Introduction: Our purpose was to evaluate the differences in metaglene positioning in deltopectoral and anterosuperior approach in total reverse shoulder arthroplasty. Methods: Patients who underwent total reverse shoulder arthroplasty for degenerative or traumatic pathology within a 10‐year period were selected. Two groups were created: group 1, deltopectoral approach; group 2, anterosuperior approach. The metaglene positioning was evaluated through anteroposterior radiography by the methods of Lévigne et al and Maurer et al. Statistical study was performed by Mann‐Whitney U‐test. Results: A total of 145 patients were admitted, 33 submited to deltopectoral approach and 112 anterosuperior. Surgery for degenerative pathology occurred in 106, for trauma in 39. The overall median age was 70 years (64‐75), in degenerative pathology 68 years (62‐72), in trauma 76 years (69‐81). Overhang showed no significant difference (p=0.882), 5.1±2.2 mm group 1 and 5.4±2 mm group 2. The tilt showed significant difference (p=0.005), 103.2±11o group 1 and 96.8±9.7o group 2. The beta angle showed significant difference (p=0.001), 81.4±7.3o group 1 and 74.6±8.6o group 2. When comparing traumatic and degenerative pathology, the overhang did not show significant difference (p=0.06), 5.8±1.6 mm traumatic pathology and 5.1±2.2 mm degenerative pathology. The tilt was signifi‐ cantly different (p<0.001), 104.8±10° traumatic pathology and 95.8±9.4o degenerative pathology. The beta angle was significantly different (zc wq <0.001), 82.5±6.6o traumatic pathology and 73.8±8.4o degenerative pathology. Conclusion: The approaches did not differ in the craniocaudal positioning of the metaglene, but tilt was lower in the anterosuperior approach and may correlate with future complications. Patients who had surgery for traumatic pathology showed greater inferior tilt of the metaglene.

Objectives: To assess the ability of the arthroscopic superior capsule reconstruction (SCR) in restoring glenohumeral stability in the presence of different preoperative patterns of irreparable rotator cuff tears (RCTs). Methods: A computational musculoskeletal (MSK) model of the upper limb was used to simulate isolated SCR and to estimate the stability of the shoulder. Four patterns of preoperative irreparable RCTs were modeled: Supraspinatus (SSP); SSP ​+ ​Subscapularis (SSC); SSP ​+ ​Infraspinatus (ISP); and SSP ​+ ​SSC ​+ ​ISP. The muscles involved in the irreparable RCT were removed from the MSK model to simulate an irreparable full-thickness tear. In the MSK model, the muscle and joint forces were estimated for a set of upper limb positions, from four types of motions (abduction in the frontal plane, forward flexion in the sagittal plane, reaching behind the back, and combing the hair) collected in a biomechanics laboratory, through inverse dynamic analysis. The stability of the shoulder was estimated based on the tangential and compressive components of the glenohumeral joint reaction force. The comparison of pre- and post-operative conditions, for the four patterns of irreparable RCTs, with the healthy condition, was performed using ANOVA and Tukey's tests (statistical level of p ​< ​0.05). Results: In the setting of an isolated irreparable SSP tear, SCR statistically significantly improved stability compared with the preoperative condition (p ​< ​0.001). For the irreparable SSP ​+ ​SSC pattern, a statistically significant loss in stability was observed (p ​< ​0.001) when SCR was applied. For the irreparable SSP ​+ ​ISP and SSP ​+ ​SSC ​+ ​ISP patterns, the postoperative condition increased shoulder stability, compared to the preoperative condition; however, the improvement was not statistically significantly different. Conclusion: Isolated SCR for irreparable RCTs extending beyond the SSP does not statistically significantly improve the stability of the glenohumeral joint

Objectives: The purpose of this study was to compare shoulder external rotation range of motion (ROM) during the hand-behind-neck (HBN) test and a standard shoulder external rotation test and to describe the 3-dimensional scapular motion during the HBN test. Methods: An electromagnetic tracking device was used to assess the dominant shoulder of 14 healthy participants while performing active full ROM in a standard shoulder external rotation test in an elevated position (EREP) and in the HBN test. The humeral and scapular 3-dimensional positions at the end of EREP and HBN were compared using a paired-sample t test. A correlation analysis was performed between humeral and scapular angles to assess the contribution of scapular motion to the full shoulder ROM during the HBN test. Results: No significant differences were found between the HBN test and the EREP at the end-range of the glenohumeral external rotation (HBN: 15.6° ± 6.3° vs EREP: 23.4° ± 4.7°; P = .08) and on scapular internal-external rotation (HBN test: 21.2° ± 6.3° vs EREP: 15.6° ± 1.8°; P = .23). Significant differences were found in scapular upward rotation (HBN: 21.2° ± 6.3° vs EREP: 15.6° ± 1.8°; P b .01) and scapular spinal tilt (HBN: − 0.4° ± 2.3° vs EREP: 8.1° ± 2.1°; P b .01). There was a positive correlation between the humeral angles and scapular internal and posterior spinal tilt angles with the HBN test. Conclusions: The results of the present study showed that, in young asymptomatic participants with no known shoulder pathology, the end-range of shoulder rotation was similar in the HBN test and in a standard shoulder rotation test. During the HBN test, the scapula assumed a more internal and anterior spinal tilted position at the end-range of active shoulder external rotation. These results suggest that the HBN test may be used to assess the end-range of glenohumeral external rotation.

ABSTRACT Objective: To assess whether Bare Spot is previously displaced by proportion (MEASURE BP-A × 1.25/MEASURE BP-P = 1). Methods: 35 patients with surgical indication for rotator cuff injury repair were evaluated. The distances from the Bare Spot to the anterior edge of the glenoid cavity (BS-A) and to the posterior edge (BS-P) were measured by arthroscopy and computed tomography with three-dimensional reconstruction of the scapula. Results: The distance from the Bare Spot to the anterior border (BS-A tc) was 11.6 mm with a median 12 mm; The distance to the posterior border (BS-P tc) was on average 15.5 mm with a median 15 mm. The distances from BS to anterior cavity edge measured by arthroscopy were on average (BS-A video) 12.25 mm with a median of 12 mm, and from BS to posterior edge (BS-P video) 16.25 mm on average with median 16 mm (p < 0.005). Conclusion: Bare Spot is displaced anteriorly at a proportion of 40% of the anterior margin and 60% of the posterior margin. Level of Evidence II - Development of diagnostic criteria on consecutive patients (with universally applied reference “gold standard”).

ABSTRACT Introduction: Scapular fractures are rare injuries and are often associated with high-energy trauma, with joint fractures accounting for only 15% of all scapular fractures. Surgical treatment is indicated for fractures with large deviations and with joint instability. Objective: This study evaluates the clinical and functional results after surgical treatment of scapular fractures. Methods: Eight patients with scapular fractures were surgically treated between 2013 and 2019. For indication for surgical treatment, mediolateral deviations, glenopolar angle, angular deviations and joint deviations greater than 4 mm were taken into account. Radiographic results of consolidation, range of motion, functional score and visual analogue pain scale were obtained. Results: In the mean follow-up of twenty-nine months (13-40 months), all patients presented fracture consolidation. The mean UCLA score was 29 points (with 75% good results and 25% moderate results). Regarding the range of motion, the mean elevation was 146° (ranging from 110° to 60°), lateral rotation of 62° (36-80°) and medial rotation at the level of T7 (T6-T10). The final VAS mean was 2.3. All patients returned to the pre-injury level at work. Conclusion: In this series of cases, surgical treatment of scapular articular fractures provided satisfactory results with low rates of complications, showing to be an option in selected cases of deviated fractures. Level of Evidence IV, Case Series.

JUSTIFICATIVA E OBJETIVO: Cirurgias artroscópicas do ombro cursam com intensa dor pós-operatória. Diversas técnicas analgésicas têm sido preconizadas. O objetivo deste estudo foi comparar o bloqueio dos nervos supraescapular e axilar nas cirurgias artroscópicas de ombro com a abordagem interescalênica do plexo braquial. MÉTODO: Sessenta e oito pacientes foram alocados em dois grupos de 34, de acordo com a técnica utilizada: grupo interescalênico (GI) e grupo seletivo (GS), sendo ambas as abordagens realizadas com neuroestimulador. No GI, após resposta motora adequada foram injetados 30 mL de levopubivacaína em excesso enantiomérico de 50% a 0,33% com adrenalina 1:200.000. No GS, após resposta motora do nervo supraescapular e axilar, foram injetados 15 mL da mesma substância em cada nervo. em seguida, realizada anestesia geral. Variáveis avaliadas: tempo para realização dos bloqueios, analgesia, consumo de opioide, bloqueio motor, estabilidade cardiocirculatória, satisfação e aceitabilidade pelo paciente. RESULTADOS: Tempo para execução do bloqueio interescalênico foi significativamente menor que para realização do bloqueio seletivo. Analgesia foi significativamente maior no pós-operatório imediato no GI e no pós-operatório tardio no GS. Consumo de morfina foi significativamente maior na primeira hora no GS. Bloqueio motor foi significativamente menor no GS. Estabilidade cardiocirculatória, satisfação e aceitabilidade da técnica pelo paciente não diferiram entre os grupos. Ocorreu uma falha no GI e duas no GS. CONCLUSÕES: Ambas as técnicas são seguras, eficazes com mesmo grau de satisfação e aceitabilidade. O bloqueio seletivo de ambos os nervos apresentou analgesia satisfatória, com a vantagem de proporcionar bloqueio motor restrito ao ombro.

Background and objective: Shoulder arthroscopic surgeries evolve with intense postoperative pain. Several analgesic techniques have been advocated. The aim of this study was to compare suprascapular and axillary nerve blocks in shoulder arthroscopy using the interscalene approach to brachial plexus blockade. Methods: According to the technique used, sixty-eight patients were allocated into two groups: interscalene group (IG, n. =. 34) and selective group (SG, n. =. 34), with neurostimulation approach used for both techniques. After appropriate motor response, IG received 30. mL of 0.33% levobupivacaine in 50% enantiomeric excess with adrenalin 1:200,000. After motor response of suprascapular and axillary nerves, SG received 15. mL of the same substance on each nerve. General anesthesia was then administered. Variables assessed were time to perform the blocks, analgesia, opioid consumption, motor block, cardiovascular stability, patient satisfaction and acceptability. Results: Time for interscalene blockade was significantly shorter than for selective blockade. Analgesia was significantly higher in the immediate postoperative period in IG and in the late postoperative period in SG. Morphine consumption was significantly higher in the first hour in SG. Motor block was significantly lower in SG. There was no difference between groups regarding cardiocirculatory stability and patient satisfaction and acceptability. Failure occurred in IG (1) and SG (2). Conclusions: Both techniques are safe, effective, and with the same degree of satisfaction and acceptability. The selective blockade of both nerves showed satisfactory analgesia, with the advantage of providing motor block restricted to the shoulder. Justificativa e objetivo: Cirurgias artroscópicas do ombro cursam com intensa dor pós-operatória. Diversas técnicas analgésicas têm sido preconizadas. O objetivo deste estudo foi comparar o bloqueio dos nervos supraescapular e axilar nas cirurgias artroscópicas de ombro com a abordagem interescalênica do plexo braquial. Método: Sessenta e oito pacientes foram alocados em dois grupos de 34, de acordo com a técnica utilizada: grupo interescalênico (GI) e grupo seletivo (GS), sendo ambas as abordagens realizadas com neuroestimulador. No GI, após resposta motora adequada foram injetados 30. mL de levopubivacaína em excesso enantiomérico de 50% a 0,33% com adrenalina 1:200.000. No GS, após resposta motora do nervo supraescapular e axilar, foram injetados 15. mL da mesma substância em cada nervo. Em seguida, realizada anestesia geral. Variáveis avaliadas: tempo para realização dos bloqueios, analgesia, consumo de opioide, bloqueio motor, estabilidade cardiocirculatória, satisfação e aceitabilidade pelo paciente. Resultados: Tempo para execução do bloqueio interescalênico foi significativamente menor que para realização do bloqueio seletivo. Analgesia foi significativamente maior no pós-operatório imediato no GI e no pós-operatório tardio no GS. Consumo de morfina foi significativamente maior na primeira hora no GS. Bloqueio motor foi significativamente menor no GS. Estabilidade cardiocirculatória, satisfação e aceitabilidade da técnica pelo paciente não diferiram entre os grupos. Ocorreu uma falha no GI e duas no GS. Conclusões: Ambas as técnicas são seguras, eficazes com mesmo grau de satisfação e aceitabilidade. O bloqueio seletivo de ambos os nervos apresentou analgesia satisfatória, com a vantagem de proporcionar bloqueio motor restrito ao ombro. © 2013 Elsevier Editora Ltda..

O treinamento resistido de baixa carga (TRBC) com restrição de fluxo sanguíneo (RFS) pode induzir adaptações neuromusculares positivas, porém, ainda existe uma lacuna na literatura sobre seus efeitos proximais a aplicação. O objetivo deste estudo será investigar os efeitos crônicos do exercício de baixa carga associado à RFS no desempenho neuromuscular dos membros superiores de mulheres saudáveis. Este protocolo de ensaio clínico incluirá 78 voluntárias randomizadas em três grupos de 26 participantes: TRBC (TRBC sem RFS); TRBC + restrição do fluxo sanguíneo placebo (20% RFS); e TRBC + 60% RFS. Os três grupos realizarão 4 séries de 15 repetições, com 20% de 1RM para cada um dos seguintes músculos: serrátil anterior, rotadores laterais de ombro e trapézio inferior. As participantes serão avaliadas antes de iniciar o protocolo, após completar o protocolo de 8 semanas, e após 4 semanas da finalização. O desfecho primário será força, e os desfechos secundários serão excitação muscular, perimetria, dor, percepção subjetiva do esforço, afetividade ao exercício e potência de membros superiores. Este projeto foi aprovado pelo comitê de ética da FACISA/UFRN (nº 4.216.594) e as coletas se iniciarão assim que a pandemia de COVID-19 estiver sob controle. Os resultados da pesquisa serão publicados em periódico revisado por pares e divulgados em eventos científicos e as participantes da pesquisa receberão um folder informativo com os resultados.

Massive rotator cuff tears can lead to large cysts, extending from the subacromial space through the acromioclavicular joint into a subcutaneous cyst, with a typical “geyser sign” on magnetic resonance imaging (MRI). To our knowledge, no cases of transdeltoid pseudo-cyst as first manifestation of septic arthritis have ever been reported.A 79-year-old female presented to the Emergency Department (ED) with a two-day evolution of a painful tumefaction over her right shoulder. She had been admitted to the ED 16 days before, after being bitten by a dog. Tumefaction drainage revealed a total cell count of 50320 cells/mL. MRI revealed glenohumeral joint cavity’s fluid “decompression” through the deltoid. Septic arthritis was presumed as the cause of the pseudo-cyst, configuring a “pseudo-geyser sign” on MRI.Septic arthritis is an orthopedic emergency, whose early diagnosis, ED referral and treatment are crucial.