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1.
Clin Orthop Surg ; 12(3): 279-285, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32904109

RESUMO

Ehlers-Danlos Syndrome (EDS) is a hereditary disorder of the connective tissue, which has been classified into numerous subtypes over the years. EDS is generally characterized by hyperextensible skin, hypermobile joints, and tissue fragility. According to the 2017 International Classification of EDS, 13 subtypes of EDS have been recognized. The majority of genes involved in EDS are either collagen-encoding genes or genes encoding collagen-modifying enzymes. Orthopedic surgeons most commonly encounter patients with the hypermobile type EDS (hEDS), who present with signs and symptoms of hypermobility and/or instability in one or more joints. Patients with joint hypermobility syndrome (JHS) might also present with similar symptomatology. This article will focus on the surgical management of patients with knee or shoulder abnormalities related to hEDS/JHS.


Assuntos
Síndrome de Ehlers-Danlos/cirurgia , Instabilidade Articular/cirurgia , Articulação do Joelho/cirurgia , Articulação do Ombro/cirurgia , Humanos , Instabilidade Articular/congênito , Articulação do Joelho/fisiopatologia , Articulação do Ombro/fisiopatologia
2.
Pan Afr Med J ; 36: 94, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32774653

RESUMO

Simultaneous bilateral anterior shoulder dislocation is rare, it often occurs after high energy trauma, we report a case of a 43-years-old male presented with bilateral anterior shoulder dislocation when he tries to stand up from the floor, shoulders in extension, abduction and external rotation. A closed reduction was performed without complications, and one month later the right shoulder was stabilized by open Laterjet technique. The evolution was favorable for both shoulders with no pain, recuperation of the range motion and no recurrence of dislocation. Through this case we underline the value of early diagnosis and appropriate treatment of bilateral anterior shoulder dislocation, to avoid complications and obtain good result.


Assuntos
Procedimentos Ortopédicos/métodos , Luxação do Ombro/terapia , Articulação do Ombro/fisiopatologia , Adulto , Humanos , Masculino , Amplitude de Movimento Articular , Luxação do Ombro/etiologia , Luxação do Ombro/fisiopatologia , Articulação do Ombro/lesões , Resultado do Tratamento
3.
J Shoulder Elbow Surg ; 29(9): 1758-1764, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32815805

RESUMO

BACKGROUND: This prospective, randomized, and double-blinded trial evaluates the effect of intraoperative glenohumeral joint lavage in open reduction and internal fixation of displaced intracapsular proximal humeral fractures. METHODS: Between January 2016 and April 2018, 86 patients (mean age: 65.2 ± 16.3 years) with a displaced intracapsular proximal humeral fracture were treated by open reduction and internal fixation using locking plates. Patients were randomized to either locked plating followed by intraoperatively performed glenohumeral joint lavage (group L, n = 36) or locked plating without the lavage (group NL, n = 36). Functional outcome assessment included range of shoulder motion, strength, and the Constant score, obtained 6 weeks, 3 months, 6 months, and 12 months postoperatively. A total of 62 shoulders could be reviewed for final investigation (86% follow-up). RESULTS: One year after open reduction and internal fixation, the mean Constant score was 70 ± 14 (group L, n = 31) compared with 73 ± 14 (group NL, n = 31, P = .272). The mean forward flexion and abduction in group L was 134 ± 33 and 128 ± 33 as compared with 139 ± 32 and 135 ± 32 in group NL, respectively (P = .538, P = .427). The mean external rotation was 40 ± 16 (group L) compared with 44 ± 16 (group NL) (P = .210). The overall complication rate was 9.6% and did not differ significantly between the groups (P = .321). In group L, there were 2 cases of avascular necrosis (6.5%) and 1 case of secondary displacement (3.2%). In group NL, 1 case of avascular necrosis (3.2%) and 1 case of secondary displacement were noted (3.2%, P = .742). CONCLUSION: The results of this study do not demonstrate a need for glenohumeral joint lavage in open reduction and internal fixation of displaced intracapsular proximal humeral fractures with regard to shoulder function at 1-year follow-up.


Assuntos
Fraturas do Ombro/cirurgia , Articulação do Ombro/fisiopatologia , Articulação do Ombro/cirurgia , Irrigação Terapêutica , Idoso , Idoso de 80 Anos ou mais , Placas Ósseas , Método Duplo-Cego , Feminino , Seguimentos , Fixação Interna de Fraturas/efeitos adversos , Consolidação da Fratura , Humanos , Cuidados Intraoperatórios , Masculino , Pessoa de Meia-Idade , Força Muscular , Redução Aberta/efeitos adversos , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Amplitude de Movimento Articular , Fraturas do Ombro/fisiopatologia , Irrigação Terapêutica/efeitos adversos , Resultado do Tratamento
4.
J Shoulder Elbow Surg ; 29(9): 1765-1774, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32815806

RESUMO

BACKGROUND: The benefit of supervised physiotherapy after rotator cuff surgery is unclear. The aim of this randomized controlled trial was to assess the effectiveness of supervised physiotherapy after arthroscopic rotator cuff reconstruction. METHODS: Eighty patients with full-thickness supraspinatus tendon tears were randomly assigned to either supervised physiotherapy or home exercises only. The primary outcome measure was the Constant score at 12 months after surgery. RESULTS: A total of 70 patients were available for analyses at 1-year follow-up. There were no statistically significant differences in the primary outcome between the treatment groups. CONCLUSION: Supervised physiotherapy after arthroscopic rotator cuff reconstruction does not provide additional benefit compared with home exercises alone at 1-year follow-up.


Assuntos
Terapia por Exercício/métodos , Lesões do Manguito Rotador/reabilitação , Articulação do Ombro/fisiopatologia , Artroscopia , Exercício Físico/fisiologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Lesões do Manguito Rotador/cirurgia , Articulação do Ombro/cirurgia , Resultado do Tratamento
5.
J Shoulder Elbow Surg ; 29(9): 1938-1949, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32815808

RESUMO

BACKGROUND: Proximal humerus fractures are common in the elderly population and are often treated with reverse shoulder arthroplasty (RSA). The purpose of this systematic review was to compare tuberosity healing and functional outcomes in patients undergoing RSA with humeral inclinations of 135°, 145°, and 155°. METHODS: A systematic review was performed of RSA for proximal humerus fracture using Preferred Reporting Items for Systemic Reviews and Meta-Analyses (PRISMA) guidelines. Radiographic and functional outcome data were extracted to evaluate tuberosity healing according to humeral inclination. Analysis was also performed of healed vs. nonhealed tuberosities. RESULTS: A total of 873 patients in 21 studies were included in the analysis. The mean age was 77.5 years (range of 58-97) and the mean follow-up was 26.2 months. Tuberosity healing was 83% in the 135° group compared with 69% in the 145° group and 66% in the 155° group (P = .030). Postoperative abduction was highest in the 155° group (P < .001). No significant difference was found in forward flexion, external rotation, or postoperative Constant score between groups. Patients with tuberosity healing demonstrated 18° higher forward flexion (P = .008) and 16° greater external rotation (P < .001) than those with unhealed tuberosities. CONCLUSION: RSA for fracture with 135° humeral inclination is associated with higher tuberosity healing rates compared with 145° or 155°. Postoperative abduction is highest with a 155° implant, but there is no difference in in postoperative forward flexion, external rotation, or Constant score according to humeral inclination. Patients with healed tuberosities have superior postoperative forward flexion and external rotation than those with unhealed tuberosities.


Assuntos
Artroplastia do Ombro , Úmero/fisiopatologia , Fraturas do Ombro/cirurgia , Articulação do Ombro/fisiopatologia , Cicatrização , Artroplastia do Ombro/métodos , Humanos , Úmero/diagnóstico por imagem , Úmero/cirurgia , Próteses e Implantes , Amplitude de Movimento Articular , Estudos Retrospectivos , Rotação , Fraturas do Ombro/diagnóstico por imagem , Articulação do Ombro/diagnóstico por imagem , Articulação do Ombro/cirurgia , Resultado do Tratamento
6.
Plast Reconstr Surg ; 146(2): 321-331, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32740582

RESUMO

BACKGROUND: Shoulder release and tendon transfer is frequently performed to address persistent weakness from neonatal brachial plexus palsy. Although postoperative improvements in motion are well described, associated deficits are poorly documented, and functional assessments are lacking. Loss of ability to reach midline can occur with surgery and may result in impairment. The purpose of this study was to comprehensively assess the gains, losses, functional changes, and patient-reported outcome associated with the authors' surgical approach. METHODS: Consecutive patients undergoing surgery with 2-year follow-up were included (n = 30). Prospectively recorded assessments by therapists were reviewed. Changes were assessed by t test and Wilcoxon rank sum (p < 0.05). RESULTS: Active external rotation and abduction improved and internal rotation diminished. Aggregate modified Mallet score increased with improvements in all subscales, except that hand to spine was unchanged and hand to belly decreased. Functional assessment using the Brachial Plexus Outcome Measure revealed an increase of aggregate score, with no decline in any subscales. Improvements were in hand to back of head, forward overhead reach, holds plate with palm up, opening large container, and strings bead. Aggregate patient self-report of appearance and function increased (from 18 to 23). Loss of ability to reach midline occurred in three patients (10 percent) who had extended Erb or total palsy and preoperative limitations of internal rotation. CONCLUSIONS: Secondary reconstruction rebalances shoulder motion by increasing external rotation and abduction and reducing internal rotation. In this study, a conservative surgical approach results in overall improvement in task-based abilities and self-reported outcomes and preservation of internal rotation within a functional range. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.


Assuntos
Tratamento Conservador/métodos , Paralisia do Plexo Braquial Neonatal/cirurgia , Amplitude de Movimento Articular , Articulação do Ombro/fisiopatologia , Transferência Tendinosa/métodos , Moldes Cirúrgicos , Tratamento Conservador/efeitos adversos , Feminino , Seguimentos , Humanos , Masculino , Paralisia do Plexo Braquial Neonatal/fisiopatologia , Paralisia do Plexo Braquial Neonatal/reabilitação , Estudos Retrospectivos , Autorrelato/estatística & dados numéricos , Articulação do Ombro/inervação , Articulação do Ombro/cirurgia , Transferência Tendinosa/efeitos adversos , Resultado do Tratamento
7.
Am J Sports Med ; 48(9): 2097-2104, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32667266

RESUMO

BACKGROUND: Pathological muscle activation patterns of the external rotators and periscapular muscles can result in posterior positional functional shoulder instability (PP-FSI). In several patients, physical therapy and surgical treatment are not successful. PURPOSE: The shoulder-pacemaker treatment concept was evaluated prospectively in patients with PP-FSI and previously failed conventional therapy attempt. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: A negative selection of 24 consecutive cases of noncontrollable PP-FSI in 16 patients with previously failed conventional therapy were included in this prospective study. The shoulder-pacemaker treatment consisted of an electrical muscle stimulation-based therapy protocol with 9 to 18 one-hour treatment sessions. Two patients were excluded because of nonadherence to the training schedule, leaving a final study cohort of 21 cases in 14 patients. Follow-up included assessment of clinical function, impairment during daily activities and sports, satisfaction, Western Ontario Shoulder Instability Index (WOSI), Rowe score, and Subjective Shoulder Value at 0 weeks, 2 weeks, 4 weeks, 3 months, 6 months, 12 months, and 24 months after intervention. RESULTS: WOSI, Subjective Shoulder Value, and Rowe score showed a highly significant improvement at all time points of follow-up (P < .001). Young age (P = .005), low weight (P = .019), shoulder activity level (P = .003), unilateral affliction (P = .046), and higher baseline WOSI score (P = .04) were associated with a better treatment effect. Cases with increased glenoid retroversion, posterior scapulohumeral decentering, and dysplastic bony glenoid shape showed a trend toward shorter treatment effect duration. No complications during the intervention or follow-up period were observed. CONCLUSION: The shoulder-pacemaker therapy concept is an effective treatment with rapid improvement and sustained outcome over the course of 2 years in patients with noncontrollable PP-FSI with previously failed conventional treatment. Young and more athletic patients with lower weight and unilateral pathology respond best to the treatment.


Assuntos
Terapia por Estimulação Elétrica , Instabilidade Articular/terapia , Luxação do Ombro/terapia , Articulação do Ombro/fisiopatologia , Humanos , Estudos Prospectivos , Ombro/fisiopatologia
8.
J Shoulder Elbow Surg ; 29(7S): S107-S114, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32643605

RESUMO

OBJECTIVES: A good outcome after arthroscopic stabilization for recurrent shoulder instability is often characterized by a successful return to sport while minimizing complications. There is currently no consensus regarding timing or objective criteria for return to sport. The objective of this study is to evaluate the ability of postoperative patients to meet expected goals by using standardized objective evaluations of strength and physical function. METHODS: Forty-three (10 females, 76.7% male) subjects (mean age, 18.1 ± 3.7 years) who underwent arthroscopic shoulder stabilization surgery (anterior or posterior) from 2016 until 2018 were referred during their postoperative rehabilitation for functional testing at 6 months postoperatively to evaluate their readiness for return to sport. The Closed Kinetic Chain Upper Extremity Stability test and Unilateral Seated Shot Put test were used to assess shoulder function. Posterior rotator cuff activation was evaluated using a repetition to failure technique with 5% body weight at 0° and 90° of abduction with the goal of 90% of nonoperative extremity. Isokinetic strength testing of external rotation (ER) and internal rotation (IR) was evaluated using a Biodex isokinetic dynamometer at angular velocities of 60° and 180° per second, and a passing score was considered achieving 90% of nonoperative shoulder strength at both 60° and 180° per second. RESULTS: All subjects were competitive athletes (20 collegiate, 23 high school). The dominant extremity was the surgical extremity in 22 subjects. Only 5 subjects were able to successfully pass the battery of tests for strength and function. Strength testing revealed that 7 patients achieved 90% of the strength of the nonoperative extremity in both repetitions to failure (23 of 43) and comparative isokinetic testing (7 of 43). More subjects were able to meet IR strength (20 of 43) than ER strength (12 of 43) goals. Functional test goals were more frequently achieved, with 26 of 43 subjects meeting both functional test goals (33 Closed Kinetic Chain Upper Extremity Stability, 34 Unilateral Seated Shot Put). Only 2 subjects were able to achieve strength goals but did not pass functional tests, whereas 21 subjects passed functional tests without meeting strength goals. CONCLUSION: A substantial number of athletes in our cohort do not meet the expected goals for their operative shoulder in achieving appropriate function and strength, compared with the contralateral shoulder. Functional goals were more often met than strength. IR strength goals were more frequently achieved than ER strength. Strength and functional testing could provide more reliable criteria than arbitrary passage of time for return to play after shoulder stabilization surgery.


Assuntos
Instabilidade Articular/fisiopatologia , Volta ao Esporte , Luxação do Ombro/fisiopatologia , Articulação do Ombro/fisiopatologia , Adolescente , Artroscopia , Teste de Esforço , Feminino , Humanos , Instabilidade Articular/cirurgia , Masculino , Força Muscular , Amplitude de Movimento Articular , Rotação , Manguito Rotador/fisiopatologia , Luxação do Ombro/cirurgia , Articulação do Ombro/cirurgia , Adulto Jovem
9.
J Shoulder Elbow Surg ; 29(7S): S126-S133, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32643606

RESUMO

INTRODUCTION: As surgeons' confidence in reverse shoulder arthroplasty (RSA) increases, they may tend to offer RSA earlier in the course of glenohumeral joint disease. This study evaluates the changes in the "tipping point" for primary RSA over a 10-year period to evaluate changes in practice. METHODS: A total of 3975 primary RSAs performed over a 10-year period were retrospectively reviewed from a multi-institutional database. Of these, 3536 primary RSAs with preoperative diagnoses of osteoarthritis with rotator cuff deficiency (1626), irreparable rotator cuff tear (396), and rotator cuff tear arthropathy (1514) were included in the analysis. Preoperative range of motion (ROM) and patient-reported outcome measures (PROMs) were used to calculate tipping points for each subgroup on a yearly basis over a 10-year period, and assessed for changes over time. RESULTS: PROMs (American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form, Simple Shoulder Test) and the Constant score remained similar over the 10-year study period, with all demonstrating slightly higher tipping points later in the study. ROM measures (forward elevation, abduction, and external rotation) all showed small increases over time, demonstrating better ROM before electing to undergo RSA in later years. CONCLUSIONS: With the increasing use of RSA over the last decade, the ROM tipping point for patients electing to undergo surgery has increased, whereas the PROM tipping point has remained stable. This indicates that patients undergoing RSA in the present have greater ROM preoperatively compared with 10 years ago; however, their perceived disability remains similar. Surgeons and patients continue to pursue RSA at a similar preoperative morbidity over the last 10 years.


Assuntos
Artroplastia do Ombro , Osteoartrite/fisiopatologia , Lesões do Manguito Rotador/fisiopatologia , Artropatia de Ruptura do Manguito Rotador/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite/cirurgia , Medidas de Resultados Relatados pelo Paciente , Período Pós-Operatório , Período Pré-Operatório , Amplitude de Movimento Articular , Estudos Retrospectivos , Rotação , Lesões do Manguito Rotador/cirurgia , Artropatia de Ruptura do Manguito Rotador/cirurgia , Articulação do Ombro/fisiopatologia , Articulação do Ombro/cirurgia , Fatores de Tempo , Resultado do Tratamento
10.
J Shoulder Elbow Surg ; 29(7S): S134-S138, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32643607

RESUMO

BACKGROUND: Reverse total shoulder arthroplasty (RTSA) as a revision procedure for failed anatomic total shoulder arthroplasty (TSA) is increasing in incidence. The purpose of this study was to analyze the results of RTSA as a revision salvage procedure for failed TSA and identify factors that influenced those outcomes. METHODS: All anatomic TSAs that were revised to RTSAs in adult patients, under the care of 2 senior surgeons at a single academic center from 2006 to 2018, were queried and reviewed. Cases in which hemiarthroplasty or RTSA was revised to RTSA were excluded. Electronic medical records and survey databases were reviewed for each subject. Demographic and surgical details were reviewed and analyzed with descriptive statistics. Preoperative and postoperative range of motion (ROM) including active forward elevation and active external rotation were evaluated. Patient-reported outcome surveys including the American Shoulder and Elbow Surgeons survey, Single Assessment Numeric Evaluation, and visual analog scale for pain were collected and analyzed. Improvement in ROM and outcome survey measures was assessed with 2-sample t tests. Complication and reoperation rates were analyzed with descriptive statistics. RESULTS: A total of 75 patients (32 men and 43 women) were available for analysis at a mean of 22.3 months. The subjects were aged 60.3 ± 11.3 years at the time of TSA and 64.6 ± 9.7 years at the time of RTSA. The average period between TSA and RTSA was 4.3 years. The 3 most common indications for revision RTSA were painful arthroplasty (n = 62, 82.7%), rotator cuff failure (n = 56, 74.7%), and unstable arthroplasty (n = 25, 33.3%), but the majority of patients had multiple indications for surgery (n = 69, 92%). Significant improvements were found in all outcome measures from the time of failed TSA diagnosis to most recent follow-up after salvage RTSA with the exception of active external rotation: American Shoulder and Elbow Surgeons score, 39 ± 15 preoperatively vs. 62 ± 25 postoperatively; Single Assessment Numeric Evaluation, 27 ± 23 vs. 60 ± 30; visual analog scale pain score, 5 ± 2 vs. 3 ± 3; and active forward elevation, 79° ± 41° vs. 128° ± 33°. Major complications occurred in 21 patients (28.4%) after salvage RTSA, and 9 (12%) underwent reoperation. CONCLUSIONS: RTSA for failed TSA can improve pain, function, and quality-of-life measures in patients with various TSA failure etiologies. However, postoperative ROM and patient-reported outcomes do not reach the values seen in the primary RTSA population.


Assuntos
Artroplastia do Ombro , Reoperação , Terapia de Salvação , Articulação do Ombro/fisiopatologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Artroplastia do Ombro/efeitos adversos , Artroplastia do Ombro/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Período Pós-Operatório , Período Pré-Operatório , Amplitude de Movimento Articular , Reoperação/efeitos adversos , Estudos Retrospectivos , Manguito Rotador/cirurgia , Articulação do Ombro/cirurgia , Dor de Ombro/etiologia , Falha de Tratamento , Resultado do Tratamento , Adulto Jovem
11.
J Shoulder Elbow Surg ; 29(7S): S139-S148, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32643608

RESUMO

BACKGROUND: Reverse total shoulder arthroplasty (rTSA) in the presence of significant glenoid bone loss remains a challenge. This study presents preliminary clinical and radiographic outcomes of primary and revision rTSA using a patient-matched, 3-dimensionally printed custom metal glenoid implant to address severe glenoid bone deficiency. METHODS: Between September 2017 and November 2018, 19 patients with severe glenoid bone deficiency underwent primary (n = 9) or revision rTSA (n = 10) using the Comprehensive Vault Reconstruction System (VRS) (Zimmer Biomet, Warsaw, IN, USA) at a single institution. Preoperative and postoperative values for the Disabilities of the Arm, Shoulder and Hand score, Constant score, American Shoulder and Elbow Surgeons score, Simple Shoulder Test score, Single Assessment Numeric Evaluation score, and visual analog scale pain score and active range of motion were compared using the Wilcoxon signed rank test with the level of statistical significance set at P < .05. RESULTS: Complications occurred in 4 patients (21%), including a nondisplaced greater tuberosity fracture treated conservatively in 1, intraoperative cortical perforation during humeral cement removal treated with an allograft strut in 1, and recurrent instability and hematoma formation treated with humeral component revision in 1. One patient with an early periprosthetic infection was treated with component removal and antibiotic spacer placement at an outside facility and was subsequently lost to follow-up. Eighteen patients with 1-year minimum clinical and radiographic follow-up were evaluated (mean, 18.2 months; range, 12-27 months). Significant improvements were noted in the mean Disabilities of the Arm, Shoulder and Hand score (57.4 ± 16.5 vs. 29.4 ± 19.5, P < .001), mean Constant score (24.6 ± 10.2 vs. 60.4 ± 14.5, P < .001), mean American Shoulder and Elbow Surgeons score (32 ± 18.2 vs. 79 ± 15.6, P < .001), mean Simple Shoulder Test score (4.5 ± 2.6 vs. 9.3 ± 1.8, P < .001), mean Single Assessment Numeric Evaluation score (25.4 ± 13.7 vs. 72.2 ± 17.8, P < .001), mean visual analog scale pain score (6.2 ± 2.9 vs. 0.7 ± 1.3, P < .001), mean active forward flexion (53° ± 27° vs. 124° ± 23°, P < .001), and mean active abduction (42° ± 17° to 77° ± 15°, P < .001). Mean external rotation changed from 17° ± 19° to 32° ± 24° (P = .06). No radiographic evidence of component loosening, scapular notching, or hardware failure was observed at last follow-up in any patient. CONCLUSION: The preliminary results of rTSA using the VRS to manage severe glenoid bone deficiency are promising, but longer follow-up is necessary to determine the longevity of this implant.


Assuntos
Artroplastia do Ombro/instrumentação , Cavidade Glenoide/cirurgia , Articulação do Ombro/fisiopatologia , Prótese de Ombro , Idoso , Idoso de 80 Anos ou mais , Artroplastia do Ombro/efeitos adversos , Feminino , Cavidade Glenoide/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Cognitivas Pós-Operatórias , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Período Pós-Operatório , Período Pré-Operatório , Desenho de Prótese , Amplitude de Movimento Articular , Reoperação , Estudos Retrospectivos , Rotação , Articulação do Ombro/diagnóstico por imagem , Articulação do Ombro/cirurgia , Fatores de Tempo , Resultado do Tratamento
12.
J Shoulder Elbow Surg ; 29(7S): S41-S47, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32643609

RESUMO

BACKGROUND: Minimal clinically important differences (MCIDs) at 1 year after subpectoral biceps tenodesis are unknown for the American Shoulder and Elbow Surgeons (ASES) scale, Subjective Shoulder Value (SSV), and visual analog scale (VAS) for pain. Our objectives were to determine MCIDs for these measures at 1 year after biceps tenodesis and to identify preoperative factors that predict attainment of MCIDs. METHODS: We included 52 patients who underwent arthroscopic débridement, decompression, and mini-open biceps tenodesis from 2016-2018. We analyzed age, sex, body mass index value, arm dominance, diagnosis, range of shoulder motion, and preoperative and 1-year postoperative ASES, SSV, and VAS scores. MCIDs were calculated using a distribution-based method of one-half the standard deviation. Preoperative thresholds predictive of MCIDs were calculated with univariate logistic regression. Multiple logistic regression was used to determine factors that predict MCIDs. Significance was set at a 2-tailed P value of <.05. RESULTS: MCIDs for the ASES, SSV, and VAS were 13, 12, and 1.6 points, respectively. Preoperative ASES score <59 predicted MCID on the ASES (P = .03); VAS score >3 predicted MCID on the VAS (P < .01); external shoulder rotation >40° predicted MCID on the SSV (P = .02); and age >41 years predicted MCID on the VAS (P = .02). CONCLUSION: At 1 year after débridement, decompression, and biceps tenodesis, MCIDs were 13, 12, and 1.6 points for the ASES, SSV, and VAS, respectively. Patients most likely to attain MCIDs were those aged >41 years, those with the most preoperative pain, and those with the poorest preoperative shoulder function.


Assuntos
Articulação do Ombro/fisiopatologia , Tenodese/métodos , Adulto , Fatores Etários , Braço , Desbridamento , Descompressão Cirúrgica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Diferença Mínima Clinicamente Importante , Medição da Dor , Período Pós-Operatório , Estudos Retrospectivos , Dor de Ombro/cirurgia , Resultado do Tratamento
13.
J Shoulder Elbow Surg ; 29(7S): S59-S66, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32643610

RESUMO

BACKGROUND: Instability arthropathy is a known cause of glenohumeral osteoarthritis (OA) among patients with and without prior shoulder stabilization. This study aims to compare the clinical, radiographic, and patient-reported outcome measure (PROM) scores among total shoulder arthroplasty (TSA) patients with and without a history of shoulder stabilization. METHODS: A case-control study was performed comparing 20 patients with a history of anterior shoulder stabilization (11 open, 9 arthroscopic) who underwent TSA to a matched cohort of 20 TSA patients without a history of shoulder surgery (mean follow-up = 2.8 years). Patients were matched by sex, age, and baseline American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) score within 10 points (mean age 59.6 ± 9.6 years). Patient characteristics, operative findings, and preoperative and postoperative radiographic characteristics for both groups were reported. Comparisons were made regarding PROM scores (ASES, 12-Item Short Form Health Survey (SF-12), Shoulder Activity Scale [SAS], numeric rating scale for pain) at baseline, 2 years, and 5 years and patient satisfaction at 2 years. RESULTS: Intraoperative findings of subscapularis scarring or attenuation was common among patients with prior anterior stabilization. The instability cohort did have a higher percentage of B2/B3 glenoid types than the OA cohort (45% vs. 15%), but this was not significantly different possibly because of the small sample size. At 2 years, both instability and OA groups reported significant improvement in pain, function, and activity level. There was no difference between groups on any PROMs or patient satisfaction level. At 5 years, instability patients had significantly lower scores on the ASES and the SF-12 PCS than the OA group. CONCLUSION: There was notable alterations in both soft tissue and bony morphology among patients with prior anterior stabilization. After TSA, both instability and primary OA groups showed significant improvements at 2 years. However, PROMs for instability patients deteriorated at 5 years compared with the control group. Complex bony and soft tissue imbalances may contribute to more unpredictable long-term PROM scores. Thoughtful preoperative consideration of these factors should influence decision making regarding selection of TSA for management of OA in this complex patient cohort.


Assuntos
Artroplastia do Ombro , Instabilidade Articular/cirurgia , Osteoartrite/cirurgia , Medidas de Resultados Relatados pelo Paciente , Adulto , Idoso , Estudos de Casos e Controles , Feminino , Humanos , Instabilidade Articular/complicações , Masculino , Pessoa de Meia-Idade , Osteoartrite/complicações , Satisfação do Paciente , Período Pós-Operatório , Amplitude de Movimento Articular , Estudos Retrospectivos , Articulação do Ombro/diagnóstico por imagem , Articulação do Ombro/fisiopatologia , Articulação do Ombro/cirurgia , Dor de Ombro/etiologia , Resultado do Tratamento
14.
J Shoulder Elbow Surg ; 29(7S): S73-S79, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32643611

RESUMO

BACKGROUND: The purpose of this study was to assess the midterm clinical and ultrasonographic outcomes of a new all arthroscopic supraglenoid origin-preserving tenodesis technique of the long head of the biceps (LHB) brachii tendon in the setting of small to medium-sized rotator cuff repairs. MATERIALS AND METHODS: Thirty patients (33 shoulders) meeting inclusion criteria were identified who underwent LHB tenodesis with this technique in the setting of small to medium-sized rotator cuff repair at a mean age at surgery of 65.6 years between 2015 and 2017. Rotator cuff tears were repaired using the Southern California Orthopedic Institute (SCOI) row technique. The biceps tenodesis was incorporated into the anterior anchor of the rotator cuff repair after bony groove preparation, including débridement and bone vent placement. Frayed edges of the biceps tendon were gently débrided, but the intra-articular glenoid attachment was left intact. Patients were assessed at follow-up by clinical and ultrasonographic examination, as well as a satisfaction questionnaire, the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) score and visual analog scale (VAS) score. RESULTS: Mean follow-up was 32.9 months for the 27 patients (30 shoulders), resulting in a 91% follow-up. Average ASES score was 94.4. Average patient-reported satisfaction with shoulder function was 9.4 of 10 and with biceps contour was 9.9 of 10. Average VAS score was 0.6 of 10, and 73% of patients reported a VAS score of 0. Ultrasonography demonstrated an intact biceps tendon in 27 of 28 shoulders and an intact supraspinatus tendon in all 28 shoulders. Mean range of motion was 170° in forward flexion, 169° in abduction, 49° in external rotation, and to thoracic vertebrae 12 in internal rotation. Mean muscle grading during Jobe test was 4.8 of 5. There were no intraoperative complications. No patients required revision surgery. CONCLUSIONS: In situ arthroscopic biceps tenodesis with maintenance of the glenoid attachment incorporated into rotator cuff repair yields a high rate of healing and consistently excellent functional and cosmetic outcomes as well as patient satisfaction while saving surgical time and cost.


Assuntos
Lesões do Manguito Rotador/cirurgia , Manguito Rotador/cirurgia , Articulação do Ombro/fisiopatologia , Tenodese/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Artroplastia/métodos , Artroscopia/métodos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Amplitude de Movimento Articular , Reoperação , Manguito Rotador/fisiopatologia , Lesões do Manguito Rotador/diagnóstico por imagem , Lesões do Manguito Rotador/fisiopatologia , Articulação do Ombro/diagnóstico por imagem
15.
J Shoulder Elbow Surg ; 29(7S): S80-S86, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32643612

RESUMO

BACKGROUND: Mood symptoms may be due to shoulder-related depression or anxiety or clinical anxiety/depression. The objective of this study was to evaluate the relationship of shoulder-related and pre-existing diagnosis of depression or anxiety with changes in American Shoulder and Elbow Surgeons (ASES) score after rotator cuff repair. METHODS: A retrospective review of prospectively collected data on subjects undergoing arthroscopic rotator cuff repair was reviewed. Preoperative and postoperative ASES, questions from the Western Ontario Rotator Cuff index questions directed to feelings of depression/anxiety related to the shoulder, and pre-existing diagnoses of depression and/or anxiety were recorded. The Wilcoxon rank sum test was used to compare changes, and Spearman's correlation was used to correlate changes in mood and ASES between male and female subjects and those with and without anxiety and/or depression. RESULTS: One hundred seventy-one subjects (53 female; mean age, 58.0 years; standard deviation [SD], 8.5) who underwent arthroscopic rotator cuff repair were evaluated with the mean follow-up of 36.6 months (SD, 17.5). Forty-six subjects (mean age, 58.8 years; SD, 8.2) had pre-existing diagnoses of depression and/or anxiety and 125 subjects (mean age, 57.7 years; SD, 8.7) did not. Patients showed improvement in Western Ontario Rotator Cuff shoulder-related depression (Δ 22.3) and anxiety (Δ 24.7). There was a strong correlation between the change in mood symptoms and the change in ASES score, for depression (r = 0.74) and anxiety (r = 0.71). Patients with and without clinical diagnosis of anxiety or depression experienced similar changes in mood symptoms related to the shoulder and ASES scores (P = .65, P = .39). Patients' ASES scores were less correlated with changes in shoulder-related mood symptoms; however, if patients had clinical depression/anxiety compared with those without (r = 0.68 vs. 0.75, P < .0001 for depression; r = 0.56 vs. r = 0.74, P < .0001 for anxiety). CONCLUSIONS: After rotator cuff repair, symptoms of depression/anxiety related to the shoulder improved dramatically with or without pre-existing clinical diagnosis of depression or anxiety. As the patient-reported functional outcomes of those with pre-existing clinical diagnosis of anxiety/depression improved, they did not experience as strong as an improvement in their mood symptoms as those without prior diagnoses and may benefit from directed treatment of these symptoms. Patients with shoulder-related mood symptoms only, conversely, experience a strong relationship between their improvement in function with their mood symptoms and may be ideal candidates for rotator cuff surgery. It is important for clinicians to separate mood symptoms related to adjustment disorder from the rotator cuff injury from clinical depression and anxiety.


Assuntos
Transtornos de Adaptação/psicologia , Ansiedade/psicologia , Depressão/psicologia , Lesões do Manguito Rotador/psicologia , Lesões do Manguito Rotador/cirurgia , Articulação do Ombro/fisiopatologia , Adulto , Idoso , Ansiedade/etiologia , Artroplastia , Artroscopia , Depressão/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medidas de Resultados Relatados pelo Paciente , Período Pós-Operatório , Escalas de Graduação Psiquiátrica , Estudos Retrospectivos , Manguito Rotador/fisiopatologia , Manguito Rotador/cirurgia , Lesões do Manguito Rotador/fisiopatologia , Fatores Sexuais
16.
J Shoulder Elbow Surg ; 29(7S): S87-S91, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32643613

RESUMO

BACKGROUND: Correcting pseudoparalysis of the shoulder due to massive rotator cuff tear is challenging. The most reliable treatment for restoring active shoulder elevation is debatable. Therefore, the purpose of this systematic review was to evaluate the success of various treatment options for reversing pseudoparalysis due to massive rotator cuff tear. METHODS: A search was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines of the MEDLINE database, Cochrane database, Sportdiscus, and Google Scholar database for articles evaluating shoulder pseudoparalysis due to massive rotator cuff tears. RESULTS: Nine articles evaluating reverse total shoulder arthroplasty (RTSA), superior capsular reconstruction (SCR), and rehabilitation programs were included in the study. Though there was variability, the definition of pseudoparalysis was active forward elevation (AFE) less than 90° with preserved passive range of motion (ROM). Reversal of pseudoparalysis was defined as restoration of AFE greater than 90°. The overall rate of reversal of pseudoparalysis across studies was similar for RTSA (96% ± 17%) and SCR (94% ± 3%). However, there was a difference in average improvement in AFE for RTSA (56° ± 11°) and SCR (106° ± 20°). A progressive rehabilitation program described improvements in a single study with 82% reversal of pseudoparalysis. CONCLUSION: The available Level IV evidence suggests that RTSA and SCR reliably reverse pseudoparalysis in most patients with massive, irreparable rotator cuff tears. However, the dissimilar improvements in ROM suggest that a more consistent definition of pseudoparalysis is warranted. Future randomized controlled trials are needed to determine the best treatment approach for patients with massive irreparable rotator cuff tears.


Assuntos
Artroplastia , Debilidade Muscular , Paralisia/fisiopatologia , Lesões do Manguito Rotador/fisiopatologia , Lesões do Manguito Rotador/cirurgia , Articulação do Ombro/fisiopatologia , Artroplastia/métodos , Artroplastia do Ombro , Humanos , Debilidade Muscular/cirurgia , Paralisia/etiologia , Amplitude de Movimento Articular , Lesões do Manguito Rotador/complicações , Lesões do Manguito Rotador/reabilitação , Articulação do Ombro/cirurgia , Resultado do Tratamento
17.
Clin Orthop Surg ; 12(2): 145-150, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32489534

RESUMO

For proper treatment of recurrent anterior instability of the shoulder with a bone defect, the defect size should be assessed preoperatively with three-dimensional computed tomography or magnetic resonance imaging. In general, the risk of postoperative recurrence of instability is estimated on the basis of preoperative imaging of bipolar bone defects: more than 20%-25% glenoid bone loss and off-track Hill-Sachs lesions have been considered risk factors for recurrence. In patients with a glenoid bone defect more than 20%-25%, a bone graft procedure, such as the Latarjet procedure, is preferred regardless of the glenoid track concept, because compared with arthroscopic stabilization procedure, it provides greater postoperative stability. For patients with a borderline glenoid bone defect (around 20%), surgeons should discuss surgical options with the patients, considering their demand and physical activity level. In addition, the surgeon should take care to prevent postoperative instability and long-term complications. Arthroscopic soft-tissue reconstruction including labral repair and capsular plication combined with the additional remplissage procedure is an anatomical procedure and could be considered as one of the primary treatment methods for patients with glenoid bone defects around 20%. Therefore, treatment strategies for recurrent anterior shoulder instability combined with bone defects should be determined more flexibly on the basis of the patient's individual condition.


Assuntos
Instabilidade Articular/fisiopatologia , Instabilidade Articular/cirurgia , Articulação do Ombro/fisiopatologia , Articulação do Ombro/cirurgia , Lesões de Bankart/diagnóstico por imagem , Lesões de Bankart/fisiopatologia , Lesões de Bankart/cirurgia , Cavidade Glenoide/patologia , Humanos , Úmero/patologia , Instabilidade Articular/diagnóstico por imagem , Recidiva , Articulação do Ombro/diagnóstico por imagem
18.
Phys Ther Sport ; 44: 128-135, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32506035

RESUMO

OBJECTIVE: To identify injuries and physical characteristics affecting swimmers' performance. DESIGN: Prospective study. SETTING: Laboratory-based. PARTICIPANTS: Sixty-four Rio Olympic candidates (36 men, 28 women), who were high level swimmers ranked among the top 32 in the 2014 World Ranking in swimming. The participants were categorized into the Olympian group (n = 25), swimmers who were consecutively selected for the Olympic team, and the non-Olympian group (n = 39), swimmers who were not. MAIN OUTCOME MEASURES: Four months prior to the Olympic qualification in 2016, an orthopedist and two physical therapists evaluated injuries and 11 physical characteristics of the swimmers. The prevalence of total overuse injuries, shoulder and low back injury, and physical characteristics were compared between the two groups. RESULTS: The female swimmers in the non-Olympian group had a 53.3% prevalence of total overuse injuries, which was significantly higher than that of those in the Olympian group with 15.4% (p = 0.037). The prevalence of total over use injuries in male swimmers in both the Olympian and non-Olympian groups was 41.7%. Female Olympian group showed that the shoulder external rotation range of motion was significantly less than that of non-Olympian group (97.8 ± 5.7 and 103.6 ± 7.3, p = 0.046). CONCLUSIONS: In female swimmers, total overuse injuries four months before an important competition influence their performance at the event.


Assuntos
Traumatismos em Atletas/epidemiologia , Transtornos Traumáticos Cumulativos/epidemiologia , Amplitude de Movimento Articular/fisiologia , Articulação do Ombro/lesões , Natação/lesões , Traumatismos em Atletas/fisiopatologia , Transtornos Traumáticos Cumulativos/fisiopatologia , Feminino , Humanos , Japão/epidemiologia , Masculino , Prevalência , Estudos Prospectivos , Articulação do Ombro/fisiopatologia , Inquéritos e Questionários , Adulto Jovem
20.
J Plast Reconstr Aesthet Surg ; 73(10): 1862-1870, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32586755

RESUMO

BACKGROUND: The latissimus dorsi (LD) flap is reliable and versatile with many indications and low donor site morbidity. The aim of this study is to evaluate the long-term effects of LD flap on the shoulder function in patients undergoing delayed breast reconstruction. METHODS: This case-control study enrolled women who underwent implant-based (IB) breast reconstruction, radical lymphadenectomy, and radiotherapy between 2006 and 2016. The study group included 72 women, with a history of severe capsular contracture, who received a secondary LD flap reconstruction. The control group consisted of a matched cohort of 80 patients with IB breast reconstruction. Shoulder function was assessed using the acromiohumeral interval (AHI) measurement in standard X-rays. The validated Western Ontario Shoulder Instability (WOSI) and BREAST-Q questionnaires were used to assess outcomes one year postoperatively and data were analyzed using Fisher's exact test and the Mann-Whitney test. RESULTS: Out of 72 patients from the study group, 40 had valuable pre- and postoperative X-rays to measure the AHI. An AHI reduction was recorded only in 7/40 patients. From the WOSI analysis, no significant differences in shoulder function and back pain between the two groups were registered. BREAST-Q scores in the LD group were higher in most domains, including satisfaction with breasts and psychosocial well-being. However, the Mann-Whitney test showed no significant difference between the two groups (p > 0.05). CONCLUSION: LD flap, with detachment of its insertions from the humerus, does not seem to have a negative impact on back and shoulder function and is correlated with high patient satisfaction in breast reconstruction following radiotherapy.


Assuntos
Implante Mamário/métodos , Articulação do Ombro/fisiopatologia , Músculos Superficiais do Dorso/transplante , Retalhos Cirúrgicos , Coleta de Tecidos e Órgãos , Adulto , Estudos de Casos e Controles , Autoavaliação Diagnóstica , Feminino , Humanos , Pessoa de Meia-Idade , Avaliação de Resultados da Assistência ao Paciente , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/fisiopatologia , Amplitude de Movimento Articular , Estudos Retrospectivos , Fatores de Tempo , Coleta de Tecidos e Órgãos/efeitos adversos , Resultado do Tratamento
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