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1.
BMJ ; 378: e069901, 2022 07 06.
Artigo em Inglês | MEDLINE | ID: mdl-35938625

RESUMO

OBJECTIVE: To provide clinicians and patients with accurate risk estimates of serious adverse events after common elective shoulder arthroscopic procedures, including reoperation within one year. DESIGN: Population based cohort study. SETTING: Hospital Episode Statistics for NHS England, including civil registration mortality data from the Office for National Statistics. PARTICIPANTS: 288 250 arthroscopic shoulder procedures performed in 261 248 patients aged ≥16 years between 1 April 2009 and 31 March 2017. Elective procedures were grouped into subacromial decompression, rotator cuff repair, acromioclavicular joint excision, glenohumeral stabilisation, and frozen shoulder release. MAIN OUTCOME MEASURES: The primary outcomes were rates of serious adverse events (mortality, pulmonary embolism, pneumonia, myocardial infarction, acute kidney injury, stroke, and urinary tract infection) requiring inpatient care within 90 days post-surgery. Secondary outcomes were specific adverse event rates at 90 days, and reoperations (including for deep infection) within one year. RESULTS: The overall rate of complications within 90 days after arthroscopic shoulder surgery (including reoperation) was low at 1.2% (95% confidence interval 1.2% to 1.3%), with one in 81 patients at risk, and varied according to type of procedure, from 0.6% (0.5% to 0.8%) for glenohumeral stabilisation to 1.7% (1.5% to 1.8%) for frozen shoulder release. After adjustment for age, comorbidities, and sex, no effect of procedure type was observed. Pneumonia was the most common adverse event (0.3%, 0.3% to 0.4%), with one in 303 patients at risk. Pulmonary embolic events were rare, at 0.1% (0.1% to 0.1%), with one in 1428 patients at risk. At one year, the overall rate for reoperation was 3.8% (3.8% to 3.9%), with one in 26 patients at risk, ranging from 2.7% (2.5% to 3.0%) for glenohumeral stabilisation to 5.7% (5.4% to 6.1%) for frozen shoulder release. The overall rate of further surgery for deep infection was low, at 0.1% (0.1% to 0.1%), with one in 1111 patients at risk, but was higher after rotator cuff repair (0.2%, 0.2% to 0.2%), with one in 526 patients at risk. Over the study period the number of arthroscopic shoulder procedures increased, except for subacromial decompression, which decreased. CONCLUSIONS: The findings of this study suggest that risks of serious adverse events associated with common shoulder arthroscopy procedures are low. Nevertheless, serious complications do occur, and include the risk of reoperation in one in 26 patients within one year. STUDY REGISTRATION: Clinical. TRIALS: gov NCT03573765.


Assuntos
Bursite , Lesões do Manguito Rotador , Artroscopia/efeitos adversos , Artroscopia/métodos , Bursite/epidemiologia , Bursite/cirurgia , Estudos de Coortes , Humanos , Reoperação , Lesões do Manguito Rotador/cirurgia , Ombro , Resultado do Tratamento
2.
Perm J ; 26(2): 83-88, 2022 Jun 29.
Artigo em Inglês | MEDLINE | ID: mdl-35933677

RESUMO

The purpose of this article is to provide a synopsis of the current medical understanding of lateral hip pain, highlighting greater trochanteric pain syndrome (GTPS) and its relation to lateral hip pain. Common causes of lateral hip pain, GTPS as a cause of lateral hip pain, prevalence of GTPS, clinical presentation of GTPS, associated risk factors, history and physical examination, laboratory testing, diagnostic imaging, and treatment options are described. A quiz serves to assist readers in their understanding of the presented material.


Assuntos
Bursite , Fêmur , Bursite/complicações , Bursite/diagnóstico por imagem , Fêmur/diagnóstico por imagem , Quadril/diagnóstico por imagem , Humanos , Dor/etiologia , Síndrome
3.
J Surg Orthop Adv ; 31(2): 96-99, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35820094

RESUMO

Conservative treatment of adhesive capsulitis fails in up to 30% of patients. Manipulation under anesthesia (MUA) has been shown to be safe and effective, although complications (iatrogenic fracture, glenohumeral dislocation, rotator cuff tears, nerve injuries) have been reported. This study details a novel technique, FEAR (Forward elevation, Extension, Adduction/abduction, and internal and external Rotation), and its results. Medical records review identified 100 patients with a diagnosis of adhesive capsulitis who had at least 6 weeks of physical therapy, with or without corticosteroid injection, with persistence of pain and loss of motion loss. An Institutional Review Board approved phone survey obtained Single Assessment Numeric Evaluation (SANE) scores, visual analog scale (VAS) scores, functional scores, and range of motion, with 43 available for survey. At average 5-year follow-up, 81% had excellent (≥ 90) scores and 77% were pain-free. Patients with diabetes and male patients had significantly lower SANE scores at follow-up. (Journal of Surgical Orthopaedic Advances 31(2):096-099, 2022).


Assuntos
Bursite , Lesões do Manguito Rotador , Bursite/cirurgia , Seguimentos , Humanos , Masculino , Amplitude de Movimento Articular , Estudos Retrospectivos , Lesões do Manguito Rotador/cirurgia
4.
Yale J Biol Med ; 95(2): 217-220, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-35782477

RESUMO

Shoulder injury related to vaccine administration (SIRVA) is a term given to describe shoulder pain and dysfunction arising within 48 hours after vaccine administration and lasting for more than one week. While SIRVA is most commonly seen after influenza and tetanus vaccines, there have been a few recent case reports describing SIRVA-like symptoms after COVID-19 vaccine administration. Two patients presented to the shoulder surgeon's practice center with complaints of shoulder stiffness and pain following the COVID-19 vaccine. The first patient was a 33-year-old man; he presented within 2 days of onset of the pain and 14 days from the vaccine date. He had a complete restriction of shoulder motion (0° flexion, and no external or internal rotation) at presentation. This patient was treated with non-steroidal anti-inflammatory drugs (NSAID) and rested in a sling for a week. The second patient was a 53-year-old woman; she presented with a 6-week duration of mild restriction of active shoulder motion and shoulder pain. Her magnetic resonance imaging (MRI) revealed the presence of subacromial-subdeltoid bursitis. She was treated with subacromial steroid injection and range of motion shoulder exercises. Both patients recovered a near-normal range of motion recovery within a month, and their pain improved significantly. The main lessons from this case report were: (1) patients presenting with a recent increase in pain and acute loss of shoulder movements after vaccination may be managed conservatively with rest and NSAID medications and (2) in case of a subacromial-subdeltoid bursitis in the MRI, subacromial injection of steroid may provide good pain relief.


Assuntos
Bursite , COVID-19 , Vacinas contra Influenza , Lesões do Ombro , Adulto , Anti-Inflamatórios não Esteroides/uso terapêutico , Bursite/complicações , Vacinas contra COVID-19/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Lesões do Ombro/complicações , Dor de Ombro/etiologia , Vacinação/efeitos adversos
5.
Dan Med J ; 69(7)2022 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-35781127

RESUMO

INTRODUCTION: Bursitis at the greater trochanter has historically been identified as a major pain generator in patients with lateral hip pain (LHP). We believe that hip abductor tendon pathology (HATP) plays an important and overlooked role in LHP. The purpose of this study was to evaluate the presence of isolated trochanteric bursitis on MRI in patients with refractory LHP. METHODS: The MRIs of 120 patients with LHP (94% women, median age 54 years) performed at our orthopaedic outpatient clinic between 2017 and 2020 were evaluated by two raters for trochanter-related pathologies, including HATP and bursitis. RESULTS: Two (2%) patients were registered with greater trochanteric bursitis with no relevant HATP, 30 (25%) patients had elements of inflammation (high-intensity signals) in the greater trochanteric bursa with relevant HATP. Five (4%) patients had relevant HATP with bursitis in the sub-gluteus minimus bursa with no bursitis in the greater trochanteric bursa. The remaining 83 (69%) patients had no sign of trochanter-related bursitis. CONCLUSION: Isolated trochanteric bursitis as the cause of refractory LHP appears to be rare. We believe that the presence of HATP in LHP has been severely underestimated and a shift in focus towards treatment of these structures is necessary. FUNDING: none. TRIAL REGISTRATION: According to current national legislation, no formal ethical approval was required for this study. The National Data Protection Agency approved the study (1-16-02-124-19).


Assuntos
Bursite , Articulação do Quadril , Artralgia/epidemiologia , Artralgia/etiologia , Bursite/complicações , Bursite/epidemiologia , Feminino , Articulação do Quadril/diagnóstico por imagem , Humanos , Ferro , Masculino , Pessoa de Meia-Idade , Dor/complicações , Dor/etiologia , Prevalência
6.
Tomography ; 8(4): 1726-1734, 2022 Jul 04.
Artigo em Inglês | MEDLINE | ID: mdl-35894010

RESUMO

We aimed to investigate clinical and ultrasound signs of shoulder overuse injuries in professional bullfighters; side-to-side differences (dominant vs. non-dominant); and to determine potential differences according to bullfighters' categories. An observational cross-sectional study was conducted. Thirty professional and active bullfighters were assessed. A bilateral ultrasound assessment of the subacromial bursa, long biceps head tendon (LHBT), and rotator cuff was performed to determine the presence of bursitis, subluxation, partial or total tendon rupture, tenosynovitis, or calcification. Supraspinatus tendon thickness was measured. Finally, a battery of clinical orthopedic tests (Yergason, Jobe, infraspinatus, Gerber, and bursa tests) were also performed. Most identified ultrasound findings were located in the dominant side, being the presence of bursitis (n = 9; 30%), LHBT tenosynovitis (n = 8; 26.7%), and subscapularis tendon calcification (n = 5; 16.7%) the most prevalent. No side-to-side or between-categories differences were found for supraspinatus tendon thickness (all, p > 0.05). The most frequent positive signs were the infraspinatus test (40.0%), Gerber lift-off test (33.3%), and bursitis, Jobe, and Yergason tests (all, 26.7%). Ultrasound signs were commonly found at LHBT, subacromial bursa, and rotator cuff in professional bullfighters without difference between categories and sides. No side-to-side or between-categories differences were found. Positive clinical test signs suggestive of bursitis, LHBT, and rotator cuff tendinopathy were frequently observed.


Assuntos
Bursite , Calcinose , Lesões do Manguito Rotador , Lesões do Ombro , Tenossinovite , Bursite/diagnóstico por imagem , Bursite/epidemiologia , Estudos Transversais , Humanos , Prevalência , Lesões do Manguito Rotador/diagnóstico por imagem , Lesões do Manguito Rotador/epidemiologia , Ombro/diagnóstico por imagem , Lesões do Ombro/diagnóstico por imagem , Lesões do Ombro/epidemiologia , Ultrassonografia
7.
Med Sci Monit ; 28: e937430, 2022 Jul 11.
Artigo em Inglês | MEDLINE | ID: mdl-35811393

RESUMO

BACKGROUND Shoulder injury related to vaccine administration (SIRVA) occurs when an intramuscular deltoid injection is administered into the shoulder joint. This observational study describes clinical features in 16 patients with SIRVA following Coronavirus 2019 (COVID-19) vaccination who presented to chiropractic, orthopedic, and physiotherapy clinics in Hong Kong between January 1, 2021, and January 1, 2022. MATERIAL AND METHODS Adults age ≥18 with new-onset shoulder pain and imaging-confirmed shoulder pathology were retrospectively identified from 35 clinics. Patient demographics and clinical and vaccination details were extracted from the electronic medical record. Shoulder injury was determined by correlating clinical and imaging features. RESULTS Of 730 patients with shoulder pain, 16 SIRVA cases (mean age, 49±10 years, 75% female) were identified; (12/16, 75%) of patients received the Pfizer-BioNTech vaccine while (4/16, 25%) received Sinovac-CoronaVac. The most common diagnosis was adhesive capsulitis (10/16, 63%), followed by bursitis (3/16, 19%) and supraspinatus tear (3/16, 19%). Mean symptom onset was 3.5±2.5 days post-vaccination, and always occurred after the 2nd or 3rd vaccination, involving reduced shoulder range of motion (ROM). Mean baseline pain was 8.1±1 (out of 10). All patients received conservative care (eg, exercise, manual therapies). At 3-month follow-up, mean pain reduced to 2.4±1.4; all patients had normal shoulder ROM. CONCLUSIONS In the past 2 years, millions of intramuscular COVID-19 vaccinations have been administered. It is important that clinicians are aware of SIRVA as a cause of new symptoms of shoulder injury and should ask the patient about recent vaccinations, including for COVID-19.


Assuntos
Bursite , COVID-19 , Quiroprática , Lesões do Ombro , Vacinas , Adulto , Bursite/complicações , Bursite/diagnóstico , Bursite/terapia , COVID-19/prevenção & controle , Vacinas contra COVID-19/efeitos adversos , Feminino , Hong Kong , Humanos , Masculino , Pessoa de Meia-Idade , Modalidades de Fisioterapia/efeitos adversos , Estudos Retrospectivos , Dor de Ombro/complicações , Vacinação/efeitos adversos
8.
Clin Orthop Surg ; 14(2): 289-296, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35685968

RESUMO

Background: The aim of this study was to evaluate clinical outcomes of sodium tetradecyl sulphate (STS) sclerotherapy for conservative treatment of lateral malleolar bursitis of the ankle. Methods: We reviewed data from 20 consecutive patients (20 ankles) who underwent STS sclerotherapy between August 2018 and June 2019. After aspiration of fluid from the lateral malleolar bursal sac, 2 mL (20 mg) STS was injected into the sac. Clinical outcomes and side effects and complications were evaluated at 2 weeks, 3 months, 1 year, and 2 years after sclerotherapy. Responses to treatment were assessed according to degree of fluctuation, shrinkage of the bursal sac, and soft-tissue swelling. The 36-item short form survey (SF-36) was completed for each patient before and after therapy. Results: Complete response was observed in 17 patients (85%), and partial response was observed in 3 patients (15%) after STS sclerotherapy. SF-36 physical component scores improved from 62.2 (interquartile range, 5.2) before therapy to 70.0 (interquartile range, 7.9) at last follow-up (p < 0.05). One patient (5%) experienced transient hyperpigmentation at the injection site. No major complications occurred. Conclusions: STS sclerotherapy was an effective and safe treatment for patients with lateral malleolar bursitis of the ankle.


Assuntos
Bursite , Tetradecilsulfato de Sódio , Tornozelo , Bursite/terapia , Humanos , Soluções Esclerosantes/efeitos adversos , Soluções Esclerosantes/uso terapêutico , Escleroterapia , Tetradecilsulfato de Sódio/efeitos adversos , Tetradecilsulfato de Sódio/uso terapêutico
9.
PLoS One ; 17(6): e0269230, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35749349

RESUMO

INTRODUCTION: Greater trochanteric pain syndrome is an overarching term used to define pain and tenderness in the greater trochanteric region of the femur, which is more common in women. Abnormal control of lower limb movements and deficient neuromuscular parameters may lead to greater trochanteric pain syndrome; however, no studies have used neuromuscular training as a treatment strategy. Thus, this study aims to compare the effect of a protocol of general exercises versus a program of motor control training on pain at baseline and after treatment in women with greater trochanteric pain syndrome. METHODS: The study was approved by the Research Ethics Committee (CAAE: 87372318.1.0000.5406) and has been prospectively registered on the Brazilian Registry of Clinical Trials (RBR-37gw2x). Sixty participants will be randomized to receive motor control exercises or general exercises. The application will be performed twice a week for 8 weeks. The participants will be evaluated before the treatment (T0), after 8 weeks of intervention (T8) and after 60 weeks of intervention (T60). The primary outcome measures will be the hip pain intensity, and secondary outcomes will be muscle strength, kinesiophobia, global perceived effect, pain catastrophization, central sensitization and quality of life. CONCLUSIONS: Studies have suggested that greater trochanteric pain syndrome may be related to poor hip and pelvic control, however, no study has investigated an exercise protocol focused on increasing the strength of the abductor and extensor muscles of the hip associated with pelvic control training, especially in positions of unilateral support, such as gait. This study will help determine whether greater trochanteric pain syndrome is related to abnormal control of lower limb movements.


Assuntos
Bursite , Qualidade de Vida , Terapia por Exercício/métodos , Feminino , Humanos , Força Muscular , Dor , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
10.
J Am Acad Orthop Surg ; 30(3): e444-e452, 2022 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-35772092

RESUMO

INTRODUCTION: One variable that could potentially affect failure of a rotator cuff repair (RCR) is the timing of beginning physical therapy (PT) after the procedure. Although many studies have demonstrated decreased stiffness with beginning PT early, studies have also demonstrated that early PT increases repair failure. The goal of this study was to identify revision surgery and capsulitis rates after RCRs from an available database and determine whether an association was present with the timing of PT post-RCR. METHODS: Medicare patients within the PearlDiver database who underwent RCR were stratified based on the timing of their first PT session postoperatively, and revision surgery and capsulitis rates were determined among the groups for both open and arthroscopic RCR. Demographics and comorbidities of the cohort were also used to formulate a multivariate analysis for revision surgery rate. RESULTS: The cohort consisted of 64,842 patients who underwent RCR and started PT within 13 weeks of surgery. Starting PT within 1 week postoperatively resulted in a significantly higher revision surgery rate compared with starting PT in weeks 2 to 5, 6 to 9, or 10 to 13 (6.9% vs. 3.6% among all other groups, P = <0.001). The multivariate analysis for revision surgery further demonstrated that starting PT within 1 week postoperatively was associated with a significantly higher rate of revision surgery compared with beginning PT after 1 week (OR = 2.086, P < 0.001). No association was found between timing of beginning PT and capsulitis rates. CONCLUSION: In the Medicare patient cohort, beginning PT within 1 week postoperatively was associated with a significantly higher revision surgery rate; however, no associated benefit was noted in capsulitis rates for beginning PT early. This calls into question the use of an early passive range of motion protocol for older patient cohort; however, further studies should be completed to conclusively determine the most efficacious time to begin rehabilitation post-RCR. LEVEL OF EVIDENCE: Level III.


Assuntos
Bursite , Lesões do Manguito Rotador , Idoso , Artroscopia/métodos , Bursite/cirurgia , Humanos , Medicare , Modalidades de Fisioterapia , Estudos Retrospectivos , Manguito Rotador/cirurgia , Lesões do Manguito Rotador/cirurgia , Resultado do Tratamento , Estados Unidos/epidemiologia
11.
Pain Physician ; 25(3): 313-321, 2022 05.
Artigo em Inglês | MEDLINE | ID: mdl-35652771

RESUMO

BACKGROUND: Intraarticular (IA) corticosteroid injection is commonly performed in patients with primary frozen shoulder (PFS). However, the best administration site remains controversial. OBJECTIVES: To compare the efficacy of rotator interval (RI) vs posterior capsule (PC) approach for ultrasound-guided corticosteroid injections into the glenohumeral joint of patients with PFS. STUDY DESIGN: A randomized, exploratory, prospective study. SETTING: A single fellowship training institution in Daegu, Republic of Korea. METHODS: This study was approved by the Institutional Review Board (2019-04-047-001).  Ninety patients with PFS were randomly assigned to either RI approach (RI group, n = 43) or PC approach (PC group, n = 45) for ultrasound-guided IA corticosteroid injection. Fluoroscopic images to assess the accuracy of the injection were obtained immediately after injection by a shoulder specialist. Visual Analog Scale for pain, the American Shoulder and Elbow Surgeons score, the subjective shoulder value, and range of motion (ROM) were used to assess clinical outcomes for all patients at the time of presentation, and at 3, 6, and 12 weeks after injection. RESULTS: The accuracy of injection was 76.7% (33/43) and 93.3% (42/45) in the RI and PC groups, respectively; the between-group difference was statistically significant (P = .028). Significant improvements were observed in both groups in terms of all clinical scores and ROMs throughout follow-up until 12 weeks after the injection (all P < .001). At 12 weeks, better improvements in forward flexion and abduction (P = .049 and .044) were observed in the RI group than in the PC group. No adverse effect related to injection was observed in either group. LIMITATIONS: This study had no control group receiving placebo injections and limited follow-up time. CONCLUSIONS: Both groups showed significant pain reduction and functional improvement until 12 weeks after injection. Although no significant differences were observed in pain and functional scores between the 2 groups, the RI group showed better improvement of ROM than the PC group. These results indicate that the RI and anterior structures are a major site in the pathogenesis and treatment target of PFS.


Assuntos
Bursite , Ultrassonografia de Intervenção , Corticosteroides/uso terapêutico , Bursite/tratamento farmacológico , Humanos , Injeções Intra-Articulares/métodos , Dor/tratamento farmacológico , Estudos Prospectivos , Método Simples-Cego , Ultrassonografia de Intervenção/métodos
12.
Arthroscopy ; 38(6): 1900-1903, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-35660184

RESUMO

Patients with femoroacetabular impingement syndrome (FAIS) often have extra-articular disorders, such as external snapping hip (ESH). We recommend that obvious ESH be addressed by endoscopic transversal iliotibial band (ITB) release during hip arthroscopy for FAIS because the residual serious snapping caused by ESH negatively affects the outcome of hip arthroscopy. However, for mild ESH without indications for severe trochanteric bursitis on magnetic resonance imaging, we still propose that physical therapy, extracorporeal shock wave therapy, or local injection be performed for pain relief. Surgical interventions for ESH including the Z-plasty technique and the modified Z-plasty technique for lengthening the ITB, as well as endoscopic cruciate or transversal incision in the ITB for release, have been reported with good results. Every technique has advantages and disadvantages, and we believe that surgeons should perform ITB release for ESH at the time of hip arthroscopy for FAIS based on their personal experience and inclination. In any case, excessive release of the ITB should be avoided. Finally, we wish to propose that more attention should be paid to the peri-greater trochanter (GT) space, an anatomic space between the ITB and the GT, which is similar to the subacromial space in the shoulder joint. Greater trochanteric pain syndrome (GTPS), related to the peri-GT space, is a spectrum of disorders, including trochanteric bursitis, abductor tendon pathology, and ESH. Precise diagnosis and proper procedures for concurrent GTPS during surgery may improve the outcome of arthroscopy in patients with both FAIS and GTPS.


Assuntos
Bursite , Impacto Femoroacetabular , Artropatias , Artroscopia/métodos , Bursite/cirurgia , Impacto Femoroacetabular/cirurgia , Articulação do Quadril/cirurgia , Humanos , Artropatias/cirurgia , Dor , Resultado do Tratamento
13.
BMC Geriatr ; 22(1): 548, 2022 06 30.
Artigo em Inglês | MEDLINE | ID: mdl-35773660

RESUMO

BACKGROUND: Primary adhesive capsulitis (AC) is not well understood, and controversy remains about the most effective treatment approaches. Even less is known about the treatment of AC in the Medicare population. We aimed to fully characterize initial treatment for AC in terms of initial treatment utilization, timing of initial treatments and treatment combinations. METHODS: Using United States Medicare claims from 2010-2012, we explored treatment utilization and patient characteristics associated with initial treatment for primary AC among 7,181 Medicare beneficiaries. Patients with primary AC were identified as patients seeking care for a new shoulder complaint in 2011, with the first visit related to shoulder referred to as the index date, an x-ray or MRI of the shoulder region, and two separate diagnoses of AC (ICD-9-CM codes: 726.00). The treatment period was defined as the 90 days immediately following the index shoulder visit. A multivariable logistic model was used to assess baseline patient factors associated with receiving surgery within the treatment period. RESULTS: Ninety percent of beneficiaries with primary AC received treatment within 90 days of their index shoulder visit. Physical therapy (PT) alone (41%) and injection combined with PT (34%) were the most common treatment approaches. Similar patient profiles emerged across treatment groups, with higher proportions of racial minorities, socioeconomically disadvantaged and more frail patients favoring injections or watchful waiting. Black beneficiaries (OR = 0.37, [0.16, 0.86]) and those residing in the northeast (OR = 0.36, [0.18, 0.69]) had significantly lower odds of receiving surgery in the treatment period. Conversely, younger beneficiaries aged 66-69 years (OR = 6.75, [2.12, 21.52]) and 70-75 years (OR = 5.37, [1.67, 17.17]) and beneficiaries with type 2 diabetes had significantly higher odds of receiving surgery (OR = 1.41, [1.03, 1.92]). CONCLUSIONS: Factors such as patient baseline health and socioeconomic characteristics appear to be important for physicians and Medicare beneficiaries making treatment decisions for primary AC.


Assuntos
Bursite , Diabetes Mellitus Tipo 2 , Idoso , Bursite/diagnóstico , Bursite/epidemiologia , Bursite/terapia , Humanos , Medicare , Modalidades de Fisioterapia , Resultado do Tratamento , Estados Unidos/epidemiologia
14.
Phys Med Rehabil Clin N Am ; 33(2): 267-306, 2022 05.
Artigo em Inglês | MEDLINE | ID: mdl-35526972

RESUMO

Peripheral joint injections are a common interventional treatment of peripheral joint-mediated pain, including arthritis, tendinopathy, and bursitis that are not responsive to conservative management. Degenerative changes of articular joints are often related to these symptoms through chronic inflammatory changes, which typically arise due to repetitive trauma, autoimmune disease, or metabolic abnormalities. The primary diagnosis for degenerative disease in the peripheral joints is osteoarthritis but can also include rheumatoid arthritis, gout, and other less common etiologies. Chronic inflammatory damage to the articular surfaces and joint capsules can lead to pain and functional decline. As such, the use of peripheral joint injections after the failure of typical conservative treatment, including physical therapy and oral medications, is common. Although these injections are typically not curative in nature, their primary objective is to decrease pain to allow functional improvement concurrently with physical and pharmaceutical modalities. Common injectates used for peripheral joint injections include local anesthetic, corticosteroid, hyaluronic acid, platelet-rich plasma, and mesenchymal stromal cells.


Assuntos
Bursite , Osteoartrite , Plasma Rico em Plaquetas , Artralgia/complicações , Bursite/tratamento farmacológico , Humanos , Injeções Intra-Articulares/efeitos adversos , Osteoartrite/complicações , Osteoartrite/tratamento farmacológico , Dor/tratamento farmacológico , Resultado do Tratamento
15.
Ned Tijdschr Geneeskd ; 1662022 04 12.
Artigo em Holandês | MEDLINE | ID: mdl-35499597

RESUMO

Frozen shoulder (FS), also known as adhesive capsulitis, is a painful inflammatory fibrotic disease of the glenohumeral joint capsule. While it's frequently self-limiting, patients can be symptomatic for years. The clinical course is often divided into three phases: the freezing phase with predominantly pain, the frozen phase with mainly stiffness, and the thawing phase during which the complaints slowly resolve. Diagnosing FS can be challenging during the freezing phase as the symptoms in this phase are similar to other common shoulder conditions (such as subacromial pain syndrome). Treatment options include analgesia, physical therapy, corticosteroid injections, hydrodilatation, manipulation under anaesthesia, and arthroscopic release. Despite the many treatment options, there is no clear treatment guideline. Based on recent literature, conservative management is indicated as it can provide temporary symptom reduction. Due to significant risk of complications, surgical management should only be considered if patients retain complaints despite long-term conservative therapy.


Assuntos
Bursite , Articulação do Ombro , Bursite/diagnóstico , Bursite/etiologia , Bursite/terapia , Tratamento Conservador , Humanos , Dor , Modalidades de Fisioterapia
16.
Magn Reson Imaging Clin N Am ; 30(2): 241-260, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35512888

RESUMO

The main function of the knee bursae is to provide cushioning for the many periarticular ligaments, tendons, and osseous structures. Bursae can only be visualized when distended by fluid, therefore bursal anatomy is best evaluated by MR imaging using fluid-sensitive sequences. Knowledge of the normal bursal distribution is important to avoid incorrectly interpreting a distended bursa as a periarticular fluid collection or cyst. Bursal pathology usually results from trauma, chronic overuse, or inflammation, and may be associated with an underlying intra-articular process, given the presence of synovial lining and different degrees of communication with the joint.


Assuntos
Bursite , Bolsa Sinovial/anatomia & histologia , Bolsa Sinovial/patologia , Bursite/diagnóstico por imagem , Humanos , Imageamento por Ressonância Magnética/métodos
17.
J Orthop Surg Res ; 17(1): 283, 2022 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-35598025

RESUMO

BACKGROUND: corticosteroid injection (CSI) has been used to treat greater trochanter pain syndrome (GTPS) for many years. However, so far, the efficacy of CSI in the treatment of GTPS is still controversial. Therefore, the aim of this review is to evaluate the effectiveness of CSI in comparison with sham intervention, nature history, usual care, platelet-rich plasma (PRP), physiotherapy/exercise therapy, dry needling, or other nonsurgical treatment for improvements in pain and function in GTPS. METHODS: PubMed (Medline), Embase, Cochrane Library were searched from their inception until April 2021. Randomized controlled trails (RCTs) comparing CSI to nonsurgical treatment were included. Data on the effect of CSI on pain and function were extracted and checked by two review authors independently. The treatment effect was analyzed in the short term, medium term, and long term. RESULTS: Eight RCTs (764 patients) were included. This review suggests CSI may be superior to usual care and 'wait and see,' ESWT, but may not be superior to exercise, PRP, dry needling, and sham intervention in short-term pain or function improvement. In terms of medium-term pain or function improvement, CSI may be superior to usual care and 'wait and see,' but may not be superior to PRP. In terms of long-term pain or function improvement, CSI may be inferior to PRP and ESWT, but it may be superior to usual care and 'wait and see' at 12 months. CONCLUSIONS: Due to the small sample size and lack of sufficient clinical studies, current evidence is equivocal regarding the efficacy of CSI in the treatment of GTPS. Considering the limitations, more large-sample and high-quality RCTs are needed to prove the therapeutic effect of CSI on GTPS. TRIAL REGISTRATION: PROSPERO registration number: CRD42021247991. Registered 09 May 2021.


Assuntos
Bursite , Corticosteroides/uso terapêutico , Bursite/terapia , Fêmur , Humanos , Dor/tratamento farmacológico , Ensaios Clínicos Controlados Aleatórios como Assunto
18.
J Int Med Res ; 50(5): 3000605221097376, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35531908

RESUMO

This current report presents a rare case of carpal tunnel syndrome with chronic bursitis that was treated successfully by open surgery. A 53-year-old female patient that had begun to experience swelling, pain and limited flexion activity of the left wrist 1 year previously presented because of a deterioration in her condition and numbness of the thumb, index finger and middle finger in the previous 2 months without any treatment. The diagnosis of bursitis should be based on clinical symptoms and signs, combined with colour ultrasonography, magnetic resonance imaging, arthroscopy and arthrography. Bursitis should be differentiated from arthritis, tendonitis, fracture and neoplasm, but complete exclusion depends on the postoperative pathological results. In this current case, the histopathological findings were consistent with bursitis without malignancy. After surgery, the patient was instructed to perform rehabilitation exercises for the wrist joint. These exercises included passive activity 3 days after surgery and active activity 1 week after surgery. There was also regular follow-up every 3 months. The patient recovered well and reported that the pain and numbness that she described preoperatively had been resolved.


Assuntos
Bursite , Síndrome do Túnel Carpal , Bursite/complicações , Bursite/diagnóstico por imagem , Bursite/cirurgia , Síndrome do Túnel Carpal/diagnóstico , Síndrome do Túnel Carpal/diagnóstico por imagem , Feminino , Humanos , Hipestesia/etiologia , Pessoa de Meia-Idade , Dor , Articulação do Punho/diagnóstico por imagem , Articulação do Punho/patologia , Articulação do Punho/cirurgia
19.
Am J Sports Med ; 50(6): 1603-1608, 2022 05.
Artigo em Inglês | MEDLINE | ID: mdl-35507471

RESUMO

BACKGROUND: Patients with gluteus medius tendinopathy present with laterally based hip pain that can be diagnosed under the greater trochanteric pain syndrome diagnosis. Magnetic resonance imaging (MRI) can assist in diagnosing pathology of the symptomatic hip, and when a pelvic MRI that includes both hips, the clinician may identify asymptomatic tears in the nonsurgical hip. In patients who undergo unilateral gluteus medius repairs, little is known about the prevalence or subsequent onset of clinical symptoms in the nonsurgical hip. PURPOSE: To describe (1) the prevalence of asymptomatic contralateral gluteus medius tears in patients with unilateral symptoms, (2) the presentation and time before symptom onset, and (3) the morphological characteristics on MRI of future symptomatic tears. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: A total of 51 consecutive patients who underwent gluteus medius tear surgery were reviewed for contralateral hip pathology; of these, 43 patients were 2 years out from index surgery with reviewable preoperative MRI scans. A musculoskeletal radiologist reviewed the MRI scans for tear size, tendon retraction, and fatty infiltration using the Goutallier-Fuchs grading system. Medical record review identified contralateral hips requiring subsequent treatment. RESULTS: Of the original 43 patients, 10 (23%) had no contralateral tear, 19 (44%) had low-grade partial tears, 9 (20%) had high-grade partial tears, and 5 (11%) had full-thickness tears. Thirty-seven patients had unilateral symptoms; the other 6 had mild contralateral hip pain at enrollment. Of the 37 patients with unilateral symptoms, 27 (73%) had a contralateral tear; of those, 10 became symptomatic at an average of 24 months after index presentation (range, 6-50 months). In patients with symptomatic progression, 7 had low-grade partial tears, 1 had a high-grade partial tear, and 2 had full-thickness tears, with an average retraction of 17 mm. Tendon tear grade on MRI did not always correlate with symptoms or future presentation. All symptomatic progression remained mild to moderate. Seven patients required a corticosteroid injection, and none needed contralateral hip surgery within 2 years. CONCLUSION: Of patients who underwent surgery for a gluteus medius tear, 73% (27/37) had an incidental MRI-confirmed contralateral hip abductor tear. Of these, 37% (10/27) developed symptoms consistent with greater trochanteric pain syndrome during the 2-year study period.


Assuntos
Bursite , Tendinopatia , Artralgia , Nádegas/diagnóstico por imagem , Nádegas/patologia , Quadril/patologia , Humanos , Imageamento por Ressonância Magnética , Dor/etiologia , Prevalência , Tendinopatia/diagnóstico por imagem , Tendinopatia/epidemiologia , Tendinopatia/patologia
20.
Artigo em Inglês | MEDLINE | ID: mdl-35627764

RESUMO

OBJECTIVE: Understanding the underlying mechanisms behind shoulder dysfunctions in patients with diabetes mellitus. STUDY DESIGN: Systematic qualitative literature review. PARTICIPANTS: Patients with shoulder dysfunctions and diagnosed with impaired glucose tolerance or diabetes mellitus. INTERVENTION: Published scientific literature containing evidence about the mechanisms of shoulder dysfunctions in the diabetic population. Articles were selected based on criteria containing diabetic population, shoulder dysfunction, methodological quality ≥ 6/9 and >20 subjects. MAIN OUTCOME MEASURES: range of motion; questionnaires (QoL, UCLA-m, SPADI, DASH); blood glucose, blood HbA1C; calculated capsular stiffness (Kcap); calcification shoulder joint; shoulder dysfunction in patients with glucose metabolism disorders and diabetes mellitus. RESULTS: We found 17 published articles with level 2 and 3 evidence. Multiple factors such as age, duration of diabetes mellitus (DM), glycated hemoglobin (HbA1c), advanced glycation end products (AGE), vascular endothelial growth factor (VEGF), interleukin-1ß (IL-1ß) were shown to be associated with tendon changes and increased capsular stiffness (Kcap) conceivably leading to limited range of motion (ROM) or frozen shoulder. Decreased ROM and frozen shoulder have a significantly higher prevalence in DM than in non-DM. CONCLUSIONS: Based on the current literature we confirm a high prevalence of shoulder dysfunctions in patients with diabetes mellitus. The cause of the shoulder complications is unknown, and more research is mandatory to shed more light on the complex interplay between the multifactorial causes of shoulder dysfunction in diabetes mellitus.


Assuntos
Bursite , Complicações do Diabetes , Diabetes Mellitus , Ombro , Bursite/etiologia , Estudos Transversais , Diabetes Mellitus/epidemiologia , Hemoglobina A Glicada/análise , Produtos Finais de Glicação Avançada , Humanos , Interleucina-1 , Qualidade de Vida , Ombro/fisiopatologia , Fator A de Crescimento do Endotélio Vascular
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