Rotator Cuff Tear Arthropathy: Evaluation, Diagnosis, and Treatment:

Rotator Cuff Tear Arthropathy: Evaluation, Diagnosis, and Treatment: 
AAOS Exhibit Selection
J Bone Joint Surg Am.  2012;94(6):E34 1-11  doi:10.2106/jbjs.k.00746Denis Nam, MD; Travis G. Maak, MD; Bradley S. Raphael, MD; Christopher K. Kepler, MD; Michael B. Cross, MD; Russell F. Warren, MD


Un resum molt ben fet sobre la ARTROSI PER RUPTURA DEL MANEGOT. Serán les proximes pròtesi i cal estar al dia de lo que insistirá la industria en que posem als pacients...

Espatlla "capturada"

Tot hi havent passat 13 anys de la seua descripció el terme es "enginyos". Espatlla capturada per diferenciar-la de la espatlla "capsulitica" ó congelada dels saxons.

Captured shoulder: a complication of rotator cuff surgery.

Mormino MA, Gross RM, McCarthy JA.

Source

Creighton-Nebraska Health Foundation, Orthopaedic Residency Program, Omaha, USA.

Abstract

Thirteen patients who developed restrictive subdeltoid adhesions after rotator cuff repair were identified. These patients underwent second-look arthroscopy and takedown of adhesions at an average of 37 weeks after their index surgery. Clinical findings include pain and restricted motion that does not yield to manipulation under anesthesia. Arthroscopic findings are subdeltoid adhesions and a chondral lesion (companion lesion) of the humeral head articular surface. Patients were reevaluated at 26 weeks after their release of adhesions. Prerelease and postrelease University of California, Los Angeles (UCLA) scores average 14.8 and 30.1, respectively. Prerelease and postrelease UCLA pain scores averaged 2.6 and 7.7, respectively. Prerelease and postrelease range of motion was as follows: Flexion, 141/158; abduction, 123/141; internal rotation, 47/69; and external rotation, 53/74. The authors have proposed a theory to explain the clinical and arthroscopic findings in this subgroup of patients who are dissatisfied after rotator cuff repair. A technique for and the results of release of the subdeltoid adhesions also are reported.

National Trends in Rotator Cuff Repair

National Trends in Rotator Cuff Repair

Alexis Chiang Colvin, MD; Natalia Egorova, PhD, MPH; Alicia K. Harrison, MD; Alan Moskowitz, MD; Evan L. Flatow, MD

The Journal of Bone & Joint Surgery.  2012; 94:227-233  doi:10.2106/JBJS.J.00739

Background: 

Recent publications suggest that arthroscopic and open rotator cuff repairs have had comparable clinical results, although each technique has distinct advantages and disadvantages. National hospital and ambulatory surgery databases were reviewed to identify practice patterns for rotator cuff repair.

Methods: 

The rates of medical visits for rotator cuff pathology, and the rates of open and arthroscopic rotator cuff repair, were examined for the years 1996 and 2006 in the United States. The national incidence of rotator cuff repairs and related data were obtained from inpatient (National Hospital Discharge Survey, NHDS) and ambulatory surgery (National Survey of Ambulatory Surgery, NSAS) databases. These databases were queried with use of International Classification of Diseases, Ninth Revision (ICD-9) procedure codes for arthroscopic (ICD-9 codes 83.63 and 80.21) and open (code 83.63 without code 80.21) rotator cuff repair. We also examined where the surgery was performed (inpatient versus ambulatory surgery center) and characteristics of the patients, including age, sex, and comorbidities.

Results: 

The unadjusted volume of all rotator cuff repairs increased 141% in the decade from 1996 to 2006. The unadjusted number of arthroscopic procedures increased by 600% while open repairs increased by only 34% during this time interval. There was a significant shift from inpatient to outpatient surgery (p < 0.001).

Conclusions: 

The increase in national rates of rotator cuff repair over the last decade has been dramatic, particularly for arthroscopic assisted repair.

Injuries Associated with Traumatic Anterior Glenohumeral Dislocations

Lesions asociades a les luxacions escapulohumerals . Mes freqüents de lo esperades Les neurologiques esperables en 1 de cada tres que tinguin lesions del manegot o fractura troquiter associada!!

Robinson

The Journal of Bone and Joint Surgery (American)  2012; 94:18-26  doi:

10.2106/JBJS.J.01795

Background: A number of shoulder girdle injuries are associated with acute anterior glenohumeral dislocations. In the present study we evaluated the prevalence of neurological deficits, greater tuberosity fractures, and rotator cuff injuries in a population of unselected patients who presented with a traumatic anterior glenohumeral dislocation.

Methods: A prospective trauma database was used to record the demographic details on 3633 consecutive patients (2250 male patients and 1383 female patients with a mean age of 47.6 years) who had sustained a traumatic anterior glenohumeral dislocation between 1995 and 2009. On the basis of these data, we assessed the prevalence of and risk factors for ultrasound-proven rotator cuff tears, tuberosity fractures, and neurological deficits occurring in association with the dislocation.

Results: Of the 3633 patients who had a dislocation, 492 patients (13.5%) had a neurological deficit following reduction and 1215 patients (33.4%) had either a rotator cuff tear or a greater tuberosity fracture. A dislocation with a neurological deficit alone was found in 210 patients (5.8%), a dislocation with a rotator cuff tear or a greater tuberosity fracture was found in 933 patients (25.7%), and a combined injury pattern was found in 282 patients (7.8%). Female patients with an age of sixty years or older who were injured in low-energy falls were more likely to have a rotator cuff tear or a greater tuberosity fracture. The likelihood of a neurological deficit after an anterior glenohumeral dislocation was significantly increased for patients who had a rotator cuff tear or a greater tuberosity fracture (relative risk, 1.9 [95% confidence interval, 1.7 to 2.1]; p < 0.001).

Conclusions: The prevalence of rotator cuff tear, greater tuberosity fracture, or neurological deficit following primary anterior glenohumeral dislocation is greater than previously appreciated. These associated injuries may occur alone or in combined patterns. Dislocations associated with axillary nerve palsy have similar demographic features to isolated dislocations. Injuries associated with a rotator cuff tear, greater tuberosity fracture, or complex neurological deficit are more common in patients sixty years of age or older. Careful evaluation of rotator cuff function is required for any patient with a dislocation associated with a neurological deficit, and vice versa

Fractura articular 4P

El handicap de este tipo de lesiones en las que el fragmento articular esta completamente desplazado y se sospecha una desconexion vacular es que la reconstrucción mediante una sustitucion protésica sea funcional. Si ademas el paciente padecia previamente una lesion crónica del manguito rotador la reconstruccion protesica anatomica ofrece un resultado funcional muy pobre. Las protesis invertidas pueden ofrecer una mobilidad de + de 100 grados de flexion pero la ausencia de un manguito eficiente limita las rotaciones activas. Al final el paciente funcionalmente esta mejor que con una artroplastia anatòmica pero NUNC como antes de la fractura.

1 mes

Fractura con pocos criterior de desplazamiento segun normas ( 45º-1 cm) descritas por Neer que hoy son criticadas enormemente...ja os dire como acaba.

RX axial

En las fracturas complejas de la cabeza del humero es dificil identificar el troquin ó valorar en la pA a 45º la exacta situacion del troquiter.La tAC es la exploracion ideal pero la proyeccion en que puedo ver mejor la relacion del troquin con el resto de fragmentos o el desplazamiento del troquiter hacia atras es esta.