Dr Michell Ruiz
Cirugía de hombro y del Manguito rotador
miércoles, 8 de enero de 2014
lunes, 6 de enero de 2014
domingo, 5 de enero de 2014
A 'new' patch for rotator cuff repairs. Is this BBC news?
http://shoulderarthritis.blogspot.mx/2014/01/a-new-patch-for-rotator-cuff-repairs-is.html
Saturday, January 4, 2014
A 'new' patch for rotator cuff repairs. Is this BBC news?
Researchers in Oxford have developed a degradable implant which they say has huge potential to improve surgical success rates
This article by the BBC talks of the promise of a "protective patch, which wraps round soft tissue repairs" that will be trialled in patients with shoulder injuries.
The article reports that 10,000 shoulder repair operations are carried out each year in England and Wales and that figure has risen by 500% in the last decade. "But one in four procedures is not successful, because the tendon tears again."
Platelet-leukocyte membrane
Platelet fibrin matrix
Platelet rich plasma
Kevin Senior can lift his left arm, but not his right
A loom was used to help make the implant
The implant helps to bind the tissue repair
This article by the BBC talks of the promise of a "protective patch, which wraps round soft tissue repairs" that will be trialled in patients with shoulder injuries.
The article reports that 10,000 shoulder repair operations are carried out each year in England and Wales and that figure has risen by 500% in the last decade. "But one in four procedures is not successful, because the tendon tears again."
This report is based on laboratory tests that have been encouraging, but clinical trials have yet to begin. The team claims, "We've used modern technology to produce very fine fibres which have the extraordinary ability to direct the way cells behave, and "wake up" tired and aging cells, and make them want to heal, whereas previously they weren't being made to want to heal. The material in the patch is degradable, and disappears after a few months."
While we're all for research in improving the currently suboptimal anatomical and clinical results of cuff repair, it seems a bit early to for the BBC to be proclaiming the promise of the 'degradable implant'. Here are some previous posts on attempts to improve the biology of tendon healing in cuff repair.
While we're all for research in improving the currently suboptimal anatomical and clinical results of cuff repair, it seems a bit early to for the BBC to be proclaiming the promise of the 'degradable implant'. Here are some previous posts on attempts to improve the biology of tendon healing in cuff repair.
Platelet fibrin matrix
Platelet rich plasma
It has been proposed that Graft Jacket may be useful in this regard, but results of aclinical trial have yet to be reported. The trial started in 2007 and was to be completed in 2010. We'd be most interested if any of the readers know of a results report.
A terrific review of 'patches' is provided here from the Wrightington Upper Limb Unit - a must read!
Trials to begin on new degradable surgical implant
Kevin Senior can lift his left arm, but not his right
Researchers in Oxford have developed a degradable implant which they say has huge potential to improve surgical success rates.
The protective patch, which wraps round soft tissue repairs, will be trialled in patients with shoulder injuries.
It is hoped in time this approach could help patients with other conditions including arthritis, hernias and heart defects.
The implant has been developed using a mix of modern and ancient technology.
Kevin Senior experiences pain every time he lifts his right arm. He has torn the tendons in his shoulder. Mr Senior, who is 59, is a plumbing engineer, so this gives him serious difficulties in his work.
Even combing his hair or shaving causes him problems.
He is looking forward to having an operation next year at Nuffield Orthopaedic Hospital in Oxford.
"It's very frustrating but obviously you've got to do the best you can. Hopefully when it's repaired I'll be able to do everything, but as it stands now, you just struggle on."
There are 10,000 of these shoulder repair operations carried out each year in England and Wales. The figure has risen by 500% in the last decade. But one in four procedures is not successful, because the tendon tears again.
The surgeon who will operate on Kevin Senior's shoulder, Professor Andrew Carr, has led a research project to improve the success rate and ensure a quicker recovery. This collaboration between the university and the hospital trust helps move ideas quickly from the lab to the clinic.
Professor Carr's team have developed a protective patch - an implant which wraps around the surgical repair, like a splint.
One side is made of resilient woven material, to help it withstand the stresses of movement after surgery.
The other side is made of thread spun a hundred times finer than human hair.
A loom was used to help make the implant
Its surface encourages cells to grip and bond, as they would naturally in a much younger patient.
Ancient technology
Professor Carr says the results in laboratory tests have been encouraging, and they hope to start clinical trials in patients soon.
"We've used modern technology to produce very fine fibres which have the extraordinary ability to direct the way cells behave, and "wake up" tired and ageing cells, and make them want to heal, whereas previously they weren't being made to want to heal.
The material in the patch is degradable, and disappears after a few months. Professor Carr says this is important for patients in their 40s, 50s and 60s who want to get back to work and may well live for several decades.
"Once the repair process has taken place we would rather not have a piece of foreign material sitting in someone's body for the rest of their lives, because experience has shown us that ultimately the body will respond and reject that tissue."
The project uses the best in modern and ancient technology. Alongside the humming, whirring and beeping of the latest laboratory gadgetry, is the click and snap of a manually operated wooden handloom - perfect for producing the patch's protective cover.
One of the team, Osnat Hakimi, says the loom enabled them to use small quantities of expensive fibre and investigate its properties.
"Scientists may look very technological, but they are very fond of simplicity and crafts. Using our hands is something we do a lot in the lab. So actually working with a handloom is something that went down quite well."
The implant helps to bind the tissue repair
Less than 5% of government funding for medical research goes on surgery, but Professor Car
sábado, 4 de enero de 2014
Cirugía De Reemplazo Articular De Hombro Para La Artritis De Hombro
http://drmillett.com/cirugia-de-reemplazo-articular-de-hombro-para-la-artritis-de-hombro
Cirugía De Reemplazo Articular De Hombro Para La Artritis De Hombro
 | Occupación:Gurú de Ventas Promocionales
Residencias:Greater Denver Colorado
Lesion:Osteoartritis de hombro
Cirugía:
Remplazo Total de Hombro |
Cirugía de Reemplazo Articular de Hombro para la Artritis de Hombro
La articulación de hombro actúa como una esfera y una cavidad, permitiéndoles a las personas el mayor rango de movilidad de todo el cuerpo. La artritis de hombro ocurre cuando el cartílago de la articulación comienza a desgastarse generando que el revestimiento protector de la articulación desaparezca. La artritis de hombro tiene como resultado dolor constante, inflamación e inflamación en el hombro. Los pacientes que sufren de artritis avanzada de hombro y que han recibido tratamientos conservadores como medicación, terapia física y, en algunos casos, cirugía artroscópica y no han obtenido alivio pueden ser candidatos a una cirugía de reemplazo anatómico del hombro.
Tratamiento
Tratamiento quirúrgico
Reemplazo anatómico total de hombro
La cirugía de reemplazo anatómico total de hombro es un procedimiento que se realiza principalmente en pacientes que sufren de formas extremas de artritis. La cirugía de reemplazo anatómico total de hombro reemplaza el cartílago y hueso dañados con implantes de plástico o metal. Se utiliza una esfera de metal para remplazar la cabeza humeral, mientras que una cavidad de polietileno se convierte en el reemplazo de la cavidad glenoidea. Una vez realizado el procedimiento los pacientes experimentan alivio del dolor intenso y continuo al que estaban habituados.
La indicación para el reemplazo total de hombro es el dolor que no ha respondido al tratamiento no quirúrgico. Si bien la artritis es la condición que mas frecuentemente lleva a un reemplazo total de hombro, existen otras afecciones que también pueden beneficiarse de este procedimiento, tales como fracturas severas y otros desórdenes degenerativos. El objetivo principal de una cirugía de reemplazo total de hombro es aliviar el dolor, y concomitantemente mejorar la movilidad, la fuerza y la función.
Reemplazo Invertido de Hombro
Una técnica relativamente nueva es el reemplazo invertido de hombro, diseñado para individuos que no fueran candidatos a un reemplazo total de hombro debido a dos condiciones subyacentes –desgarros del manguito rotador y artritis de hombro (que a veces se debe al desgarro del manguito). De modo similar al reemplazo total de hombro, el reemplazo invertido utiliza una esfera de plástico o metal y una cavidad sintética, pero la esfera se coloca en la escápula, y la cavidad se coloca en la parte superior del hueso del brazo.
El nombre “reemplazo invertido de hombro” se debe a que constituye una inversión de la anatomía normal del cuerpo.
Procedimientos de Preservación Articular y Restauración Cartilaginosa del Hombro (Procedimiento CAM)
La preservación articular y restauración cartilaginosa para cirugía de reemplazo del hombro constituye una alternativa a la cirugía artroscópica. En la restauración cartilaginosa, el tejido articular del hombro es regenerado o trasplantado de tejido de donante. Para algunos pacientes, la artroscopia solo ofrece alivio temporario porque existen otros factores subyacentes que dañan el tejido articular. En la restauración cartilaginosa del hombro, el tejido lesionado es reemplazado con cartílago sano que puede provenir tanto del cuerpo del paciente o de un donante cadavérico y que restaura la biología de la articulación. Si bien este procedimiento no es de realización habitual ha demostrado resultados positivos en pacientes que son candidatos para el mismo.
Postoperatorio
La terapia puede o no comenzar de manera inmediata luego de que se le haya otorgado el alta hospitalaria luego de su cirugía de reemplazo de hombro. Se le indicará si puede realizar ejercicios de péndulo por su cuenta y puede tener una consulta con un terapeuta durante su internación, dependiendo del tipo de cirugía al que se le haya sometido. Usted podrá utilizar su brazo del codo para abajo, pero no realizar movimientos activos del hombro hasta que nosotros se lo indiquemos. Revisaremos esta conducta en la primera consulta postoperatoria.
viernes, 3 de enero de 2014
jueves, 2 de enero de 2014
Early motion shows results comparable to immobilization after arthroscopic rotator cuff repair
FUENTE:
http://www.healio.com/orthopedics/shoulder-elbow/news/online/%7B3273398f-2576-4ac7-89eb-04cb8dfcdf18%7D/early-motion-shows-results-comparable-to-immobilization-after-arthroscopic-rotator-cuff-repair
Disclosure: One or more of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of an aspect of this work. In addition, one or more of the authors, or his or her institution, 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. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work.
http://www.healio.com/orthopedics/shoulder-elbow/news/online/%7B3273398f-2576-4ac7-89eb-04cb8dfcdf18%7D/early-motion-shows-results-comparable-to-immobilization-after-arthroscopic-rotator-cuff-repair
Early motion shows results comparable to immobilization after arthroscopic rotator cuff repair
In a 30-month follow-up of young patients who underwent arthroscopic rotator cuff repair, researchers found no significant differences in shoulder function between those who had early passive range of motion and patients who were immobilized.
“There is no apparent advantage or disadvantage of early passive range of motion compared with immobilization with regard to healing or functional outcome,” Jay D. Keener, MD, and colleagues from Washington University wrote in their abstract.
The investigators studied 124 patients younger than 65 years who underwent arthroscopic repair of full-thickness rotator cuff tears and were randomized to either an early range of motion rehabilitation process or to an immobilization group that had range of motion delayed for 6 weeks. The investigators evaluated the patients using the Visual Analog Scale (VAS) for pain, American Shoulder and Elbow Surgeons score, Simple Shoulder Test, relative Constant score and strength measurements. There were 114 patients available for final follow-up.
At 3 months postoperatively, the immobilization group had significantly better mean active range of motion into elevation and external rotation compared with the early motion cohort. “After 3 months, there were no significant differences in VAS pain score, active range-of-motion values, shoulder strength measures, or any of the functional scales between the groups at the time of the 6-month, 12-month, or final follow-up evaluation,” wrote Keener and colleagues wrote in their study.
Although the investigators’ research did not study patient satisfaction, “Immobilization did not appear to lead to greater risks of shoulder stiffness,” they wrote. There was also no difference in terms of tendon healing between groups.
“Either early passive motion or a period of early immobilization is equally safe and effective after surgical rotator cuff repair in this cohort,” the researchers wrote.
Reference:
“There is no apparent advantage or disadvantage of early passive range of motion compared with immobilization with regard to healing or functional outcome,” Jay D. Keener, MD, and colleagues from Washington University wrote in their abstract.
The investigators studied 124 patients younger than 65 years who underwent arthroscopic repair of full-thickness rotator cuff tears and were randomized to either an early range of motion rehabilitation process or to an immobilization group that had range of motion delayed for 6 weeks. The investigators evaluated the patients using the Visual Analog Scale (VAS) for pain, American Shoulder and Elbow Surgeons score, Simple Shoulder Test, relative Constant score and strength measurements. There were 114 patients available for final follow-up.
At 3 months postoperatively, the immobilization group had significantly better mean active range of motion into elevation and external rotation compared with the early motion cohort. “After 3 months, there were no significant differences in VAS pain score, active range-of-motion values, shoulder strength measures, or any of the functional scales between the groups at the time of the 6-month, 12-month, or final follow-up evaluation,” wrote Keener and colleagues wrote in their study.
Although the investigators’ research did not study patient satisfaction, “Immobilization did not appear to lead to greater risks of shoulder stiffness,” they wrote. There was also no difference in terms of tendon healing between groups.
“Either early passive motion or a period of early immobilization is equally safe and effective after surgical rotator cuff repair in this cohort,” the researchers wrote.
Reference:
Keener J. J Bone Joint Surg Am. 2014;doi: 10.2106/JBJS.M.00034.
Disclosure: One or more of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of an aspect of this work. In addition, one or more of the authors, or his or her institution, 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. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work.
miércoles, 1 de enero de 2014
¿POR QUE NECESITO INMOVILIZACION LUEGO DE MI CIRUGIA ARTROSCOPICA DE MANGUITO ROTADOR?
http://www.traumatologoaldia.com/inmovilizacion-hombro/
¿POR QUE NECESITO INMOVILIZACION LUEGO DE MI CIRUGIA ARTROSCOPICA DE MANGUITO ROTADOR?
El manguito rotador está constituido por cuatro músculos y sus correspondientes tendones que envuelven la cabeza del húmero permitiendo los movimientos de elevación, rotación y abducción del hombro.
La gran mayoría de las lesiones de manguito rotador son crónicas y los tejidos (tendones) involucrados se encuentran con variables grados de degeneración. Cuando todas las opciones conservadoras y no quirúrgicas fallan y se decide pasar a cirugía, se deben reparar y reconstruir estructuras que no se encuentran en un estado biológico óptimo, por lo que la cicatrización de estos tejidos toma tiempo, toma semanas.
Durante una cirugía artroscópica de reparación de manguito rotador, se reinsertan, por medio de dispositivos especialmente diseñados llamados anclas, el tendón o tendones lesionados o rotos nuevamente en su lecho óseo correspondiente. El objetivo es que estas anclas mantenga el tejido en posición hasta su cicatrización definitiva. La cicatrización definitiva depende de muchos factores como edad del paciente, tamaño de la rotura, número de tendones involucrados, grado de degeneración grasa muscular, entre otras, pero, en líneas generales, la inmovilización, con cabestrillo o inmovilizador universal de hombro, debe mantenerse por un tiempo promedio de cuatro a seis semanas y luego comenzar un protocolo de rehabilitación y fisioterapia dirigido.
Dependiendo de los hallazgos intra-operatorios y de la calidad del tejido reparado, en algunos casos puede estar indicado el inicio de ciertos ejercicios bajo indicación y supervisión médica antes del período anteriormente descrito.
Habla con tu médico especialista para conocer qué esperar luego de tu cirugía de manguito rotador, ésta es la mejor manera de conocer y evaluar tus expectativas y evitar frustraciones durante el postoperatorio.
Reparar una lesión de manguito rotador toma al menos dos horas, y su cicatrización definitiva hasta seis semanas.
Dr. David Maldonado S.
Cirugía de Hombro, Cadera y Rodilla.
@traumatologoald
www.traumatologoaldia.com
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