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Objective: To determine: 1) whether the patients had been oriented to use immobilization for at least four weeks and which type of immobilization was prescribed, 2) how many dislocations occurred until the patient received information about the need of surgery, 3) How long it takes for patients to have an appointment with a shoulder surgeon, 4) How many dislocations the patient had at the time of surgery. Material and Methods: Of the 100 patients surgically treated or waiting for surgery at outpatient facilities, we interviewed 61 patients with questions related to the mechanism of dislocation, emergency service sites, guidelines for acute event treatment and follow-up, time elapsed until surgery and follow-up. Collected data were submitted to analysis. Results: Only 13 patients (22%) had received correct information about their lesion, prognosis concerning recurrence, and about the need of surgery and expert follow-up in recurrent cases. None of our patients received proper information about type and duration of immobilization. Conclusion: None of our patients had received proper orientation to remain immobilized for four weeks, and the types of immobilization vary from a handmade sling to a manufactured Velpeau. Most of our patients (78%) did not receive proper orientation about specialized follow-up and surgery after their second episode of dislocation. The time for a specialized appointment with shoulder surgeon ranges from four to six months, with 1-100 dislocation episodes at the moment of surgery.

Objective: To evaluate the clinical and functional outcomes from arthroscopic repairs on small and medium-sized tears of the supraspinatus muscle tendon. Methods: 129 cases of isolated small and medium tears of the supraspinatus muscle tendon were evaluated retrospectively. The average duration of pain was 29 months. The average joint range of motion comprised active elevation of 136°, lateral rotation of 58° and medial rotation at T12 level; and the preoperative functional UCLA score averaged 17 points. In all the cases, complete repair could be achieved. Results: The average score on the UCLA functional scale in the postoperative period was 32 points. The average length of follow-up was 39 months. Seventy-five cases (58%) had excellent results and 42 (32%) had good results. The average final active elevation was 156° with an average gain of 20°, and the average final lateral rotation was 57° with an average gain of 9°. Both of these were statistically significant (P < 0.05). The patients who underwent tenotomy of the long head of the biceps (LHB), with or without tenodesis, did not present statistically inferior functional outcomes, in comparison with the patients who only underwent decompression and lesion repair (P = 1.00). Fourteen cases (10.8%) presented complications during the postoperative period. Six (4.6%) developed adhesive capsulitis and four (3.1%) presented re-rupture of the tendon, proven by means of magnetic resonance imaging. Conclusions: Arthroscopic repair of small and medium tears of the supraspinatus muscle tendon provided a functional clinical improvement, with good and excellent results in 90% of the cases.

Objective: To compare the functional results among patients undergoing tenotomy with or without tenodesis of the long head of the biceps associated with arthroscopic repair of rotator cuff injuries, with a minimum two-year follow-up. Method: This was a retrospective non-randomized trial with evidence level III, in which the medical files of 77 patients with lesions of the long head of the biceps were reviewed and clinically reassessed. Among these, 55 patients underwent tenotomy without tenodesis and 22 underwent tenotomy with tenodesis, with outpatient follow-up for at least two years. The age, dominant side, operated side, lesion size using the Gartsman classification, pre and postoperative range of motion, presence or absence of the Popeye sign, pain in the bicipital groove and assessments using the University of California at Los Angeles (UCLA) score and the elbow strength index. Results: The mean UCLA score of the sample went from 16.92 (range: 8 to 25) to 31.45 (range: 13 to 35) (p < 0.001). Comparison of the pre and postoperative UCLA scores in the two groups showed that the difference in the group with tenotomy and tenodesis was 15.95 and in the group with tenotomy alone, 14.62 (p = 0.023). However, there was no statistical significance in comparing the groups regarding pain in the bicipital groove, Popeye sign or elbow strength index. Conclusion: This study showed that the difference in UCLA scores was statistically significant. The group with tenotomy and tenodesis of the long head of the biceps presented better functional results.

OBJECTIVES: To assess the outcomes of the arthroscopic margin convergence of the posterior cuff to the biceps tendon. METHODS: From October 2003 to December 2007, 20 patients with massive rotator cuff tear which include the rotator interval were treated with arthroscopic margin convergence of the posterior cuff to biceps tendon. Sixteen patients were female and four were male. The mean age was 58.95 years old. The dominant side was affected in 16 cases (80%). The outcomes were analysed according to the UCLA Score with a minimum follow-up period of two years. RESULTS: The UCLA score improved, on average, 14 points (p < 0.001). Six patients had excellent results; nine good; three fair and two poor results. The mean improvement of forward flexion was 33º (p < 0.001), 3º of external rotation (p < 0.396) and two vertebral levels for internal rotation (p < 0.025). CONCLUSION: The arthroscopic margin convergence of the posterior cuff to the biceps tendon leads to satisfactory results. OBJETIVOS: Avaliar os resultados clínico-funcionais dos pacientes com lesão extensa do manguito rotador submetidos ao reparo artroscópico pela técnica de convergência de margens da parte posterior do manguito rotador com o tendão da cabeça longa do músculo bíceps braquial. MÉTODOS: Vinte casos de lesões extensas do manguito rotador, que tinham lesão do tendão supraespinal retraído e deficiência do intervalo rotador, foram operados em nosso serviço com essa técnica. Dezesseis casos eram do sexo feminino (80%) e quatro do sexo masculino (20%); média da idade de 58,95 anos (42 a 75 anos). Em 16 casos a lesão havia ocorrido no membro dominante (80%). Em todos os pacientes o movimento de elevação, rotação medial e lateral, assim como a pontuação pela escala da UCLA, foram documentados no período pré-operatório. Todos foram reavaliados com o mínimo de dois anos de acompanhamento, sendo estudadas a pontuação da escala funcional da UCLA e a mobilidade. RESULTADOS: A pontuação da escala funcional da UCLA no período pós-operatório foi em média de 28,95 pontos, com acréscimo de 13,9 pontos, uma melhoria estatisticamente significativa (p < 0,001). Seis casos foram classificados como excelentes, nove bons, três regulares e dois ruins. Houve uma melhoria do arco de movimento com aumento médio da elevação de 117,62 para 151,19 (p < 0,001), rotação lateral de 47,38 para 50,48 (p < 0,396) e rotação medial de L2 para T12 (p < 0,025). CONCLUSÃO: Neste estudo a técnica cirúrgica apresentada levou a uma melhoria da função e mobilidade do ombro com valores estatisticamente significantes.

ResumoObjetivos:Avaliar os resultados clínico-funcionais dos pacientes com lesão extensa do manguito rotador submetidos ao reparo artroscópico pela técnica de convergência de margens da parte posterior do manguito rotador com o tendão da cabeça longa do músculo bíceps braquial. Métodos: Vinte casos de lesões extensas do manguito rotador, que tinham lesão do tendão supraespinal retraído e deficiência do intervalo rotador, foram operados em nosso serviço com essa técnica. Dezesseis casos eram do sexo feminino (80%) e quatro do sexo masculino (20%); média da idade de 58,95 anos (42 a 75 anos). Em 16 casos a lesão havia ocorrido no membro dominante (80%). Em todos os pacientes o movimento de elevação, rotação medial e lateral, assim como a pontuação pela escala da UCLA, foram documentados no período pré- operatório. Todos foram reavaliados com o mínimo de dois anos de acompanhamento, sendo estudadas a pontuação da escala funcional da UCLA e a mobilidade. Resultados: A pontuação da escala funcional da UCLA no período pós-operatório foi em média de 28,95 pontos, com acréscimo de 13,9 pontos, uma melhoria estatisticamente significativa (p < 0,001). Seis casos foram classificados como excelentes, nove bons, três regulares e dois ruins. Houve uma melhoria do arco de movimento com aumento médio da elevação de 117,62 para 151,19 (p < 0,001), rotação lateral de 47,38 para 50,48 (p < 0,396) e rotação medial de L2 para T12 (p < 0,025). Conclusão: Neste estudo a técnica cirúrgica apresentada levou a uma melhoria da função e mobilidade do ombro com valores estatisticamente significantes.AbstractObjectives: To assess the outcomes of the arthroscopic margin convergence of the posterior cuff to the biceps tendon. Methods: From October 2003 to December 2007, 20 patients with massive rotator cuff tear which include the rotator interval were treated with arthroscopic margin convergence of the posterior cuff to biceps tendon. Sixteen patients were female and four were male. The mean age was 58.95 years old. The dominant side was affected in 16 cases (80%). The outcomes were analysed according to the UCLA Score with a minimum follow-up period of two years. Results: The UCLA score improved, on average, 14 points (p < 0.001). Six patients had excellent results; nine good; three fair and two poor results. The mean improvement of forward flexion was 33o (p < 0.001), 3o of external rotation (p < 0.396) and two vertebral levels for internal rotation (p < 0.025). Conclusion: The arthroscopic margin convergence of the posterior cuff to the biceps tendon leads to satisfactory results.

To determine if it is possible to measure glenoid bone loss by using the Bernageau view and to compare it to a 3D CT scan.Fifty healthy subjects with a mean age of 34 ± 8 years old and 31 (62 %) male were submitted to the Bernageau view X-ray of both shoulders. Three blinded evaluators measured the distance between the posterior and anterior glenoid rim. Ten patients with multiple episodes of unilateral traumatic anterior shoulder dislocation with a mean age of 34 ± 9.1 years old and 90 % male were submitted to the same X-ray technique to determine the percentage of glenoid bone loss. They were also submitted to a bilateral 3D CT scan to be compared to the radiographs.In the 50 asymptomatic subjects, the AP distance was 24.48 mm ± 3.32 mm in the left shoulder and 24.82 mm ± 3.16 mm in the right shoulder. Comparing the X-ray study and the 3D CT scan of the ten patients with multiple episodes, there was no significant statistical difference of the AP normal distance in both methods (p = 0.646), the AP erosion distance (p = 0.386), as well as the percentage of bone loss (p = 0.513). Moreover, the differences between the percentages of bone loss in the X-ray, compared with the 3D CT scan were, on average 2.28 % (range 0 to 6.05 %).The Bernageau radiographic view is an accurate and reproducible technique for measuring the presence of glenoid erosion, with similar results when compared to the 3D CT scan.

Background:The coracoid has been widely used as a graft to reconstruct anterior glenoid bone defects, as described by the Latarjet and Bristow procedures, with successful results. Nevertheless, at the present, there are no studies correlating the size of the coracoid graft and its relation to the glenoid.Purpose:To assess the mediolateral (M-L) and anteroposterior (A-P) thickness of the coracoid process as well as the widest anterior-to-posterior glenoid distance (glenoid width) and to analyze the correlation between these measurements, while comparing these with the A-P coracoid process thickness.Study Design:Descriptive laboratory study.Methods:Sixty-one unpaired, adult human cadaveric scapulae were evaluated. Three examiners performed 3 independent measurements of the largest M-L thickness of the coracoid process and also the widest anterior-to-posterior distance of the glenoid. The A-P coracoid process thickness was also measured to compare for correlations with M-L coracoid thickness.Results:The glenoid width was 26.38 ± 2.69 mm (range, 20.03-32.35 mm), and the M-L coracoid thickness was 14.51 ± 1.90 mm (range, 9.60-19.31 mm). Calculating the ratio between the M-L thickness of the coracoid and glenoid width, we observed that the coracoid represented 43% to 70% of the glenoid width (54% on average). The A-P coracoid process thickness was 8.37 ± 0.93 mm (range, 6.61-9.76 mm), representing 31% of the glenoid width on average.Conclusion:A strong positive and statistically significant relationship between the coracoid process M-L thickness and the anterior-to-posterior glenoid width exists; the coracoid represents, on average, 54% of the glenoid width.Clinical Relevance:Most cases of glenoid bone loss in recurrent shoulder dislocation can be reconstructed with the coracoid process to re-establish its anatomy.

OBJETIVO: Comparação dos resultados funcionais nos pacientes submetidos à tenotomia com ou sem tenodese da CLB associada ao reparo da lesão do manguito rotador por visão artroscópica, com seguimento superior a dois anos. MÉTODO: Estudo retrospectivo não randomizado, com nível de evidência III, em que foram revisados os prontuários e realizada reavaliação clínica de 77 pacientes com lesão da cabeça longa do bíceps, sendo que 55 foram submetidos à tenotomia sem tenodese e 22 à tenotomia com a tenodese, com seguimento ambulatorial maior que dois anos. Foram avaliados idade, dominância, lado operado, tamanho das lesões classificadas por Gartsman, arco do movimento pré e pós-operatório, presença ou ausência do sinal do Popeye, dor na corredeira bicipital, avaliação segundo a escala University of California at Los Angeles e Elbow Strength Index. RESULTADOS: O UCLA médio total da amostra foi de 16,92 (8 a 25) para 31,45 (13 a 35) (p < 0,001). Comparando a variação do UCLA pré com o pós-operatório entre os dois grupos, nos pacientes submetidos à tenotomia com a tenodese esta variação foi de 15,95 e nos pacientes submetidos somente à tenotomia a variação foi de 14,62 (p = 0,023). No entanto, não houve significância estatística na comparação entre os grupos quanto à dor na corredeira bicipital, sinal do Popeye e Elbow Strength Index. CONCLUSÃO: O estudo apresentou diferença estatística na variação do UCLA. O grupo em que foi realizada a tenotomia com a tenodese da CLB apresentou melhores resultados funcionais. OBJECTIVE: To compare the functional results among patients un dergoing tenotomy with or without tenodesis of the long head of the biceps associated with arthroscopic repair of rotator cuff in juries, with a minimum two-year follow-up. METHOD: This was a retrospective non-randomized trial with evidence level III, in which the medical files of 77 patients with lesions of the long head of the biceps were reviewed and clinically reassessed. Among these, 55 patients underwent tenotomy without tenodesis and 22 underwent tenotomy with tenodesis, with outpatient follow-up for at least two years. The age, dominant side, operated side, lesion size using the Gartsman classification, pre and postoperative range of mo tion, presence or absence of the Popeye sign, pain in the bicipital groove and assessments using the University of California at Los Angeles (UCLA) score and the elbow strength index. RESULTS: The mean UCLA score of the sample went from 16.92 (range: 8 to 25) to 31.45 (range: 13 to 35) (p < 0.001). Comparison of the pre and postoperative UCLA scores in the two groups showed that the dif ference in the group with tenotomy and tenodesis was 15.95 and in the group with tenotomy alone, 14.62 (p = 0.023). However, there was no statistical significance in comparing the groups regarding pain in the bicipital groove, Popeye sign or elbow strength index. CONCLUSION: This study showed that the difference in UCLA scores was statistically significant. The group with tenotomy and tenodesis of the long head of the biceps presented better functional results.

OBJETIVO: Avaliar o resultado da cirurgia de Latarjet para pacientes com luxação recidivante anterior do ombro com perda óssea maior que 25% da cavidade glenoidal. MÉTODO: Avaliamos 26 pacientes submetidos à cirurgia de Latarjet. O tempo médio de seguimento foi de 38 meses e a média etária, de 28 anos. Os pacientes foram avaliados quanto à amplitude de movimento e pelas escalas de Rowe e UCLA, no período pré-operatório como no período pós-operatório, radiografias do ombro para avaliar a presença de artrose, posição e consolidação do enxerto e posicionamento dos parafusos. A análise estatística foi utilizada para avaliar se haveria relação entre o número de episódios de luxação, presença de artrose, correlação entre artrose e limitação da rotação lateral. Comparar a diferença entre o arco de movimento do lado operado com o não acometido e avaliação funcional pré e pós-operatória das escalas de UCLA e Rowe. RESULTADOS: A elevação e rotação lateral foram estatisticamente inferiores do lado operado. A escala de UCLA e a de Rowe mostrou uma melhora estatisticamente significante dos resultados clínico-funcionais (P < 0,001 em ambas). Houve relação entre o número de episódios de luxação e a presença de artrose, mas não pudemos confirmar que os casos mais graves de artrose foram os que mais luxaram pela amostra ser pequena. CONCLUSÃO: A cirurgia de Latarjet é um método eficaz para casos graves de erosão da borda da cavidade glenoidal. OBJECTIVE: Evaluate the results from the Latarjet procedure in patients with anterior recurrent dislocation of the shoulder who present bone loss of the glenoid cavity greater than 25%. METHODS: Twenty six male patients underwent the Latarjet procedure, The bone loss was evaluated by means of radiography using the Bernageau view and by means of CAT scan. The patients were evaluated with regard to range of motion, using the Rowe and UCLA scales, before and after the operation, and by radiographs to assess the presence of arthrosis, position and consolidation of the graft and positioning of the screws. Statistical analysis was used to assess whether there was any relationship between the number of episodes of dislocation and the presence of arthrosis, , and any relationship between arthrosis and limitations on lateral rotation. Differences in range of motion between the operated and unaffected sides and in the UCLA and Rowe scale. RESULTS: The means for elevation and lateral rotation were statistically poorer on the operated side. The UCLA and Rowe scale showed that there was a statistically significant improvement in the clinical-functional results (P < 0.001 for both). There was a relationship between the number of episodes of dislocation and the presence of arthrosis, We also did not observe any correlation between limitations on lateral rotation and arthrosis. CONCLUSION: The Latarjet procedure is an efficient method for cases of severe erosion of the glenoid margin.

Objective: To analyze whether the Bernageau radiographic view is adequate for studying the anterior glenoid rim and to determine the distance between the posterior and anterior glenoid rims. Methods: Fifty patients (31 males) with a mean age of 34 years were evaluated by positioning their arm at 160° forward flexion and body at 70° to the x-ray chassis, while positioning the x-ray tube at 30° craniocaudally, centered on the scapula spine. Three of the authors measured the distance between the posterior and anterior glenoid rim three times. The variability and reproducibility of this distance were studied. Three shoulder surgeons performed a subjective evaluation by answering whether it was possible to evaluate the anterior glenoid rim in the view studied. Results: The mean distance was 24.48 mm ± 0.332 mm (left) and 24.82 mm ± 0.316 mm (right). The Anderson-Darling test showed that the measurements had normal distribution, and Pearson's correlation showed significant reproducibility (P < 0.01). The first observer found that 67% of the x-ray images were suitable for evaluating the anterior glenoid rim. The second found that 81% were suitable and the third, 78%. The kappa coefficient showed that the second and third observers had substantial agreement of opinion. Conclusion: The Bernageau view provided a suitable x-ray image for studying the anterior glenoid rim and for assessing erosion after comparison with the unaffected side.

As glenoid bone erosion has been related to high rates of recurrence after traditional Bankart repair, the necessity to diagnose existing bone loss is fundamental to avoiding the recurrence of shoulder dislocation. There are many techniques described in the literature explaining how to calculate glenoid bone loss; however, there are only few articles, which shows the usefulness of the x-rays for that purpose. Moreover, just one of these papers described the reliability of a specific x- ray view to measure the percentage of a glenoid bony defect, comparing it with the computed tomography scan and known glenoid osteotomy. The aim of this study was to describe a reliable and reproducible technique for calculating glenoid bone loss using the Bernageau x-ray profile view and to show the results of a earlier study in which we calculated the distance between the posterior and anterior glenoid rim on the Bernageau profile view and compared this measurement between the right and the left shoulders. This technique is cheaper than the computed tomography scan and is easier to perform.

Objective: To evaluate the efficacy of suprascapular nerve block in combination with the infusion of anesthetic into the sub-acromial space compared to an interscalene block. Methods: Forty-five patients with small or medium isolated supraspinatus tendon lesions who underwent arthroscopic repair were pro-spectively evaluated and randomly assigned to three groups of 15, each with a different combination of anesthetic methods. The efficacy of post-surgical analgesia was measured using the visual analogue scale for pain, and analgesic, anti-inflam-matory, and opioid drug consumption. Inhalation anesthetic consumption during surgery was compared among the groups. Results: Statistical analysis found no significant differences among the groups regarding anesthetic consumption during surgery or postoperative analgesic efficacy during the first 48 hours. Conclusion: Suprascapular nerve block with infusion anesthetic into the subacromial space is an excellent alternative to interscalene block, particularly in hospitals where a nerve stimulator device is unavailable.

OBJETIVO: Analisar se a incidência radiográfica de Bernageau é adequada para estudar a borda anterior da glenoide e determinar a distância entre a borda anterior e posterior da glenoide. MÉTODO: Cinquenta pacientes (31 do sexo masculino) com idade média de 34 anos, foram avaliados posicionando-se o braço em flexão anterior de 160º e o corpo a 70º do chassi radiográfico, enquanto o posicionamento da ampola de raios-X era de 30º crânio-caudal, centrada na espinha da escápula. Dos autores, três mensuraram três vezes a distância entre a borda anterior e posterior da glenoide. Foram estudadas a variabilidade e a reprodutibilidade dessa distância. Três cirurgiões de ombro realizaram uma avaliação subjetiva, respondendo se era possível a avaliação da borda anterior da glenoide na incidência estudada. RESULTADOS: A distância foi em média 24,48mm ± 0,332mm (esquerdo) e 24,82mm ± 0,316mm (direito). O teste de Anderson-Darling mostrou que as medidas tiveram distribuição normal e a correlação de Pearson's mostrou reprodutibilidade significativa (P < 0,01). O primeiro observador concluiu que 67% das radiografias eram adequadas para avaliar a borda anterior da glenoide, o segundo concluiu que 81% e o terceiro 78% eram satisfatórias para a avaliação. O coeficiente Kappa mostrou que o segundo e terceiro examinadores apresentaram concordância substancial em suas opiniões. CONCLUSÃO: A incidência de Bernageau proporciona uma radiografia adequada para o estudo da borda anterior da glenoide e para o cálculo da sua erosão após a comparação com o lado não acometido. OBJECTIVE: To analyze whether the Bernageau view is adequate for studying the anterior glenoid rim and determining the distance between the posterior and anterior glenoid rim. METHODS: Fifty patients (31 males) with a mean age of 34 years were evaluated by positioning their arm at 160º forward flexion and body at 70º with the X-Ray chassis, while positioning the X-ray tube at 30º craniocaudal, centered on the scapula spine. Three of the authors measured the distance between the posterior and anterior glenoid rim three times. The variability and reproducibility of this distance were studied. Three shoulder surgeons performed a subjective evaluation by answering whether it was possible to evaluate the anterior glenoid rim in the view studied. RESULTS: The average distance was 24.48 mm ±0.332 mm (left) and 24.82 mm ±0.316 mm (right). The Anderson-Darling test showed that this distance had a normal distribution and Pearson's correlation showed significant reproducibility (P

The purpose of this article is to describe the technique and evaluate the intraoperative and postoperative efficacy of suprascapular nerve block associated with anesthetic infusion into the subacromial space, and compare it with the efficacy of the interscalene block method. Forty-five patients with small or medium isolated lesions of the supraspinatus tendon who underwent arthroscopic repair were prospectively evaluated. Participants were assigned to 3 groups (A, B, and C) of 15 by using restricted randomization by minimization. Group A underwent arthroscopic rotator cuff repair under general anesthesia with interscalene nerve block without using the nerve stimulator device, whereas group B received general anesthesia associated with suprascapular nerve block and anesthetic infusion into the subacromial space before surgery; group C underwent suprascapular nerve block and anesthetic infusion into the subacromial space after surgery. Inhalation anesthetic consumption during surgery was compared among the 3 groups. The postoperative analgesic efficacy of each anesthetic method was measured using the visual analog scale, as well as observing the analgesic drugs consumption. The statistical analysis found no significant differences among patients in the 3 groups in terms of anesthetic consumption during surgery, postoperative analgesic efficacy during the first 48 hours and analgesic drug consumption. The 3 techniques provided similar results in terms of efficacy concerning pain control, anesthetic consumption, analgesic, and antiinflammatory drug consumption, showing that suprascapular nerve block technique with anesthetic infusion into the subacromial space is an excellent alternative to interscalene block, particularly in hospitals where the nerve stimulator device is unavailable.

OBJETIVO: Determinar: 1) se os pacientes que sofrem seu primeiro episódio de luxação traumática do ombro são orientados a manter imobilização por um período mínimo de quatro semanas e qual foi o tipo de imobilização prescrita; 2) determinar após quantos episódios de luxação os pacientes receberam a informação da necessidade de cirurgia; 3) quanto tempo os pacientes demoraram a conseguir acompanhamento com especialista em cirurgia de ombro; 4) quantos episódios de luxação os pacientes apresentavam no momento da cirurgia. MÉTODOS: Dos 100 pacientes tratados cirurgicamente ou estão aguardando cirurgia nos ambulatórios, foram avaliados 61, que responderam a um questionário com perguntas relacionadas com o mecanismo das luxações, locais de atendimento, orientações recebidas para o tratamento do evento agudo e acompanhamento, tempo necessário para conseguir o acompanhamento e cirurgia.Os dados coletados foram submetidos à análise. RESULTADOS: Apenas 13 pacientes (22%) receberam orientações adequadas sobre sua afecção, prognóstico quanto à recidiva e à necessidade de acompanhamento especializado e cirurgia nos casos recidivantes. Nenhum paciente foi orientado adequadamente como e por quanto tempo deveria ficar imobilizado. CONCLUSÃO: Nenhum paciente recebeu orientações de manter-se imobilizado por quatro semanas e o tipo de imobilização variou entre uma tipoia simples e a imobilização comercial tipo Velpeau. A maioria dos pacientes avaliados (78%) não recebeu orientações corretas sobre a necessidade de acompanhamento especializado e cirurgia após o segundo episódio de luxação. O tempo para avaliação do especialista demorou entre quatro e seis meses e possuíam entre um e cem episódios de luxação no momento da cirurgia. OBJECTIVE: To determine: 1) whether the patients had been oriented to use immobilization for at least four weeks and which type of immobilization was prescribed, 2) how many dislocations occurred until the patient received information about the need of surgery, 3) How long it takes for patients to have an appointment with a shoulder surgeon, 4) How many dislocations the patient had at the time of surgery. Material and METHODS: Of the 100 patients surgically treated or waiting for surgery at outpatient facilities, we interviewed 61 patients with questions related to the mechanism of dislocation, emergency service sites, guidelines for acute event treatment and follow-up, time elapsed until surgery and follow-up. Collected data were submitted to analysis. RESULTS: Only 13 patients (22%) had received correct information about their lesion, prognosis concerning recurrence, and about the need of surgery and expert follow-up in recurrent cases. None of our patients received proper information about type and duration of immobilization. CONCLUSION: None of our patients had received proper orientation to remain immobilized for four weeks, and the types of immobilization vary from a handmade sling to a manufactured Velpeau. Most of our patients (78%) did not receive proper orientation about specialized follow-up and surgery after their second episode of dislocation. The time for a specialized appointment with shoulder surgeon ranges from four to six months, with 1-100 dislocation episodes at the moment of surgery.

ABSTRACT For hemiarthroplasty reconstruction of a proximal hu- merus fracture, accurate restoration of humeral head po- sition is challenging, and incorrect prosthetic placement is associated with a poor outcome of surgical treatment. To recreate proper humeral length during the surgery is difficult even when preoperative planning is possible. We now use the pectoral major tendon insertion dis- tance to the top of the humeral head during the procedure to recreate the humeral length by testing positioning of the prosthesis at 5.5 cm from this reference. With this technique, we have been successful in recreating the proper humeral length of the first 11 cases of proximal humerus fracture that we treated with shoulder hemiar- throplasty.

Objective To evaluate the presence of x ray changes in the proximal humerus growth plate of 21 young pitchers. Design Case series. Setting This study was conducted at the Orthopaedic and Traumatology Department of the ABC College of Medicine, Santo Andre, Sao Paulo, Brazil, tertiary institution. Patients 21 male adolescent baseball pitchers, with a mean age of 14.5 years and selected from the Brazilian National Team, were studied. Interventions The patients underwent x ray examinations of the shoulders. Main outcome measurements The x rays of the pitchers’ shoulders were studied to determine any changes in the proximal humeral growth plate and correlate them with clinical findings. Results Fourteen athletes (66%) had radiographic changes in the humerus growth plate but only 5 (36%) had pain complaints. Nine of these 14 cases (64%) whom the observers found radiographic changes did not complain of pain. It was also observed that there was a correlation in only 11 cases between clinical and radiographic evaluations. Conclusion Radiographic changes in the proximal humerus growth plate were found in 66% of the cases, but 64% were asymptomatic. These changes indicate possible evolution, in the future, to a greater degree of retroversion in pitchers’ dominant shoulders.

Objective: To determine the distance between the axillary nerve and the antero-lateral (AL) edge of the acromion, its anatomical variability and relationship to humeral length and body height. Methods: Twenty-two shoulders were dissected. The anterosuperior (AS) approach was used; the deltoid was detached from the acromion and the distance between the AL portion and the axillary nerve was measured and submitted to statistical analysis. Results: The distance varied from 4.3 to 6.4 cm (average 5.32 ± 0.60 cm). The axillary nerve distance increased as the humeral size (p

OBJETIVO: Avaliar os resultados clínico-funcionais das reparações artroscópicas de lesões pequenas e médias do tendão do músculo supraespinal. MÉTODOS: Foram avaliados, retrospectivamente, 129 casos de lesões isoladas pequenas ou médias do tendão do músculo supraespinal. O tempo médio de dor foi de 29 meses. A amplitude articular média era de 136º de elevação ativa, 48º de rotação lateral, rotação medial no nível T12 e a escala funcional pré-operatória da UCLA foi, em média, de 17 pontos. Em todos os casos foi possível o reparo completo da lesão. RESULTADOS: A pontuação pela escala funcional da UCLA no período pós-operatório foi, em média, de 32 pontos. O tempo médio de seguimento foi de 39 meses. Setenta e cinco casos (58%) tiveram resultados excelentes e 42 (32%), bons. A elevação ativa final teve a média de 156º, com ganho médio de 20º, e a rotação lateral final foi, em média, de 57º, com ganho médio de 9º, ambos estatisticamente significativos (P < 0,05). Os pacientes submetidos à tenotomia da cabeça longa do bíceps (CLB), com ou sem tenodese, não apresentaram resultado funcional estatisticamente inferior àqueles que foram submetidos somente à descompressão e reparo da lesão (P = 1,00). Quatorze casos (10,8%) apresentaram complicações no período pós-operatório. Seis casos (4,6%) desenvolveram capsulite adesiva e quatro (3,1%) tiveram rerruptura do tendão comprovada por ressonância magnética. CONCLUSÕES: O reparo artroscópico das lesões pequenas e médias do tendão do músculo supraespinal proporcionou melhora clínico-funcional com bons e excelentes resultados em 90% dos casos. OBJECTIVE: To evaluate the clinical and functional outcomes from arthroscopic repairs on small and medium-sized tears of the supraspinatus muscle tendon. METHODS: 129 cases of isolated small and medium tears of the supraspinatus muscle tendon were evaluated retrospectively. The average duration of pain was 29 months. The average joint range of motion comprised active elevation of 136º, lateral rotation of 58º and medial rotation at T12 level; and the preoperative functional UCLA score averaged 17 points. In all the cases, complete repair could be achieved. RESULTS: The average score on the UCLA functional scale in the postoperative period was 32 points. The average length of follow-up was 39 months. Seventy-five cases (58%) had excellent results and 42 (32%) had good results. The average final active elevation was 156º with an average gain of 20º, and the average final lateral rotation was 57º with an average gain of 9º. Both of these were statistically significant (P < 0.05). The patients who underwent tenotomy of the long head of the biceps (LHB), with or without tenodesis, did not present statistically inferior functional outcomes, in comparison with the patients who only underwent decompression and lesion repair (P = 1.00). Fourteen cases (10.8%) presented complications during the postoperative period. Six (4.6%) developed adhesive capsulitis and four (3.1%) presented re-rupture of the tendon, proven by means of magnetic resonance imaging. CONCLUSIONS: Arthroscopic repair of small and medium tears of the supraspinatus muscle tendon provided a functional clinical improvement, with good and excellent results in 90% of the cases.

Introducao: As fraturas supra e intercondilianas do umero, em adultos, sao lesoes complexas e de dificil tratamento, pelas caracteristicas anatomicas locais e pela grande fragmentacao ossea que geralmente ocorre. Objetivo: Avaliar o resultado funcional do tratamento cirurgico dessas fraturas em adultos. Metodo: No periodo de junho de 1999 a agosto de 2005, 22 pacientes (22 cotovelos) com idade entre 20 e 70 anos, com fraturas supra e intercondilianas do umero, foram submetidos a tratamento cirurgico mediante reducao aberta e fixacao interna rigida, com placas e parafusos de 3,5 mm, por via de acesso posterior. Resultados: De acordo com o criterio de Jupter et al , obtivemos 68,2% de resultados classificados como satisfatorios e, como complicacoes do tratamento, um paciente (4,5%) apresentou neuropraxia ulnar, que regrediu espontaneamente e outros dois (9%) que apresentavam dor no olecrano, causada pelo material de sintese. Apos a retirada desse material de sintese referiram melhora. Conclusoes: O tratamento cirurgico para as fraturas supra e intercondilianas do umero mostrou ser um metodo eficaz com 68,2% de resultados classificados como satisfatorios neste estudo.

Introducao: Descrever um padrao diferente de fratura do processo coronoide associada a instabilidade do cotovelo tratada com sucesso em nosso servico. Relato do caso: Um paciente de 27 anos, do sexo masculino e destro, havia sofrido luxacao do cotovelo. Procurou nosso hospital com uma queixa de dor e instabilidade a extensao do cotovelo, apresentando instabilidade em varo-valgo e queixa de luxacao eminente do cotovelo quando este atingia -30o de extensao. No exame radiografico, observou-se uma fratura anteromedial do processo coronoide. Submetido ao tratamento cirurgico fixando-se a fratura, reparando-se o ligamento colateral medial, imobilizado-se com uma tala gessada por dez dias e, depois, iniciando-se o programa de reabilitacao. Apos 21 meses de seguimento, o paciente mantinha 135° de flexao e 0° de extensao, 80° de pronacao e 90° de supinacao; forca muscular grau V e sem instabilidade no exame fisico. As radiografias de controle demonstraram consolidacao completa sem ossificacao heterotopica. Discussao: Apesar de ser um tipo raro de fratura do processo coronoide, e importante que seja devidamente diagnosticado pelo ortopedista para que se realize o tratamento adequado e se evite a instabilidade cronica. O presente caso foi tratado com sucesso por meio de reducao aberta e fixacao interna, sem nenhuma queixa de instabilidade apos 21 meses de seguimento.

OBJETIVO: O objetivo do trabalho foi comparar a resistência entre os pontos simples, duplo e Mason-Allen modificado, utilizados para o reparo do manguito rotador, e verificar se há diferença significativa que justifique a utilização do ponto do tipo Mason-Allen modificado ao invés dos pontos simples ou duplo. MÉTODO: Retiramos tendões do músculo supra-espinal de 15 cadáveres humanos frescos (30 ombros), com a média de idade de 45 anos. Os testes foram realizados na máquina universal de ensaio mecânico Kratos® 500/2000 e os resultados submetidos aos testes estatísticos de t-student, análise de variância (ANOVA), comparação múltipla de Bonferroni e calculadas as correlações de Pearson. Os testes foram realizados ao nível de significância de 5%. RESULTADOS: Não houve diferença significativa com relação à idade, ao tamanho das amostras e deslocamento do tendão. A resistência variou com média de 127,50 N com o ponto simples, 163,95 N com o duplo e com o ponto de Mason-Allen modificado esta foi de 198,45 N. CONCLUSÃO: não existe diferença da resistência no tendão quanto à falha na interface sutura - tendão comparando-se o ponto duplo com o Mason-Allen modificado e os pontos simples e duplo, porém há diferença quando comparados os pontos simples e Mason-Allen modificado. OBJECTIVE: The purpose of this study was to compare the rotator cuff tendon resistance at the interface tendon-suture using three different sorts of stitches (simple, mattress and modified Mason-Allen). METHODS: To do this, 30 rotator cuffs were totally dissected from 15 specimens, which were 45 years old on average. The tests were done using a Kratos® 500/2000 machine and the statistical analyses applied were the Student t-test, ANOVA test, Multiple Bonferroni Comparison, and Pearson's correlation coefficients; all the analyses used a significance level of 5%. RESULTS: No significant difference was observed regarding the age, sample sizes and tendon displacement. The tendon resistance was 127.50 N on average when Simple stitches were used, 163.95 N when Double stitches were used and 198.45 N when the Modified Mason-Allen Knot was used. CONCLUSION: Although the tendon resistance at the interface tendon-suture was higher using the Modified Mason-Allen stitches than it was when using the Double and Simple Knots, there was no difference in tendon resistance when using the Modified Mason-Allen and Double stitches. On the other hand, we found that tendon resistance was higher when using Modified Mason-Allen stitches as compared to tendon resistance when using Simple stitches.

Objective: To evaluate the efficacy of suprascapular nerve block in combination with infusion of anesthetic into the subacromial space, compared with interscalene block. Methods: Forty-five patients with small or medium-sized isolated supraspinatus tendon lesions who underwent arthroscopic repair were prospectively and comparatively evaluated through random assignation to three groups of 15, each with a different combination of anesthetic methods. The efficacy of postoperative analgesia was measured using the visual analogue scale for pain and the analgesic, anti-inflammatory and opioid drug consumption. Inhalation anesthetic consumption during surgery was also compared between the groups. Results: The statistical analysis did not find any statistically significant differences among the groups regarding anesthetic consumption during surgery or postoperative analgesic efficacy during the first 48 hours. Conclusion: Suprascapular nerve block with infusion of anesthetic into the subacromial space is an excellent alternative to interscalene block, particularly in hospitals in which an electrical nerve stimulating device is unavailable.

Objective: Evaluate the results from the Latarjet procedure in patients with anterior recurrent dislocation of the shoulder who present bone loss of the glenoid cavity greater than 25%. Methods: Twenty six male patients underwent the Latarjet procedure, The bone loss was evaluated by means of radiography using the Bernageau view and by means of CAT scan. The patients were evaluated with regard to range of motion, using the Rowe and UCLA scales, before and after the operation, and by radiographs to assess the presence of arthrosis, position and consolidation of the graft and positioning of the screws. Statistical analysis was used to assess whether there was any relationship between the number of episodes of dislocation and the presence of arthrosis, , and any relationship between arthrosis and limitations on lateral rotation. Differences in range of motion between the operated and unaffected sides and in the UCLA and Rowe scale. Results: The means for elevation and lateral rotation were statistically poorer on the operated side. The UCLA and Rowe scale showed that there was a statistically significant improvement in the clinical-functional results (P < 0.001 for both). There was a relationship between the number of episodes of dislocation and the presence of arthrosis, We also did not observe any correlation between limitations on lateral rotation and arthrosis. Conclusion: The Latarjet procedure is an efficient method for cases of severe erosion of the glenoid margin.