http://ote.healio.com/i/140820/58
Dr Michell Ruiz
Cirugía de hombro y del Manguito rotador
jueves, 29 de agosto de 2013
sábado, 10 de agosto de 2013
Coracohumeral Distances and Correlation to Arm Rotation
http://ojs.sagepub.com/content/1/2/2325967113496059.full.pdf+html
Coracohumeral Distances and Correlation to Arm Rotation
An In Vivo 3-Dimensional Biplane Fluoroscopy Study
- John P. Brunkhorst, MD*
- J. Erik Giphart, PhD*
- Robert F. LaPrade, MD, PhD*,†‡
- Peter J. Millett, MD, MSc*,†
- Investigation performed at the Department of BioMedical Engineering, Steadman Philippon Research Institute, Vail, Colorado, USA
- *Department of BioMedical Engineering, Steadman Philippon Research Institute, Vail, Colorado, USA.
- †The Steadman Clinic, Vail, Colorado, USA.
- ↵‡Robert F. LaPrade, MD, PhD, Steadman Philippon Research Institute, Complex Knee and Sports Medicine Orthopaedic Surgery, The Steadman Clinic, 181 West Meadow Drive, Vail, CO 81657 USA (e-mail: drlaprade@sprivail.org).
Abstract
Background: Reduced coracohumeral distances have been reported to be associated with anterior shoulder disorders such as subscapularis tears, biceps tendon injuries, and leading edge supraspinatus tears.
Purpose: To determine the variability in coracohumeral distance as a function of arm rotation in healthy male subjects. The null hypothesis was that no differences in coracohumeral distance would exist with respect to arm rotation.
Study Design: Descriptive laboratory study.
Methods: A total of 9 male participants who had full range of motion, strength, and no prior surgery or symptoms in their tested shoulders were enrolled in this institutional review board–approved study. Computed tomography scans of the shoulder were obtained for each subject. A dynamic biplane fluoroscopy system recorded internal and external shoulder rotation with the arm held in the neutral position. Three-dimensional reconstructions of each motion were generated, and the coracohumeral distance and coracoid index (lateral extension of the coracoid) were measured.
Results: The mean coracohumeral distance in neutral rotation was 12.7 ± 2.1 mm. A significantly shorter minimum coracohumeral distance of 10.6 ± 1.8 mm was achieved (P = .001) at a mean glenohumeral joint internal rotation angle of 36.6° ± 19.2°. This corresponded to a reduction in coracohumeral distance of 16.4% (range, 6.6%-29.8%). The mean coracoid index was 14.2 ± 6.8 mm. A moderate correlation (R = −0.75) existed between the coracohumeral distance and coracoid index.
Conclusion: Coracohumeral distance was reduced during internal rotation. Decreased coracohumeral distance was correlated with larger coracoid indices.
Clinical Relevance: This study provides a reference value for coracohumeral distance in the healthy male population. Knowledge of how coracohumeral distance varies over the range of arm internal-external rotation may improve the clinical diagnosis and treatment plan for patients with anterior shoulder pathology, specifically subcoracoid impingement. Imaging of the coracohumeral distance during internal rotation with the hand at approximately midline should be considered to assess patients with anterior shoulder pain.
Arthroscopic Single-Row Versus Double-Row Rotator Cuff Repair: A Meta-analysis of the Randomized Clinical Trials
Arthroscopy: The Journal of Arthroscopic and Related Surgery
Volume 29, Issue 2 , Pages 343-348, February 2013
Volume 29, Issue 2 , Pages 343-348, February 2013
Arthroscopic Single-Row Versus Double-Row Rotator Cuff Repair: A Meta-analysis of the Randomized Clinical Trials
Purpose
The purpose of this meta-analysis was to critically assess whether there are differences in clinical outcomes between single-row and double-row rotator cuff repair in prospective randomized Level I studies.
Methods
Using Medline, Scopus, Scirus, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and the Cochrane Library, as well as a hand search, we searched for randomized prospective trials comparing single-row and double-row rotator cuff repair. The functional outcome scores included the American Shoulder and Elbow Surgeons shoulder scale, the Constant shoulder score, and the University of California, Los Angeles shoulder rating scale. A test of heterogeneity was performed to determine whether there was a difference across the included studies.
Results
Five studies met our inclusion criteria. A test of heterogeneity showed no difference across these studies. The functional American Shoulder and Elbow Surgeons; Constant; and University of California, Los Angeles outcomes scores showed no difference between single- and double-row rotator cuff repair.
Conclusions
We found no significant differences in clinical outcomes between single-row and double-row rotator cuff repair in a meta-analysis of Level I studies.
Level of Evidence
Level I, meta-analysis of Level I randomized controlled studies.
jueves, 8 de agosto de 2013
Partial Rotator Cuff Tears in Adolescents: Factors Affecting Outcomes
Partial Rotator Cuff Tears in Adolescents:
Factors Affecting Outcomes
Eric A. Eisner, MD, Joanna
H. Roocroft, MA, MD, Molly
A. Moor, MPH, and Eric W. Edmonds, MD
Introduction: In the adult population, rotator cuff tears are common and established treatment methods yield satisfactory results. In adolescents, however, these injuries are uncommon and few treatment methods and outcome reports exist. The purpose of this study was to examine a series of adolescent ro- tator cuff tears, identify associated pathology, and report treatment outcomes.
Methods: A retrospective comparative analysis of adolescent patients treated for rotator cuff tears diagnosed by magnetic resonance imaging (MRI) or arthroscopy between 2008 and
2010 was performed. Patients were divided by treatment ren- dered: nonoperative or operative. Demographic and diagnostic variables were compared between the 2 groups. After release to full activity, 3 patient outcome measures were obtained: QuickDASH (Disability of the Arm, Shoulder, and Hand), QuickDASH Sports module, and the Single Assessment Nu- merical Evaluation (SANE).
Results: Fifty-three adolescents (38 boys and 15 girls) with a mean age of 15.8 years (8.8 to 18.8 y) met the inclusion criteria. All rotator cuff tears were partial articular-sided tendon avul- sions, and surgical treatment (when required) consisted of de- bridement to stable edges. All patients underwent a trial of at least 6 weeks of physical therapy, with 57% failing to improve and requiring subsequent surgery. In the patients that were treated nonoperatively, 39% were diagnosed with associated pathology based on MRI findings, whereas operative patients exhibited an associated pathology rate of 70%. Patients with MRI-diagnosed associated pathology were 1.8 times more likely (95% confidence interval, 1.02-3.13, P = 0.025) to require surgery compared with those without MRI-identified associated pathol- ogy. Nineteen patients (13 operative, 6 nonoperative) completed the outcome questionnaires at a mean 16.9 months after treat- ment. QuickDASH, SANE, and QuickDASH Sports module scores were not statistically different between nonoperative and operative treatment groups (7.5 vs. 8.1, P = 0.90; 85.3 vs. 80.6, P = 0.47; and 5.2 vs. 19.5, P = 0.39, respectively). All outcome measures exhibited significant correlations with one another, with the strongest correlation being a negative association between SANE and Sports module scores (r = - 0.76, P = 0.001). Discussion: Isolated partial articular-sided tendon avulsion in- juries may be successfully treated with physical therapy, with return to sports expected; however, if associated pathology was present then nonoperative treatment was less successful. Im- provement in pain and activities of daily living can be achieved with surgery after failed conservative management for rotator cuff injuries; however, the adolescent athlete will often have residual shoulder complaints during sports participation.
Level of Evidence: Level III—retrospective cohort study.
Key Words: rotator cuff, outcomes, sports, adolescents
(J Pediatr Orthop 2013;33:2–7)
Dr Michell Ruiz /AMECRA
El dr Michell Ruiz durante su participación en el pasado congreso de la AMECRA celebrado en los cabos Baja California, México, 2013
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