Dr Michell Ruiz

Dr Michell Ruiz
Cirugía de hombro y del Manguito rotador

lunes, 30 de septiembre de 2013

Self-managed loaded exercise versus usual physiotherapy treatment for rotator cuff tendinopathy


http://www.physiospot.com/research/self-managed-loaded-exercise-versus-usual-physiotherapy-treatment-for-rotator-cuff-tendinopathy/

Self-managed loaded exercise versus usual physiotherapy treatment for rotator cuff tendinopathy

Self-managed loaded exercise versus usual physiotherapy treatment for rotator cuff tendinopathy
Rotator cuff tendinopathy is often the cause of shoulder pain characterised by persistent and/or recurrent problems for a proportion of sufferers. The authors’ objective in this study was to pilot the methods proposed to conduct a substantive study to evaluate the effectiveness of a self-managed loaded exercise programme as opposed to usual physiotherapy treatment for rotator cuff tendinopathy. They conducted a single-centre pragmatic unblinded parallel group pilot randomised controlled trial at one private physiotherapy clinic, northern England. 24 individuals with rotator cuff tendinopathy were recruited.
The intervention was a programme of self-managed loaded exercise. The control group received usual physiotherapy treatment. Baseline assessment comprised the Shoulder Pain and Disability Index (SPADI) and the Short-Form 36, repeated three months after randomisation. The recruitment target was met and the majority of participants (98%) were willing to be randomised. 100% retention was attained with all participants completing the SPADI at three months. Exercise adherence rates were excellent (90%). The mean change in SPADI score was -23.7 (95% CI -14.4 to -33.3) points for the self-managed exercise group and -19.0 (95% CI -6.0 to -31.9) points for the usual physiotherapy treatment group. The difference in three month SPADI scores was 0.1 (95% CI -16.6 to 16.9) points in favour of the usual physiotherapy treatment group.
The authors concluded that in keeping with past research which suggest the need for further study of self-managed loaded exercise for rotator cuff tendinopathy, these methods and the preliminary evaluation of outcome offer a foundation and stimulus to undertake a substantive study.
- See more at: http://www.physiospot.com/research/self-managed-loaded-exercise-versus-usual-physiotherapy-treatment-for-rotator-cuff-tendinopathy/#sthash.f9Y7NrC8.dpuf

http://www.ncbi.nlm.nih.gov/pubmed/23954024


 2013 Aug 14. pii: S0031-9406(13)00059-X. doi: 10.1016/j.physio.2013.06.001. [Epub ahead of print]

Self-managed loaded exercise versus usual physiotherapy treatment for rotator cuff tendinopathy: a pilot randomised controlled trial.

Source

School of Health & Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield S1 4DA, UK. Electronic address: c.littlewood@sheffield.ac.uk.

Abstract

OBJECTIVES:

Rotator cuff tendinopathy is a common source of shoulder pain characterised by persistent and/or recurrent problems for a proportion of sufferers. The aim of this study was to pilot the methods proposed to conduct a substantive study to evaluate the effectiveness of a self-managed loaded exercise programme versus usual physiotherapy treatment for rotator cuff tendinopathy.

DESIGN:

A single-centre pragmatic unblinded parallel group pilot randomised controlled trial.

SETTING:

One private physiotherapy clinic, northern England.

PARTICIPANTS:

Twenty-four participants with rotator cuff tendinopathy.

INTERVENTIONS:

The intervention was a programme of self-managed loaded exercise. The control group received usual physiotherapy treatment.

MAIN OUTCOMES:

Baseline assessment comprised the Shoulder Pain and Disability Index (SPADI) and the Short-Form 36, repeated three months post randomisation.

RESULTS:

The recruitment target was met and the majority of participants (98%) were willing to be randomised. 100% retention was attained with all participants completing the SPADI at three months. Exercise adherence rates were excellent (90%). The mean change in SPADI score was -23.7 (95% CI -14.4 to -33.3) points for the self-managed exercise group and -19.0 (95% CI -6.0 to -31.9) points for the usual physiotherapy treatment group. The difference in three month SPADI scores was 0.1 (95% CI -16.6 to 16.9) points in favour of the usual physiotherapy treatment group.

CONCLUSIONS:

In keeping with previous research which indicates the need for further evaluation of self-managed loaded exercise for rotator cuff tendinopathy, these methods and the preliminary evaluation of outcome offer a foundation and stimulus to conduct a substantive study.
Copyright © 2013 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

KEYWORDS:

Exercise, Quality of life, Randomised controlled trial, Rehabilitation, Rotator cuff tendinopathy
PMID:
 
23954024
 
[PubMed - as supplied by publisher]

First dislocation in athletes


Check on #eScience Prof. Ladislav Kovacic presentation on anatomy and biomechanics, talking about first dislocation in athletes during 2012 EFORT Congress. Prof. Kovacic emphases on constraints and contributions to shoulder stability.

miércoles, 25 de septiembre de 2013

Los músculos del manguito rotador

https://www.facebook.com/anatomiafisioterapia.es


Miércoles musculoesquelético Willem-Paul Wiertz, MSc:

Los músculos del manguito rotador son comúnmente vistos como estabilizadores de la articulación glenohumeral durante los movimientos del hombro. La evidencia reciente indica solo una contribución marginal del manguito a la estabilidad articular.

Este estudio investigó los patrones de activación muscular del hombro en 14 sujetos sanos durante rotación externa dinámica realizada a 90º de abducción. Se utilizó un cabestrillo ajustable para modificar el soporte del brazo – se examinaron tres situaciones: con el brazo sustentado 100%, 50% de suspensión y sin suspensión. Los participantes realizaron ejercicios de rotación completa estando de pie; los ejercicios fueron aleatorizados para cada tipo de soporte.

El infraespinoso tuvo los mayores niveles de activación en las tres tareas, sin embargo los niveles de activación no crecieron al disminuir el soporte. Por otra parte el supraespinoso mostró activación aumentada conforme el brazo tenía menos soporte. Esto indica que la actividad del infraespinoso está (como se esperaba durante la rotación externa) predominantemente dirigida a producir movimiento, mientras el supraespinoso funciona de hecho como un estabilizador.

Los niveles de activación del subescapular permanecieron relativamente bajos en todas las tareas: tiene solo un papel marginal en la estabilización de la glenohumeral durante la rotación externa. La activación del deltoides mostró patrones similares al supraespinoso, sugiriendo un rol similar para ambos músculos. > Tardo et al., Clin Anat 26 (2013) 236-243. Derechos reservados Wiley Periodicals, Inc. Imagen tomada de: en.wikipedia.org

sábado, 21 de septiembre de 2013

Shoulder Arthritis and Rotator Cuff Tears: causes of shoulder pain: Rotator cuff disease - clinical signs

Shoulder Arthritis and Rotator Cuff Tears: causes of shoulder pain: Rotator cuff disease - clinical signs: Does This Patient With Shoulder Pain Have Rotator Cuff Disease? The Rational Clinical Examination Systematic Review These authors remind us ...

Rotator cuff disease - clinical signs



Does This Patient With Shoulder Pain Have Rotator Cuff Disease? The Rational Clinical Examination Systematic Review 

These authors remind us that rotator cuff disease (RCD) is the most common cause of shoulder pain seen by physicians. They performed a meta-analysis to identify the most accurate clinical examination
findings for RCD. They located 28 studies that assessed the examination of referred patients by specialists. Only 5 of the studies reached Rational Clinical Examination quality scores of level 1-2. These included from 30 to 203 shoulders with the prevalence of RCD ranging from 33%to 81%. 

They found that among pain provocation tests, a positive painful arc test result was the only finding with a positive likelihood ratio (LR) greater than 2.0 for RCD (3.7 [95%CI, 1.9-7.0]) and a
normal painful arc test result had the lowest negative LR (0.36 [95%CI, 0.23-0.54]). 

Among strength tests, they found that a positive external rotation lag test (LR, 7.2 [95%CI, 1.7-31]) and internal rotation lag test (LR, 5.6 [95%CI, 2.6-12]) were the most accurate findings for full-thickness
tears.  A normal internal rotation lag test result was most accurate for identifying patients without a full-thickness tear (LR, 0.04 [95%CI, 0.0-0.58]). 

We observe that the tricky thing about cuff disease is that, addition to pain, it can present with (1) weakness (usually on supraspinatus testing, but also on infraspinatus and subscapularis testing), (2) subacromial crepitance on active or passive motion of the shoulder, (3) stiffness (limitation of range of motion, especially internal rotation), and (4) instability.

Our examination for patients suspected of having cuff problems is shown here.

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To see the topics covered in this Blog, click here

Use the "Search" box to the right to find other topics of interest to you.

You may be interested in some of our most visited web pages including:shoulder arthritis, total shoulder, ream and runreverse total shoulderCTA arthroplasty, and rotator cuff surgery as well as the 'ream and run essentials'

Shoulder Arthritis and Rotator Cuff Tears: causes of shoulder pain: Rotator cuff tears - ?appropriate use criteria? AA...

Friday, September 20, 2013

Rotator cuff tears - ?appropriate use criteria? AAOS

According to the AAOS website, The AAOS Board of Directors has approved new appropriate use criteria (AUC) on "Optimizing the Management of Full-Thickness Rotator Cuff (RC) Tears." This is the second AUC released by AAOS, and is supported by both a written document and the AAOS mobile-optimized AUC web app. The AUC is based on a systematic review of the literature as well as clinician expertise from several specialties. It covers five treatments—nonsurgical modalities, partial repair and/or debridement, repair, reconstruction, and arthroplasty—and presents 432 different patient scenarios to help clinicians identify for whom and when the treatments are appropriate.

It is very entertaining to play with their app.

We tried two scenarios, both of a patient with moderate symptoms, ASA 2, no factors that would interfere with healing or the outcome, both with moderate sized tears and small amounts of fatty infiltration. Let's say that the patient was 'some better' with non-surgical management. In the first scenario the surgeon enters that the patient had responded to previous treatment - the result is that non-operative treatment is appropriate. In the second, the surgeon enters that the patient had not responded to previous treatment - the result is that the appropriate treatment is repair. Thus one small change in the response justifies surgery...is it really that simple? We encourage you to 'play' with this app and see if the 'appropriate use' recommendations make sense to you.
Shoulder Arthritis and Rotator Cuff Tears: causes of shoulder pain: Rotator cuff tears - ?appropriate use criteria? AA...: According to the AAOS website , The AAOS Board of Directors has approved new appropriate use criteria (AUC) on "Optimizing the Managem...

Shoulder Arthritis and Rotator Cuff Tears: causes of shoulder pain: Rotator cuff tear, when to repair and when not to ...

Rotator cuff tear, when to repair and when not to repair


Our post yesterday on the AAOS 'appropriate use criteria' for rotator cuff tears has given rise to some thoughtful responses, such as "I read your blog every week. As a shoulder surgeon and app developer, I think AAOS had a nice idea. Of course our decision is made by our experience, but this can be a tool to encourage people to perform/not perform surgery. Like instability index, it will not substitute our judgment, but was a nice constructed tool. "

We thought about this a bit, appreciating the feedback given. We continue to opine that the AAOS AUC app is oversimplified and can be used to encourage surgery by some gentle 'tweeking' of the responses without consideration of the full picture.

Keeping in mind that 'repair' is not the only surgery that can be offered to a patient with a bothersome cuff tear, see here, there are two questions that need to be considered before embarking on REPAIR surgery:
(1) can the cuff tear be durably repaired?
 and 
(2) is it in the best interests of the patient to have a repair recognizing the need to protect the shoulder from normal use for 3-6 months after surgery, in other words, are the improvement in comfort and function from an attempted repair likely to be sufficiently superior to that of non-operative management or a 'smooth and move' to justify the time away from work and play? While some justify a repair attempt by noting that patients are 'better' even if the rotator cuff repair fails to reattach the tendon to the bone, the key difference between a repair and a smooth and move is the need for protecting the armfor months in the former.

Below are listed findings that have been shown to be encouraging or discouraging about the prospect of the shoulder having a durably reparable cuff tear. It is of interest that many of these factors can be determined without advanced testing. We first published these guidelines in 1994 and have found them as useful to day as back then. Note that the decision is not based on choosing one of two bubbles in an app, but in considering the patient as well as the shoulder (two of the 4Ps the other two are, of course, who should do the surgery and how it should be done).
Shoulder Arthritis and Rotator Cuff Tears: causes of shoulder pain: Rotator cuff tear, when to repair and when not to ...: Our post yesterday on the AAOS 'appropriate use criteria' for rotator cuff tears has given rise to some thoughtful responses, such ...

lunes, 16 de septiembre de 2013

¿Que es la lesion del manguito rotador?

http://www.nlm.nih.gov/medlineplus/spanish/ency/article/000438.htm


Un servicio de la Biblioteca Nacional de Medicina de EE.UU.
Institutos Nacionales de la Salud



Problemas con el manguito de los rotadores 

El manguito de los rotadores es un grupo de músculos y tendones que van pegados a los huesos de la articulación del hombro, permitiendo que éste se mueva y manteniéndolo estable.
  • La tendinitis del manguito de los rotadores se refiere a la irritación de estos tendones e inflamación de la bursa (una capa normalmente lisa) que recubre dichos tendones.
  • Un desgarro en el manguito de los rotadores ocurre cuando se rompe uno de los tendones a raíz de una sobrecarga o lesión.

Causas

La articulación del hombro es un tipo de enartrosis donde la parte superior del hueso del brazo (húmero) forma una articulación con el omóplato (escápula). El manguito de los rotadores sostiene la cabeza del húmero en la escápula y controla el movimiento de la articulación del hombro.
Los tendones del manguito de los rotadores pasan por debajo de un área ósea en su camino hasta fijarse a la parte superior del hueso del brazo. Cuando estos tendones se inflaman, pueden resultar más desgastados sobre esta área durante los movimientos del hombro. Algunas veces, un espolón óseo puede estrechar el espacio aún más.
Este problema se denomina tendinitis del manguito de los rotadores o síndrome de pinzamiento y puede deberse al hecho de:
  • Mantener el brazo en la misma posición durante períodos de tiempo largos, como realizar trabajo de computadora o arreglo de cabello.
  • Dormir sobre el mismo brazo cada noche.
  • Practicar deportes que requieren movimiento repetitivo del brazo por encima de la cabeza como el tenis, el béisbol (particularmente el lanzamiento), la natación y el levantamiento de pesas por encima de la cabeza.
  • Trabajar con el brazo por encima de la cabeza durante muchas horas o días (como los pintores y los carpinteros).
  • Deficiente control o coordinación de los músculos del hombro y el omóplato.
La mala postura durante muchos años y el desgaste normal de los tendones que ocurre con la edad también pueden llevar a que se presente tendinitis del manguito de los rotadores.
Los desgarros del manguito de los rotadores pueden ocurrir de dos maneras:
  • Un desgarro repentino o agudo puede suceder cuando usted se cae sobre su brazo mientras éste está estirado o después de un movimiento súbito o repentino al tratar de alzar algo pesado.
  • Un desgarro crónico del tendón del manguito de los rotadores ocurre lentamente con el tiempo. Es más probable en aquellas personas con tendinitis crónica o síndrome de pinzamiento. En algún momento, el tendón se desgasta y se rompe.
Hay dos tipos de desgarros del manguito de los rotadores:
  • Un desagarro parcial es cuando la ruptura no corta completamente las conexiones al hueso.
  • Un desgarro completo o total se refiere a una ruptura del todo. Puede ser tan pequeña como una punta de alfiler o de todo el tendón del músculo. Los desgarros completos tienen desprendimiento del tendón desde el sitio de adherencia y no sanarían muy bien.

Síntomas

TENDINITIS O SÍNDROME DE PINZAMIENTO
Al comienzo, el dolor ocurre con actividades que se realizan por encima de la cabeza y al alzar el brazo hacia el lado. Las actividades abarcan cepillarse el cabello, alcanzar objetos en los estantes o practicar un deporte con movimientos por encima de la cabeza.
  • El dolor es más probable en la parte frontal del hombro y se puede irradiar hacia el lado del brazo. Sin embargo, este dolor siempre se detiene antes del codo. Si el dolor va más allá del brazo hasta el codo y la mano, esto puede indicar que hay pinzamiento de un nervio.
  • También puede haber dolor al bajar el hombro desde una posición elevada.
Al principio, este dolor puede ser leve y ocurrir sólo con ciertos movimientos del brazo. Con el tiempo, el dolor puede presentarse en reposo o por la noche, sobre todo al acostarse sobre el hombro afectado.
Usted puede tener debilidad y pérdida de movimiento al elevar el brazo sobre su cabeza. El hombro puede sentirse rígido al alzar algo o con movimiento. Puede volverse más difícil colocar el brazo por detrás de la espalda.
DESGARROS DEL MANGUITO DE LOS ROTADORES
El dolor con un desgarro repentino después de una caída o lesión generalmente es intenso. Con frecuencia, se presenta debilidad del hombro y del brazo junto con una sensación instantánea de movimiento.
Los síntomas de un desgarro crónico del manguito de los rotadores abarcan un empeoramiento gradual del dolor, la debilidad y la rigidez o pérdida del movimiento. El momento exacto cuando comienza un desgarro del manguito de los rotadores en alguien con tendinitis crónica del hombro puede o no notarse.
La mayoría de las personas con desgarros del tendón del manguito de los rotadores presentan dolor por la noche. El dolor que es peor por la noche puede despertarlo a uno. Durante el día, el dolor es más tolerable y duele con ciertos movimientos.
Con el tiempo, los síntomas se vuelven mucho peores y no se alivian con medicamentos, reposo o ejercicio.

Pruebas y exámenes

Un examen físico puede revelar sensibilidad por encima del hombro y se puede presentar dolor cuando el hombro se eleva sobre la cabeza. Generalmente, hay debilidad del hombro cuando se coloca en ciertas posiciones.
Las radiografías pueden mostrar un espolón óseo y se puede hacer en el consultorio médico.
Si el médico piensa que usted puede tener un desgarro del manguito de los rotadores, le pueden hacer uno o más de los siguientes exámenes:
  • Una ecografía usa ondas sonoras para crear una imagen de la articulación del hombro. Con frecuencia, puede mostrar un desgarro en el manguito de los rotadores.
  • La resonancia magnética del hombro puede mostrar hinchazón o un desgarro en el manguito de los rotadores.
Algunas veces, se necesita un examen imagenológico especial llamado artrografía para diagnosticar un desgarro en dicho manguito. El médico inyectará un material de contraste en la articulación del hombro. Luego, se usa ya sea una radiografía, una tomografía computarizada o una resonancia magnética para tomarle una imagen. El material de contraste generalmente se emplea cuando el médico sospecha de un pequeño desgarro en el manguito de los rotadores.

Tratamiento

TENDINITIS O SÍNDROME DE PINZAMIENTO
El tratamiento implica descanso del hombro y evitar actividades que causen dolor. Puede consistir en:
  • Compresas de hielo aplicadas en el hombro 20 minutos a la vez, de 3 a 4 veces por día.
  • Tomar fármacos como ibuprofeno y naproxeno para ayudar a reducir la hinchazón y el dolor.
  • Evitar o reducir actividades que causen o empeoren sus síntomas.
Para mayor información acerca del manejo de los síntomas en casa y el retorno a los deportes u otras actividades, ver el artículo: cuidados personales para el manguito de los rotadores.
Usted debe empezar fisioterapia con el fin de aprender ejercicios para estirar y fortalecer los músculos del manguito de los rotadores.
Si el dolor persiste o si la terapia no es posible debido al intenso dolor, una inyección de esteroides puede reducir el dolor y la hinchazón en los tendones lesionados, para permitir la eficacia de dicha terapia.
Con reposo y ejercicio, los síntomas con frecuencia mejoran o desaparecen; sin embargo, esto puede tardar semanas o meses.
La cirugía artroscópica puede eliminar el tejido inflamado y parte del hueso que está sobre el manguito de los rotadores. Extraer el hueso puede aliviar la presión sobre los tendones.
DESGARROS EN EL MANGUITO DE LOS ROTADORES
Alguien con un desgarro parcial del manguito de los rotadores que normalmente no tiene mucha exigencia sobre el hombro puede probar con reposo y ejercicio.
Si el manguito de los rotadores ha tenido un desgarro completo o si los síntomas persisten a pesar del tratamiento farmacológico, se puede necesitar cirugía para reparar el tendón. La mayoría de las veces, se puede usar la cirugía artroscópica. Algunos desgarros grandes requieren una cirugía abierta para reparar el tendón roto.

Pronóstico

Muchas personas recuperan completamente la función después de una combinación de medicamentos, fisioterapia e inyecciones de esteroides posterior a un episodio de tendinitis del manguito de los rotadores. Algunos pacientes tal vez necesiten cambiar o reducir la cantidad de tiempo que emplean con ciertos deportes para permanecer sin dolor.
Las personas con desgarros del manguito de los rotadores tienden a evolucionar bien, aunque el desenlace clínico depende altamente del tamaño del desgarro y el tiempo durante el cual éste ha estado presente, así como de la edad y del nivel de funcionamiento previo a la lesión.

Cuándo contactar a un profesional médico

Solicite una cita con el médico si se presenta dolor persistente en el brazo. Igualmente consulte si los síntomas no mejoran con el tratamiento.

Prevención

Evite los movimientos repetitivos por encima de la cabeza. Desarrolle la fuerza del hombro en grupos musculares opuestos.

Nombres alternativos

Hombro de nadador; Hombro de lanzador; Síndrome de pinzamiento del hombro; Hombro de tenista; Tendinitis del manguito de los rotadores; Síndrome de sobrecarga del hombro

Referencias

Burbank KM, Stevenson JH, Czarnecki GR, Dorfman J. Chronic shoulder pain: part II. Treatment. Am Fam Physician. 2008;77(4):493-497.
Burbank KM, Stevenson JH, Czarnecki GR, Dorfman J. Chronic shoulder pain: part I. Evaluation and diagnosis.Am Fam Physician. 2008;77(4):453-460.
Greiwe RM, Ahmad CS. Management of the throwing shoulder: cuff, labrum and internal impingement. Orthop Clin North Am. 2010 Jul;41(3):309-23.
Matsen III FA, Fehringer EV, Lippitt SB, Wirth MA, Rockwood Jr. CA. Rotator cuff. In: Rockwood CA Jr, Matsen FA III, Wirth MA, Lippitt SB, eds. The Shoulder. 4th ed. Philadelphia, Pa: Saunders Elsevier; 2009:chap 17.
Seida JC, LeBlanc C, Schouten JR, Mousavi SS, Hartling L, Vandermeer B, Tjosvold L, Sheps DM. Systematic review: nonoperative and operative treatments for rotator cuff tears. Ann Intern Med. 2010 Aug 17;153(4):246-55.

Actualizado: 7/6/2011

Versión en inglés revisada por: C. Benjamin Ma, MD, Assistant Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.
Traducción y localización realizada por: DrTango, Inc.






domingo, 15 de septiembre de 2013

Reverse Shoulder Replacement

http://orthowebcasts.holy-cross.com/videos/reverse-shoulder-replacement

Reverse Shoulder Replacement


http://orthowebcasts.holy-cross.com/videos/reverse-shoulder-replacement Holy Cross Hospital: Reverse Shoulder Replacement orthowebcasts.holy-cross.com Watch orthopedic surgeon Jonathan Levy perform a Reverse Shoulder Replacement at Holy Cross Hospital, in Fort Lauderdale, Florida.



Jonathan C. Levy, MD
Orthopedic Surgeon
View Full Profile

Overview

Watch orthopedic surgeon Jonathan Levy perform a Reverse Shoulder Replacement at Holy Cross Hospital, in Fort Lauderdale, Florida. The Reverse Shoulder Replacement is an exciting breakthrough in shoulder surgery. It is a new treatment option for patients who have suffered with shoulder arthritis and rotator cuff dysfunction. Until now, there were limited surgical options for patients with this combination of problems. Patients were offered procedures that were unreliable in achieving and maintaining pain relief and functional improvements. The Reverse Shoulder Replacement has been used successfully in Europe for over 10 years, and has recently been approved for use in the United States.
What is a Reverse Shoulder Replacement?
The Reverse Shoulder Replacement differs from a traditional Total Shoulder Replacement in that the ball and socket are reversed. The ball (glenosphere) is placed onto the glenoid (socket), and the socket is placed on the ball (humerus). The Reverse Shoulder Replacement provides the additional shoulder stability needed when the rotator cuff is not functional. Once the shoulder regains stability, improvements are seen in both pain relief and shoulder function.
When is the Reverse Shoulder Replacement used?
The rotator cuff is a key stabilizer of the shoulder. Patients may have severe loss of rotator cuff function from massive rotator cuff tear, previous surgery, or a previous fracture. In many of these cases, shoulder arthritis develops. Once the combination of irreparable rotator cuff dysfunction and arthritis is present, the Reverse Shoulder Replacement can be considered. This procedure can also be used in revision surgery, after failed shoulder replacement and shoulder fractures.
What are the benefits of a Reverse Shoulder Replacement?
If the rotator cuff is functioning properly, you do not need a Reverse Shoulder Replacement. Your function will be much better with a Total Shoulder Replacement, as normal anatomy is reconstructed. The Reverse Shoulder Replacement is used only when the rotator cuff cannot be reconstructed.
Dramatic improvements have been seen in pain relief, range of motion, and ability to perform daily activities (ie, eating, drinking, grooming). The return of independence is probably the key benefit that patients experience, as they are able to regain function and use of the arm.
How long does the surgery take?
The surgery is done using a general anesthetic and typically takes approximately 2 hours.
What is the recovery process?
The recovery is similar to the recovery after a traditional Total Shoulder Replacement. You will be immobilized for a period of 6 to 8 weeks to allow for healing. Then you will begin a progressive therapy program that emphasizes stretching followed by strengthening.
http://orthowebcasts.holy-cross.com/videos/reverse-shoulder-replacement Holy Cross Hospital: Reverse Shoulder Replacement orthowebcasts.holy-cross.com Watch orthopedic surgeon Jonathan Levy perform a Reverse Shoulder Replacement at Holy Cross Hospital, in Fort Lauderdale, Florida.

Apuntados para el 2014 en la AAOS Annual Meeting!!!

sábado, 7 de septiembre de 2013

TENDINOPATIA DEL MANGUITO ROTADOR

http://www.ncbi.nlm.nih.gov/pubmed/19364757



 2010 Oct;44(13):918-23. doi: 10.1136/bjsm.2008.054817. Epub 2009 Apr 12.

Rotator cuff tendinopathy: a model for the continuum of pathology and related management.

Source

Therapy Department, Chelsea and Westminster NHS Healthcare, 369 Fulham Road, London SW10 9NH, UK. jeremy.lewis@chelwest.nhs.uk

Abstract

BACKGROUND:

Pathology of the soft tissues of the shoulder including the musculotendinous rotator cuff and subacromial bursa are extremely common and are a principal cause of pain and suffering. Competing theories have been proposed to explain the pathoaetiology of rotator cuff pathology at specific stages and presentations of the condition. This review proposes a model to describe the continuum of the rotator cuff pathology from asymptomatic tendon through full thickness rotator cuff tears.

CONCLUSIONS:

The pathoaetiology of rotator cuff failure is multifactorial and results from a combination of intrinsic, extrinsic and environmental factors. Recently a new and generic model detailing the continuum of tendon pathology has been proposed. This model is relevant for the rotator cuff and provides a framework to stage the continuity of rotator cuff pathology. Furthermore, it provides a structure to identify the substantial deficiencies in our knowledge base and areas where research would improve our understanding of the pathological and repair process, together with assessment and management. The strength of this model adapted for the rotator cuff tendons and subacromial bursa will be tested in its ability to incorporate and adapt to emerging research.
PMID:
 
19364757
 
[PubMed - indexed for MEDLINE]

viernes, 6 de septiembre de 2013

Which Patients Need Rotator Cuff Surgery?


Which Patients Need Rotator Cuff Surgery?

Determining who is a candidate and when he or she needs surgery are as important as how to operate. Not all tears are symptomatic, and not all result in functional disability.
By Leesa Galatz - September 3, 2013



Dr. Leesa Galatz shares her insights on determining which patients are candidates for rotator cuff surgery: http://goo.gl/UEoUKR

Author

Leesa M. Galatz, MD

Introduction
Rotator cuff repair is one of the most common procedures performed in the shoulder. Recent advances in techniques and instrumentation have made the procedure technically easier in many ways, yet no clear clinical differences result from any single repair configuration or device. [1-3] Choices in this regard depend entirely on surgeon preference.

The controversy, more often, is in regards to surgical indications. Determining who is a candidate and when he or she needs surgery are as important as how to operate.  The prevalence of rotator cuff tears is high, especially in the older population.  However, not all tears are symptomatic, and not all result in functional disability.

Factors Contributing to Treatment Guidelines

Natural History


Examining the natural history of rotator cuff disease illustrates the increasing prevalence and incidence of rotator cuff tears with age.  In a study of individuals with unilateral shoulder pain, the presence of rotator cuff disease was highly correlated with increasing age, such that the presence of a rotator cuff tear and the presence of bilateral cuff tears were seen in the sixth and seventh decades, respectively. [4]

Another study found that of 924 patients screened with ultrasound, 99 had a tear. [5] The average age in the tear group was a decade older than in the non-tear group: 60 versus 70 years old.  Although many patients were asymptomatic, the patients with tears had less shoulder function and more pain.

Understanding the natural history of rotator cuff tears helps form treatment guidelines:
  • Asymptomatic degenerative tears in older people should be treated non-operatively.
  • Patients who present with tears sooner than might be expected, such as in their 40s and early 50s, are at risk for tear size progression and concomitant development of degenerative muscle changes. 
  • Given that smaller tears and tears in younger individuals heal more predictably, [6,7] early intervention may be indicated. 
  • At the minimum, surveillance of known tears helps prevent progression to an irreparable state.
Functional and Structural OutcomeStudies reporting the functional and structural outcome after rotator cuff repair also contribute to treatment guidelines. [8-10] The literature clearly shows that rotator cuff tendon healing is less predictable after age 60 to 65 years. Tear size also has an impact on results. [11]

Therefore, factors to consider include:
  • Patient age
  • Tear size and reparability
  • Pain level
  • Functional disability
  • Extent of non-operative treatment
Potential patient outcome should also be considered. Pain relief can occur in many patients in spite of poor healing after a rotator cuff repair. [8,12] The pain relief alone is a benefit, aside from structural restoration of tendon continuity. 

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