Pre-Operative Scapular Rehabilitation for Arthroscopic Repair of Traumatic Rotator Cuff Tear: Results of a Randomized Clinical Trial.

Background: Pre-operative rehabilitation aims to improve the functional capacity of the individual to enable him/her to prepare for the period of inactivity associated with the surgical procedure. Objective: To evaluate the impact of preoperative scapular rehabilitation before arthroscopic repair of traumatic rotator cuff injury, regarding pain, range of motion of the shoulder, and functional activity. Study Design: Randomized Clinical Trial (RCT) - pilot. Methods: Twenty adult individuals (age range: 47-69 years), with a diagnosis of traumatic rotator cuff tear and arthroscopic surgical repair, were randomized and allocated into two groups: experimental (EG) (n = 10) and control group (CG) (n = 10). All participants underwent preoperative rehabilitation for six weeks, consisting of mobility exercises of the cervical spine, elbow, wrist, and hand, and analgesics education. The EG also performed scapular and core stabilization exercises, which were not performed by the CG. Exercise instruction was performed by the same physiotherapist and the surgical team was blinded to group participation in the preoperative period. After arthroscopic repair, the patients followed the same protocol of postoperative rehabilitation for 16 weeks, and functional evaluation was conducted after three months and in a follow-up of at least one year. Results: Compared to the CG, the EG presented with a significant decrease in pain between the preoperative period and after one year (p < 0.05). In relation to the preoperative period, flexion and external rotation increased significantly in both groups after three months (p<0.05), and abduction was significantly higher in the EG (p < 0.05). Compared to CG, the EG presented a significantly higher SF-12 physical component after three months (48.47 vs. 40.33, p < 0.05), and a significantly lower Western Ontario Rotator Cuff Index (WORC) total after one year (85.00 vs. 1130.00, p < 0.05). Conclusion: Preoperative scapular rehabilitation had a positive impact on recovery after arthroscopic repair of traumatic rotator cuff injury, in the assessment of pain, range of motion of the shoulder, and quality of life. Levels of Evidence: Level 1.

Hyperbaric oxygen therapy as treatment for bilateral arm compartment syndrome after CrossFit: case report and literature review.

INTRODUCTION: CrossFit is a physical fitness program characterized by high-intensity workouts that can be associated with serious injury. Acute compartment syndrome in the upper limbs is a rare occurrence. It may occur after intense physical exercise, and its usual treatment is surgical. Hyperbaric oxygen therapy is a treatment described as adjunctive in cases of compartmental syndrome. PRESENTATION: We describe the case of a CrossFit practitioner who, after intense training, developed progressive symptoms of rhabdomyolysis and acute bilateral arm compartment syndrome, who was successfully treated with hyperbaric oxygen therapy and required no fasciotomy as surgical treatment. CONCLUSIONS: Acute compartment syndrome in the arms after intense physical exercise is a rare occurrence that should be suspected by practitioners of physical activity experiencing intense, disproportionate and progressive pain. In the case presented, hyperbaric oxygen therapy was successfully used in the treatment of the disorder, with satisfactory progress, and without the need for a surgical fasciotomy as therapy.

EVALUATION OF THE RESULTS FROM ARTHROSCOPIC TREATMENT OF THE LATERAL EPICONDYLITIS.

OBJECTIVE: To evaluate the results from patients with lateral epicondylitis following surgical treatment using the arthroscopy technique. METHODS: Twenty patients underwent surgery using the arthroscopic technique. Their ages ranged from 19 to 54 years (average of 41 years and eight months). Twelve (60%) of them were female and eight (40%) were male. The minimum follow-up period was 12 months and the maximum was 48 months, with an average of 20 months. All the cases were refractory to conservative treatment (rest and physiotherapy), with previous clinical treatment times ranging in duration from six to 136 months. To evaluate the results, we used the criteria of the American Medical Association (AMA), as modified by Bruce. RESULTS: We obtained 13 excellent results (65%) and seven moderate results (13%), with just one complication (reflex sympathetic dystrophy). This was the only patient who reported dissatisfaction. CONCLUSION: Surgical treatment of the lateral epicondylitis of the elbow using arthroscopy was a good option for 65% of the cases.