15 de jul. 2017

"lag sign" i rodo menor en massives i CTA

"lag sign" i rodo menor  en massives i  CTA
Clinical Orthopaedics and Related Research®Volume 473, Issue 9, pp 2959–2966

Clinical signs can predict anatomic patterns of teres minor dysfunction with good accuracy in patients with massive rotator cuff tears. This study showed that the most accurate test for teres minor dysfunction is an external rotation lag sign and that most patients’ posterior rotator cuff tears do not lose active external rotation. Because imaging is not always accurate, examination for integrity of the teres minor is important because it may be one of the most important variables affecting the outcome of reverse shoulder arthroplasty for massive rotator cuff tears, and the functional effects of tears in this muscle on day to day activities can be significant. Additionally, teres minor integrity affects the outcomes of tendon transfers, therefore knowledge of its condition is important in planning repairs.

Fig. 1A–B
(A) The external rotation lag sign is performed with the patient seated with the elbow flexed to 90° and the shoulder elevated 20° in the scapular plane. The arm is passively taken to maximal external rotation minus 5° to allow for elastic recoil. (B) The patient was asked to maintain that position as the clinician released the wrist. A positive test is defined as any internal rotation greater than 10°.

(A) The drop sign is a lag sign beginning from 90° abduction in the scapular plane, with elbow flexion of 90°, and external rotation of the shoulder to 90°. From this position, the patient is asked to maintain the position against gravity (Medical Research Council Grade 3).

(B) Failure to resist gravity and internal rotation of the arm is considered a positive drop sign.

19 de juny 2016

New people

Benvinguts, Mònica i Ferrán

Reverse total shoulder arthroplasty in wheelchair-dependent patients


Shoulder pain and dysfunction due to arthritis and rotator cuff pathology can result in the loss of independence in wheelchair-dependent patients. We investigated whether RTSA can sustain the increased loads placed by these patients during transfers. Wheelchair-dependent patients can benefit from an RTSA for shoulder pain and dysfunction but must accept worsened impairment during the immediate postoperative period and a higher complication rate than the general population treated with an RTSA.
Level of evidence: IV Case Series
The complication rate was 25%
Es un percentatge alt de complicacions cal explicar-ho molt be al pacient...

12 d’oct. 2015

No cal una RM si sospites una Capsulitis idiopàtica

Rotator Cuff Lesions in Patients with Stiff Shoulders
A Prospective Analysis of 379 Shoulders
Yusuke UedaMD, et alt.J Bone Joint Surg Am2015 Aug 05; 97 (15): 1233 -1237 http://dx.doi.org/10.2106/JBJS.N.00910


Background: Idiopathic adhesive capsulitis is defined as a frozen shoulder with severe and global range-of-motion loss of unknown etiology. The purpose of our study was to clarify the prevalence of rotator cuff lesions according to patterns and severity of range-of-motion loss in a large cohort of patients with stiff shoulders.

Methods: Rotator cuff pathology was prospectively investigated with use of magnetic resonance imaging (MRI) or ultrasonography in a series of 379 stiff shoulders; patients with traumatic etiology, diabetes, or radiographic abnormalities were excluded. Eighty-nine shoulders demonstrated severe and global loss of passive motion (≤100° of forward flexion, ≤10° of external rotation with the arm at the side, and internal rotation not more cephalad than the L5 level) and were classified as having severe and global loss of motion (Group 1). The remaining 290 shoulders were divided into two groups: those with severe but not global loss (Group 2; 111 shoulders) and mild to moderate limitation (Group 3; 179 shoulders).

Results: Among all shoulders, imaging demonstrated an intact rotator cuff in 51%, a full-thickness tear in 35%, and a partial-thickness tear in 15%. In Group 1, 91% had an intact rotator cuff and 9% had a partial-thickness rotator cuff tear. No patient in this group demonstrated a full-thickness tear. In Group 2 and Group 3, respectively, 44% and 35% of the shoulders were intact, 17% and 16% had a partial-thickness tear, and 39% and 50% had a full-thickness tear.

Conclusions: Shoulder stiffness with severe and global loss of passive range of motion is not associated with full-thickness rotator cuff tears, although some patients may have a partial-thickness tear. Shoulders with severe and global loss of range of motion at a first visit are likely to be cases of idiopathic adhesive capsulitis and may not require further imaging studies.

El comentari seria.. sempre que sospitem una CR ( descartar procesos traumatics com les luxacions que tambe causen un proces capsular) millor una RX que si esta en una fase avancada veureu signes de ODSR. La RM sera normal i la Eco hi haura liquid en la corredera bicipital. Segurament tots direu ja ho sabia...però el tema es que es segueixen demanant i fent gasto inútil.


29 de set. 2015

A combination of subescapularis tendon transfer and small-head hemi for cuff tear atrhopaty

Carta al Dr Fukanoshi per concretar el seu tractment de les CTA publicat el agost del 2015 al journal of bone ( Britanic)

Dear Professor T. Funakoshi,
My name is Jordi Huguet and I am currently the Chef of the Shoulder and Elbow Surgery Unit of the Hospital Universitari Parc Taulí from Sabadell (Barcelona).
I am writting to you because I have recently read your paper A combination of subescapularis tendon transfer and small-head hemi for cuff tear atrhopaty from the Bone & Joint Journal, and I found it really interesting. Thereby, I would like to ask you some questions about the treatement methodology exposed.Please find attached a powerpoint presentation I have prepared with my specific questions.

1.     Do you control the radius of curvature of the prosthetic head in order to be paralel at glena curvature? Or isn´t necessary?The most important thing for select the small head is to consider the volume of humeral head. We prefer to use thinner head and one small diameter. Less volume provides to easy to repair cuff and transfer tendon.

2.     Do you also resect the greather tuberosity?Yes, we always do. We have to take care of impingment when smaller head was used. And also take care too much resection.Too much resection, insufficient bone for repair or transfer tendon.
3.     Which is your solution..Excentric head, Control of the stem’s deep with a bone graft, Osteotomy of great tuberosity, All?
All is my answer. We are not able to select excentric because of small physique in Japanese.
We always graft autologous tip and artificial bone to the medial canal for control deep and varus implantation.

4.     Which is the percentage (%) of the subscapularis tendon that you use in a transfer?
upper 2/3 or 1/2.
5.     Do you always close the rotator cuff with the suture?
If possible, we always suture. However, it depends on the patient. Sometimes not enough.

Es interessant com a mètode de tractament de la CTA. 

12 d’abr. 2015

Arthroscopic Treatment of Suprascapular Neuropathy from a Suprascapular Notch Cyst  Using a Lateral Subacromial Approach

Based on an original article: J Shoulder Elbow Surg. 2011 Sept;20(6):975-82.

Primary anterior dislocation glenohumeral joint adolescence

The natural history of primary anterior dislocation of the glenohumeral joint in adolescent
patients remains unclear and there is no consensus for management of these patients.
The objectives of this study were to report the natural history of primary anterior
dislocation of the glenohumeral joint in adolescent patients and to identify the risk factors
for recurrent dislocation.
We reviewed prospectively-collected clinical and radiological data on 133 adolescent
patients diagnosed with a primary anterior dislocation of the glenohumeral joint who had
been managed non-operatively at our hospital between 1996 and 2008. There were 115 male
(86.5%) and 18 female patients (13.5%) with a mean age of 16.3 years (13 to 18) and a mean
follow-up of 95.2 months (1 to 215).
During follow-up, 102 (absolute incidence of 76.7%) patients had a recurrent dislocation.
The median interval between primary and recurrent dislocation was ten months (95% CI 7.4 to
12.6). Applying survival analysis the likelihood of having a stable shoulder one year after the
initial injury was 59% (95% CI 51.2 to 66.8), 38% (95% CI 30.2 to 45.8%) after two years, 21%
(95% CI 13.2 to 28.8) after five years, and 7% (95% CI 1.1 to 12.9) after ten years. Neither age
nor gender significantly predicted recurrent dislocation during follow-up.

We conclude that adolescent patients with a primary anterior dislocation of the
glenohumeral joint have a high rate of recurrent dislocation, which usually occurs within
two years of their initial injury: these patients should be considered for early operative