No cal una RM si sospites una Capsulitis idiopàtica

Rotator Cuff Lesions in Patients with Stiff Shoulders

A Prospective Analysis of 379 Shoulders

Yusuke Ueda, MD, et alt.J Bone Joint Surg Am, 2015 Aug 05; 97 (15): 1233 -1237 . http://dx.doi.org/10.2106/JBJS.N.00910

Abstract

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.

Salut!!

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. 

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
stabilisation.

Arthroplasty in Posterior Glenoid Bone Loss

Shoulder Arthroplasty in the Presence of Posterior Glenoid Bone Loss
Current Concepts Review

Chronic osteoarthritis of the glenohumeral joint, traumatic injury, post-reconstruction arthropathy, and developmental conditions such as glenoid dysplasia can result in posterior glenoid bone loss and excessive retroversion of the glenoid. Shoulder replacement in this setting is technically challenging and characterized by higher rates of complications and revisions.

Current options that should be considered for managing glenoid bone loss that results in >15 of retroversion include bone-grafting, augmented glenoid components, and reverse total shoulder replacement.

Asymmetric reaming is commonly used to improve version but should be limited to correction of 10 to 15 of retroversion in order to preserve subchondral bone.

Bone-grafting of glenoid defects has had mixed results and has been associated with graft-related complications, periprosthetic radiolucencies, and glenoid component failure; however, it provides a biologic option for patients with severe bone loss.

Implantation of an augmented polyethylene glenoid component offers the potential to improve version while preserving subchondral bone, but the procedure is technically demanding and without clinical follow-up data at this point.

Reverse total shoulder arthroplasty offers improved fixation and stability compared with an anatomic prosthesis for elderly patients with severe glenoid bone loss but is associated with a high complication rate.

 Glenoid dysplasia is defined as a deformity that results in >25 of glenoid retroversion. Advanced imaging needs to be obtained in order to ensure enough glenoid bone stock is present to allow anatomic glenoid component placement.

Interessant.

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Utilitats trauma-3D: 

http://www.evilldesign.com/cortex

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The cortex cast utilizes the x-ray and 3d scan of a patient with a fracture and generates a 3d model in  relation to the point of fracture.

El tiempo de fabricación de uno de estos modelos está estimado en 3 horas, algo elevado en comparación con la aplicación de una escayola, pero hay que tener en cuenta que esta tarda unas 20 horas en secarse, mientras que el Cortex Exoskeleton es completamente sólido desde que se fabrica.