humanos , Imagen por Resonancia Magnética , Masculino , Músculo Esquelético/fisiopatología , Postura , Estudios Prospectivos , Hombro/fisiopatología , Adulto Joven
15.
J Shoulder Elbow Surg ; 29(1): 58-67, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31401130

RESUMEN

BACKGROUND: The main limits of the Grammont design reverse shoulder arthroplasty (RSA) are loss of external rotation and scapular notching. They can be addressed with glenoid or humeral lateralization. The aim of the study was to compare outcomes of lateralized bony increased-offset RSA (BIO-RSA) vs. standard RSA in patients with an onlay 145° curved stem. METHODS: A comparative cohort study of 29 standard RSAs and 30 BIO-RSAs was performed. At 2 years postoperatively, Constant score, American Shoulder and Elbow Surgeons score, visual analog scale score, range of motion, and radiographs were evaluated. After comparison between the groups, patients were analyzed considering patients younger and older than 65 years. RESULTS: All parameters significantly improved after surgery in both groups. Postoperatively, the 2 groups did not show any clinical and radiographic differences (P > .05). In patients <66 years, BIO-RSA showed a significantly higher value of external rotation (49° ± 12° vs. 30° ± 19° [P = .025], elbow at side; 81° ± 17° vs. 56° ± 22° [P = .016], elbow at 90° of abduction) and a positive trend for all other parameters (P > .05). In patients >65 years, standard technique showed a positive trend for all the parameters (P > .05). No other significant differences were found. CONCLUSIONS: At 2 years of follow-up, the use of standard RSA or BIO-RSA in an implant with an onlay 145° curved stem provided similar outcomes. The humeral lateralization alone is sufficient to decrease notching and to improve external rotation. BIO-RSA increases external rotation in patients between 50 and 65 years old. Glenoid bone graft in RSA has a high incorporation rate (completed in 90%).


Asunto(s)
Artroplastía de Reemplazo de Hombro/métodos , Cavidad Glenoidea/cirugía , Artropatía por Desgarro del Manguito de los Rotadores/cirugía , Articulación del Hombro/fisiopatología , Anciano , Artroplastía de Reemplazo de Hombro/instrumentación , Biosimilares Farmacéuticos , Trasplante Óseo , Femenino , Humanos , Húmero/fisiopatología , Masculino , Persona de Mediana Edad , Radiografía , Rango del Movimiento Articular , Estudios Retrospectivos , Rotación , Artropatía por Desgarro del Manguito de los Rotadores/complicaciones , Artropatía por Desgarro del Manguito de los Rotadores/fisiopatología , Articulación del Hombro/diagnóstico por imagen , Articulación del Hombro/cirugía , Dolor de Hombro/etiología , Prótesis de Hombro , Resultado del Tratamiento
16.
J Shoulder Elbow Surg ; 29(1): 104-112, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31409562

RESUMEN

BACKGROUND: Subscapularis function after arthroscopic Bankart repair has been widely studied. However, data regarding subscapularis performance after arthroscopic Latarjet procedures are lacking. This study aimed to evaluate subscapularis clinical and radiologic performance after arthroscopic Latarjet procedures. METHODS: We included 40 patients who underwent arthroscopic Latarjet procedure with a minimum 2-year follow-up. Clinical evaluation included Western Ontario Shoulder Instability Index and Rowe scores, specific subscapularis isokinetic study, and lift-off tests. Contralateral measurements were used for comparison. Computed tomographic evaluation included graft consolidation, muscle dimensions, and degree of fatty atrophy, calculated as the mean muscle attenuation (MMA). RESULTS: There was a decrease of 8.3% of maximum internal rotation peak torque in the operated arm (P = .02). However, there was no significant difference in the agonist-antagonist ratio: 76.9% in the operated arm and 76% in the contralateral (P = .82). Lift-off strength test demonstrated a decrease in the first year but not at final follow-up (P = .38). There was a significant decrease in lift-off distance of 23% compared to the contralateral side (P < .001). Subscapularis MMA was diminished when compared to the infraspinatus/teres minor (P < .001) at the expense of its upper part (P = .03). Hyperlaxity and number of dislocation episodes were correlated to a lower MMA (P = .046 and P = .005). CONCLUSION: Arthroscopic Latarjet procedures provide satisfactory clinical results. There seems to be a diminished subscapularis MMA depending on its superior half. Hyperlaxity and number of previous dislocations were correlated to a lower MMA. Although there was a decrease in the maximum internal rotation peak torque, we did not find any difference in the agonist-antagonist ratio or in the final lift-off strength between sides.


Asunto(s)
Inestabilidad de la Articulación/cirugía , Manguito de los Rotadores/fisiopatología , Luxación del Hombro/cirugía , Articulación del Hombro/fisiopatología , Adolescente , Adulto , Artroplastia/métodos , Artroscopía , Femenino , Estudios de Seguimiento , Humanos , Inestabilidad de la Articulación/fisiopatología , Masculino , Fuerza Muscular , Estudios Prospectivos , Rotación , Manguito de los Rotadores/diagnóstico por imagen , Luxación del Hombro/fisiopatología , Articulación del Hombro/cirugía , Tomografía Computarizada por Rayos X , Adulto Joven
17.
J Shoulder Elbow Surg ; 29(1): 86-94, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31427227

RESUMEN

BACKGROUND: Reverse total shoulder arthroplasty (RSA) is a widely accepted treatment for irreparable massive rotator cuff tear (mRCT) and cuff tear arthropathy (CTA), but its impact on activities of daily living (ADLs) remains unclear. METHODS: We retrospectively analyzed 77 patients (age range, 54-87 years; follow-up range, 36.1-120.3 months) with irreparable mRCT and CTA treated by medialized RSA between 2008 and 2015. Ten activities considered essential for daily living were selected and scored from 0 to 3. RESULTS: The mean visual analog scale scores during motion and University of California at Los Angeles and Constant scores significantly improved at final follow-up (all P < .001). Active forward flexion, external rotation at the side, and internal rotation to the posterior (IRp) were 92.5%, 79.6%, and 48.4% of the contralateral side, respectively, at final follow-up. Active forward flexion and external rotation at the side recovered within 6 months after surgery, similar to the level at final follow-up, but IRp did not reach the preoperative status until final follow-up. ADLs with mean scores of less than 2.0 at final follow-up were "wash the opposite shoulder," "wash the opposite axilla," "use a back pocket," "manage the toilet," and "wash the back" (only 36.4% of patients were able to wash their back at final follow-up). CONCLUSIONS: RSA for irreparable mRCT and CTA showed satisfactory clinical outcomes. However, IRp was associated with a limited range compared with the other shoulder motions; therefore, all ADLs associated with internal rotation demonstrated lower recovery rates than expected.


Asunto(s)
Actividades Cotidianas , Artroplastía de Reemplazo de Hombro , Rango del Movimiento Articular , Lesiones del Manguito de los Rotadores/cirugía , Artropatía por Desgarro del Manguito de los Rotadores/cirugía , Articulación del Hombro/fisiopatología , Anciano , Anciano de 80 o más Años , Artroplastía de Reemplazo de Hombro/métodos , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Recuperación de la Función , Estudios Retrospectivos , Rotación , Lesiones del Manguito de los Rotadores/fisiopatología , Artropatía por Desgarro del Manguito de los Rotadores/fisiopatología , Factores de Tiempo , Resultado del Tratamiento
18.
J Shoulder Elbow Surg ; 29(1): 95-103, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31471245

RESUMEN

BACKGROUND: The literature has reported debatable diagnostic accuracy of clinical provocative tests for a type II superior labral anteroposterior (SLAP) lesion, especially in the context of a type V SLAP (concurrent Bankart and type II SLAP) lesion. This study was conducted to determine whether the investigated provocative tests offer reliable predictive values in the diagnosis of type II SLAP lesions in patients with recurrent anterior glenohumeral (GH) instability. METHODS: This prospective case-control study carried out between September 2014 and September 2018 included 51 patients with post-traumatic recurrent anterior GH instability. Patients were prospectively evaluated for type II SLAP lesions by 9 provocative tests: Jobe relocation test, abduction-external rotation test, anterior slide test, biceps load test I, biceps load test II, pain provocation test, labral tension test, crank test, and the O'Driscoll dynamic labral shear test. The results of these tests were compared with findings of diagnostic arthroscopic GH examinations (control). RESULTS: Statistical analysis revealed the mean age of the studied group to be 26.1 ± 7.56 years, with male predominance (50 patients; 98.04%). Arthroscopic examination revealed a Bankart lesion in isolation and in association with a type II SLAP lesion (ie, a type V SLAP lesion) in 15 (29.4%) and 36 (70.6%) patients, respectively. The anterior slide test yielded the highest positive and lowest negative likelihood ratios (2.91 and 0.52, respectively). CONCLUSION: Except for the anterior slide test, which can be validated for the clinical diagnosis of type II SLAP lesions in patients with traumatic recurrent anterior GH instability, the investigated tests offer poor predictive values and should be cautiously used in clinical practice.


Asunto(s)
Artroscopía , Lesiones de Bankart/diagnóstico , Inestabilidad de la Articulación/etiología , Examen Físico/métodos , Articulación del Hombro/lesiones , Adolescente , Adulto , Lesiones de Bankart/complicaciones , Estudios de Casos y Controles , Femenino , Humanos , Masculino , Valor Predictivo de las Pruebas , Estudios Prospectivos , Recurrencia , Adulto Joven
19.
J Shoulder Elbow Surg ; 29(1): e11-e21, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31405714

RESUMEN

BACKGROUND: Massive rotator cuff (RC) tears still present a clinically challenging problem, with reported rerupture rates in up to 94%. The study objective was to determine the impact of synthetic patch augmentation for massive RC tears. METHODS: Between June 2012 and 2014, we performed 50 arthroscopic RC reconstructions augmented with a synthetic polyester patch. Pre- and postoperative imaging methods included arthrographic magnetic resonance imaging, arthrographic computed tomography, and ultrasound examination to determine tendon integrity or rerupture. Clinical outcome was evaluated using the Constant-Murley score and the subjective shoulder value. Mean clinical midterm and final follow-up was 22 months (9-35 months) and 52 months (25-74 months), respectively. RESULTS: The mean Constant-Murley score increased significantly from 36.5 (±16.4 standard deviation [SD]) preoperatively to a midterm value of 81.2 (±9.6 SD; P < .0001) and further improved to a mean of 83.4 (±10.8 SD) at final follow-up. The mean subjective shoulder value increased from 40.3 (±24.3 SD) to 89.2 (±12.9 SD; P < .0001) at midterm and to 89.6 (±15.2 SD) at final follow-up. We observed 7 complete reruptures (14%). However, reruptures did not correlate with revision surgery, which was performed in 8 patients. The main reason for revision was frozen shoulder or arthrofibrosis with an intact reconstruction and patch, which was performed in 6 cases. CONCLUSIONS: The retear rate of 14% compared favorably with nonaugmented RC repairs in the literature. Therefore, we conclude that patch augmentation in massive RC tears is feasible to reduce retears and to improve clinical outcome.


Asunto(s)
Artroplastia/instrumentación , Prótesis e Implantes , Lesiones del Manguito de los Rotadores/diagnóstico por imagen , Lesiones del Manguito de los Rotadores/cirugía , Articulación del Hombro/cirugía , Anciano , Artroscopía , Estudios de Cohortes , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Poliésteres , Estudios Prospectivos , Recurrencia , Reoperación , Articulación del Hombro/diagnóstico por imagen , Articulación del Hombro/fisiopatología , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Ultrasonografía
20.
J Shoulder Elbow Surg ; 29(1): e1-e10, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31451348

RESUMEN

BACKGROUND: We evaluated survival and midterm results of pyrocarbon interposition shoulder arthroplasty (PISA) in arthritic patients younger than 65 years. METHODS: Fifty-eight PISAs (InSpyre; Tornier-Wright, Bloomington, MN, USA), implanted in 56 patients between 2010 and 2015, were prospectively observed. The mean age at surgery was 52 ± 13 years. The cause was primary osteoarthritis (18), fracture sequelae (16), post-instability arthritis (15), aseptic necrosis (3), inflammatory disease (2), and failed hemiarthroplasty (4); 34 shoulders (61%) had previously undergone surgery. Glenoid erosion was assessed in 4 grades according to the Sperling classification. Humeral erosion was also assessed in 4 grades. Multivariate analysis was used to determine predisposing risk factors for both humeral and glenoid erosion. RESULTS: At a mean follow-up of 47 ± 15 months, survival rate was 90%. Six patients (10%) required conversion to reverse total shoulder prosthesis for painful glenoid erosion (n = 2) and humeral erosion with greater tuberosity stress fractures (n = 4). The mean Constant score and subjective shoulder value significantly increased from 36 ± 14 points to 70 ± 15 points and 32% ± 14% to 75% ± 19%, respectively (P < .001). Humeral medialization was observed in 78% of the cases with increased pain score. Uncorrected anteroposterior implant subluxation (12 cases) was associated with lower Constant score (50 points vs. 72 points; P = .02) and lower subjective shoulder value (53% vs. 78%; P = .002). On multivariate analysis, no risk factors for glenoid or humeral erosion were found. CONCLUSION: At midterm follow-up, PISA does not protect from progressive glenoid erosion and can lead to greater tuberosity erosion and stress fractures. Longer follow-up is required to see whether PISA survival will be superior to that of hemiarthroplasty.


Asunto(s)
Artroplastía de Reemplazo de Hombro/instrumentación , Osteoartritis/cirugía , Articulación del Hombro/fisiopatología , Prótesis de Hombro , Adulto , Anciano , Artroplastía de Reemplazo de Hombro/efectos adversos , Carbono , Femenino , Estudios de Seguimiento , Fracturas por Estrés/etiología , Cavidad Glenoidea/diagnóstico por imagen , Humanos , Húmero/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/etiología , Estudios Prospectivos , Radiografía , Rango del Movimiento Articular , Reoperación/instrumentación , Factores de Riesgo , Luxación del Hombro/etiología , Fracturas del Hombro/etiología , Articulación del Hombro/cirugía , Prótesis de Hombro/efectos adversos
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