Américo Zoppi Filho

Análise clínica e ultrassonográfica dos ombros de pacientes lesados medulares em programa de reabilitação

SUMMARY The increasing incidence of high energy traumas is associated to a growing prevalence of spinal cord injuries causing motor sequels on limbs. Rehabilitation programs provide an opportunity for improvement of quality of life, helping on integrating those individuals back into social activities. Shoulder pain is more frequent in individuals with spinal cord injury, regardless of the rehabilitation program adopted. In the current study, 32 shoulders of 16 patients with spinal cord injury levels between C4 and T12 submitted to a rehabilitation program at DOT/UNICAMP were evaluated by using ultrasound. Changes on rotator cuff tendons were detected in 56.25%, and 12.50% of the patients presented changes in humeral tuberosities. These changes were more prevalent in quadriplegic patients. Analgesic therapies, rotator cuff muscles’ strengthening whenever possible, and postural rehabilitation may provide shoulder pain reduction, enhancing the advantages of rehabilitation programs and providing a better quality of life.

FRACTURE OF DISTAL HUMERUS: MIPO TECHnIqUE wITH VISUALIZATIOn OF THE RADIAL nERVE

OBJECTIVES: To evaluate the outcomes in patients treated for humerus distal third fractures with MIPO technique and visualization of the radial nerve by an accessory approach, in those without radial palsy before surgery. METHODS: The patients were treated with MIPO technique. The visualization and isolation of the radial nerve was done by an approach between the brachialis and the brachiorradialis, with an oblique incision, in the lateral side of the arm. MEPS was used to evaluate the elbow function. RESULTS: Seven patients were evaluated with a mean age of 29.8 years old. The average follow up was 29.85 months. The radial neuropraxis after surgery occurred in three patients. The sensorial recovery occurred after 3.16 months on average and also of the motor function, after 5.33 months on average, in all patients. We achieved fracture consolidation in all patients (M=4.22 months). The averages for flexion-extension and prono-supination were 112.85° and 145°, respectively. The MEPS average score was 86.42. There was no case of infection. CONCLUSION: This approach allowed excluding a radial nerve interposition on site of the fracture and/or under the plate, showing a high level of consolidation of the fracture and a good evolution of the range of movement of the elbow. Level of Evidence IV, Case Series

Electromyography of the Upper Limbs During Computer Work: A Comparison of 2 Wrist Orthoses in Healthy Adults

OBJECTIVEnTo examine the effect of wrist orthoses on the electromyography activities of the extensor carpi ulnaris, flexor digitorum superficialis, and fibers of the upper trapezius muscles during computer work.nnnDESIGNnA randomized, 3 x 2 factorial design: orthoses (no orthosis, wearing a custom-made orthosis, wearing a commercial orthosis) and tasks (typing, using the mouse).nnnSETTINGnLaboratory for biomechanics and rehabilitation.nnnPARTICIPANTSnHealthy university students (N=23), ranging from 18 to 26 years of age.nnnINTERVENTIONnStudy volunteers performed standardized tasks such as typing and using the mouse while wearing 1 of 2 types of wrist orthoses or no orthosis.nnnMAIN OUTCOME MEASURESnWe used surface electromyography and considered 100% maximum voluntary contraction to represent the amplitude of electromyographic activity.nnnRESULTSnWe observed a significant increase in the electromyographic activity of the trapezius (P<.05) with the use of orthoses. No significant difference was observed in the activities of the flexor digitorum superficialis or extensor carpi ulnaris in participants who typed with or without orthoses (P>.05). However, when the participants used the mouse, the extensor muscle presented an increase in activity with both orthoses, and the same pattern was observed in the flexor muscle when the volunteers used the custom-made orthosis.nnnCONCLUSIONSnWrist orthoses affected the muscle activities in the upper limbs of healthy adults who were using a computer. Electromyographic activity increased in the trapezius when the subjects used either type of orthosis, and the same pattern was observed in the extensor carpi ulnaris when the subjects used the mouse. The flexor digitorum superficialis presented an increase in activity only when the subjects worked with the mouse and used a custom-made splint.

Estudo anatômico e funcional do complexo ligamentar colateral medial do cotovelo

OBJETIVO: Realizar um estudo anatomico do ligamento colateral medial, um importante estabilizador do cotovelo, em diferentes graus de flexo-extensao do cotovelo. METODOS: Foram dissecados 40 cotovelos para analisar o comportamento funcional das bandas anterior, posterior e transversa do ligamento nas manobras de estresse em valgo do cotovelo durante seu movimento de flexao e extensao em diferentes graus. Determinou-se dois grupos: no GPA foi seccionado, a banda posterior do ligamento, depois a capsula articular e, por fim, a banda anterior; no GAP, a ordem de dissecacao foi inversa. RESULTADOS: No GPA observou-se instabilidade somente na terceira etapa e a media de abertura foi maior entre 50o no GAP, a instabilidade apareceu desde a primeira etapa e os graus de flexao com maior instabilidade foram nos mesmos do grupo A. CONCLUSAO: A banda anterior do ligamento colateral medial do cotovelo e o mais importante estabilizador na instabilidade em valgo do cotovelo e sua atuacao principal acontece entre 50o e 70o de flexao do cotovelo. Nivel de evidencia III, Estudo Diagnostico - Investigacao de um exame para diagnostico.OBJECTIVE: To carry out an anatomical study of the medial collateral ligament, an important elbow stabilizer in different degrees of elbow flexion-extension. METHODS: Forty elbows were dissected in order to analyze the functional behavior of the anterior, posterior and transverse ligament bands during valgus stress maneuvers of the elbow in different degrees of flexion and extension. Two groups were determined; in the group GPA the posterior band of the ligament was sectioned initially, then the articular capsule and finally the anterior band; in group GAP this order was reversed. RESULTS: Instability was observed in GPA only in the third stage, when there was a greater mean elbows opening during the flexion (between 50° and 70°); in GAP, the instability was present since the first stage; the degrees of flexion with greater instability were the same as in group GPA. CONCLUSION: The anterior band of the medial collateral ligament of the elbow is the most important stabilizer of the elbow valgus instability, and its principal action occurs between 50° and 70° of elbow flexion. Level of Evidence III, Diagnostic Studies - Investigating a diagnostic test.

Tradução e adaptação cultural do Rowe score para a língua portuguesa

OBJECTIVE: To translate and culturally adapt the Rowe score for use in Brazil. METHODS: The translation and cross-cultural adaptation process initially involved the steps of translation, synthesis, back-translation and revision by the Translation Group. The pre-final version of the questionnaire was then created. The Stability and Function fields were applied to 20 patients with anterior shoulder luxation, and the Mobility field was applied to 20 health professionals. RESULTS: It was found that some of the patients had difficulty understanding some of the expressions of the questionnaire, so these were replaced with terms that were easier to understand. All health professionals understood the translation of the Mobility field. The altered questionnaire was then reapplied to another 20 patients, and this time it was understood by all the assessed subjects. CONCLUSION: After a careful process of translation and cultural adaptation, a definitive version of the Rowe questionnaire was obtained in Brazilian Portuguese. Level of Evidence II, Development of diagnostic criteria on consecutive patients.

Avaliação isocinética de 18 pacientes do sexo masculino submetidos à correção cirúrgica da luxação acromioclavicular aguda com seguimento mínimo de dois anos

Eighteen male patients, mean age 36 years, submitted to surgical treatment of ALLMAN-TOSSY grade III acute acromioclavicular luxation were studied. They were isokinetically evaluated during an evolution period ranging from 24 to 127 months. The isokinetic evaluation was carried out with a Cybex® 6000 computerized dynamometer, at a 60o/s angular speed, showing significant results in vertical abduction, with a deficit in peak torque in the operated on shoulder as compared to the contralateral side. When the groups with and without subluxation were compared a deficit in total work was observed in the group with subluxation both in adduction and abduction.

FUNCTIONAL EVALUATION OF PATIENTS WITH SURGICALLY TREATED TERRIBLE TRIAD OF THE ELBOW

OBJECTIVES: To evaluate the functional outcome of patients with surgically treated terrible triad of the elbow. METHODS: A retrospective evaluation was performed using the MEPS score (Mayo Elbow Performance Score) of patients diagnosed with terrible triad of the elbow who underwent surgical treatment. RESULTS: 14 patients (nine men and five women) and 15 elbows (one bilateral case) were evaluated. A MEPS average score of 78 points and 86% good and excellent results was obtained. As complications, we had one case of infection and three of neuropraxia of the ulnar nerve. CONCLUSION: The patients had stable elbow with good function, however with reduced range of motion. Level of Evidence IV, Case Series.

EVALUATION OF CHILDREN WITH RADIAL NECK FRACTURES TREATED WITH FLEXIBLE INTRAMEDULLARY NAIL

Objective : To evaluate the results of displaced radial neck fractures in children trated surgically with flexible titanium intramedullary nails. Method : This is a retrospective study of five cases of radial neck fractures with displacement greater than 30° fixed with flexible intramedullary nails. Patients were evaluated regarding functional outcome through range of motion and the Mayo Elbow Performance Score (MEPS), as well as radiographic exams. Results : Five patients, with a mean age of 8.4 years were assessed, during a mean post-operative follow up of 12.2 months. Open reduction was necessary in three cases with major displacement. At the end of the follow up, 80% of the patients had excellent results, 20% good results, and all fractures healed. As complications we observed: heterotopic ossification, superficial infection and radial head necrosis. Conclusions : In spite of the small sample, our results with flexible titanium intramedullary nails were similar to the current literature, with good functional outcomes. Level of Evidence III, Retrospective Study.

CLINICAL AND RADIOGRAPHIC EVALUATION OF ELBOWS FROM SPINAL CORD INJURIED PATIENTS

Objectives : To evaluate clinically and radiologically the elbows of spinal cord injured patients and compare them to the control group. Methods : Twenty patients (10 paraplegics and 10 tetraplegics) were clinically evaluated through assessment of pain scale, measurement of active and passive range of motion, degree of muscle strength and MEPS score. They were also submitted to bilateral plain radiography of the elbows. Both groups were compared to the control group. Results : Four paraplegic and three tetraplegic patients referred mild to moderate, sporadic and motion related pain. The control group was asymptomatic. No statistic significant difference was found in passive range of motion among the three groups. The tetraplegic group showed a lower active range of motion as well as lower MEPS score as compared to the control group. Equal number of patients in the spinal cord injured patients had radiological abnormalities, but those were more severe in the tetraplegic group. Conclusion : Spinal cord injured patients presented clinical and radiological elbow abnormalities, which were more evident on tetraplegics. Level of Evidence III, Case Control.

TranslaTion To PorTuguese language and cross-culTural adaPTaTion of The modified roWe score for oVerhead aThleTes

Objetctive: Study was to translate and culturally adapt the modified Rowe score for overhead athletes. Methods: The translation and cultural adaptation process initially involved the stages of translation, synthesis, back-translation, and revision by the Translation Group. It was than created the pre-final version of the questionnaire, being the areas “function” and “pain” applied to 20 athletes that perform overhead movements and that suffered SLAP lesions in the dominant shoulder and the areas “active compression test and anterior apprehension test” and “motion” were applied to 15 health professionals. Results: During the translation process there were made little modifications in the questionnaire in order to adapt it to Brazilian culture, without changing the semantics and the idiomatic concept originally described. Conclusion: The questionnaire was easily understood by the subjects of the study, being possible to obtain the Brazilian version of the modified Rowe score for overhead athletes that underwent surgical treatment of the SLAP lesion.