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1.
Acta Chir Orthop Traumatol Cech ; 88(4 Suppl): 9-14, 2021.
Artigo em Tcheco | MEDLINE | ID: mdl-34593095

RESUMO

This guide to ultrasound examination of the shoulder describes the basic scanning planes and contains corresponding high-resolution ultrasound images. The patient and probe positionings are explained in a simplified step-by-step manner using schematic drawings. This standard and simple examination technique seems to be an appropriate way to improve the learning curve of novice musculoskeletal sonographers. In this manuscript, an emphasis is placed on the rotator cuff, biceps tendon, subacromial-subdeltoid bursa, and joint recesses evaluation. This article also describes some common pitfalls to avoid when starting with shoulder ultrasonography (e.g. always determine the relevance of ultrasound findings in the context of clinical examination). Key words: tendons, bursa, synovial, shoulder, musculoskeletal, protocol, examination, ultrasound imaging, sonography, rotator cuff, acromioclavicular joint, shoulder impingement syndrome, learning curve.


Assuntos
Lesões do Manguito Rotador , Articulação do Ombro , Humanos , Manguito Rotador/diagnóstico por imagem , Lesões do Manguito Rotador/diagnóstico por imagem , Ombro , Articulação do Ombro/diagnóstico por imagem , Ultrassonografia
2.
Sensors (Basel) ; 21(19)2021 Oct 06.
Artigo em Inglês | MEDLINE | ID: mdl-34640966

RESUMO

Previous research identifies that pushing and pulling is responsible for approximately 9-18% of all low back injuries. Additionally, the handle design of a cart being pushed can dramatically alter a worker's capacity to push (≅9.5%). Surprisingly little research has examined muscle activation of the low back and its role in muscle function. Therefore, the purpose of this study was to examine the effects of handle design combination of pushing a platform truck cart on trunk muscle activity. Twenty participants (10 males and 10 females, mean age = 24.3 ± 4.3 years) pushed 475 lbs using six different handle combinations involving handle orientation (vertical/horizontal/semi-pronated) and handle height (hip/shoulder). Multichannel high-density EMG (HDsEMG) was recorded for left and right rectus abdominis, erector spinae, and external obliques. Pushing at hip height with a horizontal handle orientation design (HH) resulted in significantly less (p < 0.05) muscle activity compared to the majority of other handle designs, as well as a significantly higher entropy than the shoulder handle height involving either the semi-pronated (p = 0.023) or vertical handle orientation (p = 0.028). The current research suggests that the combination of a hip height and horizontal orientation handle design may require increased muscle demand of the trunk and alter the overall muscle heterogeneity and pattern of the muscle activity.


Assuntos
Fenômenos Fisiológicos Musculoesqueléticos , Tronco , Adulto , Fenômenos Biomecânicos , Feminino , Humanos , Masculino , Músculo Esquelético , Ombro , Adulto Jovem
3.
BMC Musculoskelet Disord ; 22(1): 840, 2021 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-34592969

RESUMO

BACKGROUND: The impact of atraumatic shoulder instability (ASI) on patients can be extensive, its management complex, with a biopsychosocial approach recommended. Currently how physiotherapists manage ASI is unknown or the extent to which current clinical practice aligns with existing evidence. At the time of this study no national guidelines or consensus to direct practice existed. METHODS: A cross-sectional electronic survey was distributed between July-September 2018, targeting UK-based physiotherapists managing shoulder pathology. Respondents were invited to describe their management of ASI, and rate their awareness and utilisation of various treatment techniques on a Likert-scale; median and interquartile ranges were calculated. Free text survey items were analysed using quantitative content analysis (QCA) to identify codes and categories. Means and percentages were calculated to summarise QCA and descriptive data. RESULTS: Valid survey responses were analysed (n = 135). Respondents had between 2 and 39 years of physiotherapy experience (mean = 13.9 years); the majority (71.1 %) reported that ASI made up < 10 % of their caseload. Only 22.9 % (n = 31/135) of respondents reported feeling 'very confident' in managing ASI; the majority feeling 'somewhat confident' (70.4 %, n = 95/135) or 'not confident' (6.7 %, n = 9/135). The majority of respondents (59.3 %) used an ASI classification system, > 90 % citing the Stanmore Classification. Physiotherapists adapted their management according to clinical presentation, responding to differing biopsychosocial needs of the patient scenario. Most respondents (> 80 %) did not use a protocol to guide their management. Exercise was the most utilised management approach for ASI, followed by education; novel treatment strategies, including cortical rehabilitation, were also reported. CONCLUSION: Findings indicate physiotherapists utilise a wide range of treatment strategies and respond to biopsychosocial cues when managing patients with ASI. The majority reported not being very confident in managing this condition, however only a minority use rehabilitation protocols to support their management. Some interventions that respondents reported using lacked evidence to support their use in ASI management and further research regarding effectiveness is required. Guidelines have been published since this survey; the impact of these will need evaluating to determine their effectiveness in the future.


Assuntos
Instabilidade Articular , Articulação do Ombro , Estudos Transversais , Humanos , Instabilidade Articular/diagnóstico , Instabilidade Articular/epidemiologia , Instabilidade Articular/terapia , Modalidades de Fisioterapia , Ombro , Inquéritos e Questionários
4.
BMC Musculoskelet Disord ; 22(1): 838, 2021 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-34592991

RESUMO

BACKGROUND: Although rotator cuff syndrome is common and extensively studied from the perspective of producing healed tendons, influence of gender on patient-reported outcomes is less well examined. As activity and role demands may vary widely between men and women, clarity on whether gender is an important factor in outcome would enhance patient education and expectation management. Our purpose was to determine if differences exist in patient-reported outcomes between men and women undergoing rotator cuff surgery. METHODS: One hundred forty-eight participants (76 W:72 M) aged 35-75 undergoing surgery for unilateral symptomatic rotator cuff syndrome were followed for 12 months after surgery. Demographics, surgical data, and the Western Ontario Rotator Cuff (WORC) scores were collected. Surgery was performed by two fellowship-trained shoulder surgeons at a single site. RESULTS: There were no gender-based differences in overall WORC score or subcategory scores by 12 months post-op. Pain scores were similar at all time points in men and women. Women were more likely to have dominant-arm surgery and had smaller rotator cuff tears than men. Complication rates were low, and satisfaction was high in both groups. CONCLUSION: Patient gender doesn't appear to exert an important effect on patient-reported rotator cuff outcomes in this prospective cohort. Further work examining other covariates as well as the qualitative experience of going through rotator cuff repair should provide greater insight into factors that influence patient-reported outcomes.


Assuntos
Lesões do Manguito Rotador , Manguito Rotador , Artroplastia , Artroscopia , Feminino , Humanos , Masculino , Estudos Prospectivos , Manguito Rotador/cirurgia , Lesões do Manguito Rotador/cirurgia , Ombro , Resultado do Tratamento
5.
BMC Musculoskelet Disord ; 22(1): 845, 2021 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-34600519

RESUMO

BACKGROUND: Anterior shoulder dislocation remains a clinical challenge. This study aimed to assess the graft position and clinical outcomes of the arthroscopic Latarjet procedure and capsular repair for the treatment of recurrent anterior shoulder dislocation with significant glenoid bone loss in 37 patients. METHODS: Between 2017 and 2017, 37 patients underwent arthroscopic Latarjet plus capsular repair procedure for recurrent anterior shoulder dislocation combined with significant glenoid bone loss. In follow-up examinations, Walch-Duplay scores, subjective shoulder value (SSV) scores, Rowe scores, and active range of motion (AROM) were assessed. Three-dimensional computed tomography (CT) was used to evaluate coracoid graft position and bone resorption. A new method of evaluating the position of the coracoid bone block after Latarjet (H-Z method) was developed. RESULTS: Thirty-seven patients were included in this study. Follow-up ranged from 6 to 36 months postoperatively (with an average of 13 months). No recurrent dislocation occurred at the final follow-up, and there was no significant effect on the AROM (all p > 0.05). Rowe (from 42.2 ± 5.6 to 91.1 ± 3.3), Walch-Duplay (from 31.5 ± 8.0 to 92.6 ± 3.7), and SSV (from 63.9 ± 6.1 to 79.3% ± 5.0%) scores were improved significantly after surgery (all p < 0.001). CT showed that the 29 patients had varying degrees of bone resorption, and 23 recovered to the preinjury level of motional function within 6-12 months after surgery. CONCLUSIONS: In active patients with recurrent anterior shoulder dislocations and significant glenoid bone loss, the arthroscopic Latarjet procedure plus capsular repair could restore shoulder stability satisfactory.


Assuntos
Luxações Articulares , Instabilidade Articular , Articulação do Ombro , Artroscopia , Humanos , Instabilidade Articular/diagnóstico por imagem , Instabilidade Articular/cirurgia , Ombro , Articulação do Ombro/diagnóstico por imagem , Articulação do Ombro/cirurgia
6.
BMC Musculoskelet Disord ; 22(1): 868, 2021 Oct 12.
Artigo em Inglês | MEDLINE | ID: mdl-34641852

RESUMO

BACKGROUND: Although recent studies have investigated the risk factors for PSI, few studies have focused on the impact of scoliotic correction on postoperative shoulder imbalance (PSI), especially in severe and rigid scoliosis (SRS). The purpose of the study was to study the effect of scoliotic correction on PSI in SRS. METHODS: The preoperative, postoperative, and minimum 2-year follow-up radiographs of 48 consecutive patients with SRS who underwent posterior spinal fusion surgery were evaluated. We regarded radiographic shoulder height (RSH) as a shoulder balance parameter and divided the patients into improved and aggravated groups of PSI from pre- to post-operation and from post-operation to last follow-up, respectively. In addition, patients were divided into nine groups based on the observed changes in PSI after surgery and at follow-up, and the correction rate ratios were calculated among the groups. Independent samples T test and Chi-squared test were performed between the improved and aggravated groups of PSI. RESULTS: After surgery, the proximal thoracic curve (PTC) flexibility (P = 0.040), correction rate of the main thoracic curve (MTC) (P = 0.010), and Cobb angle of the lumbar curve (LC) (P = 0.037) were significantly higher, while the ratio of the correction rate of the PTC to the MTC (P = 0.042) was smaller in the aggravated group. At follow-up, the improved group had significantly larger PTC flexibility (P = 0.006), larger ratio of the correction rate of PTC to MTC (P = 0.046), a larger ratio correction rate of PTC to LC (P = 0.027), and a smaller correction rate of LC (P = 0.030). The correction rate ratios of the groups after surgery were as follows: negative to negative (N-N) (1.08) > negative to balance (N-B) (0.96) > negative to positive (N-P) (0.67), B-N (1.26) > B-B (0.94) > B-P (0.89), and P-N (0.34) > P-P (0.83). The order of the correction rate ratio at follow-up was as follows: N-N (0.96) > N-B (0.51), B-B (0.97) > B-P (0.90), and P-B (0.87) > P-P (0.84). CONCLUSION: Harmonizing the correction rate ratio of the PTC, MTC, and LC should be recommended for intraoperative correction and postoperative compensation of PSI. In addition, greater PTC flexibility plays an important role in the spontaneous correction and compensation of PSI in SRS.


Assuntos
Escoliose , Humanos , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Escoliose/diagnóstico por imagem , Escoliose/cirurgia , Ombro/diagnóstico por imagem , Ombro/cirurgia , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/cirurgia
7.
Agri ; 33(4): 232-236, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34671957

RESUMO

OBJECTIVES: Emotional and cognitive factors have been shown to affect pain, and one of the main factors in the development of this effect is pain catastrophizing. The present study aims to determine the effect and frequency of the pain catastrophizing in shoulder lesions and to examine the association between pain catastrophizing and to assess the pre-operative and post-operative functional outcomes. METHODS: A total of 114 patients who underwent shoulder arthroscopy were included study. Pain catastrophizing scale, Tampa kinesiophobia scale, visual analog scale, and University of California at Los Angeles shoulder scale were used for evaluating patients' pre- and post-operative pain and functional situation. RESULTS: Pain catastrophizing was detected 42 of 114 patients (37%). Kinesiophobia was higher in patients who catastrophized shoulder pain (p<0.0001). If participant had a labrum (p=0.038), supraspinatus (p=0.043), or biceps pathology (p=0.032), catastrophization was determined more often. There was catastrophization in 50% of patients with post-operative University of California at Los Angeles score which was evaluated as fair/poor (p=0.039). CONCLUSION: Pre- and post-operative results of the current study strengthened the data about importance of catastrophization. Catastrophization (+) patient group had lower functional capacity outcomes than that of the catastrophization (-) patient group. Decreased levels of pain catastrophizing and kinesiophobia in surgically and conservatively treated patients will result in more satisfactory clinical outcomes.


Assuntos
Catastrofização , Transtornos Fóbicos , Artroscopia , Humanos , Ombro , Dor de Ombro
8.
Trials ; 22(1): 713, 2021 Oct 18.
Artigo em Inglês | MEDLINE | ID: mdl-34663424

RESUMO

BACKGROUND: Periarthritis of the shoulder is a common disease leading to dysfunction of the shoulder joint and have a significant impact on patients' daily life. Evidence shows that there is a close relationship between scapular dyskinesis (SD) and shoulder diseases. Scapular stabilization exercise has been proved to be efficacious in relieving pain and improving function. However, there is no targeted exercise based on the type of scapular dyskinesis. This study will investigate the potential of scapular stabilization exercise based on the type of scapular dyskinesis in treating periarthritis of the shoulder. METHODS: This study is a prospective, randomized controlled, parallel-group trial, intending to recruit 90 patients diagnosed with periarthritis of the shoulder. Patients will receive scapular stabilization exercise training based on the type of scapular dyskinesis or receive traditional rehabilitation training conducted for 30 min, once a day, for 6 weeks. The primary outcome is Constant-Murley score (CMS), and other outcomes include pain degree, range of motion (ROM), type of scapular dyskinesis, scapula position, and patients' satisfaction with shoulder function. Assessments will be performed at baseline, 2-, 4- and 6-week treatment, and at the 6-week follow-up after the end of treatment. DISCUSSION: This study will be the first study to investigate the clinical efficacy of scapular stabilization exercise based on the type of scapular dyskinesis in patients with periarthritis of the shoulder. The results may provide evidence of the effect of targeted scapular stabilization exercise in improving shoulder function and correcting scapular dyskinesis, and provide valuable information for future research. TRIAL REGISTRATION: This study had been registered in the Chinese Clinical Trials Registry. Registration number: ChiCTR2100044332 at March 14, 2021.


Assuntos
Periartrite , Ombro , Exercício Físico , Humanos , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Escápula
9.
Sensors (Basel) ; 21(19)2021 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-34640896

RESUMO

This study was the first to compare the differences in trunk/shoulder kinematics and impact vibration of the upper extremity during backhand strokes in wheelchair tennis players and the able-bodied players relative to standing and sitting positions, adopting an electromagnetic system along with wearable tri-axial accelerometers upon target body segments. A total of 15 wheelchair tennis players and 15 able-bodied tennis players enrolled. Compared to players in standing positions, wheelchair players demonstrated significant larger forward trunk rotation in the pre-preparation, acceleration, and deceleration phase. Significant higher trunk angular velocity/acceleration and shoulder flexion/internal rotation angular velocity/acceleration were also found. When able-bodied players changed from standing to sitting positions, significant changes were observed in the degree of forward rotation of the trunk and shoulder external rotation. These indicated that when the functions of the lower limbs and trunk are lacking or cannot be used effectively, "biomechanical solutions" such as considerable reinforcing movements need to be made before the hitting movement. The differences between wheelchair tennis players and able-bodied players in sitting positions could represent the progress made as the wheelchair players evolve from novices to experts. Knowledge about how sport biomechanics change regarding specific disabilities can facilitate safe and inclusive participation in disability sports such as wheelchair tennis.


Assuntos
Tênis , Cadeiras de Rodas , Fenômenos Biomecânicos , Humanos , Ombro , Extremidade Superior , Vibração
10.
BMC Musculoskelet Disord ; 22(1): 877, 2021 Oct 14.
Artigo em Inglês | MEDLINE | ID: mdl-34649550

RESUMO

BACKGROUND: The role of the subacromial bursa in the development or healing of shoulder pathologies is unclear. Due to this limited knowledge, we aimed to understand specific reactions of the subacromial bursa according to rotator cuff (RC) pathologies compared to non-tendon defects of the shoulder. We hypothesized that the tissue composition and inflammatory status of the bursa are likely to vary between shoulder pathologies depending on the presence and the extent of RC lesion. METHOD: Bursa samples from patients with either 1) shoulder instability with intact RC (healthy bursa, control), 2) osteochondral pathology with intact RC, 3) partial supraspinatus (SSP) tendon tear, or 4) full-thickness SSP tear were investigated histologically and on gene expression level. RESULT: Bursae from SSP tears differed from non-tendon pathologies by exhibiting increased chondral metaplasia and TGFß1 expression. MMP1 was not expressed in healthy bursa controls, but strongly increased with full-thickness SSP tears. Additionally, the expression of the inflammatory mediators IL1ß, IL6, and COX2 increased with the extent of SSP tear as shown by correlation analysis. In contrast, increased angiogenesis and nerve fibers as well as significantly upregulated IL6 and COX2 expression were features of bursae from patients with osteochondral pathology. Using immunohistochemistry, CD45+ leukocytes were observed in all examined groups, which were identified in particular as CD68+ monocytes/macrophages. CONCLUSION: In summary, besides the strong increase in MMP1 expression with SSP tear, molecular changes were minor between the investigated groups. However, expression of pro-inflammatory cytokines correlated with the severity of the SSP tear. Most pronounced tissue alterations occurred for the osteochondral pathology and full-thickness SSP tear group, which demonstrates that the bursal reaction is not exclusively dependent on the occurrence of an SSP tear rather than longstanding degenerative changes. The present bursa characterization contributes to the understanding of specific tissue alterations related to RC tears or non-tendon shoulder pathologies. This pilot study provides the basis for future studies elucidating the role of the subacromial bursa in the development or healing of shoulder pathologies.


Assuntos
Instabilidade Articular , Lesões do Manguito Rotador , Articulação do Ombro , Humanos , Projetos Piloto , Manguito Rotador , Lesões do Manguito Rotador/diagnóstico , Lesões do Manguito Rotador/genética , Ombro
11.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 35(10): 1293-1297, 2021 Oct 15.
Artigo em Chinês | MEDLINE | ID: mdl-34651483

RESUMO

Objective: To compare the effectiveness of arthroscopic intertubercular groove and open subpectoral tenodesis in treatment of long head of biceps tendon (LHBT) tendinopathy. Methods: A clinical data of 80 patients with LHBT tendinopathy who were admitted between June 2013 and May 2017 and met the selection criteria was retrospectively analyzed. After cutting LHBT under arthroscopy, the arthroscopic intertubercular groove tenodesis was performed in 40 cases (group A) and open subpectoral tenodesis was performed in 40 cases (group B). There was no significant difference in the gender, age, side of the affected shoulder joint, disease duration, and preoperative pain visual analogue scale (VAS) score, Constant score, American Society of Shoulder and Elbow Surgery (ASES) score, Disability of Arm, Shoulder, and Hand (DASH) score, LHBT score (LHBS) between the two groups ( P>0.05). The operation time and the scores of shoulder joint pain and function at 12 months after operation were compared between the two groups. Results: The operation time was (3.6±2.5) minutes in group A and (8.5±2.3) minutes in group B, showing a significant difference ( t=18.584, P=0.000). The incisions of the two groups healed by first intention, and there was no complication such as infection or thrombosis. All patients were followed up. The follow-up time was 24-30 months (mean, 26.0 months) in group A and 24-31 months (mean, 26.0 months) in group B. Both Speed test and Yergason test were negative at 3 months after operation. MRI showed that there was no obvious effusion around the LHTB and no dislocation of LHTB. At 12 months after operation, the VAS score, Constant score, ASES score, DASH score, and LHBS score of the two groups all improved when compared with preoperative ones ( P<0.05), and there was no significant difference in the differences before and after operation between the two groups ( P>0.05). No Popeye sign appeared during the follow-up. Conclusion: The arthroscopic intertubercular groove and open subpectoral tenodesis can effectively relieve shoulder pain and improve function, but the former has shorter operation time and less trauma.


Assuntos
Lesões do Manguito Rotador , Tendinopatia , Tenodese , Braço , Artroscopia , Humanos , Estudos Retrospectivos , Lesões do Manguito Rotador/cirurgia , Ombro , Tendinopatia/cirurgia , Tendões/cirurgia
12.
Zhongguo Gu Shang ; 34(9): 887-90, 2021 Sep 25.
Artigo em Chinês | MEDLINE | ID: mdl-34569218

RESUMO

Recurrent anterior dislocation of shoulder with bone defect is one of the common diseases of shoulder joint. How to effectively repair glenoid bone defect and reduce recurrence rate of shoulder dislocation is a problem that clinicians focus on. Bone grafting could stimulate bone, promote bone regeneration and bone remodeling, and restore the normal anatomical structure of glenoid. Among them, Bristow-Latarjet procedure is a classic operation for recurrent shoulder dislocation. Latarjet procedure could repair larger glenoid bone defects, but with higher surgical skills for surgeons;autogenous iliac grafting is the first choice for revision once Latarjet procedure failed;osteochondral grafting (autogenous and allogenous) has certain advantages in reconstructing original articular surface and preventing joint degeneration, but autologous osteochondral grafting may cause secondary injury, while immune rejection is difficult to avoid for allogenous osteochondral grafting. With the improvement of composite materials, and the mechanism of bone regeneration and remodeling, as well as the advantages and disadvantages of bone grafting, tissue engineering technology may become an effective method for the treatment of glenoid bone defect in the future.


Assuntos
Instabilidade Articular , Luxação do Ombro , Articulação do Ombro , Transplante Ósseo , Humanos , Recidiva , Ombro , Luxação do Ombro/cirurgia
13.
J Pak Med Assoc ; 71(9): 2139-2142, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34580502

RESUMO

Objective: To determine the prevalence of myofascial trigger points in the shoulder and neck region, and to assess association with depression, anxiety and stress. METHODS: The cross-sectional study was conducted from January to September 2019 at Riphah International University, Faisalabad, Pakistan, and comprised students from different universities in Faisalabad. Myofascial trigger points were identified among the subjects using palpation method by a therapist. Depression anxiety stress scale was used to determine the level of depression, anxiety and stress. Data was analysed using SPSS 20. RESULTS: Of the 2000 subjects, 970(49%) were male and 1030(52%) were female. The overall age range was 18-25 years. Myofascial trigger points were present in 1727(86.4%) subjects and absent in 273(13.7%). The trigger points had significant association with depression, anxiety and stress (p<0.001). Conclusion: Myofascial trigger points were quite common among university students and were associated with depression, anxiety and stress.


Assuntos
Síndromes da Dor Miofascial , Pontos-Gatilho , Adolescente , Adulto , Ansiedade/epidemiologia , Estudos Transversais , Depressão/epidemiologia , Feminino , Humanos , Masculino , Síndromes da Dor Miofascial/epidemiologia , Ombro , Estudantes , Universidades , Adulto Jovem
14.
J Int Med Res ; 49(9): 3000605211047770, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34586941

RESUMO

Shoulder manipulation under ultrasound (US)-guided C5 and C6 nerve root block is effective for treating refractory adhesive capsulitis (AC). We herein report the development of cervical nerve root injury following manipulation under anesthesia (MUA) in a patient with AC. A 47-year-old woman underwent shoulder manipulation under US-guided C5 and C6 root block with 2% lidocaine for the management of AC-induced shoulder pain. For the procedure, 3 mL of 2% lidocaine (total of 6 mL) was injected around each C5 and C6 nerve root under US guidance. Seven days after the procedure, the patient visited a university hospital because of severe neuropathic pain (numeric rating scale score of 9) in the right anterior arm, lateral arm, and forearm areas. Sensory deficits in the corresponding C5 and C6 dermatomes and motor weakness of the right shoulder abductor, elbow flexor, and wrist extensor were observed. Electrophysiologic studies demonstrated C5 and C6 nerve root injury. The patient was diagnosed with right C5 and C6 nerve root injury following MUA, and lidocaine toxicity or ischemia was the suspected cause. Clinicians should be mindful of the possibility of this complication.


Assuntos
Bloqueio Nervoso , Ombro , Feminino , Humanos , Lidocaína/efeitos adversos , Pessoa de Meia-Idade , Bloqueio Nervoso/efeitos adversos , Ultrassonografia , Ultrassonografia de Intervenção
15.
AORN J ; 114(4): P13-P16, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34586669

Assuntos
Ombro , Ombro/cirurgia
16.
Am J Sports Med ; 49(12): 3196-3201, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34528841

RESUMO

BACKGROUND: Arthroscopic treatment of calcifying tendinitis of the shoulder reveals good to excellent results. However, whether the tendon needs to be repaired after removal of the calcific deposit or simply debrided remains unclear. PURPOSE: To evaluate the structural and clinical results after arthroscopic calcific deposit removal with additional rotator cuff repair or rotator cuff debridement. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: A total of 44 patients (46 shoulders) were enrolled in this retrospective cohort study with a mean follow-up of 58.4 months. Patients underwent arthroscopic removal of a calcific deposit and bursectomy after failed nonoperative treatment. A total of 22 patients received additional rotator cuff repair irrespective of the degree of debridement (the repair group), whereas 22 patients received a simple rotator cuff debridement without additional repair (the debridement group). Groups were comparable in sex, age, and size and consistency of the deposits according to the Gärtner and Bosworth classifications. Clinical evaluation was performed by the Constant score, Simple Shoulder Test, American Shoulder and Elbow Surgeons (ASES) score, and numerical rating scales for pain, function, and satisfaction. In 29 patients (14 in the debridement group and 15 in the repair group), additional magnetic resonance imaging at follow-up was performed to evaluate the structural results using the Sugaya classification. RESULTS: All patients were satisfied with the results of surgery; 100% of the repair group and 95.7% of the debridement group reported they would undergo the surgical procedure again. Comparison of the clinical results showed significantly better results in the repair group versus the debridement group for the Constant score (86.2 vs 80.6, respectively; P = .04), the ASES score (98.3 vs 88.9; P = .004), the Simple Shoulder Test (11.6 vs 10; P = .005), and the numerical rating scales for pain (0.1 vs 0.8; P = .007), function (9.6 vs 8.8; P = .008), and satisfaction (9.8 vs 9.1; P = .036). Comparison of the postoperative tendon integrity showed 80% Sugaya grade I in the rotator cuff repair group and 64% Sugaya grade II in the debridement group, with a statistically significant difference in favor of the repair group (P = .004). Postoperative clinical evaluation revealed no positive O'Brien tests in the repair group, whereas approximately one-third of the debridement group showed a positive O'Brien test during examination. CONCLUSION: Arthroscopic removal of calcific deposits with rotator cuff debridement or cuff repair showed good to excellent clinical and structural midterm results. However, patients who underwent additional repair of the tendon defect had significantly better clinical results as well as better structural results in terms of tendon integrity.


Assuntos
Lesões do Manguito Rotador , Tendinopatia , Artroscopia , Estudos de Coortes , Desbridamento , Humanos , Imageamento por Ressonância Magnética , Estudos Retrospectivos , Manguito Rotador/cirurgia , Lesões do Manguito Rotador/cirurgia , Ombro , Tendinopatia/cirurgia , Resultado do Tratamento
17.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 35(9): 1141-1146, 2021 Sep 15.
Artigo em Chinês | MEDLINE | ID: mdl-34523279

RESUMO

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


Assuntos
Bursite , Articulação do Ombro , Artroscopia , Bursite/cirurgia , Feminino , Humanos , Liberação da Cápsula Articular , Masculino , Pessoa de Meia-Idade , Amplitude de Movimento Articular , Rotação , Ombro , Articulação do Ombro/cirurgia , Resultado do Tratamento
20.
Arthroscopy ; 37(9): 2754-2755, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34481617

RESUMO

Platelet-rich plasma (PRP) injections continue to be used at increasing rates to treat common musculoskeletal conditions. PRP has a low-risk profile and emerging in vitro evidence to support its positive effects on soft-tissue healing. PRP has been shown to be of benefit for knee osteoarthritis, but less has been published regarding the shoulder. PRP delivers a high concentration of growth factors, cytokines, and other important inflammatory modulators. Its use is appealing for treating partial-thickness rotator cuff tears, subacromial bursitis, and rotator cuff tendinopathy since rotator cuff tendons often have poor healing capacity due to intrinsic degeneration. PRP has been shown to increase cell proliferation and matrix synthesis in tenocytes, which may aid tendon regeneration and healing. Adult tendons also contain a small amount of tendon progenitor cells, which can be induced to an active state by PRP. In addition, PRP is an autologous biologic agent and easy to acquire and administer in an outpatient clinical setting. Clinical studies continue to lag and are often heterogenous in quality and in results. PRP can vary widely based on multiple intrinsic and extrinsic factors, including patient age, sex, activity level, centrifugation speed, and number of centrifugation cycles. Thus, quality research methods should include reporting using the PAW (platelets/activation/white blood cells) system. Clinicians should remain cautiously optimistic about the future role of PRP injections in the shoulder.


Assuntos
Plasma Rico em Plaquetas , Lesões do Manguito Rotador , Tendinopatia , Humanos , Manguito Rotador , Lesões do Manguito Rotador/terapia , Ombro , Tendinopatia/terapia
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