Gustavo Cará Monteiro

Pectoralis Major Muscle Rupture in Athletes A Prospective Study

Background In the past 20 years, there has been an increase in the incidence of upper extremity tendinous injuries, especially in sports including strong physical activity, such as in weight lifting, as well as with the concurrent use of anabolic steroids. Today, there are more than 200 cases describing rupture of the pectoralis major muscle in athletes. Hypothesis Surgical treatment will have a better outcome than nonsurgical treatment in total rupture of the pectoralis major muscle in athletes. Study Design Cohort study; Level of evidence, 2. Methods Twenty athletes with pectoralis major muscle (PMM) rupture were studied; 10 had surgical treatment, and the other 10 were treated nonoperatively. The mean age was 32.27 years (range, 27-47 years); all of them were men. The average follow-up was 36 months (range, 48-72 months). Injuries were diagnosed by history, physical examination, and subsidiary tests. Functional evaluation and isokinetic evaluation were performed on all 20 patients. Results The clinical evaluation revealed 70% (n = 7) excellent, 20% good (n = 2), and 10% poor (n = 1) outcomes for the cases treated with surgery and 20% good (n = 2), 50% fair (n = 5), and 40% poor (n = 4) outcomes for the cases treated nonsurgically. The isokinetic evaluation at 60-deg/s speed showed a decrease in strength of 53.8% in the nonsurgical group and 13.7% for the surgical group. Conclusion Total PMM rupture in athletes showed a better functional result after surgical treatment than after nonsurgical treatment.

Absorbable Versus Nonabsorbable Sutures for the Arthroscopic Treatment of Anterior Shoulder Instability in Athletes: A Prospective Randomized Study

PURPOSE The purpose of this study was to compare the functional results of arthroscopic treatment for traumatic anterior shoulder instability in 2 groups of athletes. METHODS Fifty patients were randomly assigned to 2 different groups with comparable patient demographics. Group A was treated with anchors loaded with absorbable sutures, and group B was treated with the same type of anchors loaded with nonabsorbable sutures. The same type of absorbable anchor, surgical technique, and rehabilitation protocol was used in both groups. The outcomes were evaluated after a minimum postoperative period of 24 months. The Rowe score and the Athletic Shoulder Outcome Scoring System were applied, and statistical analysis was performed. RESULTS The mean Rowe score was 83.8 in group A and 79.5 in group B. The mean values for the Athletic Shoulder Outcome Scoring System were 84 and 79.2, respectively. Good or excellent results were found in 90.5% of patients in group A and 87.5% in group B. We had 2 failures (9.5%) in group A and 3 (12.5%) in group B. No statistically significant difference was found in the comparison of the outcomes (P > .05). CONCLUSIONS The type of suture used, absorbable or nonabsorbable, did not influence the functional results of arthroscopic treatment for traumatic anterior shoulder instability in this series.

Disorder of the long head of the biceps tendon

This paper focuses on biceps injuries in shoulder surgery. This topic is currently of great interest, and there has been much discussion about diagnosis, treatment and prevention. Biceps tendon pathology exists in many forms and is frequently associated with other shoulder disorders. These facts must be taken into consideration in the evaluation and treatment of patients with long head of the biceps pathology. There is much controversy about the long head of the biceps tendon (LHBT). The clinical significance to shoulder function, diagnosis and treatment are still a source of debate. The purpose of this review is to discuss the anatomy, function, pathology, clinical manifestation, physical examination, imaging and treatment of disorders of the LHBT.

Anatomic study of the coracoid process: safety margin and practical implications.

PURPOSE The aim of this study was to define a safety margin for coracoid process osteotomy that does not compromise the coracoclavicular ligaments and that can be used in the coracoid transfer procedures. METHODS Thirty shoulders from 15 cadavers were dissected, exposing the coracoid process and attached anatomic structures. The distance of the insertion of these structures to the coracoid process apex was measured. RESULTS The average length of the coracoid process was 4.26 ± 0.26 cm. The average width and height at the tip were 2.11 ± 0.2 and 1.49 ± 0.12 cm, respectively. The average distance from the tip to the anterior and posterior margin of the pectoralis minor was 0.1 ± 1.17 and 1.59 ± 0.27 cm, respectively. The average distance from the tip to the posterior margin of the coracoacromial ligament was 2.79 ± 0.33 cm. The average distance from the apex to the most anterior part of the trapezoid ligament was 3.33 ± 0.38 cm. We obtained a constant value of 0.85 cm for this measure, and the value increased with each 1.0-cm increase in the distance from the tip to the posterior margin of the pectoralis minor. The safety margin for osteotomy (i.e., available bone distance for the coracoid process transfer) was 2.64 cm. CONCLUSIONS This study established a safety margin of 2.64 cm for the osteotomy of the coracoid process and its relation with the posterior margin of the pectoralis minor. The anatomic descriptions of bone and soft tissue, as well as a measure of correlation for the safety margin of the coracoid, provide tools for surgeons performing anatomic surgical procedures to correct glenohumeral instability with significant bone loss. CLINICAL RELEVANCE Knowing the safety margin allows the surgeon to perform a safe osteotomy without direct visualization of the coracoclavicular ligaments attachments, thereby making procedures more anatomic.

Resultados do tratamento das fraturas do terço proximal do úmero com placas de bloqueio

OBJECTIVE: To analyze the clinical results after proximal humerus fracture fixation using blocked plates and screws. MATERIAL AND METHODS: In the period from November 2003 to January 2008, the authors treated 33 patients with 34 fractures of the proximal humerus. The mean age was 57 years old (33 to 86 years), 14 males and 19 females. All patients were operated in the acute phase, within the first week after the trauma. The patients were treated with open reduction and internal fixation using locking plates. The surgical technique, implants, period of immobilization and rehabilitation protocol were the same for all the patients. RESULTS: The mean follow-up period was 24 months (8 to 60 months). The functional evaluation was based in the UCLA score. Good and excellent results were present in 31 (91.2%) of the patients and 3 (8.8%) of them presented poor results. CONCLUSIONS: As a conclusion, the locking plate system of fixation was considered efficient for the treatment of proximal humerus fractures.

Artroscopia da articulação escapulotorácica: relato de casos

Scapulothoracic arthroscopy is a procedure presenting restricted indications, for resecting free bodies, benign tumors, bursitis, and snaping scapula. The authors report four cases of scapulothoracic joint arthroscopy; in the first case, only a benign tumor (osteochondroma) could be visualized; in the second case, arthroscopic resection of an osteochondroma was found; in the third case, arthroscopic bursectomy due to scapulothoracic bursitis, and; in the fourth case, bursectomy and partial superomedial arthroscopic scapulectomy due to snaping scapula.

Partial rotator cuff injury in athletes: bursal or articular?

A painful shoulder is a very common complaint among athletes, especially in the case of those in sports involving throwing. Partial lesions of the rotator cuff may be very painful and cause significant functional limitation to athletes’ sports practice. The incidence of partial lesions of the cuff is variable (13–37%). It is difficult to make the clinical and radiological diagnosis, and this condition should be borne in mind in the cases of all athletes who present symptoms of rotator cuff syndrome, including in patients who are diagnosed only with tendinopathy. Objective To evaluate the epidemiological behavior of partial lesions of the rotator cuff in both amateur and professional athletes in different types of sports. Methods We evaluated 720 medical files on athletes attended at the shoulder service of the Discipline of Sports Medicine at the Sports Traumatology Center, Federal University of São Paulo. The majority of them were men (65%). Among all the patients, 83 of them were diagnosed with partial lesions of the rotator cuff, by means of ultrasonography or magnetic resonance, or in some cases using both. We applied the binomial test to compare the proportions found. Result It was observed that intra-articular lesions predominated (67.6%) and that these occurred more frequently in athletes in sports involving throwing (66%). Bursal lesions occurred in 32.4% of the athletes, predominantly in those who did muscle building (75%). Conclusion Intra-articular lesions are more frequent than bursal lesions and they occur predominantly in athletes in sports involving throwing, while bursal lesions were more prevalent in athletes who did muscle building.

The pectoralis major footprint: An anatomical study

Objective To study the insertion of the pectoralis major tendon to the humerus, through knowledge of its dimensions in the coronal and sagittal planes. Methods Twenty shoulders from 10 cadavers were dissected and the pectoralis major tendon insertion on the humerus was identified and isolated. The dimensions of its “footprint” (proximal to distal and medial to lateral borders) and the distance from the top edge of the pectoralis major tendon to apex of the humeral head structures were measured. Results The average proximal to distal border length was 80.8 mm (range: 70–90) and the medial-to-lateral border length was 6.1 mm (5–7). The average distance (and range) from the apex of the pectoralis major tendon to the humeral head was 59.3 mm. Conclusions We demonstrate that the insertion of the pectoralis major tendon is laminar, and the pectoralis major tendon has an average footprint height and width of 80.8 mm and 6.1 mm, respectively.

Osteotomias do processo coracoide: um estudo anatômico

AbSTRACT Objective: Relate the main tendinous and ligamentous structures attached in the coracoid process, correlating it to several levels of osteotomy and describing the involved structures. Methods: Thirty shoulders were dissected. The coracoid process with mainly inserted anatomic structures was dissected, and five levels of osteotomy (1.0; 1.5; 2.0; 2.5; 3.0 cm) were made from the apex of the process and the mainly involved structures were recorded. Results: In osteotomies of 1.0 cm, in 100% of the cases only the conjoint tendon (CT). In osteotomies of 1.5 cm there were 63.33% of cases involved with the CT and the Pectoralis minor (PMi), in 20% of cases only the CT, and in 16.66% the CT, PMi, and the coracohumeral ligament (CUL). In osteotomies of 2.0 cm, in 80% of the shoulders, the osteotomies embraced the CT, PMi and the CUL, and in 20% only the CT and the PMi were involved. In the osteotomies of 2.5cm there was involvement of the CT, PMi and CUL in 100% of cases. In the osteotomies of 3.0cm, six cases (20%) have presented an injury on the trapezoid ligament, and in 100% of these osteotomies, the osteotomized distal fragment had embraced the CT, PMi, CUL. Conclusion: The knowledge of anatomic structures inserted and involved in the osteotomies cuts of the coracoid process is very importan to lead with osteotomies performed in the treatment techniques of the coracoid process. Osteotomies of 3.0 cm can injure the trapezoid ligament.

Calcifying tendinopathy: a local or a systemic condition?

Objective: To evaluate the relationship between cases of calcifying tendinopathy of the shoulder and symptomatic metabolic diseases such as kidney stones, gallstones and gout. Methods: Calcifying tendinopathy of the shoulder was diagnosed in 63 patients between May 2007 and September 2011. All the patients were treated by the same orthopedic surgeon and were interviewed to gather the following data: age at diagnosis, sex, affected side, dominant side, body mass index (BMI), smoking status and previous histories of kidney stones, gallstones or gout. For statistical analysis, a control group of 63 patients with similar demographic characteristics was used. Results: Among the 63 patients with calcifying tendinopathy of the shoulder, 35 (56%) were male. The right side was affected in 38 patients (60%) and the average age was 48.2 years. Thirty-one patients (49%) had histories involving some of the metabolic diseases investigated: 20 patients (32%) reported kidney stones, six (9.5%) gallstones, four (6.3%) gout and one (2%) concurrent diagnoses of kidney stones and gout. In the control group, eleven patients (17%) had histories involving some of the metabolic diseases investigated: six patients (9.5%) reported kidney stones, four (6.3%) gallstones and one (1.6 %) gout. Conclusions: The high frequency of nephrolithiasis in patients with calcifying tendinopathy of the shoulder in our study suggests that there are common mechanisms in the pathophysiology of these disorders. Better understanding of these diseases may enable improvement of diagnostics and treatments.