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1.
World Neurosurg ; 136: 74-76, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31935525

RESUMO

BACKGROUND: Brachial plexitis is characterized by acute onset pain followed by weakness due to dysfunction of the nerves constituting the brachial plexus. The exact pathophysiology of this condition remains unknown but it is known to follow acute infections, such as a viral illness. CASE DESCRIPTION: We describe a case of idiopathic brachial plexitis in a patient after a peripheral stem cell transplant. The acute denervation of nerves in the brachial plexus may be due to reconstitution of his immune system. This is a rare entity and can be a diagnostic dilemma. CONCLUSIONS: Brachial plexitis may follow peripheral stem cell transplantation. Awareness of this phenomenon is helpful to clinicians involved in the care of these patients.


Assuntos
Neurite do Plexo Braquial/diagnóstico , Mieloma Múltiplo/terapia , Transplante de Células-Tronco de Sangue Periférico , Idoso , Neurite do Plexo Braquial/diagnóstico por imagem , Neurite do Plexo Braquial/fisiopatologia , Eletromiografia , Humanos , Imagem por Ressonância Magnética , Masculino , Debilidade Muscular/etiologia , Dor de Ombro/etiologia
2.
PLoS One ; 15(1): e0227688, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31929588

RESUMO

OBJECTIVE: To describe general practitioner's (GP's) current management of rotator cuff related shoulder pain (RCRP) in Australia and identify if this is consistent with recommended care and best available evidence. The secondary aim was to determine if GP management of RCRP changed over time. METHODS: Data about management of RCRP by Australian GPs was extracted from the Bettering the Evaluation of Care of Health program database over its final five years (April 2011-March 2016). Patient and GP characteristics and encounter management data were extracted. Results are reported using descriptive statistics with point estimates and 95% confidence intervals. A secondary analysis over a 16 year period (2000-2016) examined management data for RCRP in four year periods. RESULTS: RCRP was the most common shoulder condition managed by GPs at 5.12 per 1,000 encounters; and at an estimated 732,000 times nationally in 2015-2016. Management rate was higher among male patients (5.5 per 1000 encounters c.f. 4.8 for female patients) and was highest in the 45-64 year old age group (8.6 per 1000). RCRP was most frequently managed with medications (54.7%), steroid injection (19.5%) followed by non-steroidal anti-inflammatory drugs (NSAIDs) (19.1%). Imaging was ordered for 43.4% (ultrasound 41.2% and x-ray 11.6%) of all RCRP presentations (new and returning). Over half (53.0%) of new RCRP presentations were referred for ultrasound imaging. In the 16 year period 2000-16 ultrasound imaging more than doubled from 19.1% to 41.9% of management occasions. In parallel, prescribed steroid injection increased from 9.8% to 19.7%. CONCLUSION: The usual care provided by GPs for RCRP relies on the use of ultrasound and steroid injection. This is not consistent with recommended care and clinical guidelines that recommend these are delayed until after 6-12 weeks of NSAID medication, exercise and activity modification. There has been a significant increase in the rate of steroid injection and ultrasound imaging, which may be due in part to policy change.


Assuntos
Medicina Geral/métodos , Manguito Rotador , Dor de Ombro/etiologia , Dor de Ombro/terapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Estudos Transversais , Gerenciamento Clínico , Feminino , Medicina Geral/tendências , Humanos , Lactente , Recém-Nascido , Injeções , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Padrões de Prática Médica/tendências , Estudos Prospectivos , Manguito Rotador/diagnóstico por imagem , Dor de Ombro/epidemiologia , Esteroides/administração & dosagem , Ultrassonografia , Adulto Jovem
3.
J Shoulder Elbow Surg ; 29(1): 58-67, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31401130

RESUMO

BACKGROUND: The main limits of the Grammont design reverse shoulder arthroplasty (RSA) are loss of external rotation and scapular notching. They can be addressed with glenoid or humeral lateralization. The aim of the study was to compare outcomes of lateralized bony increased-offset RSA (BIO-RSA) vs. standard RSA in patients with an onlay 145° curved stem. METHODS: A comparative cohort study of 29 standard RSAs and 30 BIO-RSAs was performed. At 2 years postoperatively, Constant score, American Shoulder and Elbow Surgeons score, visual analog scale score, range of motion, and radiographs were evaluated. After comparison between the groups, patients were analyzed considering patients younger and older than 65 years. RESULTS: All parameters significantly improved after surgery in both groups. Postoperatively, the 2 groups did not show any clinical and radiographic differences (P > .05). In patients <66 years, BIO-RSA showed a significantly higher value of external rotation (49° ± 12° vs. 30° ± 19° [P = .025], elbow at side; 81° ± 17° vs. 56° ± 22° [P = .016], elbow at 90° of abduction) and a positive trend for all other parameters (P > .05). In patients >65 years, standard technique showed a positive trend for all the parameters (P > .05). No other significant differences were found. CONCLUSIONS: At 2 years of follow-up, the use of standard RSA or BIO-RSA in an implant with an onlay 145° curved stem provided similar outcomes. The humeral lateralization alone is sufficient to decrease notching and to improve external rotation. BIO-RSA increases external rotation in patients between 50 and 65 years old. Glenoid bone graft in RSA has a high incorporation rate (completed in 90%).


Assuntos
Artroplastia do Ombro/métodos , Cavidade Glenoide/cirurgia , Artropatia de Ruptura do Manguito Rotador/cirurgia , Articulação do Ombro/fisiopatologia , Idoso , Artroplastia do Ombro/instrumentação , Medicamentos Biossimilares , Transplante Ósseo , Feminino , Humanos , Úmero/fisiopatologia , Masculino , Pessoa de Meia-Idade , Radiografia , Amplitude de Movimento Articular , Estudos Retrospectivos , Rotação , Artropatia de Ruptura do Manguito Rotador/complicações , Artropatia de Ruptura do Manguito Rotador/fisiopatologia , Articulação do Ombro/diagnóstico por imagem , Articulação do Ombro/cirurgia , Dor de Ombro/etiologia , Prótese de Ombro , Resultado do Tratamento
4.
J Shoulder Elbow Surg ; 29(1): 12-19, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31627964

RESUMO

BACKGROUND: The patient-related factors for the perceived need for surgery for degenerative rotator cuff tears are not known. The purpose of this study is to examine patient- and tear-specific factors leading to surgery in newly painful degenerative rotator cuff tears. METHODS: Asymptomatic, degenerative rotator cuff tears were followed prospectively to identify the onset of pain and tear enlargement. Newly painful tears were continually monitored with a focus on identifying patient-specific (age, occupation, activity level) and tear-specific (tear type and size, tear progression, American Shoulder and Elbow Surgeons score, muscle degeneration) factors that are associated with surgical intervention. RESULTS: Forty-eight of 169 newly painful shoulders were eventually managed surgically. Factors associated with surgical treatment included younger age (P = .0004), pain development earlier in surveillance (P = .0002), a greater increase in pain (P = .0001), a decline in American Shoulder and Elbow Surgeons score (P < .0001), and a history of contralateral shoulder surgery (P = .0006). Eighty-five of the 169 tears (50%) enlarged either before or within 2 years of pain development. Neither tear type (P = .13), tear enlargement (P = .67) nor tear size (P = .51) was associated with surgery. Neither the severity of muscle degeneration, occupational status, hand dominance, Shoulder Activity Score, nor changes in RAND-12 mental or physical scales differed between groups. DISCUSSION: For newly painful rotator cuff tears, patient-specific factors such as younger age and prior surgery on the contralateral shoulder are more predictive of future surgery than tear-specific factors or changes in tear size over time.


Assuntos
Lesões do Manguito Rotador/complicações , Lesões do Manguito Rotador/cirurgia , Dor de Ombro/etiologia , Fatores Etários , Idoso , Doenças Assintomáticas , Tomada de Decisões , Progressão da Doença , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Medição da Dor , Estudos Prospectivos , Lesões do Manguito Rotador/diagnóstico por imagem , Lesões do Manguito Rotador/fisiopatologia , Ruptura/complicações , Ruptura/cirurgia , Articulação do Ombro/fisiopatologia , Ultrassonografia
5.
Bone Joint J ; 101-B(12): 1520-1525, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31787000

RESUMO

AIMS: Reverse shoulder arthroplasty (RSA) reliably improves shoulder pain and function for a variety of indications. However, the safety and efficacy of RSA in elderly patients is largely unknown. The purpose of this study was to report the mortality, morbidity, complications, reoperations, and outcomes of primary RSA in patients aged > 80 years. PATIENTS AND METHODS: Between 2004 and 2013, 242 consecutive primary RSAs were performed in patients aged > 80 years (mean 83.3 years (sd 3.1)). Of these, 53 were lost to follow-up before two years and ten had died within two years of surgery, leaving 179 for analysis of survivorship, pain, motion, and strength at a minimum of two years or until revision surgery. All 242 patients were considered for the analysis of 90-day, one-year, and overall mortality, medical complications (90-day and overall), surgical complications, and reoperations. The indications for surgery included rotator cuff arthropathy, osteoarthritis, fracture, the sequela of trauma, avascular necrosis, and rheumatoid arthritis. A retrospective review of the medical records was performed to collect all variables. Survivorship free of revision surgery was calculated at two and five years. RESULTS: One patient (0.4%) died within the first 90 days. A total of 45 patients (19%) were known to have died at the time of the final follow-up, with a median time to death of 67.7 months (interquartile range 40.4 to 94.7) postoperatively. Medical complications occurred in six patients (3%) and surgical complications occurred in 21/179 patients (12%). Survivorship free from revision was 98.9% at two years and 98.3% at five years; survivorship free from loosening was 99.5% at final follow-up. The presence of peripheral vascular disease correlated with a higher complication rate. CONCLUSION: Primary RSA was safe and effective in patients aged > 80 years, with a relatively low rate of medical and surgical complications. Thus, age alone should not be a contraindication to primary RSA in patients aged > 80 years. However, a careful evaluation of comorbidities is required in this age group when considering primary RSA. Cite this article: Bone Joint J 2019;101-B:1520-1525.


Assuntos
Artroplastia do Ombro , Dor de Ombro/cirurgia , Fatores Etários , Idoso de 80 Anos ou mais , Artroplastia do Ombro/mortalidade , Feminino , Seguimentos , Humanos , Masculino , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco , Dor de Ombro/etiologia , Dor de Ombro/mortalidade , Dor de Ombro/fisiopatologia , Resultado do Tratamento
6.
Medicine (Baltimore) ; 98(45): e17933, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31702679

RESUMO

Hemiplegic shoulder pain (HSP), which occurs in most patients with hemiplegia, causes considerable distress and worsens outcomes in rehabilitation. Although they have received the treatments such as anti-inflammatory drugs or physical therapy, many of the individuals remain suffering from shoulder pain 6 months after acute stroke event. In this retrospective study, we evaluated the effectiveness of ultrasound guided subacromial-subdeltoid (SASD) bursa injections with botulinum toxin type A (BoNT/A) compared to steroids for refractory HSP.The data were collected retrospectively by reviewing the patient's medical records and pain questionnaires in our rehabilitation center. In total, 38 patients who received ultrasound guided SASD bursa injection (BoNT/A group, n = 18; corticosteroid group, n = 20) were included. The pain visual analog scale (VAS) score at rest and during arm passive abduction, Fugl-Meyer score of upper limbs (F-M score) were evaluated before, 2, 4, 8, and 12 weeks after injection.Both 2 groups obtained a significant improvement of VAS score at rest or during arms passive abduction compared to baseline score (within group compare, P < .05). There were no significant differences of pain score improvement between two groups at week 2, 4, 8, and 12 after injection either at rest or during passive arm abduction (between 2 groups compare, P > .05). There were also no differences in results of the post treatment F-M score between 2 groups (between 2 groups compare, P > .05). Similarly, during the follow-up period no collateral effects were reported after BoNT/A injection.SASD bursa BoNT/A injection can substantially reduce the pain as corticosteroid in patients with HSP. BoNT/A injection could be a useful strategy for replacing steroids as a treatment for refractory HSP especially in the patients who cannot tolerate the steroids injection.


Assuntos
Toxinas Botulínicas Tipo A/administração & dosagem , Fármacos Neuromusculares/administração & dosagem , Dor de Ombro/tratamento farmacológico , Idoso , Anti-Inflamatórios/administração & dosagem , Betametasona/administração & dosagem , Betametasona/análogos & derivados , Bolsa Sinovial/efeitos dos fármacos , Estudos de Casos e Controles , Feminino , Hemiplegia/complicações , Humanos , Injeções Intra-Articulares , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Dor de Ombro/etiologia , Acidente Vascular Cerebral/complicações , Resultado do Tratamento , Ultrassonografia de Intervenção/métodos
7.
BMC Musculoskelet Disord ; 20(1): 445, 2019 Oct 12.
Artigo em Inglês | MEDLINE | ID: mdl-31604445

RESUMO

BACKGROUND: Abscess formation in the subscapularis muscle is a rare clinical condition. Few reports are available regarding the treatment methods and surgical approaches for subscapularis intramuscular abscesses. Here, we describe a case of subscapularis intramuscular abscess that was treated successfully via surgical drainage using a new approach, the "dorsal subscapularis approach". CASE PRESENTATION: A 67-year-old woman presented to our hospital with complaints of fever and disturbance of consciousness. Two days prior to visiting our hospital, right shoulder pain and limited range of motion in the shoulder were noted. Cerebrospinal fluid examination and contrast-enhanced computed tomography (CT) imaging on admission revealed a right subscapularis intramuscular abscess with concomitant bacterial meningitis. The patient's clinical symptoms improved after antibiotic administration for 3 weeks, but the right shoulder pain persisted. Contrast-enhanced CT imaging performed after antibiotic administration revealed an abscess in the right shoulder joint space, in addition to a capsule of the abscess in the right subscapularis muscle. We performed open surgical drainage for the abscess, which had spread from the subscapularis muscle to the glenohumeral joint. Using the deltoid-pectoral approach, we detected exudate and infected granulation tissue in the joint cavity. Furthermore, we separated the dorsal side of the subscapularis muscle from the scapula using a raspatory and detected infected granulation tissue in the subscapularis muscle belly. We performed curettage and washed as much as possible. After surgery, antibiotic administration continued for 2 weeks. The patient's right shoulder pain subsided and CT performed 2 months after surgery revealed no recurrence of infection. CONCLUSIONS: The present case indicated that a subscapularis intramuscular abscess could lead to severe concomitant infections of other organs via the hematogenous route. Thus, early detection and treatment are necessary. Moreover, in this case, surgical drainage using a dorsal subscapularis approach was beneficial to treating the abscess, which had spread from the subscapularis muscle to the glenohumeral joint.


Assuntos
Abscesso/terapia , Artrite Infecciosa/terapia , Drenagem/métodos , Meningite Pneumocócica/terapia , Miosite/terapia , Dor de Ombro/cirurgia , Abscesso/sangue , Abscesso/complicações , Abscesso/microbiologia , Idoso , Antibacterianos/uso terapêutico , Artrite Infecciosa/sangue , Artrite Infecciosa/complicações , Artrite Infecciosa/microbiologia , Feminino , Humanos , Meningite Pneumocócica/sangue , Meningite Pneumocócica/diagnóstico , Meningite Pneumocócica/microbiologia , Miosite/microbiologia , Manguito Rotador/diagnóstico por imagem , Manguito Rotador/microbiologia , Manguito Rotador/cirurgia , Articulação do Ombro/diagnóstico por imagem , Articulação do Ombro/microbiologia , Articulação do Ombro/cirurgia , Dor de Ombro/etiologia , Streptococcus pneumoniae/isolamento & purificação , Tomografia Computadorizada por Raios X , Resultado do Tratamento
8.
J Radiol Case Rep ; 13(6): 24-31, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31558960

RESUMO

Serious side effects of vaccinations are not common, though rare complications can occur. We present a case of one such uncommon side effect, influenza vaccine-related subacromial/subdeltoid bursitis. A 72-year-old female presented with severe shoulder pain following influenza vaccination. The pain persisted for up to two months despite conservative measures, and MRI demonstrated moderate subacromial/subdeltoid bursitis. Vaccine-related shoulder dysfunction includes a range of pathology, from osteonecrosis to bursitis, which will be reviewed in this report. Recognition of infrequent vaccine-related musculoskeletal pathology is important to prevent delay of diagnosis.


Assuntos
Bursite/diagnóstico por imagem , Bursite/etiologia , Vacinas contra Influenza/efeitos adversos , Dor de Ombro/etiologia , Idoso , Bolsa Sinovial/diagnóstico por imagem , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Ombro/diagnóstico por imagem , Articulação do Ombro/diagnóstico por imagem
10.
J Electromyogr Kinesiol ; 49: 102351, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31473453

RESUMO

Middle-aged individuals cocontract with adductor muscles during abduction. This may be crucial for counteracting deltoid forces, depressing the humerus and ensuring free passage of subacromial tissues underneath the acromion during abduction. We questioned whether adductor co-contraction is always present, or develops during ageing, in which case it may explain the age-related character of common shoulder conditions such as Subacromial Pain Syndrome. In a cross-sectional analysis with electromyography (EMG), activation patterns of the latissimus dorsi, teres major, pectoralis major and deltoid muscle were assessed during isometric force tasks in 60 asymptomatic individuals between 21 and 60 years old. Cocontraction was expressed as the degree of antagonistic activation relative to the same muscle's degree of agonistic activation, resulting in an activation ratio between -1 and 1, where lower values indicate more cocontraction. Using linear regression analyses, we found age-related decreases in the activation ratio of the latissimus dorsi (regression estimate: -0.004, 95% CI: -0.007 to 0.0, p-value: 0.042) and teres major (regression estimate: -0.013, 95% CI: -0.019 to -0.008, p-value: <0.001). In contrast to young individuals, middle-aged individuals showed a high degree of adductor cocontraction during abduction. This may indicate that during ageing, alterations in activation patterns are required for preserving pain-free shoulder function.


Assuntos
Adaptação Fisiológica , Envelhecimento/fisiologia , Contração Muscular , Extremidade Superior/fisiologia , Adulto , Músculo Deltoide/crescimento & desenvolvimento , Músculo Deltoide/fisiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Movimento , Amplitude de Movimento Articular , Articulação do Ombro/fisiologia , Dor de Ombro/etiologia
11.
Knee Surg Sports Traumatol Arthrosc ; 27(12): 4032-4037, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31486915

RESUMO

PURPOSE:  Surgical management for long head of the biceps (LHB) tendinopathy with either biceps tenotomy or tenodesis is a reliable, but debated treatment option. The aim of this prospective, randomized, single-blinded study is to evaluate differences in pain relief and subjective outcomes between biceps tenotomy versus tenodesis for LHB tendinopathy. METHODS:  Subjects were randomized and blinded to biceps tenotomy versus arthroscopic tenodesis intra-operatively. Outcomes evaluated included subjective patient outcome scores, pain, and cosmetic deformity. Subjective outcomes scores and pain were analyzed using a two-way ANOVA, controlling for concomitant rotator cuff repair. Binary outcomes were compared using Chi-square tests. RESULTS:  Thirty-four subjects (31 male, 3 female) with a median age of 56 (range 30-77) were enrolled. Twenty subjects were randomized to tenotomy and 14 to tenodesis. Fifty-six percent had concomitant rotator cuff repairs. The mean VAS pain score at 3 months was lower with tenotomy versus tenodesis. 2-year follow-up demonstrated no statistically significant differences for VAS, ASES, or SANE. 15/20 (75%) subjects with biceps tenotomy reported no pain medication use at the 2-week postoperative visit versus 5/14 (33%) for biceps tenodesis. Popeye deformity was found in 5/20 (25%) of tenotomy subjects versus 1/14 (7%) in tenodesis subjects. CONCLUSION: Outcomes appear similar between biceps tenotomy versus tenodesis; however, the tenotomy group demonstrated greater incidence of cosmetic deformity but an earlier improvement in postoperative pain. LEVEL OF EVIDENCE: Treatment Studies, Level II.


Assuntos
Artroscopia , Articulação do Ombro/cirurgia , Dor de Ombro/cirurgia , Tendinopatia/cirurgia , Tenodese , Tenotomia , Adulto , Idoso , Estética , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Lesões do Manguito Rotador/cirurgia , Dor de Ombro/etiologia , Método Simples-Cego , Tendinopatia/complicações , Escala Visual Analógica
12.
Zhen Ci Yan Jiu ; 44(8): 605-9, 2019 Aug 25.
Artigo em Chinês | MEDLINE | ID: mdl-31475496

RESUMO

OBJECTIVE: To observe the clinical therapeutic effect of "Tiaoshen Zhitong" (mental regulating and pain relieving) needling and its influence on serological indicators in the treatment of post-stroke shoulder pain, so as to provide new therapeutic thoughts and approach for post-stroke shoulder pain. METHODS: A total of 80 inpatients with post-stroke shoulder pain were randomly divided into a control group (routine needling, 39 cases) and an observation group ("Tiaoshen Zhitong" needling, 41 cases) according to the random number table. Patients of the two groups accepted basic medication treatment including anticoagulants, hypotensive drugs, hypoglycermic drugs, lipid-lowering drugs, etc. In addition, patients of the control group were also treated by routine acupuncture stimulation (uniform reinforcing-reducing stimulation) of Jianyu (LI15), Jianqian (EX-UE12), Jianhou (Extra), Jianliao (TE14), Waiguan (TE5) and Hegu (LI4) on the affected side, and those of the observation group also treated by "Tiaoshen Zhitong" needling of Ear-Shenmen (MA-TF1), bilateral Neiguan (PC6, lifting-thrusting-reducing method), Shuigou (GV26, lifting-thrusting-reducing method), and Jianyu (LI15), Jianliao(TE14), Jianzhen (SI9) and Yanglingquan (GB34, the latter 4 points were stimulated with uniform reinforcing-reducing method) on the affected side. The treatment was given once every day, 6 days a week for 4 weeks. The pain severity was assessed by using visual analogue scale (VAS), the upper limb function evaluated by using Fugl-Meyer assessment (FMA) scale, the shoulder-joint function evaluated by using Constant-Murley score (CMS) questionnaire, and the daily living ability assessed by using Barthel index (BI) scale. The enzyme linked immunosorbent assay (ELISA) was used to determine the contents of serum beta-endorphin (ß-EP), enkephalin (ENK) and dynorphin (Dyn). The clinical therapeutic effect was evaluated by using Nimodipine scale method. RESULTS: Of the 39 and 41 cases in the control and observation groups, 7(17.95%) and 12(29.27%) were basically cured, 12(30.77%) and 13(31.71%) experienced marked improvement, 8(20.51%) and 11(26.83%) were effective, 12(30.77%) and 5 (12.19%) failed, with the total effective rate being 69.23% and 87.80%, respectively. The effective rate of the observation group was significantly higher than that of the control group (P<0.05). After the treatment, the VAS score was obviously reduced (P<0.01), and the scores of FMA scale, CMS questionnaire and BI scale, and contents of serum ß-EP, ENK and Dyn were all increased obviously in the two groups compared with their own pre-treatment (P<0.01). The therapeutic effect of "Tiaoshen Zhitong" needling was significantly superior to that of the routine needling in lowering VAS, and in raising scores of FMA scale, CMS questionnaire and BI scale and in up-regulating serum ß-EP, ENK and Dyn levels (P<0.01). CONCLUSION: "Tiaoshen Zhitong" needling is effective in reducing post-stroke shoulder pain and improving the motor function of the upper limb and shoulder-joint as well as the quality of daily life in stroke patients with shoulder pain. Its analgesic effect is probably related to the increase of the levels of serum ß-EP, ENK and Dyn.


Assuntos
Terapia por Acupuntura , Dor de Ombro/terapia , Acidente Vascular Cerebral , Humanos , Ombro , Dor de Ombro/etiologia , Acidente Vascular Cerebral/complicações , Resultado do Tratamento
13.
J Shoulder Elbow Surg ; 28(12): 2259-2271, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31500986

RESUMO

BACKGROUND: Proximal humeral fractures (PHFs) are among the most common fractures in elderly patients, but there is insufficient evidence from randomized controlled trials (RCTs) to determine which interventions are the most appropriate for their management. To date, no RCT has directly compared reverse shoulder arthroplasty (RSA) with nonoperative treatment for 3- or 4-part PHFs in elderly patients. METHODS: This was a prospective RCT. The primary objective was to compare pain and function 12 months after fracture using the Constant score in patients aged 80 years or older with 3- and 4-part PHFs, treated by either RSA or nonoperative treatment. Secondary outcome measures included Disabilities of the Arm, Shoulder and Hand, visual analog scale (VAS), Short Form 12 (SF-12), EuroQol 5 Dimensions, and EQ-VAS scores. RESULTS: We analyzed 30 nonoperative and 29 RSA patients with mean ages of 85 years and 82 years, respectively. No differences between the nonoperative and RSA groups were noted for any patient-reported outcomes at 12 months' follow-up except the VAS pain score. The Constant scores were 55.7 in the nonoperative group and 61.7 in the RSA group (P = .071); the Disabilities of the Arm, Shoulder and Hand scores were 29 and 21, respectively (P = .075); the VAS scores were 1.6 and 0.9, respectively (P = .011); the physical SF-12 scores were 36 and 37, respectively (P = .709); the mental SF-12 scores were 43 and 42, respectively (P = .625); the EuroQol 5 Dimensions scores were 0.89 and 0.92, respectively (P = .319); and the EQ-VAS scores were 65 and 67, respectively (P = .604). CONCLUSIONS: This study yields important evidence for the treatment of complex PHFs in elderly patients suggesting minimal benefits of RSA over nonoperative treatment for displaced 3- and 4-part PHFs. At short-term follow-up, the main advantage of RSA appeared to be less pain perception.


Assuntos
Artroplastia do Ombro , Tratamento Conservador , Fraturas do Ombro/terapia , Articulação do Ombro/fisiopatologia , Dor de Ombro/etiologia , Idoso de 80 Anos ou mais , Avaliação da Deficiência , Epífises/cirurgia , Feminino , Humanos , Úmero/cirurgia , Masculino , Medição da Dor , Medidas de Resultados Relatados pelo Paciente , Período Pós-Operatório , Estudos Prospectivos , Qualidade de Vida , Fraturas do Ombro/complicações , Fraturas do Ombro/diagnóstico por imagem , Fraturas do Ombro/fisiopatologia , Articulação do Ombro/diagnóstico por imagem , Articulação do Ombro/cirurgia , Resultado do Tratamento
14.
J Shoulder Elbow Surg ; 28(12): 2272-2278, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31500987

RESUMO

BACKGROUND: Our objective was to examine the clinical utility of old and new clinical tests directed to the long head of the biceps tendon (LHBT) and to quantify the importance of proper test interpretation. METHODS: A consecutive 65 patients scheduled to undergo arthroscopic surgery were selected. Before surgery, 5 clinical tests were performed: Speed, Yergason, upper cut, biceps resisted flexion (BRF), and modified BRF (mBRF) using a dumbbell. Pain in an area other than the bicipital groove was noted. The presence of LHBT disease was assessed at arthroscopy, and the clinical utility of the tests was calculated. RESULTS: The upper cut test was the most sensitive test and the one with the lowest negative likelihood ratio (0.90 and 0.26, respectively); the Yergason test was the most specific and the one with the highest positive likelihood ratio (0.83 and 2.20, respectively). BRF strength did not correlate with an LHBT lesion. The mBRF test has a sensitivity of 0.34 and a specificity of 0.75. Higher age predicted an increased risk of an LHBT lesion (1.2 times). Different interpretations of the tests can result in a difference of up to 29 percentage points in performance (ie, sensitivity). CONCLUSION: Our results suggest that the upper cut test should be used as a screening test and that after a positive result, the Speed and the Yergason tests should be used as confirmatory tests.


Assuntos
Exame Físico/métodos , Tendinopatia/diagnóstico , Adulto , Artroscopia , Feminino , Humanos , Funções Verossimilhança , Masculino , Pessoa de Meia-Idade , Força Muscular , Músculo Esquelético/fisiopatologia , Período Pré-Operatório , Sensibilidade e Especificidade , Articulação do Ombro/cirurgia , Dor de Ombro/etiologia , Tendinopatia/complicações
15.
J Shoulder Elbow Surg ; 28(12): 2427-2432, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31420223

RESUMO

BACKGROUND: Recent studies of patients with rotator cuff tears have demonstrated improved efficiency with Patient-Reported Outcomes Measurement Information System (PROMIS) when compared with traditional patient-reported outcome measures (PROM). However, these studies have been cross-sectional in nature and the responsiveness of PROMIS computer adaptive test (CAT) forms has not been evaluated. The purpose of this study was to determine the responsiveness of PROMIS CAT assessments in patients undergoing arthroscopic rotator cuff repair. METHODS: All patients undergoing arthroscopic rotator cuff repair by one of 3 fellowship-trained surgeons were included in the study. PROMIS CAT upper extremity physical function ("PROMIS-UE"), pain interference ("PROMIS-PI"), and depression ("PROMIS-D") scores from preoperative and 6-month postoperative visits were collected and analyzed. Patient-centric demographic factors, tear size, and biceps involvement were also correlated to preoperative and postoperative PROMIS scores. RESULTS: A total of 101 patients were enrolled in the study. The average age was 59.8 ± 8.9 years with 51 males (50.5%). Preoperative PROMIS-UE, PROMIS-PI, and PROMIS-D CAT scores improved significantly from 29.8 ± 6.0, 62.6 ± 5.1, and 48.4 ± 8.7, respectively, to 40.9 ± 9.8, 51.2 ± 9.3, and 42.9 ± 9.0, respectively, at 6-month follow-up (P < .001). Preoperative correlations were found between PROMIS-UE and PROMIS-PI scores (P < .001) and between PROMIS-PI and PROMIS-D scores (P = .001). No significant correlation was found between PROMIS-UE and PROMIS-D scores (P = .08), preoperatively. Preoperative PROMIS-UE, PROMIS-PI, or PROMIS-D scores were not correlated with rotator cuff tear size (P = .4). CONCLUSION: PROMIS CAT forms demonstrate responsiveness in patients undergoing arthroscopic rotator cuff repair across numerous domains.


Assuntos
Depressão/etiologia , Medidas de Resultados Relatados pelo Paciente , Lesões do Manguito Rotador/fisiopatologia , Lesões do Manguito Rotador/cirurgia , Dor de Ombro/etiologia , Extremidade Superior/fisiopatologia , Adulto , Idoso , Artroscopia , Estudos Transversais , Feminino , Humanos , Sistemas de Informação , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Período Pré-Operatório , Lesões do Manguito Rotador/complicações , Lesões do Manguito Rotador/psicologia , Ruptura/complicações , Ruptura/fisiopatologia , Ruptura/psicologia , Ruptura/cirurgia , Resultado do Tratamento
17.
Appl Ergon ; 81: 102908, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31422258

RESUMO

This study aimed at determining the extent to which individuals with neck-shoulder pain and non-symptomatic individuals differ in muscle activation patterns, when performing computer work, as quantified by exposure variation analysis (EVA). As a secondary aim, we also aimed to quantify the day-to-day reliability of EVA variables describing trapezius muscle activation in a non-symptomatic control group. Thirteen touch-typing computer users (pain: n = 5, non-symptomatic: n = 8) completed three pre-selected computer tasks in the laboratory. Upper trapezius muscle activity was recorded using electromyography and analyzed using EVA with five amplitude and five duration categories. Individuals with neck-shoulder pain spent less time at low amplitudes and exhibited longer uninterrupted periods of muscle activation compared to their non-symptomatic counterparts. Thus, non-symptomatic workers tended to switch between exposure levels more often than individuals with pain. For a majority of EVA variables, ICCs ranged from 0.6 to 0.9, and between-days coefficients of variation were between 0.4 and 2.2.


Assuntos
Terminais de Computador , Cervicalgia/fisiopatologia , Doenças Profissionais/fisiopatologia , Exposição Ocupacional/análise , Dor de Ombro/fisiopatologia , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Cervicalgia/etiologia , Doenças Profissionais/etiologia , Medição da Dor , Dor de Ombro/etiologia , Músculos Superficiais do Dorso/fisiopatologia , Análise e Desempenho de Tarefas , Trabalho/fisiologia
18.
J Shoulder Elbow Surg ; 28(10): 1928-1935, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31401129

RESUMO

HYPOTHESIS: The purpose of this study was to determine the rate of opioid use before and after shoulder stabilization surgery for instability due to recurrent dislocation and assess patient factors associated with prolonged opioid use postoperatively. METHODS: Patients undergoing primary shoulder stabilization procedures for shoulder instability due to recurrent dislocation were accessed from the Humana administrative claims database. Patients were categorized as those who filled 1 or more opioid prescriptions within 1 month, those who filled opioid prescriptions between 1 and 3 months, and those who never filled opioid prescriptions before surgery. Rates of opioid use were evaluated preoperatively and longitudinally tracked for each group. Multiple binomial logistic regression analysis was used to identify factors associated with opioid use at 3 months and 1 year after surgery. RESULTS: Overall, 4802 patients (45.9% opioid naive) underwent shoulder stabilization surgery for shoulder instability during the study period. Rates of opioid use significantly declined after the first postoperative month; however, at 1 year, the rate of opioid use was significantly greater in patients who filled opioid prescriptions preoperatively (13.4% vs. 1.9%, P < .0001). Filling opioid prescriptions 1 to 3 months prior to surgery was the strongest risk factor for opioid use at 1 year after surgery. CONCLUSIONS: Patients who were prescribed opioids 1 to 3 months before surgery had the highest risk of prolonged opioid use following surgery. Obesity, tobacco use, and a preoperative diagnosis of fibromyalgia were independently associated with prolonged opioid use following surgery.


Assuntos
Analgésicos Opioides/uso terapêutico , Instabilidade Articular/cirurgia , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Dor Pós-Operatória/tratamento farmacológico , Luxação do Ombro/cirurgia , Dor de Ombro/tratamento farmacológico , Adulto , Bases de Dados Factuais , Prescrições de Medicamentos/estatística & dados numéricos , Feminino , Fibromialgia/epidemiologia , Humanos , Instabilidade Articular/etiologia , Masculino , Obesidade/epidemiologia , Período Pós-Operatório , Período Pré-Operatório , Fatores de Risco , Luxação do Ombro/complicações , Articulação do Ombro/cirurgia , Dor de Ombro/etiologia , Fumar/epidemiologia , Fatores de Tempo , Estados Unidos/epidemiologia , Adulto Jovem
19.
Trials ; 20(1): 533, 2019 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-31455407

RESUMO

BACKGROUND: A classical approach to produce interscalene brachial plexus block (ISBPB) consistently spares the posterior aspect of the shoulder and ulnar sides of the elbow, forearm, and hand, which are innervated by the lower trunk of the brachial plexus (C8-T1). As an alternative to the classical approach, a caudal approach to ISBPB successfully produces anesthesia of the ulnar sides of the elbow, forearm, and hand. However, its beneficial effects on anesthesia in the posterior aspect of the shoulder have not been investigated. In addition, the C8 nerve root is not routinely selectively blocked during ISBPB. Therefore, we will compare the C5 to C7 and C5 to C8 nerve root blocks during a caudal approach to ISBPB to assess the clinical benefit of C8 nerve blocks for the surgical anesthesia of the posterior aspect of the shoulder. METHODS/DESIGN: In this prospective parallel-group single-blind randomized controlled trial, 74 patients scheduled to undergo arthroscopic shoulder surgery under ISBPB are randomly allocated to receive the C5 to C7 or C5 to C8 nerve root block at a 1:1 ratio. The primary outcome is pain intensity, which is rated as 0 (no pain), 1 (mild pain), or 2 (severe pain), during the introduction of a posterior portal into the glenohumeral joint. The secondary outcomes are (1) the extent of the ipsilateral sensory, motor, hemidiaphragmatic, and stellate ganglion blockade, (2) changes in the results of a pulmonary function test, (3) incidence of complications related to ISBPB, (4) postoperative numerical pain rating scale scores, (5) patients' satisfaction with the ISBPB, (6) dose and frequency of analgesic use, and (7) incidence of conversion to general anesthesia. DISCUSSION: This study is the first to evaluate the beneficial effects of the C8 nerve root block during ISBPB, which has rarely been performed due to the technical challenge in visualizing and blocking the C8 nerve root. It is expected that a C8 nerve root block performed during ISBPB will provide sufficient surgical anesthesia of the posterior aspect of the shoulder, which cannot be achieved by a classical approach to ISBPB. TRIAL REGISTRATION: ClicnicalTrials.gov, NCT03487874 . Registered on 4 April 2018.


Assuntos
Artroscopia , Bloqueio do Plexo Braquial/métodos , Bloqueio do Plexo Cervical/métodos , Dor Pós-Operatória/prevenção & controle , Dor de Ombro/prevenção & controle , Ombro/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Artroscopia/efeitos adversos , Bloqueio do Plexo Braquial/efeitos adversos , Bloqueio do Plexo Cervical/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/etiologia , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , República da Coreia , Ombro/inervação , Dor de Ombro/diagnóstico , Dor de Ombro/etiologia , Método Simples-Cego , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
20.
J Shoulder Elbow Surg ; 28(12): 2284-2289, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31371159

RESUMO

HYPOTHESIS AND BACKGROUND: Surgical outcomes are dependent on multiple clinical and patient factors. One patient factor is pain catastrophizing, which is associated with poorer outcomes in other surgical populations. Our purpose was to examine relationships between gender, patient-reported disease severity, and catastrophizing in patients in whom rotator cuff surgery is planned. We hypothesized that patients with more catastrophizing would report greater disease severity. METHODS: Patients undergoing surgery for unilateral symptomatic rotator cuff disease aged 35 to 75 years were prospectively evaluated. Data collected included demographic characteristics; imaging characteristics; range of motion; and Western Ontario Rotator Cuff Index (WORC), Pain Catastrophizing Scale (PCS), and Short Form 36 scores. RESULTS: A total of 156 patients (87 men and 69 women) aged 54 ± 8 years participated. The mean WORC score was similar between men and women (1286 ± 343 vs. 1327 ± 370, P = .38). The mean PCS score was 14.7 ± 10.6 for men and 17.9 ± 12.4 for women (P = .08). A moderate positive correlation was found between the WORC and PCS scores (r = 0.59, P < .001). Women had poorer WORC-Lifestyle subscale scores (P = .012). Range of motion, Short Form 36 scores, and tear severity were not related to measures of either the WORC or PCS. DISCUSSION AND CONCLUSIONS: The direct relationship between the WORC and PCS scores is consistent with research in other patient populations. Contrary to other work, no gender-based PCS score differences were observed. Differences on the WORC-Lifestyle subscale suggest that women may experience greater functional impacts to specific lifestyle elements than men. Catastrophizing is related to patient-reported disease severity in preoperative rotator cuff patients. Further research will clarify whether this relationship leads to poorer outcomes following surgery.


Assuntos
Catastrofização/psicologia , Lesões do Manguito Rotador/cirurgia , Articulação do Ombro/fisiopatologia , Dor de Ombro/psicologia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Estudos Prospectivos , Amplitude de Movimento Articular , Lesões do Manguito Rotador/complicações , Lesões do Manguito Rotador/diagnóstico por imagem , Lesões do Manguito Rotador/fisiopatologia , Fatores Sexuais , Articulação do Ombro/diagnóstico por imagem , Articulação do Ombro/cirurgia , Dor de Ombro/etiologia , Inquéritos e Questionários , Índices de Gravidade do Trauma , Resultado do Tratamento
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