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1.
Medicine (Baltimore) ; 99(12): e19579, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32195972

RESUMO

BACKGROUND: Numerous quantitatively based studies measuring the accuracy of MRI and MRA for the diagnosis of rotator cuff tears remain inconclusive. In order to compare the accuracy of MRI with MRA in detection of rotator cuff tears a meta-analysis was performed systematically. METHODS: PubMed/Medline and Embase were utilized to retrieve articles comparing the diagnostic performance of MRI and MRA for use in detecting rotator cuff tears. After screening and diluting out the articles that met inclusion criteria to be used for statistical analysis the pooled evaluation indexes including sensitivity and specificity as well as hierarchical summary receiver operating characteristic (HSROC) curves with 95% confidence interval (CI) were calculated. RESULTS: Screening determined that 12 studies involving a total of 1030 patients and 1032 shoulders were deemed viable for inclusion in the meta-analysis. The results of the analysis showed that MRA has a higher sensitivity and specificity than MRI for the detection of any tear; similar results were observed in the detection of full-thickness tears. However, for the detection of partial-thickness tear, MRI has similar performance with MRA. CONCLUSION: MRI is recommended to be a first-choice imaging modality for the detection of rotator cuff tears. Although MRA have a higher sensitivity and specificity, it cannot replace MRI after the comprehensive consideration of accuracy and practicality.


Assuntos
Artrografia/métodos , Imagem por Ressonância Magnética/métodos , Lesões do Manguito Rotador/diagnóstico por imagem , Manguito Rotador/diagnóstico por imagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Artrografia/estatística & dados numéricos , Feminino , Humanos , Lacerações/diagnóstico por imagem , Lacerações/patologia , Imagem por Ressonância Magnética/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Manguito Rotador/patologia , Ruptura/diagnóstico por imagem , Ruptura/patologia , Sensibilidade e Especificidade , Adulto Jovem
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): 104-112, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31409562

RESUMO

BACKGROUND: Subscapularis function after arthroscopic Bankart repair has been widely studied. However, data regarding subscapularis performance after arthroscopic Latarjet procedures are lacking. This study aimed to evaluate subscapularis clinical and radiologic performance after arthroscopic Latarjet procedures. METHODS: We included 40 patients who underwent arthroscopic Latarjet procedure with a minimum 2-year follow-up. Clinical evaluation included Western Ontario Shoulder Instability Index and Rowe scores, specific subscapularis isokinetic study, and lift-off tests. Contralateral measurements were used for comparison. Computed tomographic evaluation included graft consolidation, muscle dimensions, and degree of fatty atrophy, calculated as the mean muscle attenuation (MMA). RESULTS: There was a decrease of 8.3% of maximum internal rotation peak torque in the operated arm (P = .02). However, there was no significant difference in the agonist-antagonist ratio: 76.9% in the operated arm and 76% in the contralateral (P = .82). Lift-off strength test demonstrated a decrease in the first year but not at final follow-up (P = .38). There was a significant decrease in lift-off distance of 23% compared to the contralateral side (P < .001). Subscapularis MMA was diminished when compared to the infraspinatus/teres minor (P < .001) at the expense of its upper part (P = .03). Hyperlaxity and number of dislocation episodes were correlated to a lower MMA (P = .046 and P = .005). CONCLUSION: Arthroscopic Latarjet procedures provide satisfactory clinical results. There seems to be a diminished subscapularis MMA depending on its superior half. Hyperlaxity and number of previous dislocations were correlated to a lower MMA. Although there was a decrease in the maximum internal rotation peak torque, we did not find any difference in the agonist-antagonist ratio or in the final lift-off strength between sides.


Assuntos
Instabilidade Articular/cirurgia , Manguito Rotador/fisiopatologia , Luxação do Ombro/cirurgia , Articulação do Ombro/fisiopatologia , Adolescente , Adulto , Artroplastia/métodos , Artroscopia , Feminino , Seguimentos , Humanos , Instabilidade Articular/fisiopatologia , Masculino , Força Muscular , Estudos Prospectivos , Rotação , Manguito Rotador/diagnóstico por imagem , Luxação do Ombro/fisiopatologia , Articulação do Ombro/cirurgia , Tomografia Computadorizada por Raios X , Adulto Jovem
4.
BMC Musculoskelet Disord ; 20(1): 633, 2019 Dec 29.
Artigo em Inglês | MEDLINE | ID: mdl-31884952

RESUMO

BACKGROUND: Suture anchor placement for subscapularis repair is challenging. Determining the exact location and optimum angle relative to the subscapularis tendon direction is difficult because of the mismatch between a distorted arthroscopic view and the actual anatomy of the footprint. This study aimed to compare the reliability and reproducibility of the navigation-assisted anchoring technique with conventional arthroscopic anchor fixation. METHODS: Arthroscopic shoulder models were tested by five surgeons. The conventional and navigation-assisted methods of suture anchoring in the subscapularis footprint on the humeral head were tested by each surgeon seven times. Angular results and anchor locations were measured and compared using the Wilcoxon signed rank test. Interobserver intraclass correlation coefficients (ICCs) were analyzed among the surgeons. RESULTS: The mean angular errors of the targeted anchor fixation guide without and with navigation were 17° and 2° (p < 0.05), respectively, and the translational errors were 15 and 3 mm (p < 0.05), respectively. All participants showed a narrow range of anchor fixation angular and translational errors from the original target. Among the surgeons, the interobserver reliabilities of angular errors for ICCs of the navigation-assisted and conventional methods were 0.897 and 0.586, respectively, and the interobserver ICC reliabilities for translational error were 0.938 and 0.619, respectively. CONCLUSIONS: The navigation system may help surgeons be more aware of the surrounding anatomy and location, providing better guidance for anchor orientation, including footprint location and anchor angle.


Assuntos
Artroscopia/métodos , Lesões do Manguito Rotador/cirurgia , Cirurgia Assistida por Computador/métodos , Âncoras de Sutura , Técnicas de Sutura/instrumentação , Artroscopia/instrumentação , Humanos , Cabeça do Úmero/anatomia & histologia , Cabeça do Úmero/cirurgia , Imageamento Tridimensional , Modelos Anatômicos , Reprodutibilidade dos Testes , Manguito Rotador/anatomia & histologia , Manguito Rotador/diagnóstico por imagem , Manguito Rotador/cirurgia , Articulação do Ombro/anatomia & histologia , Articulação do Ombro/diagnóstico por imagem , Articulação do Ombro/cirurgia , Cirurgia Assistida por Computador/instrumentação , Tomografia Computadorizada por Raios X
5.
BMC Musculoskelet Disord ; 20(1): 569, 2019 Nov 27.
Artigo em Inglês | MEDLINE | ID: mdl-31775808

RESUMO

BACKGROUND: The use of steroid injection for treatment of a full-thickness rotator cuff tear is still controversial. This study aimed to evaluate the effectiveness and safety of this treatment method. METHODS: Twelve patients in Group 1 received an intra-substance injection into rupture area of supraspinatus tendon with Diprospan 1 cc (betamethasone disodium phosphate 2 mg and betamethasone dipropionate 5 mg) and 1% xylocaine 1 cc. Twelve patients in Group 2 received an injection with normal saline 1 cc and 1% xylocaine 1 cc. The rupture size was measured by sonography before the injection, 3 months after the injection, and 6 months after the injection. Shoulder Pain and Disability Index (SPADI) score and Pain Visual Analogue Scale (VAS) score were measured and compared between the two groups before the injection, 1 week after the injection, 3 months after the injection, and 6 months after the injection. RESULTS: Pain and function improved more in Group 1 than in Group 2. The therapeutic effect lasted for at least 6 months in both groups. The size of the supraspinatus tendon rupture was not increased after injection in either group. CONCLUSIONS: Intra-substance injection into rupture area of supraspinatus tendon with steroid and xylocaine is effective to reduce pain and improve function in patients with full-thickness supraspinatus tendon rupture without increasing the size of the rupture. TRIAL REGISTRATION: Current Controlled Trials ChiCTR1900026376, data of registration: 2019/10/05 retrospectively registered.


Assuntos
Betametasona/análogos & derivados , Glucocorticoides/administração & dosagem , Lidocaína/administração & dosagem , Lesões do Manguito Rotador/tratamento farmacológico , Manguito Rotador/efeitos dos fármacos , Traumatismos dos Tendões/tratamento farmacológico , Idoso , Anestésicos Locais/administração & dosagem , Betametasona/administração & dosagem , Combinação de Medicamentos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Manguito Rotador/diagnóstico por imagem , Lesões do Manguito Rotador/diagnóstico por imagem , Traumatismos dos Tendões/diagnóstico por imagem
6.
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
7.
BMC Musculoskelet Disord ; 20(1): 475, 2019 Oct 25.
Artigo em Inglês | MEDLINE | ID: mdl-31653240

RESUMO

BACKGROUND: The purpose of this study to compare glenohumeral joint motion during active shoulder axial rotation between subacromial impingement syndrome (SIS) shoulders and asymptomatic shoulders using cine-magnetic resonance imaging (cine-MRI). Measurement of glenohumeral joint motion via manual intervention does not assess the usual glenohumeral joint motion, and the glenoid surface cannot be confirmed manually. However, cine-MRI can produce clear images of glenohumeral joint rotation. Therefore, we sought to measure the active ROM of the glenohumeral rotation using cine-MRI. METHODS: Seventy-three shoulders in 42 asymptomatic volunteers and 110 SIS shoulders in 103 consecutive patients were included in this study. We evaluated 36 matched pairs (72 shoulders in total) adjusting for baseline characteristics with propensity score matching method. The patients underwent cine-MRI during axial rotation of the adducted arm. During imaging, participants rotated their shoulder from the maximum internal rotation to the maximum external rotation over the first 10 s and then back to the maximum internal rotation over the subsequent 10 s. We assessed internal/external rotation, and compared the asymptomatic and SIS shoulders in this regard. Evaluation of rotation angles was performed on a series of axial images through the humeral head center. RESULTS: The mean internal rotation angles of the asymptomatic and patient groups were 55° ± 10° and 41° ± 23°, respectively, (P = .002; 95% Confidence Interval [CI], 51-58 vs 33-49); the mean external rotation angles were 47° ± 15° and 21° ± 25°, respectively, (P < .001; CI, 42-52 vs 13-29). CONCLUSIONS: Compared to asymptomatic shoulders, SIS shoulders showed significantly restricted glenohumeral rotation as determined by cine-MRI. Our results suggested that the significant limitation of active glenohumeral rotation might be associated with rotator cuff dysfunction.


Assuntos
Amplitude de Movimento Articular , Manguito Rotador/fisiopatologia , Síndrome de Colisão do Ombro/fisiopatologia , Articulação do Ombro/fisiopatologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Imagem Cinética por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Rotação , Manguito Rotador/diagnóstico por imagem , Síndrome de Colisão do Ombro/diagnóstico por imagem , Articulação do Ombro/diagnóstico por imagem , Adulto Jovem
8.
Eur J Radiol ; 121: 108706, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31655315

RESUMO

PURPOSE: Quantitative imaging methods could improve diagnosis of rotator cuff degeneration, but the capability of quantitative MR and US imaging parameters to detect alterations in collagen is unknown. The goal of this study was to assess quantitative MR and US imaging measures for detecting abnormalities in collagen using an in vitro model of tendinosis with biochemical and histological correlation. METHOD: 36 pieces of supraspinatus tendons from 6 cadaveric donors were equally distributed into 3 groups (2 subjected to different concentrations of collagenase and a control group). Ultrashort echo time MR and US imaging measures were performed to assess changes at baseline and after 24 h of enzymatic digestion. Biochemical and histological measures, including brightfield, fluorescence, and polarized microscopy, were used to verify the validity of the model and were compared with quantitative imaging parameters. Correlations between the imaging parameters and biochemically measured digestion were analyzed. RESULTS: Among the imaging parameters, macromolecular fraction (MMF), adiabatic T1ρ, T2*, and backscatter coefficient (BSC) were useful in differentiating between the extent of degeneration among the 3 groups. MMF strongly correlated with collagen loss (r=-0.81; 95% confidence interval [CI]: -0.90,-0.66), while the adiabatic T1ρ (r = 0.66; CI: 0.42,0.81), T2* (r = 0.58; CI: 0.31,0.76), and BSC (r = 0.51; CI: 0.22,0.72) moderately correlated with collagen loss. CONCLUSIONS: MMF, adiabatic T1ρ, and T2* measured and US BSC can detect alterations in collagen. Of the quantitative MR and US imaging measures evaluated, MMF showed the highest correlation with collagen loss and can be used to assess rotator cuff degeneration.


Assuntos
Imagem por Ressonância Magnética/métodos , Lesões do Manguito Rotador/diagnóstico por imagem , Lesões do Manguito Rotador/patologia , Manguito Rotador/diagnóstico por imagem , Manguito Rotador/patologia , Ultrassonografia/métodos , Adulto , Cadáver , Colagenases , Estudos de Avaliação como Assunto , Humanos , Técnicas In Vitro , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Manguito Rotador/ultraestrutura
9.
BMC Musculoskelet Disord ; 20(1): 490, 2019 Oct 27.
Artigo em Inglês | MEDLINE | ID: mdl-31656176

RESUMO

BACKGROUND: The Eclipse® (Eclipse® is a trademark of Arthrex, Naples, Florida) stemless shoulder prosthesis offers the surgeon the advantage of bone stock preservation and at the same time avoids the drawbacks of a resurfacing arthroplasty. Previous studies have shown radiographic changes on serial follow up of the Eclipse prosthesis. This study attempts to assess the significance of these radiographic changes and effect of cuff related pathology on the mid-term outcome of the Eclipse prosthesis. METHODS: Between July 2005 and October 2008, 29 shoulders underwent shoulder arthroplasty with the Eclipse prosthesis; 23 shoulders, (seven women and 16 men) were available for the final follow up. The range of motion, Constant Score; age adjusted Constant Score, Subjective Shoulder Value and radiographs were assessed at serial follow-ups. RESULTS: Significant improvements were seen in the Constant Score (78.9 ±20.1) compared to pre-operative score (32.9 ±5.2); also forward elevation, abduction and external rotation improved to 142.9 ± 36.6 °, 135.2 ± 40.5 ° and 49.8 ± 21.9 ° at 72 months (p < 0.001). Radiolucent lines and localised osteopenia, did not statistically impact on the clinical outcome. Partial tears of the supraspinatus and subscapularis had a negative impact on the Subjective Shoulder Value (p < 0.05) Partial or complete tears of the subscapularis led to worse Constant Score on follow up (p < 0.05). CONCLUSIONS: The presence of radiolucent lines or localised osteopenia does not influence the mid term clinical outcome. Pre -operative partial supraspinatus tears or tears of the subscapularis lead to an inferior outcome.


Assuntos
Artroplastia de Substituição/instrumentação , Osteoartrite/cirurgia , Lesões do Manguito Rotador/cirurgia , Articulação do Ombro/diagnóstico por imagem , Prótese de Ombro , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite/complicações , Osteoartrite/diagnóstico por imagem , Período Pós-Operatório , Período Pré-Operatório , Amplitude de Movimento Articular , Manguito Rotador/diagnóstico por imagem , Lesões do Manguito Rotador/complicações , Lesões do Manguito Rotador/diagnóstico por imagem , Articulação do Ombro/cirurgia , Resultado do Tratamento
10.
PLoS One ; 14(9): e0222783, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31545834

RESUMO

INTRODUCTION: The shoulder, a very complex joint, offers a wide range of pathologies. Intraarticular abnormalities and rotator cuff injuries are mainly assessed and diagnosed by magnetic resonance arthrography (MRA). In contrast to this well-established gold standard, high-resolution ultrasound (US) offers an additional easy and excellent modality to assess the shoulder joint. Therefore, the purpose of this study was to evaluate in which anatomic structures and pathologies comparable results of US and MRA could be achieved. MATERIALS AND METHODS: In this IRB-approved prospective study 67 patients with clinically suspected labral lesions, rotator cuff rupture, or injury of the long head of the biceps (LHB) tendon were enrolled. Each participant was examined with high resolution US, and directly followed by MRA at 3 Tesla with a standard sequence protocol. To evaluate the agreement of the diagnostic performance between US and MRA a weighted kappa statistic was used. RESULTS: Both of the investigated modalities yielded a moderate to almost perfect agreement in assessing a wide range of shoulder joint pathologies. For the rotator cuff, consistency was found in 71.64% for the supraspinatus tendon, in 95.52% for the infraspinatus tendon, in 83.58% for the subscapularis tendon, and in 98.51% for the teres minor tendon. The diagnostic accuracy between both modalities was 80.60% for the LHB tendon, 77.61% for the posterior labroligamentous complex, 83.58% for the acromioclavicular joint, and 91.04% for the assessment of osseous irregularities and impaction fractures. CONCLUSIONS: High resolution US is a reliable imaging modality for the rotator cuff, the LHB tendon, and the acromioclavicular joint, so for these structures we recommend a preference for US over MRA based on its diagnostic accuracy, comfortability, cost effectiveness, and availability. If the diagnosis remains elusive, for all other intraarticular structures we recommend MRA for further diagnostic assessment.


Assuntos
Artrografia/métodos , Traumatismos em Atletas/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Lesões do Manguito Rotador/diagnóstico por imagem , Lesões do Ombro/diagnóstico por imagem , Ultrassonografia/métodos , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Reprodutibilidade dos Testes , Manguito Rotador/diagnóstico por imagem , Articulação do Ombro/diagnóstico por imagem , Adulto Jovem
11.
Acta Orthop Traumatol Turc ; 53(6): 414-419, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31563430

RESUMO

OBJECTIVES: The objective of this study was to evaluate the incidence of osteolysis around the bioabsorbable and nonabsorbable anchors using serial magnetic resonance imaging (MRI) and to determine the relationship between osteolysis and the retear rate after arthroscopic rotator cuff repair. METHODS: From July 2012 to July 2014, 50 patients [28 men and 22 women; mean age, 56.4 (range: 45-56) years] underwent arthroscopic rotator cuff repair for a medium-to large-size tear with double-row suture-bridge technique. The bioabsorbable anchors used in the medial row comprised hydroxyapatite-polylactic acid enantiomer, and the nonabsorbable anchors in the lateral row were polyetheretherketone (PEEK)-type anchors. All patients underwent MRI evaluation at 3, 6, and 12 months postoperatively to determine osteolysis and identify any retear. RESULTS: The incidences of osteolysis at 3, 6, and 12 months postoperatively were 1%, 4%, and 6% with nonabsorbable anchors and 13%, 29%, and 39% with bioabsorbable anchors, respectively. The incidences of osteolysis were significantly higher with the bioabsorbable anchors than with the nonabsorbable anchors (P < 0.005 for all three follow-ups). There was no significant difference between osteolysis and non-osteolysis groups regarding the retear rate or retear size (P = 0.189 and 0.069, respectively). CONCLUSIONS: Osteolysis was common around bioabsorbable anchors used for arthroscopic rotator cuff repair, and it also occurred around the PEEK-type nonabsorbable anchors. The incidence of osteolysis of nonabsorbable anchors was significantly lower than that of bioabsorbable anchors. Osteolysis did not significantly affect rotator cuff retear after arthroscopic repair with either bioabsorbable or nonabsorbable anchors. LEVEL OF EVIDENCE: Level III, Therapeutic Study.


Assuntos
Implantes Absorvíveis/efeitos adversos , Artroscopia/efeitos adversos , Imagem por Ressonância Magnética/métodos , Osteólise/diagnóstico , Lesões do Manguito Rotador/cirurgia , Manguito Rotador/cirurgia , Técnicas de Sutura/efeitos adversos , Suturas/efeitos adversos , Adulto , Idoso , Artroscopia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteólise/etiologia , Estudos Retrospectivos , Manguito Rotador/diagnóstico por imagem , Lesões do Manguito Rotador/diagnóstico , Ruptura , Técnicas de Sutura/instrumentação
12.
Comput Methods Programs Biomed ; 182: 105063, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31505380

RESUMO

BACKGROUND AND OBJECTIVE: Rotator cuff muscle tear is one of the most frequent reason of operations in orthopedic surgery. There are several clinical indicators such as Goutallier grade and occupation ratio in the diagnosis and surgery of these diseases, but subjective intervention of the diagnosis is an obstacle in accurately detecting the correct region. METHODS: Therefore, in this paper, we propose a fully convolutional deep learning algorithm to quantitatively detect the fossa and muscle region by measuring the occupation ratio of supraspinatus in the supraspinous fossa. In the development and performance evaluation of the algorithm, 240 patients MRI dataset with various disease severities were included. RESULTS: As a result, the pixel-wise accuracy of the developed algorithm is 0.9984 ± 0.073 in the fossa region and 0.9988 ± 0.065 in the muscle region. The dice coefficient is 0.9718 ± 0.012 in the fossa region and 0.9463 ± 0.047 in the muscle region. CONCLUSIONS: We expect that the proposed convolutional neural network can improve the efficiency and objectiveness of diagnosis by quantifying the index used in the orthopedic rotator cuff tear.


Assuntos
Algoritmos , Aprendizado Profundo , Músculo Esquelético/fisiopatologia , Atrofia Muscular/fisiopatologia , Manguito Rotador/fisiopatologia , Automação , Humanos , Imagem por Ressonância Magnética , Músculo Esquelético/diagnóstico por imagem , Atrofia Muscular/diagnóstico por imagem , Manguito Rotador/diagnóstico por imagem
13.
Semin Musculoskelet Radiol ; 23(4): 429-435, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31509870

RESUMO

Shoulder ultrasound is a commonly performed imaging study that can accurately determine the presence of rotator cuff tendinosis and tears, as well as subacromial-subdeltoid bursal and long head of biceps tendon pathology. High accuracy depends on an awareness of imaging pitfalls that can be encountered and lead to over- or underdiagnosis of rotator cuff pathology. Ten common pitfalls of rotator cuff ultrasound scanning are presented along with ways to avoid these pitfalls.


Assuntos
Lesões do Manguito Rotador/diagnóstico por imagem , Ultrassonografia/métodos , Humanos , Manguito Rotador/diagnóstico por imagem
14.
MAGMA ; 32(6): 607-615, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31486009

RESUMO

OBJECTIVE: The Goutallier classification system is the most commonly used method for grading intramuscular fatty infiltration in rotator cuff tears. This grading system presents low inter-observer reliability and an inability to provide quantitative and repeatable outcomes for intramuscular fat. We determined the correlation and reliability of two methods, the Lava Flex and Ideal IQ MRI techniques, in quantifying volumetric intramuscular fat, while also comparing to the Goutallier method. MATERIALS AND METHODS: The supraspinatus muscles of seventeen cadaveric shoulders were scanned using the Lava Flex and Ideal IQ MRI imaging protocols. Histological analysis was performed on the same muscles. Agreement, reliability, and correlation analyses were performed to compare all outcomes. RESULTS: The Lava Flex protocol took an average of ~ 4 min, while the Ideal IQ required about ~ 11 min to complete. Bland-Altman analysis showed good agreement between the Lava Flex and Ideal IQ [LOA (- 0.10 and 0.05)], and ICC analyses showed excellent reliability (ICC (1,1) 0.948; ICC (2,1) 0.947). There was a 91% correlation between the Lava Flex and Ideal IQ MR protocols. Weighted Kappa analysis between histology and the Goutallier classification showed fair-to-moderate agreement. DISCUSSION: The Lava Flex technique, taking about 30% of the acquisition time, may prevent motion artifacts in outcomes associated with the longer Ideal IQ technique. However, potential magnetic field inhomogeneities should be considered. The Lava Flex technique may be a faster and valid alternative to the Goutallier classification system.


Assuntos
Tecido Adiposo/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Manguito Rotador/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Cadáver , Feminino , Humanos , Processamento de Imagem Assistida por Computador/métodos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes
15.
Knee Surg Sports Traumatol Arthrosc ; 27(12): 3856-3863, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31473769

RESUMO

PURPOSE: Subacromial pain syndrome is a common disorder. Arthroscopic subacromial decompression is currently the preferred treatment method. Bipolar radiofrequency microtenotomy has shown promising results in treating tendinosis. In this study, the authors compare the results after arthroscopic acromioplasty with bipolar radiofrequency microtenotomy for patients with subacromial pain syndrome. METHODS: A total of 27 patients, with subacromial pain syndrome, were followed for 2 years. There were 14 patients in the arthroscopic acromioplasty group and 13 patients in the radiofrequency microtenotomy group. Clinical outcome data included pain reported using a visual analog scale, Constant score, and strength. Magnetic resonance imaging of the affected shoulder was performed before and 2 years after intervention for an evaluation of the tendinosis grade. RESULTS: All patients attended the final follow-up 2 years after intervention. No significant differences were found at baseline between the groups. Pain measured by the visual analog scale revealed a significant reduction in both groups at 12 weeks, 6 months and 2 years compared with baseline. There was no significant difference between the groups in terms of visual analog scale, Constant score, or strength. The magnetic resonance imaging revealed a significant improvement in the tendinosis score in both groups, without any significant difference between the groups. CONCLUSION: In this prospective randomized study, the clinical assessments revealed a significant improvement in terms of the visual analog scale, strength, Constant score, and tendinosis score 2 years after intervention with either arthroscopic acromioplasty or radiofrequency microtenotomy in patients with subacromial pain syndrome. However, no significant differences were found between the groups. This study reveals that there are surgical options other than acromioplasty in patients with SAPS. LEVEL OF EVIDENCE: II.


Assuntos
Ablação por Radiofrequência , Manguito Rotador/cirurgia , Tendinopatia/cirurgia , Tenotomia/métodos , Acrômio/cirurgia , Artroscopia , Feminino , Seguimentos , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Força Muscular , Estudos Prospectivos , Distribuição Aleatória , Manguito Rotador/diagnóstico por imagem , Dor de Ombro/cirurgia , Tendinopatia/diagnóstico por imagem , Escala Visual Analógica
16.
BMC Musculoskelet Disord ; 20(1): 383, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31431192

RESUMO

BACKGROUND: Magnetic resonance imaging (MRI) is the gold standard in diagnosing rotator cuff pathology; however, there is a lack of studies investigating the reliability agreement for supraspinatus partial-thickness tears among orthopaedic surgeons and musculoskeletal (MSK) radiologists. METHODS: Sixty digital MRI scans (1.5 Tesla) were reviewed by two orthopaedic shoulder surgeons, two MSK radiologists, two fellowship-trained shoulder surgeons, and two fellowship-trained orthopaedic surgeons at two distinct times. Thirty-two scans of partial-thickness tears and twenty-eight scans of the supraspinatus tendon with no tears were included. Supraspinatus tendonosis and tears, long head of the biceps pathology, acromial morphology, acromioclavicular joint pathology and muscle fatty infiltration were assessed and interpreted according to the Goutallier system. After a four-week interval, the evaluators were asked to review the same scans in a different random order. The statistical analyses for the intra- and interobserver agreement results were calculated using the kappa value and 95% confidence intervals. RESULTS: The intraobserver agreement for supraspinatus tears was moderate among the MSK radiologists (k = 0.589; 95% CI, 0.446-0.732) and the orthopaedic shoulder surgeons (k = 0.509; 95% CI, 0.324-0.694) and was fair among the fellowship-trained shoulder surgeons (k = 0.27; 95% CI, 0.048-0.492) and the fellowship-trained orthopaedic surgeons (k = 0.372; 95% CI, 0.152-0.592). The overall intraobserver agreement was good (k = 0.627; 95% CI, 0.576-0.678). The intraobserver agreement was moderate for biceps tendonosis (k = 0.491), acromial morphology (k = 0.526), acromioclavicular joint arthrosis (k = 0.491) and muscle fatty infiltration (k = 0.505). The interobserver agreement results for supraspinatus tears were fair and poor among the evaluators: the MSK radiologists and the orthopaedic shoulder surgeons had the highest agreement (k = 0.245; 95% CI, 0.055-0.435). CONCLUSIONS: In this sample of digital MRI scans, there was an overall good intraobserver agreement for supraspinatus partial tears; however, there were also poor and fair interobserver agreement results. The evaluators with higher levels of experience (the orthopaedic shoulder surgeons and the MSK radiologists) demonstrated better results than evaluators with lower levels of experience.


Assuntos
Imagem por Ressonância Magnética , Lesões do Manguito Rotador/diagnóstico , Manguito Rotador/diagnóstico por imagem , Adulto , Competência Clínica , Feminino , Humanos , Internato e Residência/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Cirurgiões Ortopédicos/estatística & dados numéricos , Radiologistas/estatística & dados numéricos , Reprodutibilidade dos Testes
17.
Arthroscopy ; 35(9): 2553-2561, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31421961

RESUMO

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


Assuntos
Acrômio/diagnóstico por imagem , Lesões do Manguito Rotador/diagnóstico por imagem , Manguito Rotador/diagnóstico por imagem , Articulação do Ombro/diagnóstico por imagem , Acrômio/patologia , Adulto , Idoso , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Curva ROC , Radiografia , Manguito Rotador/patologia , Lesões do Manguito Rotador/patologia , Articulação do Ombro/patologia , Adulto Jovem
18.
J Shoulder Elbow Surg ; 28(10): 1936-1941, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31371160

RESUMO

BACKGROUND AND HYPOTHESIS: IDEAL (Iterative Decomposition of Echoes of Asymmetrical Length) imaging is a magnetic resonance imaging sequence that precisely measures rotator cuff muscle fatty infiltration. The influence of lower levels of fatty infiltration on outcomes after rotator cuff repair remains unclear. We hypothesized that increased preoperative fat fractions would be associated with inferior clinical outcomes after rotator cuff repair. METHODS: We retrospectively identified patients who underwent arthroscopic rotator cuff repair with preoperative IDEAL imaging. Patients completed the Patient-Reported Outcomes Measurement Information System (PROMIS) Upper Extremity computer adaptive survey at a minimum of 2 years after repair. Muscle segmentation was performed on 4 consecutive slices. Correlations between intramuscular fat fractions and PROMIS scores were determined. Patients were grouped by PROMIS scores of 50 or greater and scores lower than 50 for comparison of fat fractions. Multivariate linear regression was performed to model PROMIS scores as a function of demographic characteristics, tear size, and fat fractions. Significance was defined as P < .05. RESULTS: Eighty patients were included (mean follow-up, 42.5 ± 10.7 months). Postoperative PROMIS scores were significantly inversely correlated with the infraspinatus (ρ = -0.25, P = .02) and subscapularis (ρ = -0.29, P = .009) fat fractions. The infraspinatus (7.2% ± 4.9% vs. 5.2% ± 3.0%, P = .046) and subscapularis (10.4% ± 5.1% vs. 8.2% ± 5.0%, P = .001) fat fractions were significantly higher for patients with low PROMIS scores vs. those with PROMIS scores of 50 or greater. In multivariate modeling, the infraspinatus fat fraction (ß = -0.68, P = .029) was the only significant independent predictor of postoperative PROMIS score. CONCLUSION: Intramuscular fat as determined by quantitative magnetic resonance imaging is an important factor in postoperative outcomes even in patients with lower levels of preoperative fatty infiltration.


Assuntos
Tecido Adiposo/diagnóstico por imagem , Adiposidade , Imagem por Ressonância Magnética , Lesões do Manguito Rotador/diagnóstico por imagem , Lesões do Manguito Rotador/cirurgia , Manguito Rotador/diagnóstico por imagem , Idoso , Artroscopia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medidas de Resultados Relatados pelo Paciente , Estudos Retrospectivos , Resultado do Tratamento
19.
Knee Surg Sports Traumatol Arthrosc ; 27(12): 4014-4020, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31451843

RESUMO

PURPOSE: To assess patients with and without postoperative residual pain and to compare clinical function and magnetic resonance imaging (MRI) appearance of the repaired supraspinatus tendon between patients with and without pain. METHODS: One-hundred and seventeen patients with supraspinatus tear were included in this study. Visual Analog Scale (VAS) scores for pain were assessed at a follow-up of at least 1 year. Patients with residual shoulder pain were enrolled in the residual pain group (RP group) and patients without pain enrolled in the no pain group (NP group). The American Shoulder and Elbow Surgeons (ASES) shoulder evaluation form, the modified University of California at Los Angeles (UCLA) score and the Fudan University Shoulder Score (FUSS) were also used to evaluate shoulder function. MRI examinations were performed to evaluate rotator cuff integrity according to the Sugaya method, and muscular hypotrophy, fatty infiltration, and signal/noise quotient (SNQ) of the rotator cuff tendon. RESULTS: Thirty-five patients had residual pain (RP group) and 82 patients had no pain (NR group). At the final follow-up, there was a significant difference in ASES (92 ± 8 points vs 76 ± 10 points; p < 0.001), UCLA (32 ± 3 points vs 28 ± 3 points; p < 0.001), FUSS (90 ± 7 points vs 80 ± 9 points; p < 0.001) and strength (9 ± 3 kg vs 6 ± 2 kg; p < 0.001) between the NP group and the RP group, respectively. Postoperative MRI revealed that there was no significant difference in the retear rate (9.8% vs 8.6%; ns), the muscular hypotrophy (ns), and the fatty infiltration index (0.9 ± 0.2 vs 0.9 ± 0.2; ns) between the NP and the RP groups, respectively. The postoperative tendon SNQ of the RP group was significantly higher than that of the NP group (4.6 ± 2.5 vs 3 ± 1.7; p < 0.001). There was a significant association between tendon SNQ and VAS for this cohort ([Formula: see text] = 0.29; p = 0.003). CONCLUSION: Postoperative residual pain is associated with a high MRI signal intensity of the repaired supraspinatus tendon. Since high signal intensity of tendon tissue indicates degenerated tendon tissue quality, it highlighted the necessity of debriding the degenerated rotator cuff tendon tissue. LEVEL OF EVIDENCE: III.


Assuntos
Artroscopia , Imagem por Ressonância Magnética , Dor Pós-Operatória/etiologia , Lesões do Manguito Rotador/cirurgia , Manguito Rotador/diagnóstico por imagem , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Escala Visual Analógica
20.
Med Sci Monit ; 25: 5856-5863, 2019 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-31386649

RESUMO

BACKGROUND Physical tests are usually preferred to assess rotator-cuff syndrome but are insufficient to predict the morphology and size of the rotator-cuff. The objective of the study was to rate the ultrasound findings for patients with sudden shoulder pain and to determine potential predictors of the same. MATERIAL AND METHODS A total of 112 patients with sudden shoulder pain with rotator-cuff syndrome, suspected by orthopedic doctors, were subjected to ultrasonography. Real-time ultrasonography was done for the acromioclavicular joint, biceps, infraspinatus, posterior labrum, subscapularis, supraspinatus, teres minor tendon, and the sub-acromial-subdeltoid bursa. Each tendon was assessed via scanning planes in orientation as per longer and shorter axis, and from their myotendinous junction shoulder to bony insertions. Linear and logistic regression analysis were performed to predict the associations of medical history with rotator-cuff injury. RESULTS Ultrasonography identified that 82% of the enrolled patients had at least one particular cause of the rotator-cuff disorder. Among the rotator-cuff disorders, calcific tendonitis (54%) was observed more frequently followed by tendinopathy (32%), subacromial-subdeltoid bursitis (22%), and partial thickness tear (21%). Also, 46 patients (41%) had multiple findings. Older age (older than 40 years) was a strong predicting factor of rotator-cuff disorder (r²=0.36, P=0.0004). CONCLUSIONS Ultrasonography is a vital diagnostic procedure used by orthopedic surgeons for diagnosis of the rotator-cuff disorder(s) in patients with sudden shoulder pain.


Assuntos
Lesões do Manguito Rotador/diagnóstico por imagem , Ultrassonografia/métodos , Adulto , Idoso , Calcinose , China , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Manguito Rotador/diagnóstico por imagem , Ombro/diagnóstico por imagem , Articulação do Ombro/diagnóstico por imagem , Tendinopatia/diagnóstico por imagem , Tendões/diagnóstico por imagem
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