Pregunta sobre Rotura tendón supraespinoso - Tratamiento por artroscopia

¿Qué significa artroscopia y en que consiste el tratamiento de la rotu...

Pregunta sobre Rotura tendón supraespinoso - Tratamiento por artroscopia 

¿Qué significa artroscopia y en que consiste el tratamiento de la rotura del tendón supraespinoso?

Ha respondido 1 experto

La artroscopia es una técnica quirúrgica que permite abordar las articulaciones, siendo una técnica poco invasiva. Consiste en la visualización de las articulaciones a través de una cámara insertada por unos pequeños agujeros.
La rotura del tendón supraespinoso es una afección común a partir de los 60 años, que se produce por un proceso degenerativo del tendón. En pacientes más jóvenes suele ocurrir raramente y se relaciona con traumatismos.
En un porcentaje nada despreciable de personas, este proceso pasa desapercibido, ya que es asintomático. En otros, produce dolor y/o limitación para mover el brazo.
Excepto en los casos de pacientes jóvenes (menores de 60 años), suele recomendarse tratamiento rehabilitador, ya suele ser efectivo, ya que el tratamiento quirúrgico no evita las rerupturas. En aquellos pacientes en los que no es efectivo un largo periodo de rehabilitación, se recomienda tratamiento quirúrgico, por vía abierta convencional o por artroscopia.
Saludos.

Dr. Joan Miquel Noguera
Traumatólogo

+info: http://www.doctoralia.es/pruebamedica/rotura+tendon+supraespinoso+-+tratamiento+por+artroscopia-1912/pregunta/que-significa-artroscopia-y-en-que-consiste-el-tratamiento-de-la-rotura-del-tendon-supraespinoso-69175

Reverse total shoulder (TESS) - high rate of glenoid loosening

http://shoulderarthritis.blogspot.mx/2014/01/reverse-total-shoulder-tess-high-rate.html

Tuesday, January 28, 2014

Reverse total shoulder (TESS) - high rate of glenoid loosening

Clinical and radiological outcome of the Total Evolutive Shoulder System (TESS®) reverse shoulder arthroplasty: a prospective comparative non-randomised study.

These authors reviewed 37 consecutive patients (40 shoulders) underwent TESS RSA (see figure below) between October 2007 and January 2012; 16 were stemless and 26 were stemmed. At a mean follow-up of 39 months (15-66) there were four glenoid loosenings. In 12 shoulders had developed scapular notching and seven already had scapular bone impression evident on initial post-operative radiographs.



Comment: We have no experience with this prosthesis. It appears that the quality of glenoid fixation with this system may be less robust than some other systems.

http://www.ncbi.nlm.nih.gov/pubmed/24458592

Int Orthop. 2014 Jan 24. [Epub ahead of print]

Clinical and radiological outcome of the Total Evolutive Shoulder System (TESS®) reverse shoulder arthroplasty: a prospective comparative non-randomised study.

Kadum B, Mukka S, Englund E, Sayed-Noor A, Sjödén G.

Author information

Abstract

PURPOSE:

The aims of this study were to assess the function and quality of life after the Total Evolutive Shoulder System (TESS) reverse shoulder arthroplasty (RSA), to evaluate the radiological stability of the stemless version and to address the effect of arm lengthening and scapular notching (SN) on the outcome.

METHODS:

This was a prospective comparative non-randomised study. A total of 37 consecutive patients (40 shoulders) underwent TESS RSA between October 2007 and January 2012; 16 were stemless and 26 were stemmed. At a mean follow-up of 39 months (15-66), we evaluated range of motion (ROM), pain and functional outcome with QuickDASH and quality of life with EQ-5D score. Radiologically, component positioning, signs of loosening, SN and arm length difference were documented.

RESULTS:

We found a significant improvement in functional outcome and reduction of pain in both stemmed and stemless groups. No humeral loosening was evident, but there were four glenoid loosenings. In 12 shoulders that developed SN, seven already had scapular bone impression (SBI) evident on initial post-operative radiographs. Glenoid overhang seemed to decrease the risk of SN. Arm lengthening was associated with better EQ-5D but did not influence ROM or functional outcome.

CONCLUSIONS:

Reverse shoulder arthroplasty markedly improved shoulder function. SN is of concern in RSA, but proper positioning of the glenoid component may prevent its development.

PMID:

 

24458592

 

[PubMed - as supplied by publisher]

Shoulder pain can be a sign of frozen shoulder, a nagging condition that limits routine activities and athletics

Shoulder pain can be a sign of frozen shoulder, a nagging condition that limits routine activities and athletics: http://t.co/OktG1XfMJR
— AOSSM (@AOSSM_SportsMed) junio 11, 2013

http://www.healio.com/orthopedics/shoulder-elbow/news/online/%7B63f84a5d-c34b-45a6-a59e-be694be2f343%7D/labor-intensive-occupation-linked-to-poor-results-after-failed-rotator-cuff-repair

Labor-intensive occupation linked to poor results after failed rotator cuff repair 

Namdari S. J Bone Joint Surg. 2014;doi: 10.2106/JBJS.M.00551 

• January 27, 2014

Results of this study highlight preoperative Simple Shoulder Test score, external rotation and labor-intensive occupation as factors associated with a lower American Shoulder and Elbow Surgeons score after structural failure of repaired rotator cuff tears.  

“Successful outcomes were achieved in 54% of patients with failed rotator cuff repair. Those who self-identified their occupation as being labor-intensive represented a special group of patients who are at high risk for a poor outcome after a failed rotator cuff repair,” Surena Namdari, MD, MSc, and colleagues, wrote in their study.
To determine the factors related to clinical outcomes following failed repair, Namdari’s team retrospectively studied 61 patients with a minimum 2-year follow-up who underwent arthroscopic repair of full-thickness rotator cuff tears and had structural failure within 1 year of the repair. The investigators categorized patients with an American Shoulder and Elbow Surgeons (ASES) score of 80 or higher as having a successful clinical outcome and those with a score below 80 as having an unsuccessful outcome.
Of the 28 patients in the unsuccessful group, 15 (53.6%) reported having a labor-intensive profession as opposed to two (6.1%) of the 33 patients in the successful group. Seven patients, all from the unsuccessful group, had their preoperative ASES score decline by a mean of 6.6 points postoperatively. The investigators also found that patients in the unsuccessful group had significantly lower Simple Shoulder Test (SST) scores compared to the successful group, who had lower postoperative ASES pain scores. – by Christian Ingram

Disclosure: One or more of the authors received payments or services from a third party in support of an aspect of this work. In addition, one or more of the authors has had a financial relationship in the 36 months prior to submission of this work with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work.

Shoulder Arthroscopy

http://pixvid.me/mdbonedocsShoulderAr... The shoulder can perform movements in more directions and to greater extents than any other joint in our body. But because it can perform so many movements, the shoulder is vulnerable to stress and injury. Shoulder injuries are very common, especially among people who play sports that require overhead arm motions.

Strong tissues hold the shoulder bones together. The tissues are more likely than the bones to be affected by stress, injury, and "wear and tear." They may stretch or rupture, causing the shoulder to become weak, unstable, or dislocate. Some shoulder conditions require surgery. Arthroscopy allows surgeons to see, diagnose, and treat problems inside the shoulder joint.

Before arthroscopic surgery existed, surgeons made large incisions that affected the surrounding joint structures and tissues. They had to open the shoulder joint to see it and perform surgery. An arthroscopy requires small incisions and is guided by a small viewing instrument. Arthroscopy is less invasive than traditional surgical methods. It has a decreased risk of infection and a shorter recovery period.

http://youtu.be/e9RmgSh1oaY

Locked plates for the treatment of proximal humeral fractures

VIDEO: Roy W. Sanders, MD, shares his perspective on locked plates for the treatment of proximal humeral fractures

Publicación de Victor Ravens.

http://www.bjj.boneandjoint.org.uk/content/96-B/1/70.abstract

Temporal trends and geographical variation in the use of subacromial decompression and rotator cuff repair of the shoulder in England

1. A. Judge, PhD, MSc, BSc, Senior statistician and departmental lecturer in musculoskeletal epidemiology1 ; 
2. R. J. Murphy, MA, MBChB, MRCS, Lord Nuffield Scholar in Orthopaedic Surgery1; 
3. R. Maxwell, MSc, Senior Analyst2; 
4. N. K. Arden, FRCP, CSST, MD, Professor of Rheumatology1; and 
5. A. J. Carr, FMedSci, MA, ChM, Nuffield Professor of Orthopaedics, Head of the Department1 

+Author Affiliations

1. 1University of Oxford, Oxford NIHR Musculoskeletal Biomedical Research Unit, Windmill Road, Headington, Oxford, OX3 7LD, UK.
2. 2Public Health England, Knowledge and Intelligence Team (South West), Grosvenor House, 149 Whiteladies Road, Bristol BS8 2RA, UK.

1. Correspondence should be sent to Dr A. Judge; e-mail:andrew.judge@ndorms.ox.ac.uk

Abstract

We explored the trends over time and the geographical variation in the use of subacromial decompression and rotator cuff repair in 152 local health areas (Primary Care Trusts) across England. The diagnostic and procedure codes of patients undergoing certain elective shoulder operations between 2000/2001 and 2009/2010 were extracted from the Hospital Episode Statistics database. They were grouped as 1) subacromial decompression only, 2) subacromial decompression with rotator cuff repair, and 3) rotator cuff repair only.

The number of patients undergoing subacromial decompression alone rose by 746.4% from 2523 in 2000/2001 (5.2/100 000 (95% confidence interval (CI) 5.0 to 5.4) to 21 355 in 2009/2010 (40.2/100 000 (95% CI 39.7 to 40.8)). Operations for rotator cuff repair alone peaked in 2008/2009 (4.7/100 000 (95% CI 4.5 to 4.8)) and declined considerably in 2009/2010 (2.6/100 000 (95% CI 2.5 to 2.7)).

Given the lack of evidence for the effectiveness of these operations and the significant increase in the number of procedures being performed in England and elsewhere, there is an urgent need for well-designed clinical trials to determine evidence of clinical effectiveness.

Cite this article: Bone Joint J 2014;96-B:70–4.

Footnotes

• The HES data were made available by the NHS Health and Social Care Information Centre. Copyright © 2012, Re-used with the permission of The Health and Social Care Information Centre. All rights reserved. HES data for this analysis were extracted using the HES online service by Public Health England who did not receive funding for this work. This work is based on data provided through EDINA UK Borders with support from the ESRC and JISC, and used material that is copyright of the Crown. We would like to thank Ms S. Sheard for her help in preparing the manuscript. This work was supported by the Oxford NIHR Musculoskeletal Biomedical Research Unit, Nuffield Orthopaedic Centre, University of Oxford. The opinions expressed by the authors are theirs alone and do not represent the opinions of supporting organisations.The UKUFF trial was funded by the NIHR Health Technology Assessment programme (project number 05/47/02). See the HTA programme website for further project information. The views and opinions expressed are those of the authors and do not necessarily reflect those of the NIHR HTA programme or the Department of Health.
  No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.
  This article was primary edited by D. Rowley and first-proof edited by J. Scott.

• Received June 3, 2013.
• Accepted September 4, 2013.

• ©2014 The British Editorial Society of Bone & Joint Surgery

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2953303/

Rehabilitation after Arthroscopy of an Acetabular Labral Tear 

This article has been cited by other articles in PMC.

Abstract 

Over the past few years, arthroscopy of the hip joint is becoming more common as a technique in both the diagnosis and treatment of hip pain. A frequent cause of hip and groin pain is a tear of the acetabular labrum. Patients with labral tears complain of pain in the groin region and pain with clicking in the hip without a history of pain prior to the original onset. Once a patient presents with signs and symptoms of hip pain that are greater than four weeks in conjunction with indicative findings of a labral tear by way of MRI, he or she may be considered a good candidate for arthroscopy of the hip joint. Little evidence exists in the current literature on rehabilitative procedures performed after arthroscopy of the acetabular labrum. The purpose of this clinical commentary is to suggest a rehabilitation protocol after acetebular labral debridement or repair.

I CONGRESO GERMANO ARGENTINO DE CIRUGIA Y REHABILITACION DE HOMBRO Y CODO

Aviso!!!! Emilse Perez secretaria en Asociación Argentina de Cirugía de Hombro y Codo

I CONGRESO GERMANO ARGENTINO DE CIRUGIA Y REHABILITACION DE HOMBRO Y CODO 27, 28 DE MARZO EN MENDOZA CENTRO DE CONGRESOS Y CONVENCIONES GOBERNADOR EMILIO CIVIT ARANCEL HASTA EL 5 DE MARZO KINESIOLOGOS Y RESIDENTES $400 TRAUMATOLOGOS $500 TRAUMATOLOGOS EXTRANJEROS USD 150 KINESIOLOGOS EXTRANJEROS USD 100 PROGRAMAS EN NUESTRA PAGINA www.hombroycodo.org.ar "CONGRESOS" consultas e inscripción a Sra Emilse Pérez emilse44@gmail.com Emilse Pérez Secretaria Asociación Argentina de Cirugía de Hombro y Codo www.hombroycodo.org.ar 011 155 512 4152   Programa     I° CONGRESO GERMANO ARGENTINO DE  CIRUGIA Y REHABILITACION DE HOMBRO Y CODO Sesiones científicas: 27 y 28 de marzo Centro de Convenciones Gdor. Civit Taller cadavérico:  29 de marzo Universidad de Cuyo

Shoulder Arthritis / Rotator Cuff Tears: causes of shoulder pain: Structural failure of 33% of 212 arthroscopic repa...

Shoulder Arthritis / Rotator Cuff Tears: causes of shoulder pain: Structural failure of 33% of 212 arthroscopic repa...: Factors Affecting Outcome After Structural Failure of Repaired Rotator Cuff Tears Recognizing the high rate of retear after cuff repair, t...

Structural failure of 33% of 212 arthroscopic repairs of full thickness rotator cuff tears - half of which had 'successful' outcomes

Factors Affecting Outcome After Structural Failure of Repaired Rotator Cuff Tears

Recognizing the high rate of retear after cuff repair, these authors retrospectively studied factors associated with clinical outcome in patients with known failure of cuff repair. The preoperative size of tear and type of repair were not presented. 33 patients (54%) had American Shoulder and Elbow Surgeons scores of 80 points or more and were deemed to have had 'successful' outcomes.

Interestingly, 15 (54%) of the patients with unsuccessful outcomes reported a labor-intensive occupation compared with only two patients in the successful group. In addition to occupation, a low preoperative simple shoulder test score was associated with an unsuccessful clinical outcome.

Age and other demographic variables, including sex, dominant-sided surgery, and medical comorbidities, were similar for the successful and unsuccessful groups.

Comment: This is a well done study. It brings to light several questions:  (1) How many of these patients had 'retears' and how many had 'unhealed' repairs? (2) Why did half of these patients get better even though the surgery failed to reestablish cuff integrity (even those in the clinically unsuccessful group had on average improved clinical scores)? (3) What is the appropriate management of a cuff tear in a patient with a labor-intensive occupation and a low simple shoulder test score? (4) If this same definition of 'successful' clinical outcome were applied to patients with intact repairs, what percent would be found to have achieved the threshold of 80 or more points on the ASES scale? (5) Why was the preoperative simple shoulder test a better predictor than the preoperative ASES score? (6) How is it that the postoperative retear size was not different between the successful and unsuccessful groups?

Reestablishing cuff integrity is challenging. As pointed out in a prior post (which includes a Robert Frost poem), we have to thank the late Doug Harryman for first showing that cuff repair integrity was not essential to a good outcome from cuff repair surgery and showing us that it may not be in the best interest of the patient to perform a cuff repair and implement a prolonged period of restricted activity to protect the repair unless the conditions are optimal for healing of the repair. "When to repair and when to do a smooth and move?", that is the question.

Shoulder Arthritis / Rotator Cuff Tears: causes of shoulder pain: "Patients treated with rotator cuff repair do well...

Shoulder Arthritis / Rotator Cuff Tears: causes of shoulder pain: "Patients treated with rotator cuff repair do well...: Factors Affecting Satisfaction and Shoulder Function in Patients with a Recurrent Rotator Cuff Tear The authors of this article open with...

"Patients treated with rotator cuff repair do well regardless of the integrity of the repair" - what does this tell us?

Factors Affecting Satisfaction and Shoulder Function in Patients with a Recurrent Rotator Cuff Tear

The authors of this article open with the statement that "It is widely accepted that most patients treated with rotator cuff repair do well regardless of the integrity of the repair." This statement again makes us question whether the anatomic success of cuff repair is important to the quality of the clinical outcome.  The purpose of this cross-sectional study was to reexamine this concept and identify the factors affecting the outcomes of patients with a recurrent tear. This study is similar to that which was the subject of yesterday's post.



Reestablishing cuff integrity is challenging. As pointed out in a prior post (which includes a Robert Frost poem), we have to thank the late Doug Harryman for first showing that cuff repair integrity was not essential to a good outcome from cuff repair surgery and showing us that it may not be in the best interest of the patient to perform a cuff repair and implement a prolonged period of restricted activity to protect the repair unless the conditions are optimal for healing of the repair. "When to repair and when to do a smooth and move?", that is the question.



The authors reviewed 180 patients who had cuff repair from 2007 to 2011 who met inclusion criteria among which there were 47 (26%) patients with full thickness retear. Functional outcomes were poorer for those having full thickness retears, but not those having attenuated or partial thickness defects. In patients with retears, clinical outcomes were better in patients over 65 years of age, whereas age did not significantly correlate with the clinical outcome in the patients with no retear.



Patient factors had a strong influence on the clinical outcomes in the patients with retears. Multiple regression analysis of the retear group showed that

(1) lower education level and a Workers’ Compensation claim were independent predictors of a poorer satisfaction score;

(2) lower education level, younger age, and a Workers’ Compensation claim were independent predictors of a poorer ASES score; and

(3) lower education level was an independent predictor of a poorer SST score

Furthermore, those patients who had retired for reasons other than illness demonstrated better clinical outcomes than those who were unemployed or disabled.



When we discuss the 4 Ps that influence the outcome of treatment (problem, patient, physician, and procedure), age, Workers' Compensation and lower education levels are great examples of the 'patient' factors that are known to influence the clinical outcome of treatment. It is desirable to include each of the 4 Ps in studies of clinical outcome (e.g. did the size of the tear or the type of repair affect clinical outcome in this series?). It would have been really interesting if the authors had performed a multiple regression analysis to determine how important cuff integrity was to the clinical outcome so that we could be sure that poor outcomes were not related to lower education level, Workers' Compensation claim and young age rather than to retear. 

SAPU Dr. Juan Solorzano: Seudoartrosis de Húmero

SAPU Dr. Juan Solorzano: Seudoartrosis de Húmero: En varias ocasiones he señalado que una de las cosas más apasionantes de trabajar en urgencias es ver siempre casos que nunca habías v...

Seudoartrosis de Húmero

En varias ocasiones he señalado que una de las cosas más apasionantes de trabajar en urgencias es ver siempre casos que nunca habías visto antes.Hace pocos días atrás atendí a este señor de 80 años por un cuadro vertiginoso,al examinar me llamó la atención la gran deformidad y flexibilidad de su brazo.
Hace 6 años tuvo un accidente que generó una fractura de brazo derecho,que nunca fue tratada como correspondía,el sólo señala lo que aparentemente le habría transmitido el equipo de traumatólogos que lo atendía,"está muy viejo y los riesgos de operar son mayores que los eventuales beneficios"
Tengo certeza que si este paciente hubiese sido atendido en alguna clínica privada,hoy no tendría dolor crónico y esta seudoatrosis que se forma por una fractura mal tratada y mal consolidada.
Una nuestra más de las inequidades de nuestro Sistema de Salud

Bursitis facts by Medicine Net

Publicación de I.P.C Physical Therapy.

http://www.healio.com/orthopedics/shoulder-elbow/news/online/%7Bc80b7a38-b7ce-46f4-9fac-cb20a4233ffc%7D/shoulder-replacement-improves-range-of-motion-reduces-rheumatoid-arthritis-pain

Shoulder replacement improves range of motion, reduces rheumatoid arthritis pain 

Shoulder replacement surgery improved range of motion and reduced pain in nearly all cases of rheumatoid arthritis, especially when patients had an intact rotator cuff, based on study results recently published in the Journal of Shoulder and Elbow Surgery.

Using the data in the Mayo Clinic Total Joint Registry, researchers studied 30 patients with rheumatoid arthritis who underwent shoulder replacement surgery at the Mayo Clinic and were followed up for at least 5 years.

Among patients with a primary TSR, researchers found 96% were alive and had no need to undergo further arthroplasty on the affected shoulder at 5 years after the procedure, and at 10 years after the primary TSR 93% of patients were alive with no need for additional surgery.

However, among patients who underwent partial arthroplasty, 89% had no need for further arthroplasty at 5 years and 88% of them required no further surgery after 10 years, according to the study's results.

Overall, patients with intact rotator cuffs did better after shoulder replacement than patients who had damaged rotator cuffs.

"The data from this study suggest that shoulder arthroplasty is a predictable and durable operation to improve function and relieve pain in patients with rheumatoid arthritis,” John Sperling, MD, MBA, professor of orthopedic surgery at Mayo Clinic, told Orthopedics Today. "Among patients with an intact rotator cuff, the outcome with total shoulder arthroplasty was significantly better than hemiarthroplasty."

Disclosure: Sperling receives royalties from Biomet. Cofield, a co-author, receives royalties from Smith & Nephew.

http://www.healio.com/orthopedics/shoulder-elbow/news/online/%7B0b2de404-d50a-4d2c-8110-56941a136a7a%7D/rotator-cuff-re-tears-found-more-prevalent-after-single-row-arthroscopic-repairs

Rotator cuff re-tears found more prevalent after single-row arthroscopic repairs 

• January 14, 2014

In a recent study, patients with rotator cuff tears were more likely to have re-tears following an arthroscopic single-row repair compared to a double-row repair.

"Single-row repairs resulted in significantly higher re-tear rates compared with double-row repairs, especially with regard to partial-thickness re-tears,” Peter J. Millett, MD, MSc, and colleagues reported in the study.

From their literature search, Millett's group identified seven studies that involved level 1 randomized controlled trials in which single-row and double-row rotator cuff repairs were investigated. For the meta-analysis, they sought to compare the statistics for both types of repairs in terms of clinical outcomes and imaging-diagnosed re-tears. Millett and colleagues included studies that used the American Shoulder and Elbow Surgeons, UCLA and Constant clinical scores.

The study results showed an overall re-tear rate for double-row rotator cuff repair of 14.2% and a re-tear rate of 25.9% in the single-row group. The investigators also found a statistically significant increase in the risk of imaging-diagnosed re-tears in the single-row group vs. the double-row group, with partial thickness re-tears accounting for the majority of imaging-diagnosed re-tears across the studies.

Any improvement in clinical outcome scores for the single-row and double-row groups, however, was not statistically significantly different, based on the study abstract.

Reference:

Millett PJ. J Shoulder Elbow Surg. 2014;doi:http://dx.doi.org/10.1016/j.jse.2013.10.006

Disclosure: The authors have no relevant financial disclosures.