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1.
Sports Health ; 12(2): 139-148, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32017660

RESUMO

BACKGROUND: Posterior shoulder stretching exercises (PSSEs) aim to reduce posterior shoulder tightness (PST). Position modification of traditional PSSEs has been suggested to minimize inadequate control of scapular and glenohumeral rotation, possibly leading to increased subacromial impingement. HYPOTHESIS: Modified PSSEs will have positive effects on shoulder mobility, pain, and dysfunction. STUDY DESIGN: Randomized controlled trial. LEVEL OF EVIDENCE: Level 1. METHODS: A total of 67 symptomatic patients with subacromial impingement syndrome (SIS) and shoulder internal rotation asymmetry were randomly assigned to 3 groups: modified cross-body stretch (MCS) (n = 22; treatment program + MCS), modified sleeper stretch (MSS) (n = 22; treatment program + MSS), and a control group (n = 23; treatment program consisting of only modalities, range of motion [ROM], and strength training but no PSSEs) for 4 weeks. Pain, PST, shoulder rotation ROM, and dysfunction were evaluated. RESULTS: Pain, PST, shoulder rotation ROM, function, and disability improved in all groups (P < 0.05). The MCS and MSS groups had better results compared with the control group with regard to pain with activity, internal rotation ROM, function, and disability (P < 0.05). There was no significant difference between the stretching groups (P > 0.05). CONCLUSION: All treatments improved pain, shoulder mobility, function, and disability in patients with SIS. However, modified PSSEs in addition to a treatment program was superior to the treatment program alone (without PSSEs) in improving pain with activity, internal rotation ROM, and dysfunction. Moreover, stretching provided clinically significant improvements. CLINICAL RELEVANCE: Modified PSSEs, in addition to a treatment program, are beneficial for patients with SIS. Both modified cross-body and sleeper stretches are safe and efficacious for improving shoulder mobility, pain, and dysfunction.


Assuntos
Artralgia/prevenção & controle , Exercícios de Alongamento Muscular/métodos , Síndrome de Colisão do Ombro/fisiopatologia , Síndrome de Colisão do Ombro/terapia , Ombro/fisiopatologia , Adulto , Artralgia/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Amplitude de Movimento Articular , Treinamento de Resistência , Rotação
2.
Zhonghua Shao Shang Za Zhi ; 36(1): 67-69, 2020 Jan 20.
Artigo em Chinês | MEDLINE | ID: mdl-32023722

RESUMO

On October 23, 2017, a 52-year-old male patient with 3 recurrences of dermatofibrosarcoma protuberans in the left shoulder and chest was admitted to the Department of Burns and Plastic Surgery of Dali Bai Autonomous Prefecture People's Hospital. Dermatofibrosarcoma protuberans on the skin were completely resected, leaving wound defect of 10 cm×10 cm. The wound was planned to be repaired by the transplantation of right anterolateral thigh perforator free flap. However, the anterolateral thigh perforator branch was absent during flap removal, and only one small perforating branch was found. Moreover, it was difficult to separate. Therefore, this flap cutting was given up. The anteromedial thigh perforator was explored through the same incision, and a thicker perforator was found, which was supplied by an independent iatrogenic artery. The length and diameter of the vascular pedicle matched with the blood vessels in the receiving site. An anteromedial thigh perforator flap (10 cm×10 cm) was cut to repair the defect. The postoperative 9-month follow-up revealed that the color, texture, and thickness of the flap were good, the two-point discrimination distance was 30 mm, and the linear scar remained at the donor site of right thigh.


Assuntos
Dermatofibrossarcoma , Retalho Perfurante , Procedimentos Cirúrgicos Reconstrutivos , Lesões dos Tecidos Moles , Dermatofibrossarcoma/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Ombro , Transplante de Pele , Coxa da Perna
3.
Instr Course Lect ; 69: 255-272, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32017732

RESUMO

Compared with other joints in the body, examination of the shoulder continues to be a challenge for practitioners, whether they be trainers, physical therapists, primary care physicians, or orthopedic surgeons. There are many reasons for this challenge, the primary being the highly complex architecture of bony and soft-tissue anatomy which allows for the greatest range of motion of any joint of the body. As a result, the clinical examination as Ralph Hertel, MD, has commented "perhaps it is just not easy." His comment reflects that one cannot just expect to understand how to interpret the examination unless the observer has some knowledge of how the shoulder complex works, how to perform the basics of the examination, how to interpret radiographs, and how to integrate these variables into a diagnosis. This chapter will attempt to delineate the principles which make the shoulder examination more attainable, plus highlight the areas where a combination of factors is necessary to arrive at a diagnosis.


Assuntos
Articulação do Ombro , Ombro , Humanos , Exame Físico , Radiografia , Amplitude de Movimento Articular
4.
Anaesthesia ; 75(4): 499-508, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31984478

RESUMO

Interscalene brachial plexus block provides analgesia for shoulder surgery but is associated with hemidiaphragmatic paralysis. Before considering a combined suprascapular and axillary nerve block as an alternative to interscalene brachial plexus block, evaluation of the incidence of diaphragmatic dysfunction according to the approach to the suprascapular nerve is necessary. We randomly allocated 84 patients undergoing arthroscopic shoulder surgery to an anterior or a posterior approach to the suprascapular nerve block combined with an axillary nerve block using 10 ml ropivacaine 0.375% for each nerve. The primary outcome was the incidence of hemidiaphragmatic paralysis diagnosed by ultrasound. Secondary outcomes included: characterisation of the hemidiaphragmatic paralysis over time; numeric rating scale pain scores; oral morphine equivalent consumption; and patient satisfaction. The incidence of hemidiaphragmatic paralysis was 40% (n = 17) vs. 2% (n = 1) in the anterior and posterior groups, respectively (p < 0.001). In one third of patients with hemidiaphragmatic paralysis, it persisted beyond the eighth hour. The median (interquartile range [range]) oral morphine equivalent consumption was significantly higher in the posterior approach when compared with the anterior approach, whether in the recovery area (20 [5-31 (0-60)] mg vs. 7.5 [0-14 (0-52)] mg, respectively; p = 0.004) or during the first 24 h (82 [61-127 (12-360) mg] vs. 58 [30-86 (0-160)] mg, respectively; p = 0.01). Patient satisfaction was comparable between groups (p = 0.6). Compared with the anterior approach, diaphragmatic function is best preserved with the posterior needle approach to the suprascapular nerve block.


Assuntos
Bloqueio Nervoso/efeitos adversos , Complicações Pós-Operatórias/induzido quimicamente , Paralisia Respiratória/induzido quimicamente , Ombro/inervação , Ombro/cirurgia , Ultrassonografia de Intervenção/métodos , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Bloqueio Nervoso/métodos , Resultado do Tratamento
5.
Orthopade ; 49(2): 104-113, 2020 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-31974633

RESUMO

BACKGROUND: Sarcomas of the upper limbs commonly affect the proximal humerus or scapula. Complications after tumor resection and reconstruction are rare but cannot be neglected, particularly after tumor endoprosthetic reconstructions. MATERIALS AND METHODS: The most common complications after resection of sarcomas of the upper limbs and shoulder girdle are described, and current knowledge regarding complication management is presented. Additionally, a selective literature search was performed, incorporating personal experiences. RESULTS: Wound healing disorders and infections after tumor resection without specific reconstruction (clavicle resection, scapulectomy) usually respond well to conservative or surgical treatment. However, periprosthetic infections after reconstruction using a megaendoprosthesis constitute a severe and frequent complication, with an incidence of 5-10%. Two-stage implant replacement still represents the gold standard, although in selected cases, one-stage revision with retention of the prosthetic stem appears warranted. Secondary amputation as a result of periprosthetic infection is rare compared to the situation with infections of the lower limb. Mechanical complications necessitating surgical revision are mostly limited to joint dislocation after inverse total shoulder replacement (TSR). (Sub)luxation in anatomic TSR can be tolerated provided there is no tendency toward perforation of the skin in a asymptomatic patient. Biological reconstructions are most often indicated for reconstruction of intercalary defects of the humerus, and revision is necessitated most frequently by mechanical complications. Despite multiple surgical revisions, stable reconstructions and limb salvage can usually be achieved in the upper limb.


Assuntos
Neoplasias Ósseas/cirurgia , Procedimentos Cirúrgicos Reconstrutivos , Sarcoma/cirurgia , Humanos , Úmero , Salvamento de Membro , Reoperação , Estudos Retrospectivos , Ombro , Resultado do Tratamento
7.
Eur J Dent Educ ; 24(1): 17-25, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31518468

RESUMO

OBJECTIVES: This study aimed to investigate the effects of indirect vision skills on head and shoulder posture in dental hygienists. MATERIALS AND METHODS: This cross-sectional study included a total of 100 female clinical dental hygienists. It evaluated musculoskeletal symptoms of the neck, shoulders and back, head and shoulder posture (craniovertebral angle [CVA] and sagittal shoulder posture angle [SSPA]). Indirect vision skills were assessed using the O'Connor tweezer test under indirect vision with a mirror. To analyse factors associated with the CVA and SSPA, an independent t test, one-way ANOVA, and multiple linear regression analysis were conducted, respectively. RESULTS: The body region in which the greatest number of symptoms of work-related musculoskeletal disorders was recognised was the neck (89.0%). In the multiple linear regression model, which adjusted for other factors associated with musculoskeletal disorders, dental hygienists with poor indirect vision skills showed relatively small SSPA value (P < .05). However, indirect vision skills were not associated with the CVA value. CONCLUSIONS: Good indirect vision skills contribute to the prevention of rounded shoulders in dental hygienists. Therefore, where possible, dental hygienists should perform clinical procedures using indirect vision with a dental mirror to maintain a balanced posture and reduce flexion of the back or the neck. A dental hygiene curriculum should include training to improve clinical skills, as well as education regarding dental ergonomics and a monitoring system to determine whether ergonomic principles are well observed.


Assuntos
Doenças Musculoesqueléticas , Doenças Profissionais , Estudos Transversais , Higienistas Dentários , Ergonomia , Feminino , Humanos , Postura , República da Coreia , Ombro
8.
Anaesthesia ; 75(3): 386-394, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31583679

RESUMO

The posterior suprascapular nerve block has been proposed as an analgesic alternative for shoulder surgery based on the publication of several comparisons with interscalene block that failed to detect differences in analgesic outcomes. However, quantification of the absolute treatment effect of suprascapular nerve block on its own, in comparison with no block (control), to corroborate the aforementioned conclusions has been lacking. This study examines the absolute analgesic efficacy of suprascapular nerve block compared with control for shoulder surgery. We systematically sought electronic databases for studies comparing suprascapular nerve block with control. The primary outcomes included postoperative 24-h cumulative oral morphine consumption and the difference in area under the curve for 24-h pooled pain scores. Secondary outcomes included the incidence of opioid-related side-effects (postoperative nausea and vomiting) and patient satisfaction. Data were pooled using random-effects modelling. Ten studies (700 patients) were analysed; all studies examined landmark-guided posterior suprascapular nerve block performed in the suprascapular fossa. Suprascapular nerve block was statistically but not clinically superior to control for postoperative 24-h cumulative oral morphine consumption, with a weighted mean difference (99%CI) of 11.41 mg (-21.28 to -1.54; p = 0.003). Suprascapular nerve block was also statistically but not clinically superior to control for area under the curve of pain scores, with a mean difference of 1.01 cm.h. Nonetheless, suprascapular nerve block reduced the odds of postoperative nausea and vomiting and improved patient satisfaction. This review suggests that the landmark-guided posterior suprascapular nerve block does not provide clinically important analgesic benefits for shoulder surgery. Investigation of other interscalene block alternatives is warranted.


Assuntos
Bloqueio Nervoso/métodos , Ombro/cirurgia , Analgesia , Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/uso terapêutico , Bloqueio do Plexo Braquial , Ensaios Clínicos como Assunto , Bases de Dados Factuais , Humanos , Morfina/administração & dosagem , Morfina/uso terapêutico , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/epidemiologia , Satisfação do Paciente , Náusea e Vômito Pós-Operatórios/epidemiologia
9.
Br J Anaesth ; 124(1): 84-91, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31591018

RESUMO

BACKGROUND: Efforts to prolong interscalene block (ISB) analgesia include the use of local anaesthetic adjuvants such as dexamethasone. Previous work showing prolonged block duration suggests that both perineural and intravenous (i.v.) routes can both prolong analgesia. The superiority of either route is controversial given the design of previous studies. As perineural dexamethasone is an off-label use, anaesthesiologists should be fully informed of the clinical differences, if any, on block duration. This study was designed to test whether perineural vs i.v. dexamethasone administration are equivalent. METHODS: We randomised 182 eligible patients scheduled for arthroscopic shoulder surgery to receive low-dose ISB (0.5% ropivacaine 5 ml) with perineural or i.v. dexamethasone 4 mg. Subjects, anaesthesiologists, and research personnel were blinded. All subjects also received a standardised general anaesthetic and multimodal analgesia. The primary outcome was duration of analgesia analysed as an equivalence outcome (2 h equivalency margin) using the two one-sided test (TOST) method. RESULTS: For the primary outcome, duration of analgesia, and perineural and i.v. administration of dexamethasone were not equivalent. The upper and lower bounds of the 90% confidence interval were 1 h (P=0.12) and -2.5 h (P=0.01), respectively. The observed difference in mean block duration was not clinically relevant (0.75 h longer for i.v. dexamethasone). There were no other clinically significant differences between groups. CONCLUSION: In the context of low-volume ISB with ropivacaine, perineural and i.v. dexamethasone were not equivalent in terms of their effects on block duration. However, there were no clinically significant differences in outcomes, and there is no advantage of perineural over intravenous dexamethasone. WWW.CLINICALTRIALS. GOV REGISTRATION: NCT02322242.


Assuntos
Adjuvantes Anestésicos/administração & dosagem , Adjuvantes Anestésicos/farmacologia , Bloqueio do Plexo Braquial/métodos , Plexo Braquial , Dexametasona/administração & dosagem , Dexametasona/farmacologia , Bloqueio Nervoso/métodos , Administração Intravenosa , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Artroscopia/métodos , Método Duplo-Cego , Feminino , Humanos , Injeções , Masculino , Pessoa de Meia-Idade , Ombro/cirurgia , Adulto Jovem
10.
J Oral Rehabil ; 47(2): 132-142, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31520546

RESUMO

BACKGROUND: Uncertainties still exist about the role of playing musical instruments on the report of musculoskeletal complaints and headache. OBJECTIVES: To evaluate the prevalence of and risk indicators for symptoms of temporomandibular disorders, pain in the neck or shoulder, and headache among musicians. METHODS: A questionnaire was distributed among 50 Dutch music ensembles. RESULTS: The questionnaire was completed by 1470 musicians (response rate 77.0%). Of these, 371 musicians were categorised as woodwind players, 300 as brass players, 276 as upper strings players, 306 as vocalists and 208 as controls; nine musicians had not noted their main instrument. The mean age was 41.6 years (standard deviation [SD] 17.2), and 46.5% were male. Irrespective of instrumentalist group, 18.3% of the musicians reported TMD pain, 52.5% reported pain in the neck and shoulder area, and 42.5% reported headache. Of the functional complaints, 18.3% of the musicians reported TMJ sounds, whereas a jaw lock or catch on opening or on closing was reported by 7.1% and 2.4%, respectively. TMD pain was associated with playing a woodwind instrument, whereas pain in the neck and shoulder was associated with playing the violin or viola. For each complaint, oral behaviours were found as risk indicator, supplemented by specific risk indicators for the various complaints. CONCLUSIONS: The current finding that pain-related symptoms varied widely between instrumentalist groups seems to reflect the impact of different instrument playing techniques. Playing a musical instrument appears not the primary aetiologic factor in precipitating a functional temporomandibular joint problem.


Assuntos
Música , Doenças Profissionais , Transtornos da Articulação Temporomandibular , Adulto , Feminino , Cefaleia , Humanos , Masculino , Cervicalgia , Ombro
11.
Sports Biomech ; 19(2): 258-270, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30004294

RESUMO

Female gymnasts have been evidenced to experience sport-specific growth, of which broad shoulders and narrow hips are common characteristics. In addition to being a central component of handstand performance, postural control mechanisms, including whole-body and lumbo-pelvic stability, have been identified as risk factors for overuse spinal pathology. The study aimed to develop a fundamental understanding of musculoskeletal growth and postural control responses of female artistic gymnasts in order to extend longitudinal insights into overuse spinal pathology risk. Whole-body anthropometric measures were collected for 12 competitive female gymnasts (age at recruitment: nine to 15 years) at three time points across a 12 month period. Musculoskeletal growth was partially defined as the rate of bicristal-to-biacromial breadth ratio development, and informed shoulder- and pelvis-dominant growth sub-groups. Kinematic and kinetic indicators of postural control were determined for a total of 700 handstand trials. The shoulder-dominant (gymnastics-specific) growth group was found to have significantly greater biomechanical risk for general stability (p < 0.001) than the pelvis-dominant group. Significantly greater lumbo-pelvic risk was demonstrated for the pelvis-dominant group (p < 0.001). Extended idiosyncratic examination of proportional sport-specific growth measures alongside multi-faceted risk monitoring was advocated for the effective development of future overuse pathology prevention protocols.


Assuntos
Ginástica/fisiologia , Desenvolvimento Musculoesquelético/fisiologia , Equilíbrio Postural/fisiologia , Adolescente , Antropometria , Fenômenos Biomecânicos , Índice de Massa Corporal , Criança , Transtornos Traumáticos Cumulativos/fisiopatologia , Feminino , Ginástica/lesões , Quadril/anatomia & histologia , Quadril/crescimento & desenvolvimento , Humanos , Estudos Longitudinais , Vértebras Lombares/lesões , Pelve/anatomia & histologia , Pelve/crescimento & desenvolvimento , Fatores de Risco , Ombro/anatomia & histologia , Ombro/crescimento & desenvolvimento
12.
J Shoulder Elbow Surg ; 29(1): 175-184, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31420224

RESUMO

BACKGROUND: Scapular malposition and posterior shoulder tightness are key pathologic processes in the shoulder of throwing athletes. The objective of this study was to investigate the effects of posterior capsule tightness, posterior rotator cuff muscle tightness, or both on scapular position. METHODS: Ten shoulders from 5 fresh frozen cadaveric male torsos were tested in maximum internal, neutral, and maximum external shoulder rotations at 0°, 45°, and 90° of shoulder abduction. Scapular rotation-namely, upward and downward rotation, internal and external rotation, and anterior and posterior tilt-and the scapula-spine distance were measured by using a MicroScribe digitizer (Revware, Raleigh, NC, USA). Each shoulder underwent 4 experimental stages: intact; isolated posterior rotator cuff muscle (infraspinatus and teres minor) tightness; both posterior rotator cuff muscle and capsule tightness; and isolated posterior capsule tightness. RESULTS: Posterior muscle tightness significantly decreased upward rotation (P< .05) only in maximum shoulder internal rotation at 45° or 90° of shoulder abduction, whereas posterior capsule tightness did not affect upward rotation (P= .09 to .96). Posterior capsule tightness significantly increased scapular internal rotation (P< .01), but posterior muscle tightness did not change scapular internal rotation (P= .62 to .89). Posterior capsule tightness significantly increased both the superior and inferior scapula-spine distance (ie, caused scapular protraction) in maximum shoulder external rotation at 90° of abduction (P< .01). CONCLUSION: Posterior shoulder tightness resulted in scapular malposition. However, the muscular and capsular components of that tightness affected the scapular position differently. For the treatment of scapula malposition, stretching of the posterior shoulder capsule and muscles is recommended.


Assuntos
Amplitude de Movimento Articular , Manguito Rotador/fisiopatologia , Escápula/fisiopatologia , Articulação do Ombro/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Fenômenos Biomecânicos , Cadáver , Humanos , Cápsula Articular/fisiopatologia , Masculino , Fatores de Risco , Rotação , Ombro
13.
J Shoulder Elbow Surg ; 29(1): 68-78, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31378683

RESUMO

BACKGROUND: Pathologic activation pattern of muscles can cause shoulder instability. We propose to call this pathology functional shoulder instability (FSI). The purpose of this prospective study was to provide an in-detail description of the characteristics of FSI. METHODS: In the year 2017, a total of 36 consecutive cases of FSI presenting to our outpatient clinic were prospectively collected. Diagnostic investigation included a pathology-specific questionnaire, standardized clinical scores, clinical examination, psychological evaluation, video and dynamic fluoroscopy documentation of the instability mechanism, as well as magnetic resonance imaging (MRI). In a final reviewing process, the material from all collected cases was evaluated and, according to the observed pattern, different subtypes of FSI were determined and compared. RESULTS: Based on the pathomechanism, positional FSI (78%) was distinguished from nonpositional FSI (22%). Controllable positional FSI was observed in 6% of all cases and noncontrollable positional FSI in 72%, whereas controllable and noncontrollable nonpositional FSI were each detected in 11% of the cases. The different subtypes of FSI showed significant differences in all clinical scores (Western Ontario Shoulder Instability Index: P = .002, Rowe Score: P = .001, Subjective Shoulder Value: P = .001) and regarding functional impairment (shoulder stability: P < .001, daily activities: P = .001, sports activities: P < .001). Seventy-eight percent had posterior, 17% anterior, and 6% multidirectional instability. Although several patients showed constitutional glenoid shape alterations or soft tissue hyperlaxity, only few patients with acquired minor structural defects were observed. CONCLUSION: FSI can be classified into 4 subtypes based on pathomechanism and volitional control. Depending on the subtype, patients show different degrees of functional impairment. The majority of patients suffer from unidirectional posterior FSI.


Assuntos
Instabilidade Articular/diagnóstico por imagem , Instabilidade Articular/fisiopatologia , Articulação do Ombro/diagnóstico por imagem , Articulação do Ombro/fisiopatologia , Ombro/diagnóstico por imagem , Adolescente , Adulto , Feminino , Fluoroscopia , Humanos , Imagem por Ressonância Magnética , Masculino , Músculo Esquelético/fisiopatologia , Postura , Estudos Prospectivos , Ombro/fisiopatologia , Adulto Jovem
14.
Anaesthesia ; 75(4): 493-498, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31854463

RESUMO

The shoulder block may impair ventilatory function and diaphragmatic movement less than the interscalene brachial plexus block. We randomly allocated 30 adults who underwent shoulder arthroscopy under general anaesthesia to ultrasound-guided shoulder block or interscalene block with 20 ml bupivacaine 0.5%. The primary outcome, rate of ultrasound-measured hemidiaphragmatic excursion < 25% of baseline 30 min after blockade, was reduced from 12/15 with brachial plexus block to 2/15 with shoulder block, a difference (95%CI) of 67% (40-93%), p < 0.001. The mean (SD) numeric rating scale pain scores at rest after shoulder block were higher than after interscalene block at two postoperative hours, 1.4 (1.2) vs. 0.3 (0.7), p = 0.02, but lower at 24 postoperative hours, 1.3 (1.3) vs. 3.4 (2.3), p = 0.008. Mean (SD) pain scores on movement in the shoulder and interscalene blocks were similar, with respective values of 1.9 (1.9) vs. 0.7 (1.2), p = 0.13 at two postoperative hours and 3.7 (2.3) vs. 5.3 (2.5), p = 0.41, at 24 postoperative hours.


Assuntos
Artroscopia/métodos , Bloqueio Nervoso/métodos , Insuficiência Respiratória/prevenção & controle , Ombro/inervação , Ombro/cirurgia , Adulto , Anestésicos Locais/uso terapêutico , Bloqueio do Plexo Braquial/métodos , Bupivacaína/uso terapêutico , Feminino , Humanos , Masculino , Ultrassonografia de Intervenção
15.
Braz Dent J ; 30(6): 569-576, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31800751

RESUMO

This study evaluated the influence of a retentive shoulder design to prevent early failure of three resin composite build-ups on molars. Ninety-six intact extracted human maxillary third molars were assigned to two groups (n=48) based on occlusal, buccal cusps only and all cusps reduction. The groups were divided into two subgroups: pin retained and non-pin retained build-ups resulting in four groups (n=24), according the cusps reduction: pin retained/partial, pin retained/complete, non-pin retained/partial, non-pin retained/complete. Occlusal reduction was 3 mm with a semi-lunar retentive shoulder of 3 mm and an axial wall height of 1.5 mm. Groups were restored using a microhybrid, flowable or titanium reinforced resin composite. Modified self-curing acrylic resin provisional crowns were fabricated, cemented with non-eugenol temporary cement and thermal cycled. An instron machine applied tension to the provisional crowns parallel to the long axis of the tooth until dislodgement. A three-way analysis of variance was conducted on the influence of the variables on the retention of the core build-up. Ninety-three build-ups were retained under tensile load, while three core build-ups without pins were dislodged. Three-way analysis of variance showed no statistically significant difference between core build-ups using a retentive shoulder and pin retained core build-ups when tested under tensile load. With the advent of adhesive systems, increased surface area and retentive shoulder design can provide a retentive core foundation to prevent early failures of core build-ups during indirect restoration fabrication which will contribute to the longevity of final restorations.


Assuntos
Retenção em Prótese Dentária , Ombro , Resinas Compostas , Coroas , Cimentos Dentários , Análise do Estresse Dentário , Humanos , Teste de Materiais , Cimentos de Resina
17.
J Sports Sci Med ; 18(4): 798-804, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31827365

RESUMO

In recent years, there is an increasing importance of double poling (DP) performance regarding the outcome in classic cross-country skiing (XCS) races. So far, different approaches were used to predict DP performance but there is a lack of knowledge how general strength parameters are related to DP performance parameters gathered from in field-test situations. Therefore, the aim of this study was to determine the relationship between general strength measurements of different upper-body segments and pole force measurements during a DP sprint exercise. In addition, multiple linear regressions were calculated to determine the predictive power of theses variables regarding DP sprint performance, represented as maximum velocity. Thirteen none-elite cross-country skiers performed two 60 m DP sprints at maximal speed on a tartan track using roller skis. In addition, maximum isometric and concentric strength tests were performed on a motor-driven dynamometer with four major upper-body segments (trunk flexion / extension, shoulder / elbow extension). Especially the mean pole force and the strength test parameters correlated significantly (r ≥ 0.615) in all except one comparison. However, regression analyses revealed that neither pole force parameters (R² = 0.495) nor isometric (R² = 0.456) or dynamic (R² = 0.596) strength test parameters could predict the DP performance significantly. This study showed that standardized isokinetic strength tests could be used to estimate pole force capabilities of XCS athletes. However, pole-force and strength test parameters failed to predict significantly maximal velocity during a DP sprint exercise, which might be attributed to the non-elite subject group.


Assuntos
Desempenho Atlético/fisiologia , Destreza Motora/fisiologia , Força Muscular/fisiologia , Esqui/fisiologia , Adulto , Cotovelo/fisiologia , Feminino , Humanos , Masculino , Contração Muscular/fisiologia , Análise de Regressão , Ombro/fisiologia , Torque , Tronco/fisiologia
18.
J Surg Orthop Adv ; 28(4): 268-271, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31886762

RESUMO

The purpose of this study is to evaluate the fluid volume required for a saline load test to detect intra-articular involvement of the glenohumeral joint after penetrating trauma. A human cadaver study was conducted with 22 thawed, fresh-frozen forequarter amputations. A standard posterior shoulder portal was made with an 11-blade scalpel. A 19-gauge needle was inserted into the anterior portal site, and intra-articular position of both the blade and needle was confirmed with fluoroscopy. The blade was removed and normal saline was injected through the needle until extravasation of fluid was observed through the posterior portal. Injection volume required for extravasation was recorded. A logarithmic distribution of the volumes was then calculated in order to obtain estimated sensitivity ranges. Using a logarithmic distribution, 90%, 95% and 99% of simulated glenohumeral arthrotomies could be detected using injections of: 62 ml [41-96], 81 ml [50-133] and 136 ml [72-252], respectively. (Journal of Surgical Orthopaedic Advances 28(4):268-271, 2019).


Assuntos
Articulação do Ombro , Ombro , Cadáver , Humanos , Injeções Intra-Articulares , Solução Salina
19.
J Surg Orthop Adv ; 28(4): 290-294, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31886767

RESUMO

Recent literature suggests that many online patient resources are poor in quality and lack important clinical information. The purpose of this study was to investigate the value of online resources available to patients considering shoulder arthroplasty. A total of 84 websites were discovered with the terms "total shoulder replacement" (TSR) and "reverse shoulder replacement" (RSR), they were reviewed and graded for quality and accuracy. Overall quality scores were low for TSR and RSR websites, 22.8/45 (95% confidence interval (CI): 19.9-25.6) and 24.2/45 (95% CI: 21.6-26.9), respectively. The authorship of a website significantly influenced the quality for both TSR (p = 0.013) and RSR (p = 0.048). When comparing search rank to quality scores, websites that appeared earlier demonstrated significantly higher quality scores, TSR (p = 0.017) and RSR (p = 0.018). Overall, most websites were accurate but provided incomplete information. Websites authored by professional societies have higher quality scores than websites authored by medical providers or commercial entities. (Journal of Surgical Orthopaedic Advances 28(4):290-294, 2019).


Assuntos
Artroplastia do Ombro , Ortopedia , Humanos , Disseminação de Informação , Internet , Ombro
20.
No Shinkei Geka ; 47(12): 1275-1279, 2019 Dec.
Artigo em Japonês | MEDLINE | ID: mdl-31874949

RESUMO

Suprascapular nerve entrapment is rarely treated by neurosurgeons in Japan. However, it is often observed in post-stroke patients and in cases of accessory nerve injury as a complication of posterior fossa craniotomy. We report a case of suprascapular nerve entrapment due to superior transverse scapular ligament, which was successfully diagnosed and surgically treated. The patient was a 66-year-old female who used be a janitor. She complained of dysesthesia around the shoulder. The diagnosis was made based on the characteristic neurological findings including pain around the scapula, supraspinatus muscle weakness, and favorable but temporary response to suprascapular nerve block. After undergoing conservative management for one and a half year, she decided to undergo the nerve decompression surgery. The surgical treatment was performed under microscope with neuromonitoring. Following surgery, the painful area was dramatically reduced. We believe that suprascapular nerve disorders can be treated with careful neurological evaluation by neurosurgeons.


Assuntos
Síndromes de Compressão Nervosa , Ombro , Idoso , Descompressão Cirúrgica , Feminino , Humanos , Japão , Escápula
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