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1.
Rev. clín. esp. (Ed. impr.) ; 223(1): 17-24, ene. 2023.
Artigo em Espanhol | IBECS | ID: ibc-214305

RESUMO

Introducción La osteonecrosis avascular (ONA) de cadera y de hombro es una enfermedad poco estudiada y no se conocen bien los factores de riesgos predisponentes para desarrollarla. Existe un porcentaje alto de pacientes diagnosticados como osteonecrosis idiopática. Este estudio tiene como objetivo investigar la prevalencia de los posibles factores etiológicos de la ONA y realizar un cribado de la enfermedad de Gaucher en los pacientes diagnosticados de ONA idiopática. Material y método Estudio observacional retrospectivo y unicéntrico de los pacientes que hayan presentado al menos un episodio de osteonecrosis avascular de la cadera o del hombro en el Hospital de Poniente (Almería, España) desde enero de 2010 a diciembre de 2019. Se recogieron datos clínicos y analíticos. Los pacientes en cuya historia clínica no se describían factores etiológicos fueron cribados para enfermedad de Gaucher. Resultados Se incluyeron un total de 81 pacientes, de los cuales 58 eran hombres. La edad media de presentación de ONA fue de 45,9 años. Presentaron necrosis unilateral de cadera (n = 43), necrosis bilateral de cadera (n = 34), necrosis bilateral de cadera y unilateral de hombro (n = 3) y necrosis unilateral de hombro (n = 1). Los potenciales factores etiológicos más frecuentes fueron tabaquismo (46,9%) y obesidad (17,3%). Se realizó un cribado de la enfermedad de Gaucher en 10 pacientes, que resultó ser negativo. Conclusiones En nuestro estudio los principales potenciales factores etiológicos de aparición de la ONA fueron el tabaquismo y la obesidad. Existe un porcentaje alto de pacientes diagnosticados de osteonecrosis avascular idiopática. Creemos que en estos casos se debería realizar un estudio más exhaustivo de los factores de riesgo menos frecuentes (AU)


Introduction Avascular necrosis (AON) of the hip and shoulder is a little studied disease and the predisposing risk factors for its development are not well known. A high percentage of patients are diagnosed with idiopathic osteonecrosis. This study aims to investigate the prevalence of potential etiological factors for AON and to screen for Gaucher disease among patients with idiopathic AON. Material and methods This retrospective, single-center, observational study was conducted on patients who had at least one episode of AON of the hip or shoulder at the Hospital de Poniente (Almería, Spain) from January 2010 to December 2019. Clinical and analytical data were collected. Patients whose medical record described no etiological factors for this disease were screened for Gaucher disease. Result The study sample consisted of 81 patients, of whom 58 were male. The mean age at presentation of AON was 45.9 years. They presented with unilateral hip necrosis (n = 43), bilateral hip necrosis (n = 34), bilateral hip and unilateral shoulder necrosis (n = 3), and unilateral shoulder necrosis (n = 1). The most frequent potential etiological factors were smoking (46.9%) and obesity (17.3%). Screening for Gaucher disease was performed in ten patients, all of whom tested negative. Conclusions In our study population, the main potential etiological factors the onset of AON of the shoulder or hip were smoking and obesity. A high percentage of patients were diagnosed with idiopathic AON. We believe that a more exhaustive study of less frequent risk factors should be carried out in these cases (AU)


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Doença de Gaucher/diagnóstico , Osteonecrose/diagnóstico , Osteonecrose/etiologia , Quadril/patologia , Ombro/patologia , Estudos Retrospectivos , Programas de Rastreamento , Fatores de Risco , Prevalência
2.
Curr Oncol ; 30(1): 673-680, 2023 Jan 04.
Artigo em Inglês | MEDLINE | ID: mdl-36661701

RESUMO

OBJECTIVE: This study aimed to compare postoperative patients with breast cancer aged ≥65 years with those aged <65 years and clarify the characteristics of postoperative patients with breast cancer aged ≥65. METHODS: In total, 376 patients in whom we were able to evaluate survey items one month after surgery were included in the study. Comorbidity, including diabetes mellitus and hypertension, shoulder range of motion (ROM), upper-limb function, and psychological problems, was evaluated. RESULTS: Hypertension and diabetes mellitus were significantly higher in patients aged ≥65 years (the elderly group) than in those aged <65 years (the non-elderly group) (p < 0.05). Preoperative shoulder flexion ROM was significantly restricted in the elderly group compared with the non-elderly group (p < 0.05). Preoperative shoulder abduction ROM was significantly restricted in the elderly group compared with the non-elderly group (p < 0.05). At one month after surgery, upper-limb function was more impaired in the non-elderly group than in the elderly group (p < 0.05). In both groups, both ROM and upper-limb function were significantly impaired one month after surgery compared with before surgery (p < 0.05). CONCLUSIONS: Postoperative patients with breast cancer aged ≥65 years should be careful about risk management and intervention during rehabilitation. Preoperative evaluation of shoulder ROM should be performed because patients aged ≥65 years have limited ROM before surgery.


Assuntos
Neoplasias da Mama , Diabetes Mellitus , Hipertensão , Humanos , Pessoa de Meia-Idade , Feminino , Neoplasias da Mama/cirurgia , Ombro , Amplitude de Movimento Articular
3.
PLoS One ; 18(1): e0280048, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36662745

RESUMO

MAIN OBJECTIVE: Sickness absence duration for shoulder lesion patients is difficult to prognosticate, and scientific evidence for the sick-listing practice is lacking. Our objective was to develop a clinically implementable prediction model for the duration of a sickness absence spell due to shoulder lesions. METHODS: All new sickness absence spells due to shoulder lesions (ICD-10-code: M75) issued in the period January 2010-June 2012 that were longer than 14 days were identified through the nationwide sickness absence insurance register. Information on predictors was linked from four other nationwide registers. Piecewise-constant hazards regression models were fitted to predict duration of sickness absence. The model was developed and validated using split sample validation. Variable selection was based on log-likelihood loss ranking when excluding a variable from the model. The model was evaluated using calibration plots and the c-statistic. RESULTS: 20 049 sickness absence spells were identified, of which 34% lasted >90 days. Predictors included in the model were age, sex, geographical region, occupational status, educational level, birth country, specialized healthcare at start of the spell, number of sickness absence days in the last 12 months, and specialized healthcare the last 12 months, before start date of the index sickness absence spell. The model was satisfactorily specified and calibrated. Overall c-statistic was 0.54 (95% CI 0.53-0.55). C-statistic for predicting durations >90, >180, and >365 days was 0.61, 0.66, and 0.74, respectively. SIGNIFICANCE: The model can be used to predict the duration of sickness absence due to shoulder lesions. Covariates had limited predictive power but could discriminate the very long sickness absence spells from the rest.


Assuntos
Emprego , Ombro , Humanos , Prognóstico , Suécia/epidemiologia , Modelos de Riscos Proporcionais , Licença Médica
4.
Toxins (Basel) ; 15(1)2023 Jan 10.
Artigo em Inglês | MEDLINE | ID: mdl-36668878

RESUMO

Spasticity of the upper extremity can result in severe pain, along with many complications that can impair a patient's activities of daily living. Failure to treat patients with spasticity of the upper limb can result in a decrease in the range of motion of joints and contracture development, leading to further restriction in daily activities. We aimed to investigate the practice patterns of Canadian physicians who utilize Botulinum toxin type-A (BoNT-A) injections in the management of shoulder spasticity. 50 Canadian Physical Medicine and Rehabilitation (PM&R) physicians completed a survey with an estimated completion rate of (36.23%). The demographics of the survey participants came from a variety of provinces, clinical settings, and patient populations. The most common muscle injected for shoulder adduction and internal rotation spasticity was the pectoralis major, this was followed by latissimus dorsi, pectoralis minor, subscapularis and teres major. Injection of BoNT-A for problematic post-stroke shoulder spasticity was common, with (81.48%) of participants responding that it was always or often used in their management of post-stroke spasticity (PSS). Dosing of BoNT-A demonstrated variability for the muscle injected as well as the type of toxin used. The goals of the patients, caregivers, and practitioners were used to help guide the management of these patients. As a result, the practice patterns of Canadian physicians who treat shoulder spasticity are varied, due to numerous patient factors. Future studies are needed to analyze optimal treatment patterns, and the development of algorithms to standardize care.


Assuntos
Toxinas Botulínicas Tipo A , Fármacos Neuromusculares , Humanos , Ombro , Estudos Transversais , Fármacos Neuromusculares/uso terapêutico , Atividades Cotidianas , Resultado do Tratamento , Canadá , Toxinas Botulínicas Tipo A/efeitos adversos , Extremidade Superior , Espasticidade Muscular/etiologia , Injeções Intramusculares
5.
BMC Musculoskelet Disord ; 24(1): 50, 2023 Jan 20.
Artigo em Inglês | MEDLINE | ID: mdl-36670364

RESUMO

BACKGROUND AND OBJECTIVES: Frozen shoulder (FS) is characterized by pain and significant loss of active and passive shoulder motion. Strengthening exercises are among the standard exercises used for FS. Neuromuscular exercise (NME) effectively improved pain and the range of motion in shoulder. However, no prior research has looked into the effects of NME compared to strengthening exercises in FS rehabilitation. The aim of the present study was to evaluate the effects of NME compared to strengthening exercises on pain and active range of motion (AROM) in individuals with idiopathic frozen shoulder. METHODS: Forty individuals with idiopathic frozen shoulder were randomly assigned to either the experimental group (NME with regular physical therapy, n = 20) or the control group (strengthening exercises with regular physical therapy, n = 20). In both groups, the interventions were performed once a day, 5 days a week for 8 weeks. Pain scores on the visual analogue scale (VAS) and AROM of the shoulder were assessed at baseline and after the 8-week treatment. The primary analysis was the group × time interaction. RESULTS: Two-by-two mixed analysis of variance (ANOVA) revealed a significant group × time interaction for VAS (F = 29.67; p < 0.01); AROM in flexion (F = 12.05; p < 0.01), internal rotation (F = 6.62; p < 0.05) and external rotation (F = 16.93; p < 0.01) in favor of the experimental group. The two-by-two mixed ANOVA revealed a significant main effect of time for VAS (F = 1648.47; p < 0.01); AROM in flexion (F = 591.70; p < 0.01), extension (F = 114.57; p < 0.01), abduction (F = 1602.04; p < 0.01), internal rotation (F = 664.14; p < 0.01) and external rotation (F = 1096.92; p < 0.01). No other significant differences were found. CONCLUSIONS: NME is superior to strengthening exercises in terms of pain and AROM of shoulder flexion, internal rotation and external rotation in individuals with idiopathic FS. NME could be used to treat individuals with FS. TRIAL REGISTRATION: Trial registration number: ChiCTR2100054453. Registration date: 17/12/2021.


Assuntos
Bursite , Terapia por Exercício , Humanos , Ombro , Dor , Amplitude de Movimento Articular , Bursite/terapia , Dor de Ombro/diagnóstico , Dor de Ombro/terapia , Resultado do Tratamento
6.
Jt Dis Relat Surg ; 34(1): 226-233, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36700287

RESUMO

Neglected bilateral posterior shoulder dislocation is a rare injury caused primarily by an epileptic seizure. The injury is usually associated with a reverse Hill-Sachs lesion in the anteromedial aspect of the humeral head. The modified McLaughlin technique may avoid instability and osteoarthritis when 20 to 40% of the articular surface is affected by reverse Hill-Sachs. In this article, we present the clinical results of a case overlooked in the literature for the longest time, i.e., for 15 months. A 46-year-old male patient was receiving treatment for epilepsy for five years. There was no fall or trauma in the four seizures he had during this time. The last seizure was 15 months ago. When the patient presented to our clinic, both shoulders were symmetrically deformed, the anterior shoulder contour disappeared (empty socket sign), and there was a loss of upper contour. The computed tomography (CT) scan revealed a posteriorly locked dislocation with a reverse Hill-Sachs lesion in 32% of the left shoulder and 36% of the right shoulder. We applied the modified McLaughlin procedure to the dominant right shoulder and, two months later, we used it to the left shoulder (with a graft taken from the anterior superior iliac spine). At one-year of follow-up, both shoulders were moderately functional: forward elevation left 70° and right 50°, abduction left 40° and right 60°, and internal rotation: the back of the hand could touch the fifth lumbar vertebra. Meanwhile, the patient did not suffer from recurrent dislocation. The pre- and postoperative Constant-Murley Scores for the right and left shoulder were 30/52 and 11/48, respectively. Although the operational outcomes using the modified McLaughlin technique were not ideal, with no recurrence, the patient seemed to be satisfied with this outcome. In conclusion, in neglected locked shoulder fracture-dislocations, the modified McLaughlin technique is a method that can respond to the pathophysiology by eliminating reverse Hill-Sachs lesion.


Assuntos
Lesões de Bankart , Fratura-Luxação , Luxação do Ombro , Fraturas do Ombro , Masculino , Humanos , Pré-Escolar , Luxação do Ombro/diagnóstico por imagem , Luxação do Ombro/cirurgia , Lesões de Bankart/cirurgia , Ombro , Fraturas do Ombro/cirurgia , Fratura-Luxação/cirurgia
7.
J Int Med Res ; 51(1): 3000605231152384, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36694987

RESUMO

Axillary web syndrome (AWS) is characterized by the formation of cords in the axilla. Classically, it develops after surgical biopsy or removal of axillary lymph nodes for breast cancer. It can cause a limited range of motion and may contribute to abnormal shoulder movements or patterns that can cause pain. In this report, an atypical case of AWS presented in a 38-year-old male after physical activity but with no surgical history or breast cancer. This case report highlights that AWS can appear in healthy individuals with no history of breast cancer and/or surgical intervention. It also emphasizes the need to consider AWS in clinical practice as a differential diagnosis of painful shoulder movement and restricted range of motion.


Assuntos
Neoplasias da Mama , Excisão de Linfonodo , Masculino , Humanos , Adulto , Excisão de Linfonodo/efeitos adversos , Ombro/cirurgia , Axila/cirurgia , Axila/patologia , Neoplasias da Mama/patologia , Linfonodos/cirurgia , Dor/patologia
8.
Ann Afr Med ; 22(1): 45-48, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36695221

RESUMO

Introduction: Shoulder capsulitis (SC) is a common musculoskeletal complication in patients with diabetes. It can be particularly disabling. It is often overlooked by clinicians. The aim of this study is to evaluate the prevalence of retractile capsulitis and to identify the risk factors in a population of Moroccan diabetic patients. Materials and Methods: We realised a cross-sectional study including patients with diabetes mellitus (DM). We recorded the demographic and diabetic characteristics of our patients. SC and vascular complications were assessed by clinical and para-clinical investigations. The prevalence of SC was calculated. The factors associated with SC were evaluated by suitable statistical tests. Results: Three hundred and Sixty-five patients were included; 84.9% had Type 2 DM (T2DM). The mean age of the participants was 52.6 ± 13.6. Shoulder capsulitis was present in 12.6% of patients. In statistical analysis, age >50 years (P = 0.001), T2DM (P = 0.03), duration of progression >10 years (P = 0.03), dyslipidemia (P = 0.013) and macrovascular complications (P = 0.009) were associated with an increased frequency of SC. Conclusion: This study shows that the prevalence of SC is higher in diabetic patients. Therefore, inclusion of this pathology in the global management of the diabetic patient is necessary.


Résumé Introduction: la capsulite rétractile de l'épaule (CR) est une complication musculo-squelettique fréquente chez les patients diabétiques. Elle peut être particulièrement invalidante. Elle est souvent méconnue par les cliniciens. Cette étude a pour objectif d'évaluer la prévalence de la capsulite rétractile et d'identifier les facteurs de risque dans une population de patients diabétiques marocains. Methodes: Une étude transversale incluant des patients diabétiques. Nous avons enregistré les caractéristiques démographiques et les caractéristiques du diabète de nos patients. La CR et les complications vasculaires ont été évalués par des examens cliniques et para cliniques. La prévalence de la CR a été calculée, ensuite les facteurs associés à la CR ont été évalués par des tests statistiques adaptés. Resultat: 365 patients ont été inclus ; 84.9 % avaient un diabète de type 2. L'âge moyen des participants était de 52.6 ±13.6. Une capsulite de l'épaule était présente chez 12,6 % des patients. Dans l'analyse statistique, l'âge supérieur à 50 ans (P=0,001), le diabète de type 2 (P=0.03), la durée d'évolution >10 ans (P=0.03), la dyslipidémie (P=0.013) et les complications macro vasculaires (P=0.009) étaient associées à une fréquence accrue de la capsulite rétractile. Conclusion: cette étude montre que la prévalence de la CR est plus élevée chez les patients diabétiques. D'où la nécessité d'inclure cette pathologie dans la prise en charge globale du patient diabétique, et de la même manière, réaliser un dépistage de diabète chez les patients souffrant d'un capsulite rétractile. Mots clés: diabète sucré, complications musculo squelettiques, capsulite rétractile.


Assuntos
Bursite , Diabetes Mellitus Tipo 2 , Humanos , Pessoa de Meia-Idade , Ombro , Estudos Transversais , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/epidemiologia , Bursite/epidemiologia , Bursite/complicações , Fatores de Risco
10.
Sensors (Basel) ; 23(2)2023 Jan 16.
Artigo em Inglês | MEDLINE | ID: mdl-36679809

RESUMO

BACKGROUND: The aim of this study was to analyze differences in three-dimensional shoulder kinematics between asymptomatic subjects and patients who were diagnosed with rotator cuff tears. METHODS: This cross-sectional study recruited 13 symptomatic subjects and 14 asymptomatic subjects. Data were obtained from three inertial sensors placed on the humerus, scapula and sternum. Kinematic data from the glenohumeral, scapulothoracic and thoracohumeral joints were also calculated. The participants performed shoulder abductions and flexions. The principal angles of movements and resultant vectors in each axis were studied. RESULTS: The glenohumeral joint showed differences in abduction (p = 0.001) and flexion (p = 0.000), while differences in the scapulothoracic joint were only significant during flexion (p = 0.001). The asymptomatic group showed higher velocity values in all sensors for both movements, with the differences being significant (p < 0.007). Acceleration differences were found in the scapula during abduction (p = 0.001) and flexion (p = 0.014), as well as in the sternum only during shoulder abduction (p = 0.022). CONCLUSION: The results showed kinematic differences between the patients and asymptomatic subjects in terms of the mobility, velocity and acceleration variables, with lower values for the patients.


Assuntos
Lesões do Manguito Rotador , Articulação do Ombro , Humanos , Ombro , Estudos Transversais , Fenômenos Biomecânicos , Amplitude de Movimento Articular
11.
Ann Plast Surg ; 90(2): 144-150, 2023 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-36688857

RESUMO

BACKGROUND: Obstetric brachial plexus injury (OBPI) remains a fairly common problem in newborns despite the improved obstetric care. Children who do not show complete recovery often present with residual shoulder deformity of limited external rotation and abduction. Secondary interventions in the form of tendon transfer and soft tissue release are aimed at correcting the implicated muscular imbalance to restore shoulder function. AIM: The aim of this work was to compare the results of latissimus dorsi versus teres major tendon transfer in patients with OBPI with limited shoulder external rotation. PATIENTS AND METHODS: This study included 40 patients admitted to El Hadara University Hospital with OBPI and limited shoulder abduction and external rotation aged between 1.5 and 4 years. Half of the patients had a latissimus dorsi transfer, and the other half, a teres major one. Children with limited preoperative passive external rotation in both groups required a subscapularis slide. Patients were evaluated preoperatively, at 6 months, and 12 months postoperatively using the Gilbert scale. RESULTS: Teres major tendon transfer showed better results in restoring limited shoulder abduction and external rotation than latissimus dorsi transfer. Limited shoulder internal rotation was the main complication occurring postoperatively. Loss of the last degree of internal rotation occurred in most patients who had subscapularis slide. Most patients regained functional midline abilities with physiotherapy and required no further interventions. CONCLUSIONS: Isolated teres major transfer has shown better results in improving the range of external rotation and abduction compared with isolated latissimus dorsi tendon transfer. Age of the patients did not affect the overall final improvement in shoulder range of motion. Limited internal rotation is the main complication postoperatively, which was prevalent in patients who required a subscapularis slide but was not statistically significant.


Assuntos
Neuropatias do Plexo Braquial , Plexo Braquial , Articulação do Ombro , Músculos Superficiais do Dorso , Recém-Nascido , Criança , Humanos , Lactente , Pré-Escolar , Ombro , Neuropatias do Plexo Braquial/cirurgia , Resultado do Tratamento , Articulação do Ombro/cirurgia , Plexo Braquial/lesões , Transferência Tendinosa/métodos , Amplitude de Movimento Articular
12.
Artigo em Inglês | MEDLINE | ID: mdl-36674262

RESUMO

A new ergonomic-risk-assessment tool was developed that combines musculoskeletal-model-based loading estimates with insights from fatigue failure theory to evaluate full-body musculoskeletal loading during dynamic tasks. Musculoskeletal-modeling output parameters, i.e., joint contact forces and muscle forces, were combined with tissue-specific injury thresholds that account for loading frequency to determine the injury risk for muscles, lower back, and hip cartilage. The potential of this new risk-assessment tool is demonstrated for defining ergonomic interventions in terms of lifting characteristics, back and shoulder exoskeleton assistance, box transferring, stoop lifting, and an overhead wiring task, respectively. The MATE identifies the risk of WMSDs in different anatomical regions during occupational tasks and allows for the evaluation of the impact of interventions that modify specific lifting characteristics, i.e., load weight versus task repetition. Furthermore, and in clear contrast to currently available ergonomic assessment scores, the effects of the exoskeleton assistance level on the risk of WMSDs of full-body musculoskeletal loading (in particular, the muscles, lower back, and hips) can be evaluated and shows small reductions in musculoskeletal loading but not in injury risk. Therefore, the MATE is a risk-assessment tool based on a full-body, musculoskeletal-modeling approach combined with insights from the fatigue failure theory that shows the proof of concept of a shoulder and back exoskeleton. Furthermore, it accounts for subject-specific characteristics (age and BMI), further enhancing individualized ergonomic-risk assessment.


Assuntos
Doenças Musculoesqueléticas , Doenças Profissionais , Humanos , Doenças Musculoesqueléticas/epidemiologia , Ergonomia/métodos , Medição de Risco/métodos , Dorso , Ombro
13.
Arthroscopy ; 39(2): 202-203, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36603990

RESUMO

Historically, it was believed that the shoulder long head of the biceps tendon (LHBT) was a pain generator and had to be routinely sacrificed. Recently, it has become apparent that the LHBT is useful as an autograft for various types of surgical reconstruction, including superior capsular reconstruction for irreparable rotator cuff tears, and augmentation for poor soft-tissue quality during rotator cuff repair or shoulder arthroplasty. In cases of shoulder instability, the biceps can reinforce the capsule or reconstruct a missing labrum for glenohumeral stabilization. Dynamic anterior stabilization transfers the LHBT through the subscapularis to the anterior glenoid margin, creating "sling" and "hammock" effects. Various labral augmentation techniques also have been described. In a paradigm shift, shoulder surgeons may become LHBT users instead of LHBT "killers."


Assuntos
Instabilidade Articular , Lesões do Manguito Rotador , Articulação do Ombro , Humanos , Ombro/cirurgia , Instabilidade Articular/cirurgia , Articulação do Ombro/cirurgia , Tendões/cirurgia , Músculo Esquelético/cirurgia , Lesões do Manguito Rotador/cirurgia
14.
Arthroscopy ; 39(2): 232-233, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36603993

RESUMO

There are 2 distinct types of rotator cuff tears. The first is a chronic, degenerative tear, which is more common. The second is an acute traumatic tear. (There is also likely a third, hybrid type consisting of an acute-on-chronic tear) Traumatic tears result in acute dysfunction with weakness and loss of range of motion. Traumatic tears are large to massive in size and have higher degrees of subscapularis involvement. If a patient has an acute cuff tear, the surgeon should fix it. The surgeon should not take the time to measure the critical shoulder angle (CSA) or plan an acromioplasty but should just fix the tear-the sooner, the better. The CSA has been emerging as a concept in trying to figure out the pathogenesis and treatment of degenerative tears. But, when it comes to traumatic tears, the CSA can be ignored. It likely does not have a role in the causation or treatment of traumatic rotator cuff tears.


Assuntos
Lacerações , Lesões do Manguito Rotador , Articulação do Ombro , Humanos , Lesões do Manguito Rotador/diagnóstico por imagem , Lesões do Manguito Rotador/cirurgia , Lesões do Manguito Rotador/patologia , Ombro , Manguito Rotador/diagnóstico por imagem , Manguito Rotador/cirurgia , Manguito Rotador/patologia , Ruptura/cirurgia , Articulação do Ombro/cirurgia
15.
Arthroscopy ; 39(2): 211-212, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36603991

RESUMO

Male athletes have been shown to have a higher incidence of shoulder instability and higher rates of recurrence after arthroscopic stabilization. However, when similar sports are compared, the incidence of instability effectively equalizes. When similar sports are compared, outcomes after arthroscopic Bankart repair may also equalize when compared by sex. Next, contact and collision athletes with shoulder instability have more severe intra-articular pathologies that affect their treatment and outcomes. As these sports become more available to women worldwide, we may see more women athletes with more complex shoulder instability-related pathology. Ultimately, the solution may be to ensure equal resources available to optimize surgical outcomes for athletes after surgery, regardless of sex. We must not leave female athletes on the bench.


Assuntos
Instabilidade Articular , Luxação do Ombro , Articulação do Ombro , Esportes , Humanos , Masculino , Feminino , Articulação do Ombro/cirurgia , Articulação do Ombro/patologia , Ombro , Instabilidade Articular/etiologia , Luxação do Ombro/cirurgia , Luxação do Ombro/complicações , Artroscopia/efeitos adversos , Recidiva
16.
Arthroscopy ; 39(2): 452-458, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36604006

RESUMO

PURPOSE: To study the literature to evaluate the functional outcomes, radiologic outcomes, and revision rates following arthroscopic rotator cuff repair (ARCR) at a minimum of 10-years follow-up. METHODS: Two independent reviewers performed a literature search of PubMed, Embase, and Scopus using the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Only studies reporting on outcomes of ARCR with a minimum 10-year follow-up were considered for inclusion. Patient demographics, satisfaction, and clinical, radiologic, and surgical outcomes were evaluated. RESULTS: Our search found 9 studies including 455 shoulders in 448 patients (51.6% male patients), with age at time of surgery ranging from 45 to 90 years met our inclusion criteria. Overall follow-up ranged from 10 to 18 years. At final follow-up, the ranges of American Shoulder & Elbow Surgeons, age- and sex-adjusted Constant-Morley, and University of California Los Angeles scores were reported in 5, 6, and 3 studies, respectively, as 79.4 to 93.2, 73.2 to 94, and 26.5 to 33, respectively. Of the included studies, satisfaction rates varied in 6 studies from 85.7% to 100% in the long-term. Additionally, the overall radiologic retear rate ranged from 9.5% to 63.2%. The overall surgical revision rates ranged in 6 studies from 3.8% to 15.4%, with from 0% to 6.7% requiring revision ARCR and from 1.0% to 3.6% requiring revision subacromial decompression in 6 and 2 studies, respectively, at minimum 10-years' follow-up. CONCLUSIONS: In this study, we found that ARCR results in high rates of patient satisfaction, satisfactory clinical outcomes with respect to patient-reported functional outcomes and range of motion, and low revision rates at minimum 10-years' follow-up. However, an overall 30% retear rate was observed in asymptomatic patients. LEVEL OF EVIDENCE: Level IV, systematic review of Level II-IV studies.


Assuntos
Lesões do Manguito Rotador , Manguito Rotador , Humanos , Masculino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Feminino , Manguito Rotador/cirurgia , Lesões do Manguito Rotador/cirurgia , Resultado do Tratamento , Ombro , Artroscopia/métodos
17.
BMC Musculoskelet Disord ; 24(1): 1, 2023 Jan 02.
Artigo em Inglês | MEDLINE | ID: mdl-36588148

RESUMO

BACKGROUND: Clinical management of musculoskeletal shoulder pain can be challenging due to diagnostic uncertainty, variable prognosis and limited evidence for long-term treatment benefits. The UK-based PANDA-S programme (Prognostic And Diagnostic Assessment of the Shoulder) is investigating short and long-term shoulder pain outcomes. This paper reports linked qualitative research exploring patients' and clinicians' views towards primary care consultations for shoulder pain. METHODS: Semi-structured interviews were conducted with 24 patients and 15 primary care clinicians. Twenty-two interviews (11 patients, 11 clinicians) were conducted as matched patient-clinician 'dyads'. Data were analysed thematically. RESULTS: Clinicians reported attempts to involve patients in management decisions; however, there was variation in whether patients preferred treatment choice, or for decisions to be clinician-led. Some patients felt uncertain about the decisions made, due to a lack of discussion about available management options. Many General Practitioners expressed a lack of confidence in diagnosing the underlying cause of shoulder pain. Patients reported either not being given a diagnosis, or receiving different diagnoses from different professionals, resulting in confusion. Whilst clinicians reported routinely discussing prognosis of shoulder pain, patients reported that prognosis was not raised. Patients also expressed concern that their shoulder pain could be caused by serious pathology; however, clinicians felt that this was not a common concern for patients. CONCLUSIONS: Findings showed disparities between patients' and clinicians' views towards shoulder pain consultations, indicating a need for improved patient-clinician communication. Findings will inform the design of an intervention to support treatment and referral decisions for shoulder pain that will be tested in a randomised controlled trial.


Assuntos
Dor Musculoesquelética , Dor de Ombro , Humanos , Dor de Ombro/diagnóstico , Dor de Ombro/terapia , Ombro , Prognóstico , Pesquisa Qualitativa , Encaminhamento e Consulta , Atenção Primária à Saúde
18.
BMC Musculoskelet Disord ; 24(1): 18, 2023 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-36624428

RESUMO

BACKGROUND: Dog Bone™ button fixation is frequently used to treat acromioclavicular joint (ACJ) dislocation. However, various studies have reported complications after fixation. OBJECTIVE: To investigate the effect of the coracoid bone tunnel location on the treatment of ACJ dislocation through single-tunnel coracoclavicular (CC) ligament fixation with the Dog Bone™ button. METHODS: Six cadaveric shoulders were used. Each specimen was subjected to five testing conditions in the following order: (1) normal ACJ (Gn); (2) acromioclavicular and CC ligaments were removed (G0); (3) CC ligament reconstruction was performed using the Dog Bone™ technique, and the coracoid bone tunnel was at the center of the coracoid base (G1); (4) reconstruction was performed at 5 mm distal from the G1 site, along the axis of the coracoid (G2); (5) reconstruction was performed at 10 mm distal from the G1 site, along the axis of the coracoid (G3). The angles of pronation and supination of the clavicle under the same load (30 N) were measured. Next, a finite element (FE) model was created using computed tomography (CT) images of the normal shoulder. Model 1 (M1), model 2 (M2), and model 3 (M3) correspond to G1, G2, and G3, respectively. A force of 70 N was applied as a vertical upward load to the distal clavicle. Subsequently, the von Mises stress, the strain LE along the FiberWire, and the displacement nephogram of the three models were obtained. RESULTS: After single-tunnel CC ligament fixation using the Dog Bone™ technique, the clavicle in the G2 group (20.50 (19.50, 21.25) °, 20.00 (18.75, 21.25) °) had the best rotational stability. The peak von Mises stress, the strain LE along the FiberWire, and the maximum displacement were smaller in M2 than in M1 and M3. CONCLUSIONS: When the coracoid bone tunnel was located 5 mm anterior to the center of the coracoid base (along the axis of the coracoid), the clavicle showed greater rotational stability.


Assuntos
Articulação Acromioclavicular , Luxações Articulares , Luxação do Ombro , Articulação Acromioclavicular/diagnóstico por imagem , Articulação Acromioclavicular/cirurgia , Cadáver , Clavícula/cirurgia , Análise de Elementos Finitos , Luxações Articulares/diagnóstico por imagem , Luxações Articulares/cirurgia , Ligamentos Articulares/cirurgia , Ombro , Luxação do Ombro/cirurgia , Humanos
19.
J Pediatr Orthop ; 43(2): 123-127, 2023 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-36607932

RESUMO

INTRODUCTION AND AIMS OF STUDY: Timely detection of shoulder subluxation in infants with brachial plexus birth injury (BPBI) is essential to prevent the progression of glenohumeral deformity. Shoulder ultrasonography (USG) is routinely used to detect an infantile subluxation/dislocation, but its use is limited because of the paucity of expert radiologists in developing countries. The aim of this study was to determine the clinical examination predictors to determine shoulder subluxation in patients with BPBI correlating with ultrasound confirmation. METHODS: We prospectively studied children who presented to our hospital between 2017 and 2021 diagnosed as brachial plexus birth injury. In patients developing internal rotation contracture of the shoulder, we looked for 3 standard clinical signs: reduced passive external rotation <60 degrees, deep anterior crease (DAC) and relatively short arm segment. Shoulder subluxation was defined as USG measurement of alpha angle>30 degrees and ossific nuclei of the humerus lying behind the dorsal scapular line. Sensitivity and specificity were used to assess their efficacy in clinical diagnosis of shoulder subluxation in different groups. The predicted probability of shoulder subluxation from each prediction rule was compared with actual distributions based on USG confirmation. RESULTS: Of the 58 BPBI infants who developed PER<60 degrees at the shoulder, 41 had USG confirmed shoulder subluxation. The 2 independent predictors of shoulder subluxation (PER<45 degrees and DAC) were identified in the current patient population based on data analysis. The presence of short arm segment is a very specific marker of shoulder subluxation but not sensitive. The predicted probability of shoulder subluxation from the prediction rule combining all the 3 markers were similar to the actual distributions in the current patient population. CONCLUSIONS: PER<45 degrees and presence of deep anterior crease are clinical markers indicating shoulder dislocation in patients with BPBI developing reduced external rotation at the shoulder. On the basis of the proposed clinical diagnosis algorithm, the above markers along with the selective use of USG can help in early detection and treatment of infantile shoulder dislocation.


Assuntos
Traumatismos do Nascimento , Neuropatias do Plexo Braquial , Plexo Braquial , Luxações Articulares , Luxação do Ombro , Articulação do Ombro , Lactente , Criança , Humanos , Luxação do Ombro/diagnóstico por imagem , Luxação do Ombro/epidemiologia , Ombro , Neuropatias do Plexo Braquial/diagnóstico por imagem , Neuropatias do Plexo Braquial/complicações , Luxações Articulares/complicações , Plexo Braquial/lesões , Articulação do Ombro/diagnóstico por imagem , Ultrassonografia , Traumatismos do Nascimento/diagnóstico por imagem , Traumatismos do Nascimento/complicações , Amplitude de Movimento Articular
20.
JBJS Rev ; 11(1)2023 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-36608169

RESUMO

BACKGROUND: Obstetrical brachial plexus palsy (OBPP) is a relatively common stretch injury of the brachial plexus sustained during delivery. Tendon transfers are commonly performed to improve shoulder function among patients with OBPP. Although several techniques for the surgical management of OBPP exist, it is unclear whether tendon transfers to the rotator cuff vs. posterior humerus yield different outcomes. METHODS: A systematic search in PubMed, Web of Science, the Cumulative Index to Nursing and Allied Health Literature, the Cochrane Library, and Google Scholar up to January 1, 2021, was performed. Relevant publications were classified by surgical technique of tendon transfers to the rotator cuff or posterior humerus. The standard mean difference (SMD) and 95% confidence intervals were calculated to compare preoperative and postoperative aggregate Mallet scores as well as abduction and external rotation scores using the Mallet scale. A p value of <0.01 was considered significant. RESULTS: Data from 26 studies and 951 patients (46.2% male patients) with a mean age of 68.9 ± 29.3 months were included. Eight hundred three patients underwent tendon transfer to the rotator cuff and 148 to the posterior humerus. The average postoperative follow-up period was 45.2 ± 21.7 months. The pooled cohort had an overall improvement in postoperative aggregate Mallet scores (SMD = 5.53, p < 0.001), abduction scores (SMD = 1.79, p < 0.001), and external rotation scores (SMD = 1.99, p < 0.001). Tendon transfer to the rotator cuff had a greater postoperative improvement in abduction (SMD = 1.90, p < 0.001) than transfer to the posterior humerus (SMD = 1.32, p < 0.001) while both techniques yielded similar improvements in external rotation (rotator cuff SMD = 2.01, p < 0.001, posterior humerus SMD = 1.98, p < 0.001). CONCLUSION: This is the first systematic review comparing outcomes for tendon transfers to the rotator cuff vs. the posterior humerus for improving shoulder function in patients with OBPP. Overall, tendon transfers are an effective treatment for improving shoulder function. Transfer of the latissimus dorsi and teres major to the rotator cuff compared with transfer to the posterior humerus results in greater improvement in abduction while both techniques have similar results in improving external rotation. LEVEL OF EVIDENCE: Level I Systematic review of Level I and Level II studies.


Assuntos
Traumatismos do Nascimento , Neuropatias do Plexo Braquial , Paralisia do Plexo Braquial Neonatal , Articulação do Ombro , Músculos Superficiais do Dorso , Humanos , Masculino , Pré-Escolar , Criança , Feminino , Ombro , Transferência Tendinosa/métodos , Neuropatias do Plexo Braquial/cirurgia , Articulação do Ombro/cirurgia , Traumatismos do Nascimento/cirurgia
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