Luis Henrique Almeida

Reparação artroscópica de lesões pequenas e médias do tendão do músculo supraespinal: avaliação dos resultados clínico-funcionais após dois anos de seguimento

OBJECTIVE: To evaluate the clinical and functional outcomes from arthroscopic repairs on small and medium-sized tears of the supraspinatus muscle tendon. METHODS: 129 cases of isolated small and medium tears of the supraspinatus muscle tendon were evaluated retrospectively. The average duration of pain was 29 months. The average joint range of motion comprised active elevation of 136o, lateral rotation of 58o and medial rotation at T12 level; and the preoperative functional UCLA score averaged 17 points. In all the cases, complete repair could be achieved. RESULTS: The average score on the UCLA functional scale in the postoperative period was 32 points. The average length of follow-up was 39 months. Seventy-five cases (58%) had excellent results and 42 (32%) had good results. The average final active elevation was 156o with an average gain of 20o, and the average final lateral rotation was 57o with an average gain of 9o. Both of these were statistically significant (P < 0.05). The patients who underwent tenotomy of the long head of the biceps (LHB), with or without tenodesis, did not present statistically inferior functional outcomes, in comparison with the patients who only underwent decompression and lesion repair (P = 1.00). Fourteen cases (10.8%) presented complications during the postoperative period. Six (4.6%) developed adhesive capsulitis and four (3.1%) presented re-rupture of the tendon, proven by means of magnetic resonance imaging. CONCLUSIONS: Arthroscopic repair of small and medium tears of the supraspinatus muscle tendon provided a functional clinical improvement, with good and excellent results in 90% of the cases.

The Technique to Calculate Glenoid Bone Loss With the Bernageau Profile View: Is it Possible?

As glenoid bone erosion has been related to high rates of recurrence after traditional Bankart repair, the necessity to diagnose existing bone loss is fundamental to avoiding the recurrence of shoulder dislocation. There are many techniques described in the literature explaining how to calculate glenoid bone loss; however, there are only few articles, which shows the usefulness of the x-rays for that purpose. Moreover, just one of these papers described the reliability of a specific x-ray view to measure the percentage of a glenoid bony defect, comparing it with the computed tomography scan and known glenoid osteotomy. The aim of this study was to describe a reliable and reproducible technique for calculating glenoid bone loss using the Bernageau x-ray profile view and to show the results of a earlier study in which we calculated the distance between the posterior and anterior glenoid rim on the Bernageau profile view and compared this measurement between the right and the left shoulders. This technique is cheaper than the computed tomography scan and is easier to perform.

Estudo da resistência do tendão do supra-espinal com pontos simples, duplos e Mason Allen

OBJECTIVE: The purpose of this study was to compare the rotator cuff tendon resistance at the interface tendon-suture using three different sorts of stitches (simple, mattress and modified Mason-Allen). METHODS: To do this, 30 rotator cuffs were totally dissected from 15 specimens, which were 45 years old on average. The tests were done using a Kratos® 500/2000 machine and the statistical analyses applied were the Student t-test, ANOVA test, Multiple Bonferroni Comparison, and Pearsons correlation coefficients; all the analyses used a significance level of 5%. RESULTS: No significant difference was observed regarding the age, sample sizes and tendon displacement. The tendon resistance was 127.50 N on average when Simple stitches were used, 163.95 N when Double stitches were used and 198.45 N when the Modified Mason-Allen Knot was used. CONCLUSION: Although the tendon resistance at the interface tendon-suture was higher using the Modified Mason-Allen stitches than it was when using the Double and Simple Knots, there was no difference in tendon resistance when using the Modified Mason-Allen and Double stitches. On the other hand, we found that tendon resistance was higher when using Modified Mason-Allen stitches as compared to tendon resistance when using Simple stitches.

Mensuração da erosão da borda anterior da glenoide através do exame radiográfico: uma forma simples de realizar a incidência de Bernageau

OBJECTIVE: To analyze whether the Bernageau view is adequate for studying the anterior glenoid rim and determining the distance between the posterior and anterior glenoid rim. METHODS: Fifty patients (31 males) with a mean age of 34 years were evaluated by positioning their arm at 160o forward flexion and body at 70o with the X-Ray chassis, while positioning the X-ray tube at 30o craniocaudal, centered on the scapula spine. Three of the authors measured the distance between the posterior and anterior glenoid rim three times. The variability and reproducibility of this distance were studied. Three shoulder surgeons performed a subjective evaluation by answering whether it was possible to evaluate the anterior glenoid rim in the view studied. RESULTS: The average distance was 24.48 mm ±0.332 mm (left) and 24.82 mm ±0.316 mm (right). The Anderson-Darling test showed that this distance had a normal distribution and Pearsons correlation showed significant reproducibility (P<0.01). The first observer found that 67% of the X-Rays images were suitable for evaluating the anterior glenoid rim. The second found that 81% were suitable and the third 78%. The Kappa coefficient test showed that the second and third observers had substantial agreement of opinion. CONCLUSION: The Bernageau view provided a suitable X-Ray for studying the anterior glenoid rim and for assessing erosion after comparison with the unaffected side.

ARTHROSCOPIC REPAIR OF SmALL AND mEDIum TEARS OF THE SuPRASPINATuS muSCLE TENDON: EVALuATION OF THE CLINICAL AND FuNCTIONAL OuTCOmES AFTER TWO YEARS OF FOLLOW-uP

Objective: To evaluate the clinical and functional outcomes from arthroscopic repairs on small and medium-sized tears of the supraspinatus muscle tendon. Methods: 129 cases of isolated small and medium tears of the supraspinatus muscle tendon were evaluated retrospectively. The average duration of pain was 29 months. The average joint range of motion comprised active elevation of 136°, lateral rotation of 58° and medial rotation at T12 level; and the preoperative functional UCLA score averaged 17 points. In all the cases, complete repair could be achieved. Results: The average score on the UCLA functional scale in the postoperative period was 32 points. The average length of follow-up was 39 months. Seventy-five cases (58%) had excellent results and 42 (32%) had good results. The average final active elevation was 156° with an average gain of 20°, and the average final lateral rotation was 57° with an average gain of 9°. Both of these were statistically significant (P < 0.05). The patients who underwent tenotomy of the long head of the biceps (LHB), with or without tenodesis, did not present statistically inferior functional outcomes, in comparison with the patients who only underwent decompression and lesion repair (P = 1.00). Fourteen cases (10.8%) presented complications during the postoperative period. Six (4.6%) developed adhesive capsulitis and four (3.1%) presented re-rupture of the tendon, proven by means of magnetic resonance imaging. Conclusions: Arthroscopic repair of small and medium tears of the supraspinatus muscle tendon provided a functional clinical improvement, with good and excellent results in 90% of the cases.

Anterior glenoid rim erosion measured by X-Ray exam: a simple way to perform the Bernageau profile view

Objective: To analyze whether the Bernageau radiographic view is adequate for studying the anterior glenoid rim and to determine the distance between the posterior and anterior glenoid rims. Methods: Fifty patients (31 males) with a mean age of 34 years were evaluated by positioning their arm at 160° forward flexion and body at 70° to the x-ray chassis, while positioning the x-ray tube at 30° craniocaudally, centered on the scapula spine. Three of the authors measured the distance between the posterior and anterior glenoid rim three times. The variability and reproducibility of this distance were studied. Three shoulder surgeons performed a subjective evaluation by answering whether it was possible to evaluate the anterior glenoid rim in the view studied. Results: The mean distance was 24.48 mm ± 0.332 mm (left) and 24.82 mm ± 0.316 mm (right). The Anderson-Darling test showed that the measurements had normal distribution, and Pearsons correlation showed significant reproducibility (P < 0.01). The first observer found that 67% of the x-ray images were suitable for evaluating the anterior glenoid rim. The second found that 81% were suitable and the third, 78%. The kappa coefficient showed that the second and third observers had substantial agreement of opinion. Conclusion: The Bernageau view provided a suitable x-ray image for studying the anterior glenoid rim and for assessing erosion after comparison with the unaffected side.

Recurrent shoulder dislocation: aspects between the first episode and surgical treatment

Objective: To determine: 1) whether the patients had been oriented to use immobilization for at least four weeks and which type of immobilization was prescribed, 2) how many dislocations occurred until the patient received information about the need of surgery, 3) How long it takes for patients to have an appointment with a shoulder surgeon, 4) How many dislocations the patient had at the time of surgery. Material and Methods: Of the 100 patients surgically treated or waiting for surgery at outpatient facilities, we interviewed 61 patients with questions related to the mechanism of dislocation, emergency service sites, guidelines for acute event treatment and follow-up, time elapsed until surgery and follow-up. Collected data were submitted to analysis. Results: Only 13 patients (22%) had received correct information about their lesion, prognosis concerning recurrence, and about the need of surgery and expert follow-up in recurrent cases. None of our patients received proper information about type and duration of immobilization. Conclusion: None of our patients had received proper orientation to remain immobilized for four weeks, and the types of immobilization vary from a handmade sling to a manufactured Velpeau. Most of our patients (78%) did not receive proper orientation about specialized follow-up and surgery after their second episode of dislocation. The time for a specialized appointment with shoulder surgeon ranges from four to six months, with 1-100 dislocation episodes at the moment of surgery.

Luxação recidivante do ombro: aspectos do período entre o primeiro episódio e o tratamento cirúrgico

AbSTrACT Objective: To determine: 1) whether the patients had been oriented to use immobilization for at least four weeks and which type of immobilization was prescribed, 2) how many dislocations occurred until the patient received information about the need of surgery, 3) How long it takes for patients to have an appointment with a shoulder surgeon, 4) How many dislocations the patient had at the time of surgery. Material and Methods: Of the 100 patients surgically treated or wait-ing for surgery at outpatient facilities, we interviewed 61 pa-tients with questions related to the mechanism of dislocation, emergency service sites, guidelines for acute event treatment and follow-up, time elapsed until surgery and follow-up. Col-lected data were submitted to analysis. Results: Only 13 pa-tients (22%) had received correct information about their le-sion, prognosis concerning recurrence, and about the need of surgery and expert follow-up in recurrent cases. None of our patients received proper information about type and dura-tion of immobilization. Conclusion: None of our patients had received proper orientation to remain immobilized for four weeks, and the types of immobilization vary from a handmade sling to a manufactured Velpeau. Most of our patients (78%) did not receive proper orientation about specialized follow-up and surgery after their second episode of dislocation. The time for a specialized appointment with shoulder surgeon ranges from four to six months, with 1-100 dislocation episodes at the moment of surgery.

Lesão da pequena liga

Here we describe a case report of a small ligament injury in the shoulder of a 14-year-old young male athlete, player of the Brazilian Baseball National team. This kind of injury is uncommon and little described in literature. Treatment provided was the suspension of sport-related activities for three months, followed by a gradual return to throws. The patient evolved to clinical picture resolution.

Instabilidade do cotovelo causada por fratura sagital do processo coronoide

Introducao: Descrever um padrao diferente de fratura do processo coronoide associada a instabilidade do cotovelo tratada com sucesso em nosso servico. Relato do caso: Um paciente de 27 anos, do sexo masculino e destro, havia sofrido luxacao do cotovelo. Procurou nosso hospital com uma queixa de dor e instabilidade a extensao do cotovelo, apresentando instabilidade em varo-valgo e queixa de luxacao eminente do cotovelo quando este atingia -30o de extensao. No exame radiografico, observou-se uma fratura anteromedial do processo coronoide. Submetido ao tratamento cirurgico fixando-se a fratura, reparando-se o ligamento colateral medial, imobilizado-se com uma tala gessada por dez dias e, depois, iniciando-se o programa de reabilitacao. Apos 21 meses de seguimento, o paciente mantinha 135° de flexao e 0° de extensao, 80° de pronacao e 90° de supinacao; forca muscular grau V e sem instabilidade no exame fisico. As radiografias de controle demonstraram consolidacao completa sem ossificacao heterotopica. Discussao: Apesar de ser um tipo raro de fratura do processo coronoide, e importante que seja devidamente diagnosticado pelo ortopedista para que se realize o tratamento adequado e se evite a instabilidade cronica. O presente caso foi tratado com sucesso por meio de reducao aberta e fixacao interna, sem nenhuma queixa de instabilidade apos 21 meses de seguimento.