Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 535
Filtrar
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.
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
3.
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
4.
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
5.
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
6.
Orthop Traumatol Surg Res ; 108(4): 103312, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-35568296

RESUMO

The goal of this study was to describe and evaluate endoscopic bursectomy combined with fascia lata lengthening in the treatment of type I and II greater trochanteric pain syndrome recalcitrant to conservative management. This was a retrospective study of 20 patients (7 type I, 13 type II) reviewed with a minimum follow-up of 2 years. The mean follow-up was 44±11 [26-65] months. While significant improvements in pain, mHHS and NAHS were found, 80% of patients still had hip pain graded at≥3 on VAS. The satisfaction rate was 7/10±2 [3-10]. Snapping in the hip had been eliminated in 100% of cases. No complications were observed. This is a minimally invasive surgery that is feasible in patients who have failed an optimal course of conservative treatment. But patients must be informed that pain might not be completely eliminated by this procedure. LEVEL OF EVIDENCE: IV; retrospective, case series.


Assuntos
Bursite , Impacto Femoroacetabular , Artroscopia/métodos , Bursite/cirurgia , Impacto Femoroacetabular/cirurgia , Seguimentos , Articulação do Quadril/cirurgia , Humanos , Dor , Estudos Retrospectivos , Resultado do Tratamento
8.
J Shoulder Elbow Surg ; 31(7): 1399-1408, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35346849

RESUMO

BACKGROUND: Tranexamic acid (TXA) is commonly used in upper and lower limb arthroplasty to limit blood loss and postoperative hematoma formation. The role of TXA in rotator cuff repair (RCR) surgery is less defined. This trial assessed the effect of preoperative TXA on early postoperative pain scores. METHODS: A randomized double-blind trail was conducted in 89 patients undergoing RCR. Patients were randomized to either 2 g of intravenous TXA or placebo at induction. The primary outcome was visual analog scale (VAS)-pain score at day 3 postoperation, with secondary outcomes including VAS-pain, American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), and Constant scores at 2, 8, 24, and 52 weeks. RESULTS: There was no significant difference in VAS-pain scores between groups at day 3 postoperation. Pain scores were significantly better in the TXA group at 8 weeks. There was no difference between groups at any time point in the ASES or Constant score. The TXA group had improved motion at 6 months with a reduced rate of secondary adhesive capsulitis. CONCLUSION: TXA did not improve postoperative pain scores after RCR, however, patients who received the intervention demonstrated greater range of motion at 6 months with lower rates of secondary adhesive capsulitis.


Assuntos
Bursite , Lesões do Manguito Rotador , Ácido Tranexâmico , Artroplastia , Artroscopia , Bursite/cirurgia , Humanos , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/prevenção & controle , Amplitude de Movimento Articular , Manguito Rotador/cirurgia , Lesões do Manguito Rotador/cirurgia , Ácido Tranexâmico/uso terapêutico , Resultado do Tratamento
9.
J Healthc Eng ; 2022: 1076112, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35222874

RESUMO

OBJECTIVE: To compare the outcomes of visualized puncture needle and small needle-knife therapy in 68 patients with primary frozen shoulder. METHOD: Sixty-eight patients with primary frozen shoulder were recruited and randomly divided into two groups, with 34 patients in each group. In the treatment group, an ultrasound-guided 18G-PTC puncture needle was inserted into the joint space, followed by a liquid injection until complete lysis and dissociation of the intraarticular adhesion were achieved. Then, the lesser tuberosity of the coracoid and humerus, the intertubercular groove of the humerus, and the greater tuberosity of the humerus were stripped, first vertically and then horizontally, by an amplitude ≦ 0.5 cm per treatment. This treatment procedure was performed once per week, and each cycle covered three treatments. The small needle-knife therapy was set as a control, and the efficacy was observed. RESULT: The visualized puncture needle significantly outperformed the small needle-knife therapy in overall efficacy, UCLA scores of the shoulder joint, shoulder mobility, and muscle elasticity and thickness. CONCLUSION: The efficacy of the visualized puncture needle for primary frozen shoulder was better compared to the small needle-knife therapy. The former was safer and more convenient, which caused less pain to patients and took effect more quickly. In a word, the visualized puncture needle for primary frozen shoulder is worthy of clinical popularization.


Assuntos
Bursite , Articulação do Ombro , Bursite/diagnóstico por imagem , Bursite/cirurgia , Humanos , Agulhas , Punções , Ultrassonografia
10.
Acad Emerg Med ; 29(1): 6-14, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34698411

RESUMO

OBJECTIVES: Many guidelines for septic olecranon bursitis recommend aspiration of the bursa prior to initiation of antimicrobial therapy despite the absence of robust clinical data to support this practice and known risk of aspiration complications. Our objective was to describe outcomes associated with empiric antibiotic therapy without bursal aspiration among emergency department (ED) patients with suspected septic olecranon bursitis. METHODS: We conducted a retrospective observational cohort study of patients presenting to an academic ED from January 1, 2011, to December 31, 2018, with olecranon bursitis. The health record was reviewed to assess patient characteristics and outcomes within 6 months of the ED visit. Olecranon bursitis was considered "suspected septic" if the patient was treated with antibiotics. The primary outcome of interest was complicated versus uncomplicated bursitis resolution. Uncomplicated resolution was defined as bursitis resolution without subsequent bursal aspiration, surgery, or hospitalization. RESULTS: During the study period, 264 ED patients were evaluated for 266 cases of olecranon bursitis. The median age was 57 years and 85% were men. Four (1.5%) patients had bursal aspiration during their ED visit, 39 (14.7%) were admitted to the hospital, 76 (28.6%) were dismissed without antibiotic therapy, and 147 (55.3%) were dismissed with empiric antibiotic therapy for suspected septic olecranon bursitis. Among these 147 patients, 134 had follow-up available including 118 (88.1%, 95% confidence interval [CI] = 81.1%-92.8%) with an uncomplicated resolution, eight (6.0%, 95% CI = 2.8%-11.8%) who underwent subsequent bursal aspiration, and nine (6.7%, 95% CI = 3.3%-12.7%) who were subsequently admitted for inpatient antibiotics. CONCLUSIONS: Eighty-eight percent of ED patients with suspected septic olecranon bursitis treated with empiric antibiotics without aspiration had resolution without need for subsequent bursal aspiration, hospitalization, or surgery. Our findings suggest that empiric antibiotics without bursal aspiration may be a reasonable initial approach to ED management of select patients with suspected septic olecranon bursitis.


Assuntos
Bursite , Olécrano , Antibacterianos/uso terapêutico , Bursite/tratamento farmacológico , Bursite/etiologia , Bursite/cirurgia , Serviço Hospitalar de Emergência , Humanos , Masculino , Pessoa de Meia-Idade , Olécrano/cirurgia , Estudos Retrospectivos
11.
Iowa Orthop J ; 41(2): 45-57, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34924870

RESUMO

Background: While excision of the trochanteric bursae to treat lateral hip pain has increased in popularity, no comparison exists between the surgical outcomes and complications of the open and arthroscopic techniques involving trochanteric bursectomy. The purpose of this study was to determine the efficacies and complication rates of arthroscopic and open techniques for procedures involving trochanteric bursectomy. Methods: The terms "trochanteric," "bursectomy," "arthroscopic," "open," "outcomes," and "hip" were searched in five electronic databases. Fifteen studies from 120 initial results were included. Patient-reported outcomes (PRO), pain, satisfaction, and complications were included for analysis. Results: Five hundred-two hips in 474 total patients (77.7% female) were included in this study. The average age was 54. The fourteen distinct PRO scores that were reported by the included studies improved significantly from baseline to final mean follow-up (12-70.8 months for open; 12-42 months for arthroscopic) for both approaches, demonstrating statistically significant patient benefit in a variety of hip arthroscopy settings (P > 0.05). The complication rates of all procedures ranged from 0%-33% and failure to improve pain ranged from 0%-8%. Patient satisfaction with surgery was high at 95% and 82% reported a willingness to undergo the same surgery again. No significant mean differences were found between the open and arthroscopic techniques. Conclusion: The open and arthroscopic approaches for trochanteric bursectomy are both safe and effective procedures in treating refractory lateral hip pain. No significant differences in PROs, pain, total complications, severity of complications, and total failures were seen between technique outcomes.Level of Evidence: IV.


Assuntos
Artroscopia , Bursite , Artralgia , Bursite/cirurgia , Feminino , Articulação do Quadril/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
12.
Mymensingh Med J ; 30(4): 903-906, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34605454

RESUMO

Retrocalcaneal bursitis is one of the important causes of posterior heel pain which is due to repetitive friction of the retrocalcaneal bursa between the postero-superior calcaneal tuberosity (haglund deformity) and Achilles tendon. Most of the patients are treated by conservative methods. But when the condition becomes chronic and not responding to the conservative treatment, surgical treatment is an option of these cases. This prospective interventional study was conducted in the Department of Orthopaedic Surgery, BSMMU (Bangabandhu Sheikh Mujib Medical University), Dhaka, Bangladesh from September 2017 to August 2019. Within this period, total 40 cases of chronic retrocalcaneal bursitis were operated at BSMMU. The clinical and functional outcome was evaluated according to AOFAS (American Orthopedic Foot Ankle Society) scale. The results of this study showed significantly improvement of pain, functional status and deformity at the time of final follow-up period of 1 year, total mean score improved from 46/100 to 89/100. The outcome of the subjects was satisfactory 90% and unsatisfactory 10%. Surgical intervention is an effective option of treatment with satisfactory outcome, in the treatment of chronic retrocalcaneal bursitis.


Assuntos
Tendão do Calcâneo , Bursite , Calcâneo , Bangladesh , Bursite/cirurgia , Calcâneo/diagnóstico por imagem , Calcâneo/cirurgia , Humanos , Estudos Prospectivos , Resultado do Tratamento
13.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 35(9): 1141-1146, 2021 Sep 15.
Artigo em Chinês | MEDLINE | ID: mdl-34523279

RESUMO

OBJECTIVE: To investigate the effectiveness of arthroscopic 360° capsular release for frozen shoulder. METHODS: Between April 2018 and April 2019, 42 patients with frozen shoulders were treated with arthroscopic 360° capsular release. There were 13 males and 29 females, with an average age of 52.3 years (range, 45-56 years). There were 14 left shoulders and 28 right shoulders. The disease duration ranged from 5 to 18 months (mean, 11.1 months). The main clinical symptoms were limited active and passive movement of the shoulder joint with severe pain. All patients excluded impingement syndrome and shoulder osteoarthritis. Preoperative range of motion was as follows: forward flexion (93.2±15.4)°, external rotation at side (15.9±6.0)°, external rotation at 90° abduction (18.4±9.9)°, and internal rotation reaching the greater trochanter in 5 cases, buttocks in 20 cases, S 1 level in 17 cases. The visual analogue scale (VAS) score was 6.7±1.7 and the American Society of Shoulder and Elbow Surgery (ASES) score was 41.6±9.3. The active range of motion of shoulder joint, VAS score, and ASES score were recorded during follow-up. RESULTS: All incisions healed by first intention, and no early complications occurred. Patients were followed up 12-24 months (mean, 15.6 months). After operation, forward flexion, external rotation at side, and external rotation at 90° abduction significantly improved when compared with preoperatively ( P<0.05). The range of internal rotation restored to the level of T 6-12 at 3 weeks, which was equivalent to that of the normal side at 12 months after operation ( Z=-0.943, P=0.346). VAS scores decreased and ASES scores increased after operation, and the differences between pre- and post-operation were significant ( P<0.05); and with time, the VAS scores and ASES scores improved further ( P<0.05). CONCLUSION: Arthroscopic 360° capsular release can significantly increase the range of motion of the shoulder joint, release pain, and improve function. It is an effective method for the treatment of frozen shoulders.


Assuntos
Bursite , Articulação do Ombro , Artroscopia , Bursite/cirurgia , Feminino , Humanos , Liberação da Cápsula Articular , Masculino , Pessoa de Meia-Idade , Amplitude de Movimento Articular , Rotação , Ombro , Articulação do Ombro/cirurgia , Resultado do Tratamento
14.
Jt Dis Relat Surg ; 32(2): 536-541, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34145836

RESUMO

Tuberculous trochanteric bursitis (TTB) is an extremely rare form of extrapulmonary tuberculosis. Due to a low clinical suspicion and poor collaboration among medical professionals, the diagnosis of TTB can be often delayed. In this report, we describe a case of neglected TTB in an adolescent girl that initially presented with right thigh swelling and fluctuance. The patient underwent repeated unsuccessful surgical treatment; however, dull pain and periodic wound drainage remained for eight years. Complete excision of fistula and trochanteric bursa and one year of oral antituberculous drug therapy led to complete recovery. This case report highlights tuberculosis as a diagnostic challenge, when rare localizations are affected. In addition, this report addresses several diagnostic pitfalls and reviews the literature regarding TTB in adolescent patients. Orthopedic surgeons need to consider TTB, when swelling, fluctuance or repeated wound drainage are present on the thigh.


Assuntos
Antituberculosos/uso terapêutico , Bursite/cirurgia , Fêmur/cirurgia , Fístula/cirurgia , Articulação do Quadril/cirurgia , Tuberculose Osteoarticular/diagnóstico , Administração Oral , Adolescente , Bolsa Sinovial/cirurgia , Bursite/tratamento farmacológico , Bursite/microbiologia , Croácia , Feminino , Humanos , Tuberculose Osteoarticular/tratamento farmacológico , Tuberculose Osteoarticular/microbiologia , Tuberculose Osteoarticular/cirurgia
15.
Knee Surg Sports Traumatol Arthrosc ; 29(8): 2640-2647, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34085108

RESUMO

PURPOSE: Intra-articular pathologies, such as labral and chondral lesions, are common in patients with frozen shoulder. This study evaluated the correlations between the range of motion and labral and chondral lesions in patients with frozen shoulder and investigated their pathophysiologies. METHODS: In total, 125 individuals (53 men and 72 women) who underwent arthroscopic pan-capsular release between 2014 and 2020 were included in the study. The range of motion was measured using scapular fixation and true glenohumeral motion under general anaesthesia. The American Shoulder and Elbow Surgeons Shoulder score and the Shoulder Rating Scale score of the University of California, Los Angeles were used to compare intra-articular pathologies. RESULTS: More than 80% of patients with frozen shoulder had labral pathologies, and nearly half of them had chondral pathologies. Labral lesions extending to the anterior rim of the glenoid had a greater range of motion and the greatest total American Shoulder and Elbow Surgeons Shoulder score. More severe chondral lesions had a lesser range of motion, but presented the greatest function scores and the lowest strength scores according to the Shoulder Rating Scale of the University of California, Los Angeles. The pain scores of the American Shoulder and Elbow Surgeons Shoulder score and the Shoulder Rating Scale of the University of California, Los Angeles were not correlated with the degree of these pathologies. The traction force affected the labrum during true range of motion, and the compression force occurred on the articular cartilage during internal rotation at 90° of forward flexion during diagnostic arthroscopy. CONCLUSION: Labral and chondral lesions are common in patients with frozen shoulder. Adherence to the capsulolabral complex induced a limited range of motion and labral and chondral pathologies. Diagnostic arthroscopy with motion is an important method of reproducing the pathogenesis of intra-articular structures for patients with frozen shoulder. LEVEL OF EVIDENCE: Level III.


Assuntos
Bursite , Articulação do Ombro , Artroscopia , Bursite/cirurgia , Feminino , Humanos , Cápsula Articular/cirurgia , Masculino , Amplitude de Movimento Articular , Articulação do Ombro/cirurgia , Resultado do Tratamento
16.
Z Rheumatol ; 80(10): 972-979, 2021 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-33931806

RESUMO

In soft tissue tumors of the extremities it is of utmost importance to differentiate between benign and malignant entities. The majority of the swellings vary from benign tissue changes through soft tissue sarcomas up to pseudotumors. Because of the low incidence of malignancy and the predominantly benign alterations together with a high heterogeneity, there is a need for a reproducible diagnostic and therapeutic concept for the treatment of all tumors of the extremities. This article reports the case of a 59-year-old patient with longstanding rheumatoid arthritis who presented to the orthopedic rheumatologic consultation with a massive swelling directly ventral to the knee joint. At that point the tumor had already grown very slowly for 5 years. The staged diagnostic process (patient history, clinical, laboratory tests, sonographic examinations, X­ray, MRI with contrast medium) revealed no trace of malignancy whatsoever. The treatment then consisted of the complete surgical excision in accordance with the recommendations for tumor surgery. Histopathological findings confirmed the diagnosis of a massive prepatellar bursitis. Initially, the extreme and solid prepatellar swelling was suspected of being malignant; however, this could already be broadly excluded preoperatively. This article presents the rationale and the orthopedic rheumatologic approach for addressing unclear space-occupying lesions of the musculoskeletal system in patients with rheumatism. In the inflammatory systemic disease in the differential diagnosis periarticular swellings can ultimately also have benign causes, such as an organized bursitis.


Assuntos
Artrite Reumatoide , Bursite , Neoplasias , Artrite Reumatoide/diagnóstico , Bursite/diagnóstico , Bursite/cirurgia , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade
17.
Orthop Traumatol Surg Res ; 107(4): 102915, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33812092

RESUMO

BACKGROUND: Arthroscopic surgery has earned its place as the reference standard treatment for rotator cuff calcific tendinopathy refractory to conservative medical treatment. Adhesive capsulitis of the shoulder is the most common complication (12%). Standard practice involves routine gleno-humeral exploration before calcification removal. The objective of this study was to identify risk factors for adhesive capsulitis. HYPOTHESIS: The development of adhesive capsulitis is associated with gleno-humeral exploration. METHODS: We conducted a multicentre, multi-surgeon, retrospective cohort study of 340 consecutive patients who underwent arthroscopic removal of rotator cuff calcifications between 1 January 2012 and 1 January 2018. We collected epidemiological data (age, sex, work-related physical activity), the history of previous treatments (local injections, needling), the type and location of the calcifications as assessed radiologically, the clinical findings (Constant score before and 6 months after surgery, diagnosis of adhesive capsulitis defined as shoulder pain with motion range limitation in all directions), and the surgical details (type of anaesthesia, gleno-humeral exploration). RESULTS: Of the 340 patients, 251 underwent routine gleno-humeral exploration and 89 did not. Adhesive capsulitis developed in 40 (12%) patients. By multivariate analysis, gleno-humeral exploration was an independent risk factor for adhesive capsulitis (p=0.022; odds ratio, 5.60). Of the 251 gleno-humeral explorations, 8% identified concomitant lesions and only 4% led to a curative procedure. CONCLUSION: Given our results and the data in the literature, we believe that routine gleno-humeral exploration during the arthroscopic treatment of rotator cuff calcific tendinopathy is inadvisable. LEVEL OF EVIDENCE: III; case-control study.


Assuntos
Bursite , Lesões do Manguito Rotador , Articulação do Ombro , Artroscopia/efeitos adversos , Bursite/epidemiologia , Bursite/etiologia , Bursite/cirurgia , Estudos de Casos e Controles , Humanos , Lactente , Amplitude de Movimento Articular , Estudos Retrospectivos , Fatores de Risco , Manguito Rotador/diagnóstico por imagem , Manguito Rotador/cirurgia , Articulação do Ombro/cirurgia
19.
Clin Podiatr Med Surg ; 38(2): 165-181, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33745649

RESUMO

Calcification of the posterior portion of the calcaneus has numerous terms that refer to this pathology. Given the number of names, there can be confusion when discussing the different pathologies involving calcification at the insertion of the Achilles tendon at the calcaneus. Two of the diagnosis that can be confused with each other are Haglund's deformity and Achilles insertional calcific tendinosis. This article discusses how these 2 entities are differentiated clinically and how their surgical management is different.


Assuntos
Tendão do Calcâneo , Calcâneo , Calcinose/diagnóstico , Tendinopatia/diagnóstico , Tendão do Calcâneo/diagnóstico por imagem , Tendão do Calcâneo/cirurgia , Bursite/diagnóstico , Bursite/cirurgia , Calcâneo/diagnóstico por imagem , Calcâneo/cirurgia , Calcinose/cirurgia , Diagnóstico Diferencial , Calcanhar/diagnóstico por imagem , Humanos , Tendinopatia/cirurgia
20.
Clin Sports Med ; 40(2): 311-322, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33673889

RESUMO

The hip trochanteric bursa, tendinous insertions of the gluteal muscles, and the origin vastus lateralis make up the main structures of the peritrochanteric space. Greater trochanteric pain syndrome (GTPS) refers to pain generated by one or multiple disorders of the peritrochanteric space, such as trochanteric bursitis, gluteus medius and minimus tendinopathy or tear, and disorders of the proximal iliotibial band. Patients with GTPS might present with associated intra-articular hip pathology, which requires further investigation and appropriate management. Successful midterm outcomes have been reported in patients undergoing surgical treatment of GTPS using an open or endoscopic approach.


Assuntos
Quadril/fisiologia , Bursite/cirurgia , Articulação do Quadril/fisiologia , Articulação do Quadril/cirurgia , Humanos , Lacerações , Músculo Esquelético/lesões , Dor , Tendinopatia/complicações , Tendões/cirurgia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...