Asunto(s)
Arterias , Enfermedades Cutáneas Genéticas , Malformaciones Vasculares , Humanos , Malformaciones Vasculares/diagnóstico por imagen , Arterias/anomalías , Arterias/diagnóstico por imagen , Enfermedades Cutáneas Genéticas/diagnóstico por imagen , Enfermedades Cutáneas Genéticas/genética , Inestabilidad de la Articulación/diagnóstico por imagen , Femenino , Masculino , Angiografía por Tomografía Computarizada/métodosRESUMEN
The relationship between structural changes in the cerebral gray matter and diminished balance control performance in patients with chronic ankle instability (CAI) has remained unclear. This paper aimed to assess the difference in gray matter volume (GMV) between participants with CAI and healthy controls (HC) and to characterize the role of GMV in the relationship between disease duration and balance performance in CAI. 42 participants with CAI and 33 HC completed the structural brain MRI scans, one-legged standing test, and Y-balance test. Regional GMV was measured by applying voxel-based morphometry methods. The result showed that, compared with HC, participants with CAI exhibited lower GMV in multiple brain regions (familywise error [FWE] corrected p < 0.021). Within CAI only, but not in HC, lower GMV in the thalamus (ß = -0.53, p = 0.003) and hippocampus (ß = -0.57, p = 0.001) was associated with faster sway velocity of the center of pressure (CoP) in eyes closed condition (i.e., worse balance control performance). The GMV in the thalamus (percentage mediated [PM] = 32.02%; indirect effect ß = 0.119, 95% CI = 0.003 to 0.282) and hippocampus (PM = 33.71%; indirect effect ß = 0.122, 95% CI = 0.005 to 0.278) significantly mediated the association between the disease duration and balance performance. These findings suggest that the structural characteristics of the supraspinal elements is critical to the maintenance of balance control performance in individuals suffering from CAI, which deserve careful consideration in the management and rehabilitation programs in this population.
Asunto(s)
Articulación del Tobillo , Sustancia Gris , Inestabilidad de la Articulación , Imagen por Resonancia Magnética , Equilibrio Postural , Humanos , Equilibrio Postural/fisiología , Masculino , Inestabilidad de la Articulación/fisiopatología , Inestabilidad de la Articulación/diagnóstico por imagen , Femenino , Adulto Joven , Sustancia Gris/diagnóstico por imagen , Sustancia Gris/patología , Articulación del Tobillo/diagnóstico por imagen , Articulación del Tobillo/fisiopatología , Articulación del Tobillo/patología , Estudios de Casos y Controles , Adulto , Enfermedad Crónica , Tálamo/diagnóstico por imagen , Tálamo/patología , Tálamo/fisiopatología , Hipocampo/diagnóstico por imagen , Hipocampo/patología , Factores de TiempoRESUMEN
The glenohumeral joint is the least congruent and least constrained joint with a complex relationship of static and dynamic stabilizers to balance its native mobility with functional stability. In the young athlete, anterior shoulder instability is multifactorial and can be a challenge to treat, requiring a patient-specific treatment approach. Surgical decision-making must consider patient-specific factors such as age, sport activity and level, underlying ligamentous laxity, and goals for return to activity, in addition to careful scrutiny of the underlying pathology to include humeral and glenoid bone loss and surrounding scapular bone morphology.
Asunto(s)
Inestabilidad de la Articulación , Articulación del Hombro , Humanos , Inestabilidad de la Articulación/fisiopatología , Articulación del Hombro/fisiopatología , Articulación del Hombro/anatomía & histología , Articulación del Hombro/fisiología , Fenómenos Biomecánicos , Volver al DeporteRESUMEN
Shoulder glenohumeral joint dislocations and subluxations are a relatively common injury among athletic populations. Evaluating the patient both on the field initially and through early recovery helps to determine the best treatment strategies and predict the natural history of each unique injury.
Asunto(s)
Traumatismos en Atletas , Inestabilidad de la Articulación , Luxación del Hombro , Humanos , Inestabilidad de la Articulación/diagnóstico , Traumatismos en Atletas/diagnóstico , Traumatismos en Atletas/terapia , Luxación del Hombro/terapia , Luxación del Hombro/diagnóstico , Examen Físico , Articulación del Hombro/fisiopatología , Lesiones del HombroRESUMEN
In the evaluation of shoulder instability, recognition of relevant pathology on imaging is critical to planning a surgical treatment that minimizes the risk for recurrent instability. The purpose of this review is to (1) discuss the use of radiography, computed tomography, and MRI in evaluating shoulder instability and (2) demonstrate how various imaging modalities are useful in identifying critical pathologies in the shoulder that are relevant for treatment.
Asunto(s)
Inestabilidad de la Articulación , Imagen por Resonancia Magnética , Articulación del Hombro , Tomografía Computarizada por Rayos X , Humanos , Inestabilidad de la Articulación/cirugía , Inestabilidad de la Articulación/diagnóstico por imagen , Articulación del Hombro/diagnóstico por imagen , Articulación del Hombro/cirugía , Traumatismos en Atletas/diagnóstico por imagen , Traumatismos en Atletas/cirugía , Traumatismos en Atletas/diagnóstico , Luxación del Hombro/diagnóstico por imagen , Luxación del Hombro/cirugía , Luxación del Hombro/diagnóstico , Lesiones del Hombro/diagnóstico por imagenRESUMEN
Utilizing fresh distal tibia allograft in anterior glenoid reconstruction has emerged as a highly advantageous approach in addressing instances of failed anterior shoulder stabilization with glenoid bone loss. This procedure offers several benefits, including the absence of donor-site morbidity, restoration of significant glenoid defects, reestablishment of joint congruity with the humeral head, restoration of glenoid biomechanics, and the addition of cartilage to the glenoid. Furthermore, it provides a robust and reliable alternative for managing failed stabilization procedures, leading to improved clinical outcomes and a high graft healing rate, while maintaining a low occurrence of recurrent instability.
Asunto(s)
Trasplante Óseo , Inestabilidad de la Articulación , Articulación del Hombro , Humanos , Inestabilidad de la Articulación/cirugía , Trasplante Óseo/métodos , Articulación del Hombro/cirugía , Tibia/cirugía , Insuficiencia del TratamientoRESUMEN
In-season management of anterior shoulder instability in athletes is a complex problem. Athletes often wish to play through their current season, though recurrent instability rates are high, particularly in contact sports. Athletes are generally considered safe to return to play when they are relatively pain-free, and their strength and range of motion match the uninjured extremity. If an athlete is unable to progress toward recovering strength and range of motion, surgical management is an option, though this is often a season-ending decision.
Asunto(s)
Traumatismos en Atletas , Inestabilidad de la Articulación , Volver al Deporte , Humanos , Inestabilidad de la Articulación/cirugía , Inestabilidad de la Articulación/fisiopatología , Inestabilidad de la Articulación/diagnóstico , Traumatismos en Atletas/cirugía , Traumatismos en Atletas/diagnóstico , Articulación del Hombro/fisiopatología , Articulación del Hombro/cirugía , Luxación del Hombro/cirugía , Luxación del Hombro/diagnóstico , Luxación del Hombro/fisiopatología , Lesiones del Hombro , Rango del Movimiento Articular , Toma de Decisiones , AtletasRESUMEN
Overhead athletes with anterior, posterior, and multidirectional shoulder instability present with a wide range of symptoms, especially considering the injury mechanism and affected supportive structures. As such, the management of shoulder instability is widely variable and relies on rehabilitation, operative management, and sport-specific considerations, such as positional and seasonal demands on the athlete. Biomechanical analysis may further aid in the recovery process or serve as a predictive tool to identify an increased risk for injury.
Asunto(s)
Traumatismos en Atletas , Inestabilidad de la Articulación , Lesiones del Hombro , Articulación del Hombro , Humanos , Inestabilidad de la Articulación/diagnóstico , Inestabilidad de la Articulación/terapia , Traumatismos en Atletas/terapia , Traumatismos en Atletas/diagnóstico , Fenómenos Biomecánicos , Articulación del Hombro/fisiopatologíaRESUMEN
Anterior glenohumeral instability is one of the most common injuries suffered from sport. Despite padding and conditioning, the shoulder joint remains particularly vulnerable to injury, especially in the setting of contact. The overall rate of anterior instability is reported to be 0.12 injuries per 1000 athlete exposures, although this is increased up to 0.40 to 0.51 in the contact athlete. Successful treatment requires consideration of restoring stability while minimizing loss of glenohumeral motion. Common treatment strategies involve addressing the pathology that results from anterior shoulder dislocation including labral detachment as well as bony defects to the humeral head and glenoid.
Asunto(s)
Artroscopía , Traumatismos en Atletas , Inestabilidad de la Articulación , Luxación del Hombro , Articulación del Hombro , Humanos , Artroscopía/métodos , Inestabilidad de la Articulación/cirugía , Traumatismos en Atletas/cirugía , Luxación del Hombro/cirugía , Articulación del Hombro/cirugía , Articulación del Hombro/fisiopatología , Lesiones del Hombro/cirugíaRESUMEN
Historically considered the gold standard technique for glenohumeral instability, the open Bankart repair is being performed at decreased rates because of the current trends favoring arthroscopic Bankart repair and the lack of consistent training of the open technique. However, open Bankart repairs may be more appropriate for certain high-risk populations (ie, high-level collision athletes) because of their reduced recurrent instability rates. Further investigations are needed to identify the indications for arthroscopic versus open Bankart repair and compare their outcomes in high-level athletes. This review highlights the indications, surgical technique, and clinical outcomes following open Bankart repairs in athletes.
Asunto(s)
Artroscopía , Traumatismos en Atletas , Inestabilidad de la Articulación , Humanos , Inestabilidad de la Articulación/cirugía , Traumatismos en Atletas/cirugía , Artroscopía/métodos , Luxación del Hombro/cirugía , Resultado del Tratamiento , Articulación del Hombro/cirugíaRESUMEN
In young athletes, anterior shoulder instability is a prevalent condition. Because of high-energy traumas, contact athletes often suffer recurrent instability, bone loss and postoperative recurrences. Patients younger than 20 years, symptomatic for more than 6 months, with ≥ 2 dislocations, with off-track Hill-Sachs lesion, glenoid bone loss, ALPSA lesion, Instability Severity Index Score > 3, and Glenoid Track Instability Management Score > 3 are at higher risk of failure. In cases of multiple dislocations with critical or subcritical glenoid bone loss, notably in collision and contact athletes, the Latarjet procedure is widely recognized as the treatment of choice.
Asunto(s)
Traumatismos en Atletas , Inestabilidad de la Articulación , Recurrencia , Luxación del Hombro , Humanos , Inestabilidad de la Articulación/cirugía , Luxación del Hombro/cirugía , Traumatismos en Atletas/cirugía , Articulación del Hombro/cirugía , Articulación del Hombro/fisiopatología , Procedimientos Ortopédicos/métodosRESUMEN
The indications for bone block augmentation of the glenoid following recurrent anterior shoulder instability are expanding. Arthroscopic anatomic glenoid reconstruction (AAGR) is an evolving technique with similar clinical results to the Latarjet procedure and other open bone block procedures. Multiple types of bone grafts and fixation techniques have been described, with varying results on bony integration, resorption, articular congruity, and recurrence rates. This review focuses on biomechanics, patient workup, indications, current evidence, and the authors' preferred surgical technique for AAGR.
Asunto(s)
Artroscopía , Trasplante Óseo , Inestabilidad de la Articulación , Humanos , Artroscopía/métodos , Trasplante Óseo/métodos , Inestabilidad de la Articulación/cirugía , Articulación del Hombro/cirugía , Fenómenos BiomecánicosRESUMEN
Posterior shoulder instability is a distinct subcategory of shoulder instability with an incidence higher than previously reported. Pain is typically the primary complaint, with pathology due to repetitive microtrauma being more common that a specific traumatic event. If nonoperative treatment fails, arthroscopic posterior capsulolabral repair has been shown to result in excellent outcomes and return to sport, with American football players having the best outcomes and throwers being slightly less predictable. Risk factors for surgical failure include decreased glenoid bone width, rotator cuff injury, female gender, and the use of less than 3 anchors.
Asunto(s)
Artroscopía , Inestabilidad de la Articulación , Articulación del Hombro , Humanos , Artroscopía/métodos , Inestabilidad de la Articulación/cirugía , Articulación del Hombro/cirugía , Articulación del Hombro/fisiopatología , Factores de Riesgo , Volver al DeporteRESUMEN
Posterior glenohumeral instability represents a wide spectrum of pathoanatomic processes. A key consideration is the interplay between the posterior capsulolabral complex and the osseous anatomy of the glenoid and humeral head. Stability is dependent upon both the presence of soft tissue pathology (eg, tears to the posteroinferior labrum or posterior band of the inferior glenohumeral ligament, glenoid bone loss, reverse Hill Sachs lesions, and pathologic glenoid retroversion or dysplasia) and dynamic stabilizing forces. This review highlights unique pathoanatomic features of posterior shoulder instability and associated biomechanics that may exist in patients with posterior glenohumeral instability.
Asunto(s)
Inestabilidad de la Articulación , Articulación del Hombro , Humanos , Inestabilidad de la Articulación/fisiopatología , Fenómenos Biomecánicos , Articulación del Hombro/fisiopatología , Articulación del Hombro/anatomía & histología , Lesiones del Hombro/fisiopatología , Luxación del Hombro/fisiopatología , Luxación del Hombro/patologíaRESUMEN
Recurrent posterior shoulder instability after primary repair is uncommon, but presents a challenging clinical scenario. Most revisions in failed labral repair were associated with glenoid bone morphology related to critical bone loss, retroversion, or dysplasia. A variety of treatment options exist which include revision labral repair with or without capsular plication, glenoid osteotomy, humeral rotational osteotomy, or glenoid bone augmentation. No single technique has been shown to be superior and each technique has strengths and limitations. Therefore, thoughtful evaluation and planning is critical to address each patient's individual pathology to maximize success after revision surgery.
Asunto(s)
Inestabilidad de la Articulación , Reoperación , Articulación del Hombro , Humanos , Articulación del Hombro/cirugía , Articulación del Hombro/fisiopatología , Inestabilidad de la Articulación/cirugía , Osteotomía/métodos , Insuficiencia del Tratamiento , Artroscopía/métodos , RecurrenciaRESUMEN
There has been growing interest in the rehabilitation process and timing of returning an athlete to sport following the management options for anterior shoulder instability. The purpose of this article is to review the current rehabilitation and return to sport (RTS) protocols for various nonoperative and operative management strategies following anterior shoulder instability events. When appropriate in the rehabilitation protocol, RTS testing should be criteria based, rather than time based, with a special focus given to psychological readiness in order to promote successful return to athletics and prevention of recurrent instability episodes in the future.
Asunto(s)
Traumatismos en Atletas , Inestabilidad de la Articulación , Volver al Deporte , Humanos , Inestabilidad de la Articulación/cirugía , Inestabilidad de la Articulación/rehabilitación , Traumatismos en Atletas/cirugía , Traumatismos en Atletas/rehabilitación , Luxación del Hombro/cirugía , Luxación del Hombro/rehabilitación , Luxación del Hombro/terapia , Articulación del Hombro/cirugía , Articulación del Hombro/fisiopatologíaRESUMEN
¼ Instability and dislocation after reverse shoulder arthroplasty may occur in up to 31% of patients.¼ Clinical risk factors for instability include younger age, male sex, increased body mass index, preoperative diagnosis of proximal humerus fracture or rotator cuff pathology, history of instability of the native shoulder or after surgery, and a medical history of Parkinson's disease.¼ Patients with rheumatoid arthritis and decreased proximity to the coracoid may also be at greater risk.¼ In patients at a high risk of instability, surgeons should consider a more lateralized prosthesis (particularly in patients with an incompetent rotator cuff), repairing the subscapularis (particularly when using a medialized prosthesis), and upsizing the glenosphere (>40 mm in male and 38-40 mm in female patients).¼ While potentially useful, less evidence exists for the use of a constrained liner (particularly with a lateralized glenosphere and/or in low-demand patients) and rotating the polyethylene liner posteriorly to avoid impingement.
Asunto(s)
Artroplastía de Reemplazo de Hombro , Inestabilidad de la Articulación , Humanos , Artroplastía de Reemplazo de Hombro/efectos adversos , Inestabilidad de la Articulación/cirugía , Inestabilidad de la Articulación/etiología , Factores de Riesgo , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/prevención & control , Articulación del Hombro/cirugía , Articulación del Hombro/fisiopatología , Prótesis de Hombro/efectos adversos , Femenino , MasculinoRESUMEN
Duchenne muscular dystrophy (DMD) is an X-linked recessive genetic disorder with progressive proximal weakness as the principal sign. Glucocorticoids and physical therapy are the mainstay of treatment. Exercise intolerance is the hallmark of metabolic myopathies, which require a combination of laboratory testing, electrodiagnostic testing, and muscle biopsy for diagnosis. Joint hypermobility may be an isolated finding or be associated with hypermobility Ehlers-Danlos syndrome (EDS), other variants of EDS, or marfanoid syndromes. The latter conditions are associated with aortic and cardiac valvular abnormalities. Osteogenesis imperfecta encompasses a group of disorders characterized by bone fragility presenting with a low-impact fracture as a result of minimal trauma. Management includes multidiscipline specialists. Down syndrome (DS), or trisomy 21, is the most common chromosome abnormality identified in live births. Routine evaluation of atlantoaxial instability with x-ray is no longer recommended for children with DS without symptoms of atlantoaxial instability; however, clinical evaluation of symptoms is required for sports preparticipation. Achondroplasia is the most common skeletal dysplasia. Clinical signs are macrocephaly, short limb, short stature with disproportionately shorter humerus and femur, along with characteristic findings in pelvis and lumbar spine x-rays. Caregivers should be educated on proper positioning and handling to avoid complications, including car seat-related deaths.
Asunto(s)
Acondroplasia , Síndrome de Ehlers-Danlos , Osteogénesis Imperfecta , Humanos , Niño , Síndrome de Ehlers-Danlos/diagnóstico , Síndrome de Ehlers-Danlos/terapia , Adolescente , Acondroplasia/diagnóstico , Acondroplasia/genética , Acondroplasia/terapia , Osteogénesis Imperfecta/diagnóstico , Osteogénesis Imperfecta/terapia , Inestabilidad de la Articulación/diagnóstico , Inestabilidad de la Articulación/terapia , Distrofia Muscular de Duchenne/diagnóstico , Distrofia Muscular de Duchenne/complicaciones , Distrofia Muscular de Duchenne/genética , Distrofia Muscular de Duchenne/terapia , Síndrome de Down/complicaciones , Síndrome de Down/diagnóstico , Enfermedades Musculoesqueléticas/diagnóstico , Enfermedades Musculoesqueléticas/terapia , Síndrome de Marfan/diagnóstico , Síndrome de Marfan/terapia , Síndrome de Marfan/complicaciones , Síndrome de Marfan/genética , Glucocorticoides/uso terapéutico , Modalidades de FisioterapiaRESUMEN
BACKGROUND: Acute ankle sprains represent one of the most common traumatic injuries to the musculoskeletal system. Many individuals with these injuries experience unresolved symptoms such as instability and recurrent sprains, leading to chronic ankle instability (CAI), which affects their ability to maintain an active lifestyle. While rehabilitation programs focusing on sensorimotor, neuromuscular, strength and balance training are primary treatments, some patients require surgery when rehabilitation fails. A critical analysis of the patient-reported outcome tools (PROs) used to assess CAI surgical outcomes raises some concerns about their measurement properties in CAI patients, which may ultimately affect the quality of evidence supporting current surgical practice. The aim of this research is to develop and validate a new PRO for the assessment of ankle instability and CAI treatment outcomes, following recent methodological guidelines, with the implicit aim of contributing to the generation of scientifically meaningful evidence for clinical practice in patients with ankle instability. METHODS: Following the COnsensus-based Standards for the selection of Health Measurement Instruments (COSMIN), an Ankle Instability Treatment Index (AITI) will be developed and validated. The process begins with qualitative research based on faceâtoâface interviews with CAI individuals to explore the subjective experience of living with ankle instability. The data from the interviews will be coded following an inductive approach and used to develop the AITI content. The preliminary version of the scale will be refined through an additional round of faceâtoâface interviews with a new set of CAI subjects to define the AITI content coverage, relevance and clarity. Once content validity has been examined, the AITI will be subjected to quantitative analysis of different measurement properties: construct validity, reliability and responsiveness. DISCUSSION: The development of AITI aims to address the limitations of existing instruments for evaluating surgical outcomes in patients with CAI. By incorporating patient input and adhering to contemporary standards for validity and reliability, this tool seeks to provide a reliable and meaningful assessment of treatment effects. TRIAL REGISTRATION: Not applicable.