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Introduction: The aim of this study was to evaluate the effect of using an intra-articular injection of hylan G-F 20 (HA group) on primary shoulder osteoarthritis compared with an intra-articular triamcinolone injection (T group). Materials and Methods: The patients were randomized into 2 groups: in the HA group a single dose of intra-articular hylan G-F 20 was administered and in the T control group a dose of triamcinolone 20 mg was administered. The participants were evaluated at 1 week, 1, 3, and 6 months after the procedure. The patients were evaluated for pain, range of motion, Constant score, modified UCLA score, and SPADI. Results: Seventy patients met the inclusion criteria and were randomized to the HA (38) and T (32) groups. Improvements in range of motion were significant (p > 0.05). We observed decreases in the general visual analog scale (VAS) for pain in both groups, especially in the cases of mild and moderate arthritis that received hyaluronic acid (mean values from 8.1 initially to 4.9 after 6 months) (p = 0). Conclusions: Both injections led to a decrease in pain and an increase in patient satisfaction. The results tend to be better and longer lasting in patients receiving hyaluronic acid. Level of evidence II b; Cohort study.

Introdução: O objetivo deste estudo foi avaliar o efeito do uso de uma injeção intra-articular de Hilano G-F 20 (Grupo HA) na osteoartrite primária do ombro em comparação com injeção intra-articular de triancinolona (Grupo T). Material e Método: Os pacientes foram randomizados em dois grupos: no Grupo HA foi administrada uma dose única de Hilano G-F 20 intra-articular e no Grupo controle T foi administrada uma dose de 20 mg de triancinolona. Os participantes foram avaliados 1 semana, 1, 3 e 6 meses depois do procedimento. Os pacientes foram avaliados quanto à dor, amplitude de movimento, escore de Constant, escore UCLA modificado e índice SPADI. Resultados: Setenta pacientes satisfizeram os critérios de inclusão e foram randomizados para os Grupos HA (38) e T (32). As melhoras da amplitude de movimento foram significativas (p > 0,05). Observamos diminuições na escala visual analógica (EVA) geral para dor em ambos os grupos, principalmente nos casos de artrite leve e moderada que receberam ácido hialurônico (valores médios de 8,1 inicialmente a 4,9 depois de 6 meses) (p = 0). Conclusões: Ambas as injeções reduziram a dor e aumentaram a satisfação do paciente. Os resultados tendem a ser melhores e mais duradouros em pacientes que recebem ácido hialurônico. Nível de evidência II b; Estudo de Coorte.

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ABSTRACT Introduction The aim of this study was to evaluate the effect of using an intra-articular injection of hylan G-F 20 (HA group) on primary shoulder osteoarthritis compared with an intra-articular triamcinolone injection (T group). Materials and Methods The patients were randomized into 2 groups: in the HA group a single dose of intra-articular hylan G-F 20 was administered and in the T control group a dose of triamcinolone 20 mg was administered. The participants were evaluated at 1 week, 1, 3, and 6 months after the procedure. The patients were evaluated for pain, range of motion, Constant score, modified UCLA score, and SPADI. Results Seventy patients met the inclusion criteria and were randomized to the HA (38) and T (32) groups. Improvements in range of motion were significant (p > 0.05). We observed decreases in the general visual analog scale (VAS) for pain in both groups, especially in the cases of mild and moderate arthritis that received hyaluronic acid (mean values from 8.1 initially to 4.9 after 6 months) (p = 0). Conclusions Both injections led to a decrease in pain and an increase in patient satisfaction. The results tend to be better and longer lasting in patients receiving hyaluronic acid. Level of evidence II b; Cohort study.

RESUMO Introdução O objetivo deste estudo foi avaliar o efeito do uso de uma injeção intra-articular de Hilano G-F 20 (Grupo HA) na osteoartrite primária do ombro em comparação com injeção intra-articular de triancinolona (Grupo T). Material e Método Os pacientes foram randomizados em dois grupos: no Grupo HA foi administrada uma dose única de Hilano G-F 20 intra-articular e no Grupo controle T foi administrada uma dose de 20 mg de triancinolona. Os participantes foram avaliados 1 semana, 1, 3 e 6 meses depois do procedimento. Os pacientes foram avaliados quanto à dor, amplitude de movimento, escore de Constant, escore UCLA modificado e índice SPADI. Resultados Setenta pacientes satisfizeram os critérios de inclusão e foram randomizados para os Grupos HA (38) e T (32). As melhoras da amplitude de movimento foram significativas (p > 0,05). Observamos diminuições na escala visual analógica (EVA) geral para dor em ambos os grupos, principalmente nos casos de artrite leve e moderada que receberam ácido hialurônico (valores médios de 8,1 inicialmente a 4,9 depois de 6 meses) (p = 0). Conclusões Ambas as injeções reduziram a dor e aumentaram a satisfação do paciente. Os resultados tendem a ser melhores e mais duradouros em pacientes que recebem ácido hialurônico. Nível de evidência II b; Estudo de Coorte.

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The influence of genetic inheritance has been increasingly investigated in shoulder disorders, such as rotator cuff injury, instability and frozen shoulder. Although the initial findings are enlightening, it is necessary to progressively build a database of genetic markers to catalog genomic profiles that, later, may contribute for predicting the risk of the disease, as well as to the development of better diagnostic and treatment tools. The present article seeks to update what is evidence of genetic studies in the literature for these diseases, from polymorphism analyses, expression of candidate genes in tissues and broad genomic association studies (GWAS). However, it is necessary to point out that there is great difficulty in replicating and using the findings, mainly due to the lack of statistical power, the high rate of false-positive results and the large number of variables involved.

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Abstract The influence of genetic inheritance has been increasingly investigated in shoulder disorders, such as rotator cuff injury, instability and frozen shoulder. Although the initial findings are enlightening, it is necessary to progressively build a database of genetic markers to catalog genomic profiles that, later, may contribute for predicting the risk of the disease, as well as to the development of better diagnostic and treatment tools. The present article seeks to update what is evidence of genetic studies in the literature for these diseases, from polymorphism analyses, expression of candidate genes in tissues and broad genomic association studies (GWAS). However, it is necessary to point out that there is great difficulty in replicating and using the findings, mainly due to the lack of statistical power, the high rate of false-positive results and the large number of variables involved.

Resumo A influência da herança genética tem sido cada vez mais investigada nas afecções do ombro, como a lesão do manguito rotador, instabilidade e ombro congelado. Ainda que os achados iniciais sejam pouco esclarecedores, é necessário construir progressivamente um banco de marcadores genéticos para catalogar perfis genômicos que, mais adiante, poderão contribuir para a previsão do risco da doença, desenvolvimento de melhores ferramentas de diagnóstico e tratamento. O presente artigo busca atualizar o que há de evidências de estudos genéticos na literatura para essas doenças, desde análises de polimorfismos, expressão de genes candidatos em tecidos e estudos de associação genômica ampla (GWAS, na sigla em inglês). Porém, é necessário apontar que existe grande dificuldade na replicação e utilização dos achados, principalmente em razão da falta de poder estatístico, da alta taxa de resultados falso-positivos e da grande quantidade de variáveis envolvidas.

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Objective To clarify the association of thyroid disorders and primary frozen shoulder by comparing this group with controls without shoulder disease and with patients with rotator cuff tears. Methods We evaluated 166 patients who presented frozen shoulder with treatment in progress or already treated, which were compared with 129 patients with diagnosis of rotator cuff tears and 251 control subjects. All of the participants answered the questionnaire on the following variables: age, gender, body mass index (BMI), occupation, physical activity, presence of thyroid disorders and other comorbidities, smoking and use of alcohol. Results When comparing the frozen shoulder group with the control and rotator cuff groups, there is a specific association between the presence of thyroid disorders and frozen shoulder. By calculating relative risk, it is possible to state that an individual with thyropathy has 2.69 more chance of developing frozen shoulder. Also, there was an association with gender, since women with frozen shoulder exceeded significantly the risk. Conclusions Thyroid disorders, especially hypothyroidism and the presence of benign thyroid nodules, are risk factors significantly associated with frozen shoulder, rising the chances to 2.69 times of developing frozen shoulder. This is the first study that uses, in addition to the control group, a second group with rotator cuff tears, so it was shown that there is a specific association of thyroid disorders and frozen shoulder, but not with shoulder disorders in general.

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Abstract Objective To clarify the association of thyroid disorders and primary frozen shoulder by comparing this group with controls without shoulder disease and with patients with rotator cuff tears. Methods We evaluated 166 patients who presented frozen shoulder with treatment in progress or already treated, which were compared with 129 patients with diagnosis of rotator cuff tears and 251 control subjects. All of the participants answered the questionnaire on the following variables: age, gender, body mass index (BMI), occupation, physical activity, presence of thyroid disorders and other comorbidities, smoking and use of alcohol. Results When comparing the frozen shoulder group with the control and rotator cuff groups, there is a specific association between the presence of thyroid disorders and frozen shoulder. By calculating relative risk, it is possible to state that an individual with thyropathy has 2.69 more chance of developing frozen shoulder. Also, there was an association with gender, since women with frozen shoulder exceeded significantly the risk. Conclusions Thyroid disorders, especially hypothyroidism and the presence of benign thyroid nodules, are risk factors significantly associated with frozen shoulder, rising the chances to 2.69 times of developing frozen shoulder. This is the first study that uses, in addition to the control group, a second group with rotator cuff tears, so it was shown that there is a specific association of thyroid disorders and frozen shoulder, but not with shoulder disorders in general.

Resumo Objetivo Verificar a asssociação entre tireopatias e ombro congelado primário, comparando com grupo controle e com grupo de pacientes com lesão no manguito rotador. Métodos Foram avaliados 166 pacientes com diagnóstico de ombro congelado primário com tratamento em andamento ou já tratados. Este grupo foi comparado com 129 pacientes com diagnóstico de lesão de manguito rotador e com um terceiro grupo controle formado por 251 indivíduos sem acometimento dos ombros. Todos os participantes responderam questionário sobre as seguintes variáveis: idade, gênero, índice de massa corpórea (IMC), profissão, atividade física, presença de tireopatia e de outras comorbidades, hábito tabagista e etilismo. Resultados Quando comparamos o grupo de ombro congelado com os grupos controle e lesão de manguito rotador, percebemos que existe uma associação específica entre presença de doenças da tireoide (tireoidite, hipotireoidismo, hipertireoidismo, nódulos e câncer) e ombro congelado. Através do cálculo do risco relativo, é possível afirmar que um indivíduo com tireopatia tem probabilidade 2.69 maior de desenvolver ombro congelado. Também houve associação com gênero, já que as mulheres com ombro congelado elevam significativamente esse risco. Conclusão Os distúrbios da tireoide, especialmente o hipotireoidismo e a presença de nódulos tireoidianos benignos, são fatores de risco significativamente associados ao ombro congelado, aumentando as chances em 2,69 vezes de desenvolver a doença. Este é o primeiro estudo que utiliza, além do grupo controle, um segundo grupo com lesões do manguito rotador, de modo que foi demonstrada uma associação específica de distúrbios da tireoide e ombro congelado.

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Objective To identify the clinical, radiological, and arthroscopic correlation of long head of the biceps tendon injuries and their influence on pain when associated with rotator cuff injuries. Methods Between April and December 2013, 50 patients were evaluated, including 38 (76%) women and 12 (24%) men, with a mean age of 65.1 years old. The patients were operated by the Shoulder and Elbow Group, Discipline of Sports Medicine, Orthopedics and Traumatology Department, Universidade Federal de São Paulo. The subjects underwent repair of the rotator cuff lesion with clinical, radiological and/or arthroscopic evidence of involvement of the long head of the biceps tendon. Results An association between pain at palpation of the intertubercular groove of the humerus and high-grade partial lesions (partial rupture of the tendon affecting more than 50% of its structure) was observed at the arthroscopy ( p = 0.003). There was also an association between the high-grade lesion of the long head of the biceps and injury to the supraspinatus muscle tendon ( p < 0.05). For each centimeter of the supraspinatus muscle tendon injury, the patient presented a 1.7 higher probability of having a high-grade lesion at the long head of the biceps. Conclusion Pain at the anterior shoulder region during palpation of the intertubercular groove of the humerus may be related to high-grade lesions to the long head of the biceps. Rotator cuff injury and its size are risk factors for high-grade injuries to the long head of the biceps tendon.

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Abstract Objective To identify the clinical, radiological, and arthroscopic correlation of long head of the biceps tendon injuries and their influence on pain when associated with rotator cuff injuries. Methods Between April and December 2013, 50 patients were evaluated, including 38 (76%) women and 12 (24%) men, with a mean age of 65.1 years old. The patients were operated by the Shoulder and Elbow Group, Discipline of Sports Medicine, Orthopedics and Traumatology Department, Universidade Federal de São Paulo. The subjects underwent repair of the rotator cuff lesion with clinical, radiological and/or arthroscopic evidence of involvement of the long head of the biceps tendon. Results An association between pain at palpation of the intertubercular groove of the humerus and high-grade partial lesions (partial rupture of the tendon affecting more than 50% of its structure) was observed at the arthroscopy (p = 0.003). There was also an association between the high-grade lesion of the long head of the biceps and injury to the supraspinatus muscle tendon (p < 0.05). For each centimeter of the supraspinatus muscle tendon injury, the patient presented a 1.7 higher probability of having a high-grade lesion at the long head of the biceps. Conclusion Pain at the anterior shoulder region during palpation of the intertubercular groove of the humerus may be related to high-grade lesions to the long head of the biceps. Rotator cuff injury and its size are risk factors for high-grade injuries to the long head of the biceps tendon.

Resumo Objetivo Identificar a correlação clínica, radiológica, e artroscópica das lesões do tendão da cabeça longa do bíceps e sua influência na dor do paciente quando associada às lesões do manguito rotador. Métodos Entre abril e dezembro de 2013, foram avaliados 50 pacientes, sendo 38 (76%) do sexo feminino e 12 (24%) do sexo masculino, com idade média de 65,1 anos. Os pacientes foram operados pelo Grupo de Ombro e Cotovelo da Disciplina de Medicina Esportiva do Departamento de Ortopedia e Traumatologia da Universidade Federal de São Paulo. Os indivíduos foram submetidos a reparo da lesão do manguito rotador com evidência clínica, radiológica e/ou artroscópica de acometimento do tendão da cabeça longa do bíceps. Resultados Observou-se associação entre dor à palpação do sulco intertubercular do úmero com lesão parcial de alto grau (ruptura parcial acometendo mais de 50% do tendão) na artroscopia (p = 0,003). Encontramos ainda uma associação entre a lesão de alto grau da cabeça longa do bíceps e a lesão do tendão do músculo supraespinal (p < 0,05), sendo que, para cada centímetro de lesão do tendão do músculo supraespinal, o paciente apresenta probabilidade 1,7 maior de ter uma lesão de alto grau da cabeça longa do bíceps. Conclusão A dor na região anterior do ombro à palpação do sulco intertubercular do úmero pode estar relacionada às lesões de alto grau da cabeça longa do bíceps. A lesão do manguito rotador e o seu tamanho são fatores de risco para lesão de alto grau do tendão da cabeça longa do bíceps.

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Rotator cuff tears (RCT) is a multifactorial disease with genetic factors contributing for the disease etiology. We hypothesized that genetic variants in genes involved in extracellular matrix (ECM) homeostasis may alter susceptibility to RCT. We evaluated 20 polymorphisms of genes involved in ECM homeostasis in 211 cases of full-thickness tears of the supraspinatus (Nfemales = 130; Nmales = 81) and 567 age-matched controls (Nfemales = 317; Nmales = 250). Multivariate logistic regressions were carried out with age, gender, genetic ancestry (based on the analysis of 61 biallelic short insertion/deletion polymorphisms), and common co-morbidities (diabetes, dyslipidemia, and smoking habits) as covariates. We observed that carriers of the rare allele of both studied variants of TGFB1, as well as their G/A (rs1800470/rs1800469) haplotype, were less susceptible to RCT (p < 0.05). In contrast, carriers of the G allele of MMP9 rs17576 (p = 0.014) or G/G haplotype (rs17576/rs17577; p < 0.001) had an increased risk for tendon tears. The presence of the T allele of MMP2 rs2285053 (p = 0.033), the T allele of MMP3 rs679620 (p = 0.024), and the TT-genotype of TIMP2 rs2277698 (p = 0.01) was associated with susceptibility to tears, especially in females. In males, the A allele of COL5A1 rs3196378 (p = 0.032) and the G allele of TGFBR1 rs1590 (p = 0.039) were independent risk factors for RCT. The C/T COL5A1 (rs3196378/rs11103544) haplotype was associated with a reduced risk of tears in males (p = 0.03). In conclusion, we identified the genetic variants associated with RCT susceptibility, thereby reinforcing the role of genes involved in the structure and homeostasis of the ECM of tendons in disease development. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:192-201, 2020.

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Frozen shoulder is a condition of loss of active and passive motion as result of inflammatory contracture and fibrosis of the joint capsule. We hypothesize that genetic variants in genes involved in these processes such as genes that play a role in extracellular matrix homeostasis (collagens, glycoproteins, genes involved in TGFß signaling, and metalloproteinases and its inhibitors) may contribute to the susceptibility to frozen shoulder. We evaluated eighteen SNPs of genes involved in extracellular matrix homeostasis in 186 cases (Nfemales = 114; Nmales = 72) of frozen shoulder and 600 age-matched controls (Nfemales = 308; Nmales = 292). Multivariate logistic regressions were carried out with age, gender, genetic ancestry, and common comorbidities as covariates. Carriers of the C allele of MMP13 rs2252070 and G/G MMP9 (rs17576 A>G/rs17577 G>A) haplotype may have an increased risk of frozen shoulder (p = 0.002, OR = 1.64, 95%CI = 1.20-2.26, and p = 0.046, OR = 1.40, 95%CI = 1.01-1.95, respectively), especially in females (p = 0.005, OR = 1.91, 95%CI = 1.22-2.99, and p = 0.046, OR = 1.59, 95%CI = 1.01-2.51, respectively). In females, the G allele of MMP9 rs17576 tended to contribute to the susceptibility to the studied disease (p = 0.05, OR = 1.51, 95%CI = 0.97-2.33). In contrast, the presence of the C allele of TGFB1 rs1800470 seems to be associated with a reduced risk (p = 0.04, OR = 0.47, 95%CI = 0.23-0.96) while the GG-genotype of TGFBR1 rs1590 was associated with increased risk (p = 0.027, OR = 4.11, 95%CI = 1.17-14.38) to frozen shoulder development in males. Thus, we identified genetic variants that were independent risk factors that can aid in the risk assessment of frozen shoulder reinforcing the involvement of MMP and TGFß signaling in disease development. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res.

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