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3.
Zhongguo Gu Shang ; 32(6): 504-507, 2019 Jun 25.
Artigo em Chinês | MEDLINE | ID: mdl-31277531

RESUMO

OBJECTIVE: To explore the method and effect of ultrasound-guided suprascapular nerve block combined with acupuncture in the treatment of calcified tendinitis of rotator cuff. METHODS: From January 2015 to December 2017, total 30 patients with calcified tendinitis, including 23 cases of supraspinatus tendon, 5 cases of infraspinatus tendon and 2 cases of subscapular tendon, were treated with ultrasound-guided suprascapular nerve block combined with acupuncture. There were 7 males and 23 females, ranging in age from 36 to 71 years old, with an average of 51.6 years old. There were 17 cases on the right and 13 cases on the left. VAS pain score, Constant-murley score, UCLA score and X-ray examination were used to evaluate the clinical results before and after surgery. RESULTS: The mean follow-up was 14.3 months (6 to 30 months). The preoperative VAS score was 3.82±1.13, Constant-Murley score was 36.91±7.95 and UCLA score was 11.35±2.17. The final follow-up scores were 1.32±1.06, 90.61±2.89 and 33.22±1.51, respectively. The final follow-up scores were improved significantly(P<0.05). CONCLUSIONS: Conservative treatment of calcified rotator cuff tendinitis is ineffective. Suprascapular nerve block guided by ultrasound combined with acupuncture has a good therapeutic effect. It is a minimally invasive, economic, safe and effective method, which is worth promoting.


Assuntos
Terapia por Acupuntura , Bloqueio Nervoso , Lesões do Manguito Rotador , Tendinopatia , Adulto , Idoso , Artroscopia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Manguito Rotador , Tendinopatia/terapia , Resultado do Tratamento
4.
Cuad. Hosp. Clín ; 60(1): 11-16, jun. 2019. ilus.
Artigo em Espanhol | LILACS, LIBOCS | ID: biblio-1006566

RESUMO

INTRODUCCIÓN: una gran parte de la población adulta padece dolor de hombro en algún momento de su vida. Dejando aparte las enfermedades neoplásicas, sistémicas y traumáticas directas, una de las causas de dolor de hombro es la patología inflamatoria o degenerativa del manguito rotador, que puede ser responsable de una limitación funcional importante adulto. OBJETIVO: determinar el grado de correlación clínica y ultrasonográfica con los hallazgos intra-operatorios en pacientes con diagnóstico de ruptura de manguito rotador en el servicio de Traumatología del Hospital Obrero Nº 1, durante el periodo 2010 ­ 2014. MATERIAL Y MÉTODOS: estudio descriptivo transversal y analítico. Se estudiaron 56 pacientes de ambos sexos, internados en el servicio de Traumatología y Ortopedia del Hospital Obrero Nº1, durante el periodo del 1° de enero del 2010 al 31 de diciembre del año 2014. Se realizó la valoración clínica (maniobra de Jobe y manobra de Yocum) y ultrasonográfica y se compararon los resultados con los hallazgos intra-operatorios, para determinar la validez y la seguridad de la clínica y la ecografía. RESULTADOS: se determina que el test diagnóstico clínico tiene mayor validez (Sensibilidad: 92,7-87,8% y Especificidad: 73,3-60%) y seguridad (Valor Predictivo Positivo: 90,5-85,7% y Valor Predictivo Negativo: 78,6-64,3%) que el test diagnóstico ultrasonográfico (Sensibilidad: 85,4%, Especificidad: 66,7%, Valor Predictivo Positivo: 87,5% y Valor Predictivo Negativo: 62,5%). CONCLUSIÓN: se determina que existe una correlación clínica y ultrasonográfica con los hallazgos intra-operatorios en pacientes con diagnóstico de ruptura de manguito rotador en el servicio de Traumatología del Hospital Obrero Nº 1


INTRODUCTION: a great part of the adult population suffers shoulder pain at some moment of life. Leaving aside direct neoplastic systems and traumatic diseases, one of the causes of pain of shoulder is the inflammatory or degenerative pathology of the muff rotator, which can result in an important functional limitation. OBJECTIVE: determining the degree of clinical and ultrasonographic correlation with the intra-operative findings in patients with yielding-point diagnosis of muff rotator in the service of Traumatology of the Hospital Obrero Nº 1, during the period 2010 ­ 2014. MATERIAL AND METHODS: cross-sectional descriptive and analytical study. 56 patients of both sexes were surveyed, inpatients in the service of Traumatology y Orthopedic of the Hospital Obrero Nº 1, during the period January 1 of 2010 to December 31 of 2014. The clinical assessment was carried out (maneuver of Jobe and maneuver of Yocum) and ultrasonographic and the results were compared with the intra operative findings, in order to determine the value and security of the clinic and the echography. RESULTS: it is determined that the diagnostic test has higher validity (Sensitivity: 92,7-87,8% and specificity: 73,3-60%) and certainty (Positive Predictive Value: 90,5-85,7% and Negative Predictive Value: 78,6-64,3%) than the diagnostic ultrasonographic test (Sensitivity: 85.4%, Specificity: 66.7%, Positive Predictive Value: 87.5% and Negative Predictive Value: 62.5%). CONCLUSIONS: it is determined that there is a clinical and ultrasonographic correlation with the intra operative findings in patients with yielding-point diagnosis of muff rotator at the service of Traumatology of the Hospital Obrero Nº 1


Assuntos
Humanos , Animais , Masculino , Ultrassonografia/instrumentação , Manguito Rotador/diagnóstico por imagem , Traumatologia/métodos , Tendinopatia
5.
J Shoulder Elbow Surg ; 28(6S): S100-S109, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31196503

RESUMO

BACKGROUND: Superior capsule reconstruction (SCR) has shown promising outcomes in its initial description, but lacks additional reports analyzing outcomes. This study analyzes early outcomes of SCRs in patients with massive irreparable rotator cuff tears. METHODS: A retrospective analysis of all SCRs at our institution from January 1, 2015, to August 31, 2017, was performed with a minimum 6-months follow-up. A total of 34 patients were included with a mean age of 60 years. SCR was performed by 1 of 6 fellowship trained surgeons. RESULTS: At an average follow-up of 12 months, 22 patients were identified as failures after modified Neer classification. Furthermore, 8 of these patients have undergone a reoperation, whereas an additional 14 patients were considered clinical failures experiencing continued pain and a lack of shoulder function. Of note, 2 of the 3 patients with a subscapularis tear had a failure. In addition, revision cases, female gender, increased fatty infiltration in the infraspinatus and low surgeon volume were associated with a higher rate of failure. There was no significant improvement in range of motion or functional scores. CONCLUSION: SCR performed for large-to-massive irreparable rotator cuff tears has a high rate of persistent pain and poor function leading to clinical failure in 65% of patients. Risk factors predicting clinical failure included revision cases, female gender, increased Goutallier fatty infiltration of the infraspinatus, and low surgeon volume (n ≤ 10).


Assuntos
Cápsula Articular/cirurgia , Lesões do Manguito Rotador/cirurgia , Transplante de Pele , Tecido Adiposo/patologia , Idoso , Aloenxertos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Amplitude de Movimento Articular , Reoperação , Estudos Retrospectivos , Manguito Rotador/patologia , Lesões do Manguito Rotador/complicações , Lesões do Manguito Rotador/patologia , Lesões do Manguito Rotador/fisiopatologia , Fatores Sexuais , Dor de Ombro/etiologia , Falha de Tratamento
6.
Harefuah ; 158(6): 395-397, 2019 Jun.
Artigo em Hebraico | MEDLINE | ID: mdl-31215193

RESUMO

INTRODUCTION: Platelet rich plasma (PRP) intra-articular injections are gaining popularity worldwide. Albeit its vast application, its efficacy has not been proven unequivocally. This position statement was conducted for the Israeli Shoulder and Elbow Society and is intended to guide practitioners on treatment with PRP injections. Platelets secrete growth factors as part of their function which stimulates angiogenesis, cellular proliferation and tissue repair. Four main PRP subtypes exist: activated, non-activated, leucocyte-rich and leukocyte-poor. The function of leukocytes in PRP is not yet clearly understood and may locally cause harm. There are 3 main pathologies involving the shoulder and elbow in which PRP is being used: rotator cuff tendinopathy, rotator cuff tears and epicondylitis. Contraindications to PRP injection are infection, systemic disease presenting at the injection site, bone marrow pathology, thrombocytopenia, systemic steroids use and anticoagulant therapy. Most studies that explored the efficacy of PRP for rotator cuff tendinopathy failed to demonstrate any clinical benefit when compared to other non-operative treatments. Research shows that PRP injection improves rotator cuff tear healing when used as an augmentation to surgical repair, irrespective of tear size. Furthermore, high quality studies reported less pain in the early postoperative period with PRP augmentation in rotator cuff repair surgery but no significant changes to post-operative shoulder function. Larger studies were conducted on PRP injection to various joints which reported no side effects and approved its safety.


Assuntos
Plasma Rico em Plaquetas , Lesões do Manguito Rotador , Tendinopatia , Artroplastia , Artroscopia , Humanos , Manguito Rotador , Lesões do Manguito Rotador/terapia , Resultado do Tratamento
7.
Adv Gerontol ; 32(1-2): 198-202, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31228389

RESUMO

The aim of the study is to compare the frequency of the rotator cuff tears in patients younger and older than 60 years during shoulder dislocation. The study included the results of observation of 101 patients after shoulder dislocation without signs of damage of the rotator cuff before the trauma. All the patients were divided into 2 groups: older and younger than 60. All the patients after the injury underwent radiography and MRI. Pattern of injury of the shoulder joint was assessed via MRI. In patients younger than 60 years, the risk of a fracture of anterior margin of glenoid during the acute shoulder dislocation is higher by 5,18 times (95% CI 1,4-12,7) than in patients older than 60 years, due to direct mechanism and high-energy trauma in patients younger than 60 years. The risk of a fracture of the head of the humerus in the group of patients older than 60 years is 27,75 times higher (95% CI 3,57-215,135) than in the group of patients younger than 60, which is associated with age-related osteoporosis in the proximal humerus in patients of the older age group. In patients older than 60 years during the dislocation of the shoulder, the rotator cuff of the shoulder is damaged in 78,6% of cases, whereas in young patients it is 32,9%. The risk of rotator cuff damage in the older age group is 11,15 times (95% CI 4,047-30,734) higher than in young patients. Thus, all patients, especially those older than 60, should be undergo MRI to increase the accuracy of diagnosing of soft tissue injuries, which affects the choice of techniques and method of treatment.


Assuntos
Lesões do Manguito Rotador , Luxação do Ombro , Articulação do Ombro , Idoso , Humanos , Imagem por Ressonância Magnética , Manguito Rotador , Lesões do Manguito Rotador/diagnóstico por imagem , Lesões do Manguito Rotador/terapia , Luxação do Ombro/diagnóstico por imagem , Luxação do Ombro/terapia
8.
Bone Joint J ; 101-B(5): 603-609, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31038994

RESUMO

AIMS: Failure of healing is a well-known problem after repair of the rotator cuff. This study aimed to investigate if early repair of trauma-related full-thickness rotator cuff tears (FTRCTs) could prevent this failure. PATIENTS AND METHODS: In this prospective trial, 62 consecutive patients (14 women (23%), 48 men (77%); median age 61 years (interquartile range (IQR) 54 to 65)) with trauma-related FTRCT underwent arthroscopic single-row repair within six weeks of trauma. Tendon integrity was assessed one year after surgery using the Sugaya score on MR images. Patients were followed up with Western Ontario Rotator Cuff (WORC) index, EuroQol visual analogue scale (EQ VAS), and the Constant-Murley score (CS) two years after repair. RESULTS: A total of 57 patients (92%) had MR images available at one year; 59 patients (95%) had CS (one year), WORC (two years), and EQ VAS scores (two years). Intact repair was found on MRI in 36 patients (63%); 13 patients (23%) displayed healing failure of at least one repaired tendon and eight patients (14%) displayed total healing failure. Median WORC index and relative CS improved from 30.8 points (IQR 20.1 to 38.6) at baseline to 85.0 points (IQR 60.6 to 95.7) at two years and 26.5 points (IQR 21.2 to 37.4) to 83.2 points (IQR 71.9 to 97.5) at one year, respectively. The relative CS at one year was significantly better among those with intact repairs compared with those with healing failure (91.6 vs 78.1 points; p = 0.031). CONCLUSION: Although early repair of trauma-related FTRCT improved patient relevant outcomes over two years for the entire cohort, only two out of three repaired rotator cuffs displayed intact structural integrity on MRI after one year. Consequently, early repair did not seem to prevent healing failure after trauma-related FTRCT. Cite this article: Bone Joint J 2019;101-B:603-609.


Assuntos
Artroscopia/efeitos adversos , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Lesões do Manguito Rotador/cirurgia , Idoso , Artroscopia/métodos , Estudos de Coortes , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Manguito Rotador/diagnóstico por imagem , Manguito Rotador/cirurgia , Fatores de Tempo , Resultado do Tratamento , Cicatrização
9.
Forensic Sci Int ; 300: 82-84, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31079011

RESUMO

Muscular hemorrhages around the scapula are frequently found in fatal drowning cases without injuries in the upper back at time of autopsy. The present study investigated the frequency of muscular hemorrhages around the scapula and determined the mechanism responsible for this phenomenon. Muscular hemorrhages around the scapula were found in 104 of 164 (63.4%) bodies assessed. Hemorrhage in the infraspinatus muscle was most common, followed by the supraspinatus muscle. These muscular hemorrhages were not associated with upper extremity injuries and were most frequently found in accidental drowning cases (78.7%), followed by cases of suicide (56.0%), and in natural disease prior to drowning (19.0%). We examined muscular hemorrhage around the scapula and cervical injuries that restricted the active motion of upper extremities in drowning cases. The vertebral level of cervical injuries were related to muscular hemorrhages around the scapula. These results suggested that muscular hemorrhages around the scapula were not a result of agonal convulsions but were caused by consciously active excessive motion of the upper extremities while drowning. Investigations of the muscular hemorrhages around the scapula can provide insights towards the manner of fatal drowning.


Assuntos
Afogamento/diagnóstico , Hemorragia/patologia , Músculo Esquelético/patologia , Manguito Rotador/patologia , Escápula , Acidentes , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Vértebras Cervicais/lesões , Criança , Pré-Escolar , Patologia Legal , Humanos , Masculino , Pessoa de Meia-Idade , Suicídio , Adulto Jovem
10.
Rev Col Bras Cir ; 46(2): e2151, 2019 May 27.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31141032

RESUMO

Our objective is to describe the long biceps tendon transfer technique for the treatment of shoulder anterior instability. In this procedure, the long tendon of the biceps brachii is detached from the supraglenoid tubercle and transferred to the anterior edge of the glenoid cavity through a subscapularis tenotomy, reproducing the sling effect and increasing the anterior block. The technique is easy to perform and minimizes the risks of the coracoid process transfer. In conclusion, the transfer of the long tendon of the biceps brachii is an option for the treatment of glenohumeral instability.


Assuntos
Instabilidade Articular/cirurgia , Manguito Rotador/cirurgia , Articulação do Ombro/cirurgia , Transferência Tendinosa/métodos , Tendões/cirurgia , Tenotomia/métodos , Humanos , Ilustração Médica , Reprodutibilidade dos Testes , Resultado do Tratamento
11.
Managua; s.n; maio 2019. 59 p. ilus, tab, graf.
Tese em Espanhol | LILACS | ID: biblio-1015449

RESUMO

OBJETIVO: Caracterizar al personal con tendinopatía del Manguito Rotador de industrias cárnicas de Juigalpa y Nandaime atendido en la Clínica de Medicina Laboral "Oscar Benavides Lanuza", Enero 2014 - Diciembre 2016. METODOLOGÍA: Estudio descriptivo, corte transversal, constituido por una muestra de 48 personas, se obtuvo del registro de los expedientes médicos suministrados por la oficina de Archivo. La recolección de la información se realizó a partir del llenado de ficha elaborada por el autor, se recolectó datos según los objetivos, para el procesamiento de la información se empleó programa estadístico SPSS versión 21, se hizo gráficos en Excel, el texto en Microsoft Word y la presentación en Power Point. RESULTADOS: El personal con tendinopatía del Manguito Rotador fue más numeroso en mayores de 41 años con 21 casos (44%), con predominio en hombres 45 casos (94%), cumpliendo una jornada laboral de 8 horas 26 casos (54%), con más de 16 años de laborar en la empresa 20 casos, (42%), no se realiza rotación de puesto de trabajo 38 casos, (79%), el personal afectado labora en ambiente térmico que oscila entre 10 ­ 28 grados centígrados. CONCLUSIONES: Las características más frecuentes en el personal estudiado fueron lesión bilateral de hombros, mayoría son hombres, no hacen rotación de puesto de trabajo, usan herramientas cortantes, laboran 8 horas o más la mayoría tuvo manejo medico conservador y la mayoría tiene una pensión parcial otorgada por la Comisión Médica de Invalidez (CMI)


Assuntos
Humanos , Indústria da Carne , Saúde do Trabalhador , Manguito Rotador , Tendinopatia , Doenças Profissionais , Epidemiologia Descritiva , Estudos Transversais , Saúde do Trabalhador
12.
J Shoulder Elbow Surg ; 28(6S): S168-S174, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31126793

RESUMO

BACKGROUND: The purpose of this study was to compare preoperative radiographic evaluation with intraoperative video and explant analysis in patients undergoing revision of a previous anatomic total shoulder arthroplasty (TSA). METHODS: We evaluated the preoperative radiographs of 165 revisions of failed TSAs for component loosening and glenohumeral registry (ie, the spatial relationship of the glenoid component and the prosthetic humeral head). Seventy-nine intraoperative videos were evaluated for component stability, rotator cuff (RC) integrity, synovitis, and glenoid bone loss. Eighty-seven explants were reviewed to assess wear patterns and presence of backside cement. RESULTS: Of 79 glenoid components, 47 were radiographically loose, but only 30 of 79 were loose intraoperatively. Thirty-two were radiographically fixed, but only 26 of 32 were fixed intraoperatively. If radiographically loose, 53% had severe glenoid bone loss. If radiographically fixed, 77% had mild to moderate bone loss (P = .008). Synovitis was associated with glenoid fixation: mild with a loose glenoid (6%) and severe with a fixed glenoid (30%, P = .012). Superior registry comprised 46%. RC deficiency was associated with posterior and anterior registry (88% and 79%, respectively). Explant examination revealed an eccentric wear pattern was predominant. CONCLUSION: Radiographic evaluation of glenoid loosening in patients undergoing revision of TSAs will often differ from intraoperative findings (40% false-positive rate and 17% false-negative rate). Assessment of glenohumeral registry can help anticipate RC deficiency, with posterior and anterior registry associated with RC deficiency. Patients with a loose glenoid are more likely to have severe synovitis and more severe glenoid bone deficiencies. Failed TSAs are more likely to have asymmetrical wear of the glenoid component, suggesting altered pathomechanics that may have led to failure.


Assuntos
Artroplastia do Ombro , Cavidade Glenoide/diagnóstico por imagem , Cabeça do Úmero/diagnóstico por imagem , Reoperação , Articulação do Ombro/diagnóstico por imagem , Articulação do Ombro/cirurgia , Idoso , Feminino , Humanos , Período Intraoperatório , Masculino , Pessoa de Meia-Idade , Período Pré-Operatório , Falha de Prótese , Radiografia , Manguito Rotador/diagnóstico por imagem , Prótese de Ombro , Sinovite/diagnóstico por imagem , Gravação em Vídeo
13.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 33(5): 628-633, 2019 May 15.
Artigo em Chinês | MEDLINE | ID: mdl-31090359

RESUMO

Objective: Electrospinning technique was used to manufacture polycaprolactone (PCL)/collagen typeⅠ nanofibers orientated patches and to study their physical and chemical characterization, discussing their feasibility as synthetic patches for rotator cuff repairing. Methods: PCL patches were prepared by electrospinning with 10% PCL electrospinning solution (control group) and PCL/collagen typeⅠorientated nanofibers patches were prepared by electrospinning with PCL electrospinning solution with 25% collagen type Ⅰ(experimental group). The morphology and microstructure of the two patches were observed by gross and scanning electron microscopy, and the diameter and porosity of the fibers were measured; the mechanical properties of the patches were tested by uniaxial tensile test; the composition of the patches was analyzed by Fourier transform infrared spectroscopy; and the contact angle of the patch surface was measured. Two kinds of patch extracts were co-cultured with the third generation of rabbit tendon stem cells. Cell counting kit 8 (CCK-8) was used to detect the toxicity and cell proliferation of the materials. Normal cultured cells were used as blank control group. Rabbit tendon stem cells were co-cultured with the two patches and stained with dead/living cells after 3 days of in vitro culture, and laser confocal scanning microscopy was used to observe the cell adhesion and activity on the patch. Results: Gross and scanning electron microscopy showed that the two patch fibers were arranged in orientation. The diameter of patch fibers in the experimental group was significantly smaller than that in the control group ( t=26.907, P=0.000), while the porosity in the experimental group was significantly larger than that in the control group ( t=2.506, P=0.032). The tensile strength and Young's modulus of the patch in the experimental group were significantly higher than those in the control group ( t=3.705, P=0.029; t=4.064, P=0.034). Infrared spectrum analysis showed that PCL and collagen type Ⅰ were successfully mixed in the experimental group. The surface contact angle of the patch in the experimental group was (73.88±4.97)°, which was hydrophilic, while that in the control group was (128.46±5.10) °, which was hydrophobic. There was a significant difference in the surface contact angle between the two groups ( t=21.705, P=0.002). CCK-8 test showed that with the prolongation of culture time, the cell absorbance ( A) value increased gradually in each group, and there was no significant difference between the experimental group and the control group at each time point ( P>0.05). Laser confocal scanning microscopy showed that rabbit tendon stem cells could adhere and grow on the surface of both patches after 3 days of culture. The number of cells adhered to the surface of the patches in the experimental group was more than that in the control group, and the activity was better. Conclusion: PCL/ collagen type Ⅰ nanofibers orientated patch prepared by electrospinning technology has excellent physical and chemical properties, cell adhesion, and no cytotoxicity. It can be used as an ideal scaffold material in tendon tissue engineering for rotator cuff repair in the future.


Assuntos
Nanofibras , Manguito Rotador , Tecidos Suporte , Animais , Proliferação de Células , Colágeno , Poliésteres , Coelhos , Engenharia Tecidual
14.
Biomed Res Int ; 2019: 7387131, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31061826

RESUMO

Background: Significant proportion of rotator cuff tears (RCTs) in clinical field are of a kind of repairable tear wherein the degree of fatty infiltration is of Goutallier stage 1 or stage 2. Therefore, the animal model, showing similar fatty infiltration, seems preferable for researches. The purpose of this study is to find out the proper time frame in which there is Goutallier stage 1 or stage 2 fatty infiltration in the rabbit RCT model for the research of repairable RCT in humans. Methods: Supraspinatus tendon tears were created in forty male New Zealand white rabbits at their right shoulder (n= 8 for each group), and a sham operation on the left shoulder. Rabbits were divided into five groups (2nd, 4th, 6th, 8th, and 12th weeks). Specimens were harvested from the central portion of the supraspinatus muscle for haematoxylin and eosin (H &E) staining, followed by histological and Goutallier grading evaluation. Results are expressed as mean ± standard deviation by Sigma Plot software (version 7.0). Results: At two weeks, mainly lipoblasts were observed around the muscle fibers, and at four weeks these lipoblasts were replaced by mature adipocytes with fatty infiltration amount (2.13 ± 0.35). The degree of muscle atrophy was (1.50 ± 0.53) at four weeks compared to sham group (0.88 ± 0.64) with significant difference (p < 0.05). The inflammatory process appeared as two phases. At two weeks, it was increased with grading value (1.88 ± 0.35). However, in the four-week group, it showed a sharp decrease (0.50 ± 0.53). At six weeks, inflammation reappeared to increase (1.13 ± 0.83). Then, a gradual decline appeared at eight weeks (0.88 ± 0.83) and at 12 weeks (0.50 ± 0.92). Conclusions: At two and four weeks, both fat distribution in rabbit supraspinatus muscles and Goutallier grading scale mostly appeared as grade 2. Therefore, we can consider four weeks to be a suitable period for making a repairable RCT animal model for the human research, considering the early acute tissue reaction at 2 weeks after the tendon tears.


Assuntos
Tecido Adiposo/metabolismo , Atrofia Muscular/metabolismo , Lesões do Manguito Rotador/metabolismo , Manguito Rotador/metabolismo , Tecido Adiposo/patologia , Animais , Modelos Animais de Doenças , Humanos , Masculino , Atrofia Muscular/etiologia , Atrofia Muscular/patologia , Coelhos , Manguito Rotador/patologia , Lesões do Manguito Rotador/patologia , Ombro/patologia , Fatores de Tempo
15.
Biomed Res Int ; 2019: 9346567, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31073531

RESUMO

Background: Repairs of large to massive rotator cuff tears have a high failure rate. We investigated the efficacy of a novel, reinforced, low immunogenic, porcine small intestine submucosa (SIS) patch to repair a supraspinatus tendon defect in a rabbit model. We hypothesized that the histological and biomechanical results of SIS patch repair would be comparable with those of autologous fascia lata (FL) repair. Methods: The study mainly comprised two parts. First, the characteristics of the SIS patch were evaluated, including its micromorphology, mechanical properties, and immunogenic properties. Second, a supraspinatus tendon defect model was created in 36 rabbits (72 shoulders). The bilateral shoulders were randomly chosen to undergo repair using either a SIS patch (SIS group) or autologous FL (FL group). At 4, 8, and 12 weeks, histological analysis was performed using four shoulders from each group, and biomechanical tests were performed using eight shoulders from each group. Results: The SIS patch was a three-dimensional construct mainly composed of collagen fibers. The mean single and double suture retention loads of the SIS patch were 48.6 ± 5.8 N and 117.9 ± 2.7 N, respectively. The DNA content in the SIS patch was 53.9 ± 10.9 ng/mg dry weight. Both the histological score and ultimate load to failure increased in a time-dependent manner in both groups, with no significant differences between the SIS and FL groups at 12 weeks. Conclusion: Repair of a large supraspinatus tendon defect using a reinforced, low immunogenic, SIS patch achieves similar effects as autologous FL in a rabbit model. This novel patch might be useful to be employed as a structural tissue replacement in medical activities.


Assuntos
Mucosa Intestinal/ultraestrutura , Intestino Delgado/ultraestrutura , Lesões do Manguito Rotador/terapia , Traumatismos dos Tendões/terapia , Animais , Tecido Conjuntivo/transplante , Modelos Animais de Doenças , Humanos , Mucosa Intestinal/química , Intestino Delgado/química , Coelhos , Manguito Rotador/fisiopatologia , Lesões do Manguito Rotador/fisiopatologia , Articulação do Ombro/crescimento & desenvolvimento , Articulação do Ombro/lesões , Suínos , Traumatismos dos Tendões/fisiopatologia , Adesivo Transdérmico , Cicatrização
16.
J Shoulder Elbow Surg ; 28(6S): S118-S123, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31133407

RESUMO

BACKGROUND: There is currently a paucity of non-database studies looking at safety and outcomes after outpatient shoulder arthroplasty. The purpose of this study was to report our initial safety experience with outpatient shoulder arthroplasty including 90-day complications and readmissions. Our hypothesis was that the rate of early complications after outpatient shoulder arthroplasty would be low and similar to that of inpatient procedures regardless of outpatient setting. METHODS: We analyzed 50 consecutive patients who underwent outpatient shoulder arthroplasties (44 anatomic total shoulder arthroplasties, 4 reverse total shoulder arthroplasties, and 2 hemiarthroplasties) from 2014-2017. The readmission rate and complications were recorded. All patients were available for minimum 3-month follow-up. Preoperative and postoperative Single Assessment Numeric Evaluation, American Shoulder and Elbow Surgeons, and visual analog scale scores were recorded. RESULTS: The average age was 56.9 ± 6.9 years; average body mass index, 29.75 ± 5.9; and average Charleston Comorbidity Index, 1.6 ± 1.2. There were 6 complications (12%) (hematoma, deep venous thrombosis, axillary nerve injury, acute infection, and 2 subscapularis failures). Only 4 occurred within the 90-day global period, and only 1 patient required readmission. Our subscapularis failures occurred after 3 months postoperatively and required additional surgery (arthroscopic repair and revision to reverse total shoulder arthroplasty). At last follow-up, all had significant improvements (P < .001) in range of motion and functional scores (American Shoulder and Elbow Surgeons, Single Assessment Numeric Evaluation, and visual analog scale scores). No difference in the complications and functional outcomes was found between the patients based on their surgical setting. CONCLUSION: Outpatient shoulder arthroplasty is a safe option for appropriately selected patients. No difference in complications and outcomes occurs regardless of outpatient setting.


Assuntos
Procedimentos Cirúrgicos Ambulatórios/efeitos adversos , Artroplastia do Ombro/efeitos adversos , Readmissão do Paciente , Complicações Pós-Operatórias/etiologia , Artroplastia do Ombro/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Amplitude de Movimento Articular , Reoperação , Manguito Rotador/cirurgia , Articulação do Ombro/fisiopatologia , Articulação do Ombro/cirurgia , Resultado do Tratamento
17.
Maturitas ; 123: 9-14, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31027684

RESUMO

Rotator cuff tears (RCTs) are a common cause of shoulder pain and weakness in the elderly (age > 65yrs) and result in reduced quality of life, loss of income and a burden on health care. With the elderly population living longer there is a growing interest in the effective and efficient management of RCTs. In a majority of cases, the initial treatment is conservative, with physical therapy, analgesics and possibly corticosteroid or plasma rich protein injections. There are various surgical options, including rotator cuff repair, superior capsule reconstruction, subacromial decompression and reverse shoulder arthroplasty. The aim of this article is to provide a narrative review of evidence guiding the management options for RCTs in the elderly.


Assuntos
Corticosteroides/uso terapêutico , Analgésicos/uso terapêutico , Procedimentos Ortopédicos , Modalidades de Fisioterapia , Plasma Rico em Plaquetas , Lesões do Manguito Rotador/terapia , Idoso , Descompressão Cirúrgica , Humanos , Injeções Intra-Articulares , Satisfação do Paciente , Qualidade de Vida , Procedimentos Cirúrgicos Reconstrutivos , Manguito Rotador/cirurgia , Dor de Ombro , Tenodese , Tenotomia
18.
J Shoulder Elbow Surg ; 28(5): 819-827, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30928396

RESUMO

BACKGROUND: Arthroscopic rotator cuff repair (ARCR) provides excellent clinical outcomes but is often associated with significant postoperative pain. The use of intraoperative anesthesia in conjunction with multimodal pharmacologic strategies is a widely accepted approach for managing surgical pain and reducing opiate use. The purpose of this study was to determine whether using a combined field and suprascapular nerve block with liposomal bupivacaine (LB) in addition to an interscalene block would provide greater pain relief and a reduction in opiate consumption compared with an interscalene block alone. METHODS: The study enrolled 50 patients with full-thickness rotator cuff tears undergoing primary ARCR surgery. Patients were randomized to receive intraoperative LB (n = 25) or not (n = 25) and given postoperative "pain journals" to document visual analog scale pain scores and to track their daily opioid consumption during the first 5 postoperative days. RESULTS: Patients in the LB group reported statistically and clinically lower pain scores during postoperative days 1 and 2 (P < .0001 and P = .03, respectively). In addition, patients in the LB group consumed significantly fewer narcotics than the control group during the 5-day period, demonstrating a 64% reduction in total narcotic consumption (P = .002). CONCLUSION: The findings of this study suggest that the addition of LB to multimodal anesthetic protocols significantly reduces the acute perioperative pain experienced following rotator cuff repair and the number of narcotic pills consumed in the first 5 days after ARCR. Furthermore, the findings provide guidelines for postoperative narcotic prescribing to reduce the quantity of opiates prescribed.


Assuntos
Analgésicos Opioides/administração & dosagem , Anestésicos Locais/administração & dosagem , Artroplastia/efeitos adversos , Bupivacaína/administração & dosagem , Dor Pós-Operatória/tratamento farmacológico , Lesões do Manguito Rotador/cirurgia , Artroplastia/métodos , Artroscopia/efeitos adversos , Artroscopia/métodos , Feminino , Humanos , Injeções Intra-Articulares , Lipossomos , Masculino , Pessoa de Meia-Idade , Bloqueio Nervoso/métodos , Alcaloides Opiáceos/administração & dosagem , Manejo da Dor , Medição da Dor , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/etiologia , Manguito Rotador/cirurgia , Método Simples-Cego
19.
J Back Musculoskelet Rehabil ; 32(3): 519-527, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30932877

RESUMO

BACKGROUND: Studies have emphasized the importance of the presence of myofascial trigger points (MTrPs) in patients with rotator cuff pathologies and the high frequency of MTrPs in rotator cuff muscles. OBJECTIVE: Evaluate the effectiveness of the treatment of active MTrPs in patients with rotator cuff pathologies. METHODS: Fifty-three patients with rotator cuff tear were randomized into two groups. All patients received the same standard conservative treatment twice a week for 6 weeks. Patients in Group 1 additionally received ischemic compression (IC) of MTrPs. Pain, range of motion (ROM), function, and anxiety and depression were assessed. MTrPs in rotator cuff muscles were assessed manually, and the number of MTrPs on the shoulder complex was counted. RESULTS: There were no significant differences between the groups in terms of changes in resting/activity/night pain, ROM, function, or anxiety and depression (p> 0.05). Pain scores improved only in Group 1. However, the total number of MTrPs was significantly decreased in Group 1 (p= 0.001). CONCLUSION: A six-week course of IC helps treat active MTrPs. A standard conservative treatment program reduced pain and increased function; the addition of MTrP treatment did not improve clinical outcomes in patients with rotator cuff pathologies.


Assuntos
Manipulações Musculoesqueléticas , Lesões do Manguito Rotador/terapia , Dor de Ombro/terapia , Pontos-Gatilho , Adulto , Idoso , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Amplitude de Movimento Articular , Recuperação de Função Fisiológica , Manguito Rotador/fisiopatologia , Lesões do Manguito Rotador/fisiopatologia , Ombro/fisiopatologia , Dor de Ombro/fisiopatologia
20.
Beijing Da Xue Xue Bao Yi Xue Ban ; 51(2): 273-276, 2019 Apr 18.
Artigo em Chinês | MEDLINE | ID: mdl-30996367

RESUMO

OBJECTIVE: To evaluate the association between rotator cuff tear and the proximal migration of humeral head. METHODS: In this research, we retrospectively selected 30 patients with unilateral rotator cuff tear in Peking University People's Hospital from September 2015 to May 2016, who received magnetic resonance imaging (MRI) and X-ray of the painful shoulder before enrollment in this study, the duration between the two examinations was no longer than 1 week, and also there was no past history of surgery in the selected shoulders. There was no other exclusion criteria. Upward migration index (UMI) was the ratio between the distance of humeral head center to the lower surface of acromion, and the radius of humeral head circle, which could help to minimize the effect of anatomy difference and imaging magnification, compared with the traditional acromiohumeral distance (AHD). Then we introduced this index to stratify the selected 30 patients into 3 groups, and each group contained 10 patients, UMI of group 1 was >1 and ≤1.2, UMI of group 2 was >1.2 and ≤1.4, UMI of group 3 was >1.4. As the supraspinatus was most commonly affected by pathological change among the four rotator cuff tendons, we took it as the research object. Then we used the Spearman correlation analysis to evaluate the relationship between UMI and fatty degeneration, rotator cuff tear size and the thickness of ruptured supraspinatus tendon from X-ray and MRI. RESULTS: In the A-P view, the average UMI was 1.33 (1.02-1.51, SD: ±0.22). UMI and the tear size had a significant negative correlation (R=-0.584, P<0.01), and also there was a negative correlation between the fatty degeneration of the supraspinatus (R=-0.312, P=0.033). However, there was no correlation between UMI and the thickness of ruptured supraspinatus (R=0.127, P=0.071). CONCLUSION: UMI is related with the fatty degeneration of supraspinatus and the tear size. The reduction of UMI is a predictable and reliable mark of rotator cuff tear and degeneration in clinic. Physicians can use physical examination and X-ray first when facing the patients with shoulder pain, which is convenient and helpful for evaluating rotator cuff tears.


Assuntos
Cabeça do Úmero , Lesões do Manguito Rotador , Articulação do Ombro , Humanos , Imagem por Ressonância Magnética , Estudos Retrospectivos , Manguito Rotador
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