Introdução: A dor no ombro é muito comum e o tratamento preferencial é a fisioterapia. Objectivo: Avaliar a efectividade da mobilização passiva na dor, força,amplitude de movimento e/ou função no tratamento de indivíduos com tendinopatias da coifa ou síndrome de colisão do ombro por meio de revisão sistemática de literatura. Métodos: Os estudos foram pesquisados na PubMed, Cochrane Library, Scielo, PEDro e Web of Science. Dois investigadores analisaram os artigos para determinar os trabalhos a incluir. A qualidade metodológica desses foi avaliada por meio da escala de PEDro e feita a sua caracterização detalhada. Resultados: Os resultados sugerem que a mobilização passiva quando aplicada em conjunto com outros tratamentos leva a significativa diminuição da dor e a melhoria da força e função. Conclusão: A mobilização passiva aplicada em conjunto com outros tratamentos parece ser uma mais valia no tratamento de tendinopatias da bainha rotadora e síndrome de colisão do ombro. São necessários mais estudos que confirmem esses resultados.

Purpose: To find ultrasound prognostic factors for shoulder pain. Methods: This was an observational, prospective study, comparing the evolution of ultrasound findings with clinical outcomes, in patients with shoulder pain. Data were collected in two appointments, from February 2018 to March 2021. Two-tailed non-parametric statistics were used, and p values <0.05 were considered significant. Results: A total of 79 participants were included in this study (median age 59 years, range 24-70, 61 women). A positive Doppler signal on tendons (p = 0.002) and absent tendon heterogeneity (p = 0.01) were associated with the patient's self-reported improvement. Tendon calcifications with poorly defined contours (p = 0.03) and sparse distribution (p = 0.001) were associated with VAS improvement. A reduction in the number of calcifications (p = 0.004), in the supraspinatus tendon thickness (p = 0.01), in subacromial effusions (p = 0.03), and in color Doppler grade (p = 0.02), between initial and follow-up exams, was found in patients with an improved DASH outcome. Conclusion: A positive Doppler signal on shoulder tendons can be a marker for a better prognosis in shoulder pain. Poorly defined and sparsely distributed calcifications can also indicate a better course of the disease.

Shoulder pain is a common problem in clinical practice, with data in the literature showing an increased prevalence and stronger consequences with age, reaching an annual cumulative incidence of 2.4% in the age group from 45 to 64 years, with a higher incidence in women. The shoulder is one of the most frequent sites of musculoskeletal pain. There are multiple causes, but rotator cuff and subacromial pathologies are predominant. Pathologies of the glenohumeral and acromioclavicular joints, as well as referred pain, especially of cervical origin, are also pointed out as frequent etiologies. The rotator cuff is an usual site for degenerative tendinopathy, a common cause for shoulder pain which most often affects the supraspinatus; it may progress to partial or full-thickness tendon tear. Subacromial conflict has been recognized since Neer as a cause for tendinopathy and rotator cuff tear. Calcifying tendinitis has generally a more favorable course, being able to resolve completely and spontaneously, and predominates at a younger age. It involves the deposition of calcium hydroxyapatite crystals, more frequently in the supraspinatus and infraspinatus, but the etiopathogenesis is controversial; it seems to occur as a primary tendinopathy reactive to ischemia or mechanical factors in a viable tendon, in a cycle including fibrocartilaginous metaplasia of tenocytes, crystal deposition and resorption, and tendon repair. But not all calcifications are symptomatic. Calcifications with a diameter greater than 1.5 cm, with an ill-defined contour, and associated with Doppler signal and subacromial effusion have been described as related to symptoms, but only in a few studies. This research project was aimed to validate clinical tests in the determination of the level of pain and disability and to search for ultrasound characteristics in rotator cuff calcifications, or another marker or set of ultrasound markers, which allow for the prediction of symptoms and, in addition, to determine the prognosis. The dimension of calcifications was particularly focused. The project included a case-control observational study to identify characteristics associated with shoulder pain, and a longitudinal observational study to look for prognostic factors. Relevant aspects on the physical examination of patients with shoulder pain were also investigated, by an observational cross-sectional study. A total of 140 patients and 62 controls were enrolled (median age 56 years, 155 women), and inflammatory pathology was excluded. The evaluation comprised a DASH questionnaire (Disabilities of the Arm, Shoulder and Hand outcome measure), a physical examination and an ultrasound exam with recording of the size, morphology and location of calcifications, Doppler signal, changes in echotexture, rotator cuff tears and joint or subacromial effusion. P-values < 0,05 were considered significant. On the clinical evaluation of the patients, a linear regression model with six independent variables (age, gender, complaints on dominant side, palm-up test, range of motion in active flexion and external rotation) was found capable of predicting 44% of the variability of the DASH score (R = 0.665; p < 0.001). A calcification size ≥ 6 mm was associated with shoulder pain (p = 0.02), but only in younger subjects (< 56 years). In older subjects (≥ 56 years), a distance to the tendon insertion ≥ 6 mm was also associated with pain (p = 0.009). Pain was also associated with a positive Doppler signal (p = 0.003), the number of calcifications (p = 0.02), alterations in the tendon echotexture (p < 0.001), bone irregularity or thickening at the insertion of the supraspinatus and subscapularis tendons (p < 0.05) and rotator cuff tears (p = 0.001). Subacromial effusion was only found in symptomatic subjects (p = 0.002). Follow-up of patients suggested a better prognosis when a tendinous Doppler signal or when poorly defined or sparsely distributed calcifications were present. Clinical improvement was associated with a reduction in the Doppler signal and subacromial effusion, when present on first exam, suggesting a role in the pathophysiological mechanism of pain. An algorithm was proposed, based on a set of specific ultrasonographic criteria, which makes it possible to classify the sample of this study for rotator cuff pathology likely to cause pain, with a sensitivity of 69% and a specificity of 92%.

Background: Over the season, competitive swimmers experience a progressive imbalance in rotator cuff strength, predisposing them to a significant risk factor for a swimmer’s shoulder injury. Objectives: Verify the effectiveness of two 12-week preventive programs on the shoulder rotators’ peak torque and conventional/functional ratios. Design: A care provider- and participant-blinded, parallel, randomized controlled trial with three groups. Participants: Competitive swimmers aged 16 to 35 years with no prior clinical issues related to their shoulders. Interventions: Twice a week, over 12 weeks, the two experimental groups performed five exercises where the only difference was executing the program with weights or elastic bands, and the control group performed a sham intervention. Main outcome measures: The concentric and eccentric peak torque of the internal and external rotators of the dominant shoulder were assessed before and after the intervention using an isokinetic dynamometer Biodex System 3, at 60°/s, 120°/s, and 180°/s. Results: Among the experimental groups, only one test indicated a reduction (p ≤ 0.05) in rotator peak torque, while the control group showed a decrease (p ≤ 0.05) in five tests. Swimmers who completed the prevention programs demonstrated less imbalance in conventional/functional ratios than controls. Conclusions: Implementing a 12-week preventive program minimizes the progressive shoulder rotational imbalance over the season in competitive swimmers. Clinical Trial Registration number: NCT06552585.

OBJECTIVE: To compare the strength generated by the rotator muscles of the shoulder joint between the right upper limb and left upper limb among healthy individuals. METHODS: To evaluate the muscle strength of upper limbs from isometric contractions in the horizontal direction (rotation) an isometric dynamometer was used, equipped with transducers, signal conditioning, a data acquisition board, and finally, a computer. Study participants were 22 male military subjects, aged between 18 and 19 years old, body mass between 57.7 and 93.0 kg (71.8 ± 9.45 kg) and height between 1.67 and 1.90 m (1.75 ± 0.06 m), healthy and without clinical diseases or any type of orthopedic injury in the muscle skeletal system. RESULTS: The internal rotation in the right upper limb (RUL) was higher than the average strength of internal rotation in the left upper limb (LUL) (p = 0.723). The external rotation strength in RUL was lower than the average strength of external rotation in the LUL (p=0.788). No statistical difference was observed by comparing the strength values of all isometric strength tests. CONCLUSION: For the sample and methodology used to assess muscle strength, there was no statistical difference between the strength generated by the muscles of the rotator cuff of the right and left upper limbs. Experimental Study.

OBJECTIVE: To identify prognostic factors of postoperative functional outcomes. METHODS: Retrospective case series evaluating patients undergoing rotator cuff repair, analyzed by the UCLA score (pre and 12-month postoperative) and Magnetic Resonance Imaging (preoperative). Patients' intrinsic variables related to the injury and intervention were evaluated. Multivariate linear regression analysis was performed to determine variables impact on postoperative functional assessment. RESULTS: 131 patients were included. The mean UCLA score increased from 13.17 ± 3.77 to 28.73 ± 6.09 (p<0,001). We obtained 65.7% of good and excellent results. Age (r= 0.232, p= 0.004) and reparability of posterosuperior injuries (r= 0.151, p= 0.043) correlated with the functional assessment at 12 months. After multivariate linear regression analysis, only age was associated (p = 0.008). CONCLUSIONS: The surgical treatment of rotator cuff tears lead to good and excellent results in 65.6% of patients. Age was an independent predictor factor with better clinical outcomes by UCLA score in older patients. Level of Evidence IV, Case Series.

ABSTRACT Objective: To investigate the safety and efficacy of allogeneic platelet-rich plasma (PRP) in rotator cuff repair . Methods: Seventeen patients with a full-thickness rotator cuff tear were included. Ten patients underwent arthroscopic rotator cuff repair with allogeneic, and seven patients with autologous PRP. Three PRP gels in a volume 3 ml each were applied between the torn end and the greater tuberosity. Clinical outcomes were assessed preoperatively and at a minimum of 2 years after surgery. Structural outcomes were evaluated with the presence of retear and the change of the cross-sectional area (ACT) of the supraspinatus . Results: Allogeneic PRP did not cause any adverse events during the follow-up period. There was no significant difference in the clinical outcome measures between the two groups (all p > 0.05). The retear rate was 33.3% and 25.0% in the allogeneic group and autologous group, respectively (p = 0.764). The change between the one-year postoperative and immediately postoperative ACT was not also significantly different between the two groups (p = 0.373) . Conclusion: Allogeneic PRP in arthroscopic rotator cuff did not cause any local or general complications and that has the efficacy comparable to autologous PRP with respect to the clinical and structural outcomes. Level of Evidence III, Retrospective Comparative Study.

ABSTRACT OBJECTIVE: To describe shoulder disorders in patients evaluated by two shoulder and elbow surgeons. METHODS: This cross-sectional study analyzed patients evaluated by two authors, excluding acute fractures and dislocations and patients with symptoms not involving the shoulder. Age and sex distribution was determined for the different diagnoses. RESULTS: We evaluated 1001 patients. Mean age was 51.43±15.15 years and 51.0% were female. Disorders of the rotator cuff occurred in 64.3% (41.2% tendinopathy, 11.0% partial tears and 12.2% full-thickness tears). Adhesive capsulitis occurred in 13.5% of cases and glenohumeral instability in 8.1%. Rotator cuff disorders were more common in women, with a peak between 50 and 59 years for tendinopathy and partial tears and between 60 and 69 years for full-thickness tears. Glenohumeral instability was more frequent in men, with a peak between 30 and 39 years. CONCLUSION: The most frequent diagnosis was rotator cuff tendinopathy, followed by adhesive capsulitis, full-thickness rotator cuff tears, partial rotator cuff tears and glenohumeral instability. Rotator cuff lesions were more common in women, with a peak between 60 and 69 years for full-thickness tears. Level of Evidence IV, Case Series.

ABSTRACT Objective: To evaluate the influence of partial- and full-thickness upper third subscapularis tendon tears on the functional scores of patients undergoing arthroscopic rotator cuff repair. Methods: Patients who underwent arthroscopic rotator cuff repair were divided into three groups according to the subscapularis tendon condition: intact, partial-thickness tear, or full-thickness upper third tear. Functional scores were compared among groups. Second, the influence of biceps and infraspinatus tears on the scores was tested using multivariate regression analysis. Results: We evaluated 307 shoulders in 297 patients. Full-thickness upper third subscapularis tears presented significantly worse scores than intact tendons. Partial-thickness tears had scores that did not differ significantly from those of the other groups. Patients with full-thickness upper third tears presented a greater rate of injured and unstable biceps tendons. The multivariate analysis showed that biceps and infraspinatus tendon tears did not influence the scores or the intergroup comparison. Conclusion: Full-thickness upper third subscapularis tendon tears presented worse functional scores than intact subscapularis tendons among patients undergoing posterosuperior rotator cuff repair. Patients with full-thickness subscapularis tears were more likely to suffer biceps tears, but this fact did not influence functional scores. Level of Evidence I; Clinical randomized trial

ABSTRACT Objective: To evaluate the functional result of arthroscopic treatment in anterosuperior rotator cuff tears. Methods: Fifty-six patients submitted to arthroscopic repair of anterosuperior rotator cuff tears were evaluated. The follow-up time was five year and five months. All the tears were diagnosed by detailed physical and imaging examination. Statistical analysis was used to compare the preoperative and postoperative results of range of motion and the UCLA score, with Wilcoxon signed-rank test, 5% significance level (p≤0.05), the relationship between the subscapularis tear and postoperative results using the Mann-Whitney test, and between the pain length and the UCLA scale using Spearman's correlation. Results: A statistically significant improvement (p<0.001) was found, comparing the range of motion and the UCLA preoperatively and postoperatively. 39% of the cases were classified as excellent, 33.9% as good, 23.7% as regular and 3.4% as bad results. A statistically significant relationship was found between the subscapularis tear type and the functional state, the pain length and the postoperative UCLA scale. Five complications, four reruptures and one adhesive capsulitis were found. Conclusions: The arthroscopic treatment for anterosuperior tears presented satisfactory results, with 8.5% of complications. Level of Evidence IV, Case series.