Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 2.390
Filtrar
1.
J Surg Oncol ; 121(4): 612-619, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31919856

RESUMO

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.


Assuntos
Neoplasias Ósseas/cirurgia , Salvamento de Membro/métodos , Osteossarcoma/cirurgia , Articulação do Ombro/cirurgia , Adolescente , Adulto , Amputação/efeitos adversos , Amputação/métodos , Amputação/mortalidade , Neoplasias Ósseas/mortalidade , Neoplasias Ósseas/patologia , Desarticulação/efeitos adversos , Desarticulação/métodos , Desarticulação/mortalidade , Feminino , Humanos , Estimativa de Kaplan-Meier , Salvamento de Membro/efeitos adversos , Salvamento de Membro/mortalidade , Masculino , Pessoa de Meia-Idade , Osteossarcoma/mortalidade , Osteossarcoma/patologia , Próteses e Implantes , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Procedimentos Cirúrgicos Reconstrutivos/mortalidade , Estudos Retrospectivos , Articulação do Ombro/patologia , Adulto Jovem
2.
Int. j. morphol ; 37(4): 1551-1556, Dec. 2019. graf
Artigo em Espanhol | LILACS | ID: biblio-1040168

RESUMO

La inyección con monoiodo acetato de sodio (MIA) es ampliamente utilizada para producir osteoartritis en diversas articulaciones. El objetivo fue describir los daños histológicos provocados por MIA en la articulación humeral de rata. Se inyectó 0,1 mL de mezcla de 0,5 mg de MIA disuelto en 10 mL de solución fisiológica en la articulación humeral izquierda de 21 ratas SpragueDawley. Como control se utilizó la articulación derecha de cada rata. Se realizó la eutanasia a las 4, 8 y 12 semanas post inyección en grupos de 7 ratas. Los miembros mantenidos en formalina tamponada al 10% fueron descalcificados con EDTA por tres meses. Para la evaluación histológica se realizó la inclusión en parafina y se realizaron cortes coronales de 5 µm de espesor, para posterior tinción con azul de toluidina. En el cartílago sano, se observó una superficie lisa sin fisuras, todas las células de las zonas del cartílago se observaron normales. Se observaron cambios en el cartílago articular a partir de las 4 semanas post inyección, los condrocitos de la zona radial hipertróficos con gran producción de proteoglicanos. A las 12 semanas post inyección, se observa un gran deterioro, el espacio articular se ve disminuido, La superficie del cartílago se observa con fisuras y grietas que llegan hasta la zona radial. Las células alrededor de estas fisuras han desaparecido. Se observa una pérdida prominente de proteoglicanos debido a la débil tinción con azul de toluidina. La inyección articular con MIA produce lesiones similares a la OA. La gran ventaja de la OA inducida por MIA, es la facilidad de su aplicación y la rapidez en la progresión de OA.


Injection with monoiode sodium acetate (MIA) is widely used to produce osteoarthritis in various joints. The aim of this work was to describe the histological damage caused by MIA in the rat humeral joint; 0.1 mL of 0.5 mg mixture of MIA dissolved in 10 mL of physiological solution was injected into the left humeral joint of 21 Sprague-Dawley rats. As a control, the right joint of each rat was used. Euthanasia was performed at 4, 8 and 12 weeks post injection in groups of 7 rats. The samples maintained in 10 % buffered formalin were descaled with EDTA for three months. For histological evaluation, paraffin inclusion was performed and 5 µm thick coronal cuts were made for subsequent staining with toluidine blue. In the healthy cartilage, a smooth surface was observed, all cells in the cartilage areas were normal. Changes in articular cartilage were observed after 4 weeks post injection, hypertrophic radial chondrocytes with high proteoglycan production. At 12 weeks post injection, a great deterioration was observed, the articular space was diminished. The surface of the cartilage was observed with fissures and cracks that reach the radial zone. The cells around these fissures have disappeared. A prominent loss of proteoglycans was observed due to weak toluidine blue staining. Joint injection with MIA produced lesions similar to OA. The great advantage of the OA induced by MIA, is the ease of its application and the rapidity in the progression of OA.


Assuntos
Animais , Feminino , Ratos , Osteoartrite/induzido quimicamente , Articulação do Ombro/patologia , Ácido Iodoacético/farmacologia , Osteoartrite/patologia , Articulação do Ombro/efeitos dos fármacos , Cartilagem Articular/patologia , Ratos Sprague-Dawley , Modelos Animais de Doenças , Úmero/patologia
3.
Acta Orthop Belg ; 85(3): 274-282, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31677622

RESUMO

The purpose is to report the clinical and radiographic outcomes, complications and reoperations of reverse shoulder arthroplasty (RSA) for glenoid dysplasia. All patients who had undergone RSA for osteoarthritis secondary to underlying glenoid dysplasia were retrospectively identified. The study included twelve shoulders (11 patients), with a mean (SD) patient age of 62.2 (13.2) years and median (range) clinical follow-up of 28 (24-34) months. RSA resulted in substantial improvements in pain and function. At most recent follow-up, there was a significant improvement in forward flexion range of motion (ROM), a non-significant improvement in internal rotation ROM, and no changes in external rotation ROM. The mean (SD) SST and ASES scores were 7.8 (3.7) and 73.5 (20.4), respectively. There were no reoperations or radiographic loosening. The results were excellent in 1 case, satisfactory in 8, and unsatisfactory in 3. RSA provides acceptable function and good pain relief, though patients should be advised that shoulder rotation may be somewhat limited.


Assuntos
Cavidade Glenoide , Osteoartrite/cirurgia , Articulação do Ombro/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Artroplastia do Ombro/métodos , Feminino , Cavidade Glenoide/diagnóstico por imagem , Cavidade Glenoide/patologia , Cavidade Glenoide/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite/diagnóstico por imagem , Osteoartrite/etiologia , Osteoartrite/patologia , Radiografia , Articulação do Ombro/diagnóstico por imagem , Articulação do Ombro/patologia
4.
J Bone Joint Surg Am ; 101(21): 1912-1920, 2019 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-31567672

RESUMO

BACKGROUND: Although glenoid morphology has been associated with fatty infiltration of the rotator cuff in arthritic shoulders, the association of rotator cuff muscle area with specific patterns of glenoid wear has not been studied. The purpose of our study was to assess the associations of glenoid deformity in primary glenohumeral osteoarthritis and rotator cuff muscle area. METHODS: A retrospective study of 370 computed tomographic (CT) scans of osteoarthritic shoulders was performed. Glenoid deformity according to the modified Walch classification was determined, and retroversion, inclination, and humeral-head subluxation were calculated using automated 3-dimensional software. Rotator cuff muscle area was measured on sagittal CT scan reconstructions. A ratio of the area of the posterior rotator cuff muscles to the subscapularis was calculated to approximate axial plane potential force imbalance. Univariate and multivariate analyses to determine associations with glenoid bone deformity and rotator cuff measurements were performed. RESULTS: Patient age and sex were significantly related to cuff muscle area across glenoid types. Multivariate analysis did not find significant differences in individual rotator cuff cross-sectional areas across glenoid types, with the exception of a larger supraspinatus area in Type-B2 glenoids compared with Type-A glenoids (odds ratio [OR], 1.5; p = 0.04). An increased ratio of the posterior cuff area to the subscapularis area was associated with increased odds of a Type-B2 deformity (OR, 1.3; p = 0.002). Similarly, an increase in this ratio was significantly associated with increased glenoid retroversion (beta = 0.92; p = 0.01) and humeral-head subluxation (beta = 1.48; p = 0.001). Within the Type-B glenoids, only posterior humeral subluxation was related to the ratio of the posterior cuff to the subscapularis (beta = 1.15; p = 0.001). CONCLUSIONS: Age and sex are significantly associated with cuff muscle area in arthritic shoulders. Asymmetric glenoid wear and humeral-head subluxation in osteoarthritis are associated with asymmetric atrophy within the rotator cuff transverse plane. Increased posterior rotator cuff muscle area compared with anterior rotator cuff muscle area is associated with greater posterior glenoid wear and subluxation. It is unclear if the results are causative or associative; further research is required to clarify the relationship. LEVEL OF EVIDENCE: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.


Assuntos
Cavidade Glenoide/patologia , Osteoartrite/patologia , Manguito Rotador/patologia , Articulação do Ombro/patologia , Fatores Etários , Idoso , Análise de Variância , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Estudos Retrospectivos , Fatores Sexuais , Tomografia Computadorizada por Raios X/métodos
5.
Magn Reson Imaging Clin N Am ; 27(4): 575-585, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31575394

RESUMO

This article discusses the typical findings seen on conventional radiography in 3 common shoulder pathologies, namely glenohumeral instability, rotator cuff pathology, and acromioclavicular joint dislocation. Correlative MR images are used to explain and illustrate the significance of radiographic findings that suggest the presence of underlying shoulder pathology.


Assuntos
Artropatias/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Radiografia/métodos , Articulação do Ombro/diagnóstico por imagem , Ombro/diagnóstico por imagem , Humanos , Artropatias/patologia , Ombro/patologia , Articulação do Ombro/patologia
6.
Rev. chil. ortop. traumatol ; 60(2): 58-66, oct. 2019. ilus
Artigo em Espanhol | LILACS | ID: biblio-1095955

RESUMO

El objetivo primario de esta revisión es realizar una actualización de los conceptos básicos relacionados a los cambios morfológicos glenoideos durante la artrosis glenohumeral primaria, métodos de medición relevantes y describir las modificaciones en la nueva clasificación de Gilles Walch. La medición de esos parámetros influyen en forma directa tanto en el acto quirúrgico dentro una prótesis de hombro como en los resultados clínicos post operatorios. Los diferentes métodos de medición descritos en la literatura han permitido evaluar la magnitud de esos fenómenos morfológicos y describir la "glenoides bicóncava", caracterizada por presentar 3 subtipos: la paleoglena, neoglena y la glena intermedia. A partir de esos conceptos, Walch en 1999 describe la clasificación de los cambios morfológicos glenoideos en artrosis primaria, la cual ha presentado una reciente modificación debido a la mala concordancia intra e interobservador de esa medición obtenida por varios investigadores, además de reconocer una carencia en la precisión para describir cada subtipo. A la fecha, diferentes autores investigan la influencia de esos factores morfológicos preoperatorios en los resultados post operatorios, y hasta que valor límite podrían guiar un tratamiento especifico. Conclusión: Enfatizamos que un análisis acabado y minucioso de la morfología glenoidea es importante para una adecuada planificación quirúrgica en artroplastia de hombro, ya que eso puede guiarnos en cuál técnica o implante puede ser el más adecuado para cada tipo de glenoides.


The main purpose of this review is to up date the basic concepts regarding the glenoid morphological changes in primary glenohumeral osteoarthritis, relevant measuring methods, and a description of the modifications in the Gilles Walch classification. The measurement of these parameters influences both surgical indications for total shoulder arthroplasty and the post op clinical outcomes. The different measuring methods described in literature have allowed to evaluate the magnitude of these morphological phenomena describing the "biconcave glenoid", which characteristically presents 3 subtypes: paleoglenoid, neoglenoid and intermediate glenoid. Based on these concepts, Walch classified the glenoid morphological changes in primary ostheoarthritis in 1999, which has been recently modified due to the poor inter-observer and intra-observer reliability described by a vast number of researchers, and also because of an observed lack of precision when describing each sub-type. Up to date, different authors are debating the influence of these pre operative morphological factors on the post op outcomes; and the cut-off value up to which this could lead to a specific treatment. As a conclusion, we emphasize that a deep and thorough analysis of the glenoid morphology is important for an adequate surgical planning of a shoulder arthroplasty, as this can guide us to the most adequate technique and type of implant for each type of glenoid.


Assuntos
Humanos , Osteoartrite/patologia , Artroplastia/métodos , Articulação do Ombro/patologia , Osteoartrite/classificação
7.
J Orthop Surg Res ; 14(1): 312, 2019 Sep 14.
Artigo em Inglês | MEDLINE | ID: mdl-31521195

RESUMO

BACKGROUND: There are no published studies of the influence of geometry of the scapula on the postoperative recovery of rotator cuff injuries. Our aim was to explore the relationship between the critical shoulder angle (CSA), acromion index (AI), glenoid inclination (GI), and postoperative repair outcomes in shoulder joints after arthroscopic supraspinatus tendon repair. METHODS: Sixty two patients suffering a supraspinatus tear were analyzed retrospectively following failure of conservative treatment and subsequent shoulder arthroscopy in our hospital. Standard anterior and posterior X-rays of the injured shoulder had been performed prior to surgery, with follow ups for at least 2 years (24-43 months). Magnetic resonance imaging (MRI) was performed 2 years after surgery to assess repair of the supraspinatus tendon. Patients were divided into either the intact or re-tear group, according to the MRI results. In addition, assessments using the Constant Shoulder Score (CSS), the American Shoulder and Elbow Surgeon (ASES) Shoulder Assessment Form, the University of California at Los Angeles (UCLA) score and visual analog scale (VAS) score were performed to establish shoulder function at the 2-year evaluation for each patient. RESULTS: The mean CSA of all patients was 35.79° ± 3.59°, mean AI was 0.72 ± 0.05, and mean GI was 15.87° ± 3.62°. The CSA, AI, and GI in the intact group were statistically significantly different than the re-tear group (p < 0.05). There was no correlation between the magnitude of the CSA, AI, or GI and any shoulder function score (p > 0.05). CONCLUSIONS: The geometry of the scapula had no significant effect on the recovery of postoperative function of patients with rotator cuff injury, but the value of the CSA, AI, and GI affected the risk of rotator cuff re-tear.


Assuntos
Artroscopia/métodos , Lesões do Manguito Rotador/cirurgia , Escápula/patologia , Articulação do Ombro/cirurgia , Adulto , Idoso , Artroscopia/reabilitação , Feminino , Seguimentos , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Cuidados Pós-Operatórios/métodos , Radiografia , Amplitude de Movimento Articular , Recuperação de Função Fisiológica , Estudos Retrospectivos , Lesões do Manguito Rotador/diagnóstico por imagem , Lesões do Manguito Rotador/patologia , Lesões do Manguito Rotador/reabilitação , Articulação do Ombro/diagnóstico por imagem , Articulação do Ombro/patologia , Articulação do Ombro/fisiopatologia , Resultado do Tratamento
8.
Workplace Health Saf ; 67(10): 501-505, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31540569

RESUMO

Transient shoulder pain is a common complaint following intramuscular vaccine administration into the deltoid. More severe vaccination-associated shoulder complications comprising of weakness and decreased range of motion are categorized under the construct "shoulder injury related to vaccine administration" (SIRVA) that subsumes both subjective and objective findings consistent with injury. We describe the presentation and management of a case of SIRVA in a health care worker following seasonal influenza vaccine administration as part of a hospital-based employee health program and review the relevant biomedical literature. We present a case from a single medical center. All data were collected by professionals in occupational health by interviewing, performing physical examinations, and reviewing medical records associated with the injured worker. Severe pain and limited range of shoulder motion developed following an influenza vaccination that was administered using a poorly positioned, larger than recommended needle. Magnetic resonance imaging (MRI) demonstrated moderate glenohumeral joint effusion and synovitis, with fluid accumulating in the subscapularis recess within 1 week of injury. At 8 months after initial injury, MRI showed persistent mild tenosynovitis of the long head of the biceps tendon, interval accumulation of a large glenohumeral joint effusion, and infraspinatus tendinitis with subjacent reactive bone marrow edema. The affected worker experienced work restrictions but had no complete lost workdays to date due to the injury. Occupationally related SIRVA is a preventable adverse event that should be considered in workplace vaccine administration programs, and appropriate education and training provided to vaccine administrators to address this.


Assuntos
Vacinas contra Influenza/efeitos adversos , Traumatismos Ocupacionais/induzido quimicamente , Articulação do Ombro/lesões , Adulto , Medula Óssea/patologia , Feminino , Pessoal de Saúde , Humanos , Vacinas contra Influenza/administração & dosagem , Imagem por Ressonância Magnética , Traumatismos Ocupacionais/diagnóstico por imagem , Traumatismos Ocupacionais/terapia , Articulação do Ombro/diagnóstico por imagem , Articulação do Ombro/patologia , Dor de Ombro/induzido quimicamente , Tenossinovite/induzido quimicamente
10.
Arthroscopy ; 35(9): 2553-2561, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31421961

RESUMO

PURPOSE: To explore whether the critical shoulder angle (CSA) and acromion index (AI) on nonstandard anteroposterior (AP) radiographs could be used as parameters for rotator cuff tear (RCT) diagnosis and to determine the optimized parameters. METHODS: This study included 174 patients with RCTs or intact rotator cuffs in whom AP radiographs were obtained at our hospital. The radiographs were assessed by 2 independent radiologists and were grouped according to the Suter-Henninger criteria. The CSA and AI were measured on all films. We performed receiver operating characteristic curve analysis by calculating the area under the curve (AUC) to compare the sensitivity and accuracy of both parameters. RESULTS: Of the 174 enrolled patients, only 47 (27%) met the requirements for standard AP films (types A1 and C1). On standard AP films, both the CSA and AI were significantly different between the RCT and control groups (P < .001 for CSA and P < .001 for AI), with AUCs of 0.86 and 0.80 for the CSA and AI, respectively. On nonstandard AP films (other radiograph types), the mean CSA value was not significantly different between the RCT and control groups (P = .536) whereas the AI showed a significant difference (P = .024). The AUCs were 0.57 for the CSA and 0.64 for the AI. CONCLUSIONS: On standard AP films, both the CSA and AI could predict rotator cuff disorders, and the CSA had a higher diagnostic accuracy than the AI. In contrast, on nonstandard AP films, the diagnostic efficacy of the AI was better than that of the CSA. On the basis of this study, we suggest an evaluation of the AP films of patients before diagnosis to confirm whether the AP films meet the criteria for standard AP films. LEVEL OF EVIDENCE: Level I, diagnostic study.


Assuntos
Acrômio/diagnóstico por imagem , Lesões do Manguito Rotador/diagnóstico por imagem , Manguito Rotador/diagnóstico por imagem , Articulação do Ombro/diagnóstico por imagem , Acrômio/patologia , Adulto , Idoso , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Curva ROC , Radiografia , Manguito Rotador/patologia , Lesões do Manguito Rotador/patologia , Articulação do Ombro/patologia , Adulto Jovem
11.
Am J Pathol ; 189(11): 2258-2268, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31437425

RESUMO

Tendon stromal cells isolated from patients with chronic shoulder rotator cuff tendon tears have dysregulated resolution responses. Current therapies do not address the biological processes concerned with persistent tendon inflammation; therefore, new therapeutic approaches that target tendon stromal cells are required. We examined whether two specialized proresolving mediators (SPMs), lipoxin B4 (LXB4) and resolvin E1 (RvE1), modulate the bioactive lipid mediator profiles of IL-1ß-stimulated tendon cells derived from patients with shoulder tendon tears and healthy volunteers. We also examined whether LXB4 or RvE1 treatments moderated the proinflammatory phenotype of tendon tear stromal cells. Incubation of IL-1ß-treated patient-derived tendon cells in LXB4 or RvE1 up-regulated concentrations of SPMs. RvE1 treatment of diseased tendon stromal cells increased 15-epi-LXB4 and regulated postaglandin F2α. LXB4 or RvE1 also induced expression of the SPM biosynthetic enzymes 12-lipoxygenase and 15-lipoxygenase. RvE1 treatment up-regulated the proresolving receptor human resolvin E1 compared with vehicle-treated cells. Incubation in LXB4 or RvE1 moderated the proinflammatory phenotype of patient-derived tendon tear cells, regulating markers of tendon inflammation, including podoplanin, CD90, phosphorylated signal transducer and activator of transcription 1, and IL-6. LXB4 and RvE1 counterregulate inflammatory processes in tendon stromal cells, supporting the role of these molecules as potential therapeutics to resolve tendon inflammation.


Assuntos
Ácido Eicosapentaenoico/análogos & derivados , Lipoxinas/farmacologia , Lesões do Ombro/patologia , Células Estromais/efeitos dos fármacos , Traumatismos dos Tendões/patologia , Tendões/efeitos dos fármacos , Idoso , Anti-Inflamatórios/farmacologia , Células Cultivadas , Ácido Eicosapentaenoico/farmacologia , Feminino , Humanos , Inflamação/metabolismo , Inflamação/patologia , Inflamação/prevenção & controle , Mediadores da Inflamação/metabolismo , Lacerações/metabolismo , Lacerações/patologia , Masculino , Pessoa de Meia-Idade , Ombro/patologia , Lesões do Ombro/metabolismo , Articulação do Ombro/efeitos dos fármacos , Articulação do Ombro/lesões , Articulação do Ombro/metabolismo , Articulação do Ombro/patologia , Células Estromais/metabolismo , Células Estromais/patologia , Traumatismos dos Tendões/metabolismo , Tendões/metabolismo , Tendões/patologia
12.
BMC Musculoskelet Disord ; 20(1): 364, 2019 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-31391025

RESUMO

BACKGROUND: Using mass spectrometry, we evaluated the metabolic profiles of patients who had rotator cuff tears with shoulder stiffness, or shoulder stiffness only, and compared these with samples from a control group. METHODS: This study enrolled 28 patients, including 10 patients with shoulder stiffness only (group I), nine patients with rotator cuff tear and stiffness (group II), and nine controls selected from patients diagnosed with impingement syndrome or long head of the biceps lesions without evident limitation of joint motion or rotator cuff tears. Serum and tissue from the rotator interval and anterior capsule were collected. In all, 82 samples were analyzed for metabolite profiling using the AbsoluteIDQ™p180 Kit. RESULTS: Comparison of 186 metabolites revealed that groups I and II had significantly higher concentrations of sphingolipids in serum (SM C24:1; group I = 65.16 µm, group II = 68.07 µm) than controls (55.37 µm, p = 0.005 & 0.015, respectively). Higher concentrations of sphingolipids were also present in the rotator interval tissue (SM C22:3) of groups 1 (0.0197 µm) and 2 (0.0144 µm) than controls (0.0081 µm, p = 0.012 & 0.014, respectively). The concentration of glycerophospholipid (PC aa C30:0) was higher in the anterior capsule tissue of groups I (0.850 µm) and II (1.164 µm) than controls (0.572 µm; p = 0.007) Total cholesterol was positively correlated with sphingolipid concentration in serum (SM C24:1, rho = 0.782, p = 0.008) and rotator interval tissue (SM C22:3, rho = 0.750, p = 0.017). There was no significant difference in the metabolites evaluated in groups I and II. CONCLUSION: Metabolic profiling showed that levels of lipid-related metabolites were increased in the anterior capsule tissue and rotator interval tissue of patients with shoulder stiffness. Sphingomyelin (SM C22:3) in the tissue of the rotator interval was positively correlated with the serum level of total cholesterol in patients with shoulder stiffness only. The level of glycerophospholipid (PC30:0) in the anterior capsule was positively correlated with the serum level of total cholesterol in patients who had rotator cuff tear with shoulder stiffness. The results indicate that serum total cholesterol may be related to shoulder stiffness. Future studies are needed to evaluate the role of serum cholesterol in the pathogenesis of shoulder stiffness. TRIAL REGISTRATION: KC12OISI0532. Registered Nov 15, 2012. approval by the Institutional Review Board of Seoul St. Mary's Hospital, the Catholic University of Korea.


Assuntos
Metaboloma/fisiologia , Lesões do Manguito Rotador/metabolismo , Articulação do Ombro/fisiopatologia , Biomarcadores/sangue , Glicemia/análise , Estudos de Casos e Controles , Colesterol/sangue , Feminino , Glicerofosfolipídeos/sangue , Humanos , Masculino , Espectrometria de Massas , Metabolômica , Pessoa de Meia-Idade , Amplitude de Movimento Articular/fisiologia , Manguito Rotador/patologia , Manguito Rotador/fisiopatologia , Lesões do Manguito Rotador/sangue , Lesões do Manguito Rotador/patologia , Síndrome de Colisão do Ombro/sangue , Síndrome de Colisão do Ombro/metabolismo , Síndrome de Colisão do Ombro/patologia , Articulação do Ombro/patologia , Esfingolipídeos/sangue , Resultado do Tratamento
13.
J Shoulder Elbow Surg ; 28(12): 2418-2426, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31324501

RESUMO

BACKGROUND: This study analyzed the alteration in glenoid articular geometry with increasing anterior bone loss, as well as its subsequent correction with 2 modifications of the Latarjet procedure. METHODS: Anterior defects were simulated by creating glenoid osteotomies (10%, 20%, 30%, and 40%), and defects were reconstructed using 2 Latarjet modifications (classic and congruent arc). A total of 108 computed tomography scans were performed (1) on intact scapulae (n = 12), (2) after each bone defect (n = 48), and (3) after each reconstruction (n = 48). Glenoid parameters (width, area, arc length, and version) were analyzed on computed tomography scans. Statistical analysis was used to determine significant differences between intact, deficient, and reconstructed glenoids. RESULTS: All parameters were reduced with every 10% defect increment (mean change in width, 2.5 mm; area, 64 mm2; version, 2.2°; and arc length, 2.2 mm). Width correction with the classic Latarjet procedure was not statistically significant in 30% and 40% defects. Area correction in 30% defects was not significant with the classic Latarjet procedure and was significantly undercorrected in 40% defects. Version correction was not significant after the classic Latarjet procedure in 20%, 30%, and 40% defects. Arc-length correction was not significant in 20% and 30% defects with the classic Latarjet procedure and was significantly undercorrected in 40% defects. The congruent-arc Latarjet procedure overcorrected glenoid parameters in all defects; however, area and arc length were not significantly different from intact glenoids in 40% defects (P < .05). CONCLUSION: Glenoid articular geometry is progressively altered with a sequential increase in anterior bone defects from 0% to 40%. The classic Latarjet procedure provided significant correction in bone defects of 10% and 20%. The congruent-arc Latarjet procedure restored and overcorrected most parameters even in 40% glenoid defects.


Assuntos
Processo Coracoide/transplante , Cavidade Glenoide/cirurgia , Instabilidade Articular/cirurgia , Articulação do Ombro/diagnóstico por imagem , Articulação do Ombro/patologia , Artroplastia , Transplante Ósseo , Cadáver , Cavidade Glenoide/diagnóstico por imagem , Cavidade Glenoide/patologia , Humanos , Masculino , Articulação do Ombro/cirurgia , Tomografia Computadorizada por Raios X
14.
Ann Anat ; 226: 10-15, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31330305

RESUMO

BACKGROUND: The spinoglenoid notch (SGN) is the second most common location for suprascapular nerve (SN) entrapment; however, there are few relative morphological reports on this condition. Hence, the present morphological study mainly explored the anatomical structure and classification of the SGN and the relationship with entrapment of SN. MATERIALS AND METHODS: Four hundred seventy-eight scapulae were analysed thoroughly and systematically in this study. Anatomical structure and classification of the SGN were observed and measured by a three-dimensional (3D) reconstruction of computed tomography (CT). The measurement results were then analysed and recorded. RESULTS: Chinese scapulae were classified into three types at the SGN, and it was found that left scapulae had deeper SGN than right ones. Then, significant differences were also noted between sexes. Men had thicker, wider and deeper SGN than women. Type II (small U, 46.04%) was the most common. Type I (large U) was the widest (15.67±1.43mm) and deepest (13.71±2.39mm) compared with other types. Lastly, no significant differences in the above criteria were found in other measurements. CONCLUSIONS: These morphological measurements of the SGN may help to improve the diagnosis and successful treatment rate of the surgery for the SN entrapment, but the relative clinical trial is necessary to support it.


Assuntos
Síndromes de Compressão Nervosa/patologia , Articulação do Ombro/anatomia & histologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Grupo com Ancestrais do Continente Asiático , Cadáver , Feminino , Humanos , Processamento de Imagem Assistida por Computador , Imageamento Tridimensional , Masculino , Pessoa de Meia-Idade , Síndromes de Compressão Nervosa/cirurgia , Nervos Periféricos/anatomia & histologia , Escápula/anatomia & histologia , Caracteres Sexuais , Articulação do Ombro/patologia , Tomografia Computadorizada por Raios X , Adulto Jovem
15.
Arthroscopy ; 35(9): 2571-2577, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31351811

RESUMO

PURPOSE: To analyze the utility of arthroscopic biopsies for detection of periprosthetic infection in painful shoulder arthroplasty without objective signs of infection. METHODS: A retrospective analysis of all patients who underwent a diagnostic arthroscopy for painful shoulder arthroplasty from June 2012 through July 2018 was performed. Patients with a subsequent revision shoulder arthroplasty after diagnostic arthroscopy were included. Arthroscopic tissue culture results were compared with the culture results of intraoperative tissue samples obtained at the time of open revision surgery. A minimum of 3 tissue samples from synovia and bone-prosthesis interface with signs of synovitis or abnormal appearance was routinely collected. Cases with 2 or more positive cultures for the same microorganism obtained at open revision surgery were considered as true presence of infection. The study protocol was reviewed and approved by the institutional ethics committee. RESULTS: Twenty-three cases in 22 patients were included in this study. Five of these 23 cases were classified as true infection based on the samples obtained during open revision surgery, and 16 cases had a positive culture in diagnostic arthroscopy. Cutibacterium acnes was isolated in each case. Classifying any microbiologic growth in the arthroscopic biopsies as positive resulted in a sensitivity and negative predictive value of 100%, specificity of 39%, and positive predictive value of 31.3% for the detection of a periprosthetic shoulder infection (PPSI). If at least 2 positive samples with the same microbiologic growth in the arthroscopic biopsies were considered as positive, sensitivity and negative predictive value dropped to 80% and 94.4%, respectively, but the specificity and positive predictive value increased to 94.4% and 80%, respectively. CONCLUSIONS: Diagnostic arthroscopy is a useful diagnostic tool in patients with suspicion but no clear evidence of PPSI. Arthroscopically obtained tissue biopsies for culture offer a high sensitivity and specificity in the diagnosis of PPSI if at least 2 cultures positive for the same microorganism are considered as infection. LEVEL OF EVIDENCE: Level III.


Assuntos
Artroplastia do Ombro/efeitos adversos , Artroscopia/métodos , Infecções Relacionadas à Prótese/diagnóstico , Prótese de Ombro/efeitos adversos , Adulto , Idoso , Biópsia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Propionibacterium acnes/isolamento & purificação , Infecções Relacionadas à Prótese/etiologia , Infecções Relacionadas à Prótese/microbiologia , Infecções Relacionadas à Prótese/patologia , Reoperação , Estudos Retrospectivos , Sensibilidade e Especificidade , Articulação do Ombro/microbiologia , Articulação do Ombro/patologia , Articulação do Ombro/cirurgia , Membrana Sinovial/microbiologia , Membrana Sinovial/patologia , Sinovite/microbiologia
16.
J Shoulder Elbow Surg ; 28(12): 2334-2342, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31300369

RESUMO

BACKGROUND: Rapidly destructive arthropathy (RDA) of the shoulder is rare. Consequently, there are very few studies that have reported the characteristic findings of this disease. This study aimed to analyze the clinical, radiographic, and histologic features of patients with RDA of the shoulder. METHODS: In total, 9 cases (8 patients) were enrolled in this study. All patients were elderly women, with a mean age of 72.7 years (range, 57-78 years). The mean duration of symptoms was 4.1 months (range, 1.2-5.9 months). Reverse total shoulder arthroplasty and total shoulder arthroplasty were performed in 5 cases with massive rotator cuff tears and 4 without them, respectively. RESULTS: The mean duration of radiologically evident joint destruction after negative results on radiography was 3.1 months (range, 1.0-5.9 months). On plain radiography, humeral head flattening and collapse that appeared like cut grass were observed (100%). Relatively good preservation of the glenoid with a normal joint space was observed in 7 cases, whereas glenoid erosion was observed in 2 (22.2%). T1-weighted magnetic resonance imaging showed a subchondral fracture (100%) of low signal intensity with associated bone marrow edema. Histologically, chronic inflammation of the synovium and osteocytes in the lacunae, as well as callus formation, were observed along the subchondral fracture. CONCLUSION: Flattening and collapse of the humeral head within an average of 4 months of symptom onset are characteristic of RDA of the shoulder. Bone marrow edema, joint effusion, and subchondral fracture on magnetic resonance imaging and fracture fragments and callus formation on histopathologic analysis were observed. Glenoid erosion was observed in 2 cases with arthrosis progression.


Assuntos
Doenças da Medula Óssea/diagnóstico por imagem , Edema/diagnóstico por imagem , Fraturas Ósseas/diagnóstico por imagem , Artropatias/diagnóstico por imagem , Artropatias/patologia , Articulação do Ombro/diagnóstico por imagem , Articulação do Ombro/patologia , Idoso , Artroplastia do Ombro , Doenças da Medula Óssea/complicações , Edema/complicações , Feminino , Fraturas Ósseas/complicações , Fraturas Ósseas/patologia , Cavidade Glenoide/diagnóstico por imagem , Humanos , Cabeça do Úmero/diagnóstico por imagem , Artropatias/complicações , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Radiografia
18.
Proc Natl Acad Sci U S A ; 116(25): 12183-12192, 2019 06 18.
Artigo em Inglês | MEDLINE | ID: mdl-31160441

RESUMO

Arthrofibrosis is a prevalent condition affecting greater than 5% of the general population and leads to a painful decrease in joint range of motion (ROM) and loss of independence due to pathologic accumulation of periarticular scar tissue. Current treatment options are limited in effectiveness and do not address the underlying cause of the condition: accumulation of fibrotic collagenous tissue. Herein, the naturally occurring peptide hormone relaxin-2 is administered for the treatment of adhesive capsulitis (frozen shoulder) and to restore glenohumeral ROM in shoulder arthrofibrosis. Recombinant human relaxin-2 down-regulates type I collagen and α smooth muscle actin production and increases intracellular cAMP concentration in human fibroblast-like synoviocytes, consistent with a mechanism of extracellular matrix degradation and remodeling. Pharmacokinetic profiling of a bolus administration into the glenohumeral joint space reveals the brief systemic and intraarticular (IA) half-lives of relaxin-2: 0.96 h and 0.62 h, respectively. Furthermore, using an established, immobilization murine model of shoulder arthrofibrosis, multiple IA injections of human relaxin-2 significantly improve ROM, returning it to baseline measurements collected before limb immobilization. This is in contrast to single IA (sIA) or multiple i.v. (mIV) injections of relaxin-2 with which the ROM remains constrained. The histological hallmarks of contracture (e.g., fibrotic adhesions and reduced joint space) are absent in the animals treated with multiple IA injections of relaxin-2 compared with the untreated control and the sIA- and mIV-treated animals. As these findings show, local delivery of relaxin-2 is an innovative treatment of shoulder arthrofibrosis.


Assuntos
Bursite/tratamento farmacológico , Relaxina/uso terapêutico , Animais , Bursite/patologia , Linhagem Celular , Colágeno/metabolismo , Modelos Animais de Doenças , Feminino , Fibrose , Humanos , Injeções Intra-Articulares , Masculino , Camundongos , Amplitude de Movimento Articular/efeitos dos fármacos , Ratos , Ratos Sprague-Dawley , Relaxina/administração & dosagem , Articulação do Ombro/efeitos dos fármacos , Articulação do Ombro/patologia
19.
BMC Musculoskelet Disord ; 20(1): 270, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31153372

RESUMO

BACKGROUND: It is difficult to diagnose the pathology of the long head of the biceps tendon (LHBT) clinically. This study aimed to determine the diagnostic value of standard non-enhancing magnetic resonance imaging (MRI) for detecting LHBT pathology and identify the most useful diagnostic signs on MRI. METHODS: A total of 554 patients with preoperative 3-Tesla (3 T) MRI who underwent arthroscopic surgery for rotator cuff tears were retrospectively enrolled. Abnormal signs of LHBT on MRI included diameter change, contour irregularity, and alteration of signal intensity. Arthroscopic findings were classified according to tear progress and used as a reference standard: Type I, normal tendon; Type II, hourglass-shaped hypertrophic tendon with fraying extending into the bicipital groove; Type III, partial tear involving less than 50% of tendon width at the intraarticular region without fraying in the bicipital groove; Type IV, partial tear involving more than 50% of tendon width and extending into the bicipital groove; and Type V, complete tear (cutoff) of the tendon. Using receiver operating characteristic, prediction accuracies of MRI findings were assessed compared to those of arthroscopic findings. RESULTS: Arthroscopic findings showed LHBT pathology in 124 (22.4%) cases. High diagnostic efficacy was achieved when 'at least 2 abnormal signs' was set as diagnostic criteria (sensitivity: 77.9%; specificity: 93.7%; positive predictive value: 76.3%). Types II and III lesions showed the highest sensitivities (36.8 and 66.7%, respectively) in abnormal alteration of signal intensity in the parasagittal view while Type IV showed the highest sensitivity (82.3%) in diameter change in axial view. Interobserver agreements were substantial to almost perfect, with kappa value of 0.69-0.81. CONCLUSIONS: The standard non-enhancing 3 T MRI had a high diagnostic value in preoperative detection of LHBT pathology. Its accuracy was increased when diagnostic criterion was set as '2 or more abnormal signs (diameter change, contour irregularity, and alteration of signal intensity)'. The single diagnostic sign with the highest sensitivity was alteration of signal intensity in the parasagittal view.


Assuntos
Artroscopia , Imagem por Ressonância Magnética , Lesões do Manguito Rotador/cirurgia , Manguito Rotador/diagnóstico por imagem , Humanos , Variações Dependentes do Observador , Valor Preditivo dos Testes , Período Pré-Operatório , Estudos Retrospectivos , Manguito Rotador/patologia , Sensibilidade e Especificidade , Articulação do Ombro/diagnóstico por imagem , Articulação do Ombro/patologia , Articulação do Ombro/cirurgia
20.
J Shoulder Elbow Surg ; 28(6S): S32-S66, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31196514

RESUMO

The Second International Consensus Meeting on Orthopedic Infections was held in Philadelphia, Pennsylvania, in July 2018. More than 800 experts from all 9 subspecialties of orthopedic surgery and allied fields of infectious disease, microbiology, and epidemiology were assembled to form the International Consensus Group. The shoulder workgroup reached consensus on 27 questions related to culture techniques, inflammatory markers, and diagnostic criteria used to evaluate patients for periprosthetic shoulder infection. This document contains the group's recommendations and rationale for each question related to evaluating periprosthetic shoulder infection.


Assuntos
Artroplastia do Ombro/efeitos adversos , Citocinas/metabolismo , Técnicas Microbiológicas , Infecções Relacionadas à Prótese/diagnóstico , Infecções Relacionadas à Prótese/microbiologia , Prótese de Ombro/efeitos adversos , Biomarcadores/metabolismo , Biópsia , Proteína C-Reativa/metabolismo , Consenso , Índices de Eritrócitos , Humanos , Contagem de Leucócitos , Infecções Relacionadas à Prótese/complicações , Infecções Relacionadas à Prótese/metabolismo , Articulação do Ombro/patologia , Articulação do Ombro/cirurgia , Líquido Sinovial/citologia , Líquido Sinovial/metabolismo , Técnicas de Cultura de Tecidos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA