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Abstract Purpose To evaluate the agreement in tear size obtained through preoperative imaging and intraoperative measurement, and to determine the accuracy of preoper-ative imaging in the classification of tear size and identification of tears in each rotator cuff tendon. Methods Data from 44 patients recruited to a randomized controlled trial were reviewed retrospectively. Size and location of the rotator cuff tears were confirmed by either ultrasound or magnetic resonance imaging scans preoperatively and evaluated during surgery. A t-test and Bland and Altman plot were used to determine the agreement between the preoperative and intraoperative measurements. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated for tear size and involvement of the rotator cuff tendon. Results There was good agreement in terms of the measurements (91%) and classification (89%) of the tear size preoperatively and during surgery. When classifying tear size, the sensitivity and PPV were high for medium-sized tears (100%) and lower for large tears (75%), reflecting that all medium-sized tears but not all large tears were identified preoperatively. For the preoperative identification of the tears, the sensitivity and PPV were highest for the supraspinatus (84%), with progressively lower sensitivities and PPV for the infraspinatus (57%), subscapularis (17%) and teres minor (0%). Conclusions Through preoperative imaging, the measurement or classification of the tear size can be accurately performed. Where there is disagreement, it is unclear whether the tear size is either underestimated on the scan or overestimated during surgery. The high sensitivity demonstrates that a supraspinatus tear is usually detected by scan. The lower sensitivities for the infraspinatus and subscapularis indicate that the identification of tears in these tendons is less accurate.

Resumo Objetivo Avaliar a concordância no tamanho de ruptura obtido por imagem préoperatória e por medição intraoperatória, e determinar a precisão da imagem préoperatória na classificação do tamanho da ruptura e na identificação de rupturas em cada tendão do manguito rotador. Métodos Os dados de 44 pacientes recrutados para um ensaio controlado randomizado foram revisados retrospectivamente. O tamanho e a localização do manguito rotador foram confirmados por ultrassom ou ressonância magnética préoperatórios, e avaliados durante a cirurgia. Um teste t e o gráfico de Bland e Altman foram usados para determinar a concordância entre as medições pré-operatória e intraoperatória. Sensibilidade, especificidade, valor preditivo positivo (VPP) e valor preditivo negativo (VPN) foram calculados para o tamanho do rompimento e o envolvimento do tendão do manguito rotador. Resultados Houve boa concordância para medidas de tamanho da ruptura (91%) e classificação (89%) pré-operatória e durante a cirurgia. Ao classificar o tamanho da ruptura, a sensibilidade e o VPP foram elevados para rupturas de tamanho médio (100%), e menor para rupturas grandes (75%), o que indica que todas as rupturas de tamanho médio, mas nem todas as grandes, foram identificadas pré-operatoriamente. Para a identificação de rupturas, a sensibilidade pré-operatória e o VPP foram maiores para o supraespinal (84%), com sensibilidade e VPP progressivamente menores para o infraespinal (57%), o subescapular (17%), e o redondo menor (0%). Conclusões Por meio da imagem pré-operatória, pode-se medir ou classificar com precisão o tamanho da ruptura. Quando há discordância, não está claro se o tamanho da ruptura é subestimado no exame ou superestimado durante a cirurgia. A alta sensibilidade demonstra que uma ruptura do supraespinal é geralmente detectada por escaneamento. As sensibilidades mais baixas para o infraespinal e o subescapular indicam que a identificação de rupturas nestes tendões é menos precisa.

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La capsulitis adhesiva de hombro se caracteriza por la inflamación crónica de la capa subsinovial de la cápsula articular que produce fibrosis, contractura y adherencia de la cápsula a sí misma y al cuello anatómico del húmero. La rehabilitación enfocada en optimizar el rango de movilidad en forma activa y pasiva es la base del tratamiento, independientemente de la etapa. Sobre la base de la historia natural de la enfermedad, la inyección con corticoides en forma precoz tiene utilidad en acortar la duración general de los síntomas, y permite a los pacientes trabajar el rango de movilidad en las etapas de rehabilitación y así volver a sus actividades cotidianas más rápidamente. La mayoría de los pacientes tratados con terapia física logran la resolución completa de síntomas. En casos con rigidez refractaria, puede estar indicada la manipulación bajo anestesia o la liberación capsular artroscópica; debido a varios riesgos potenciales de complicaciones con las manipulaciones, se prefiere esta última. Existen escasos estudios con alto nivel de evidencia que comparen diferentes técnicas para la liberación capsular: tanto la liberación circunferencial como la capsular anteroinferior han demostrado ser efectivas como técnica quirúrgica. La cirugía debe ser seguida de forma temprana por una terapia física diligente y dirigida a prevenir la rigidez recurrente

Adhesive capsulitis is characterized by chronic inflammation of the capsular subsynovial layer, which produces capsular fibrosis, contracture, and adherence of the capsule to itself and to the anatomic neck of the humerus. Physical therapy is the mainstay of treatment, regardless of stage. Based on the natural history of the disease, early corticosteroid injection has a role in shortening the overall duration of symptoms allowing patients to move faster in the stages of rehabilitation and thus return to their daily life activities more rapidly. Most patients will see complete resolution of symptoms with nonsurgical management. In cases with refractory stiffness, manipulation under anesthesia or arthroscopic capsular release may be indicated. Because of various potential risks of complications with manipulations, arthroscopic capsular release is preferred. There is a lack of high-level studies comparing different techniques for capsular release. Both circumferential and anteroinferior release have proven to be effective. Surgery should be followed by early, diligent and directed therapy to prevent recurrent stiffness

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Resumen: La sinovitis villonodular pigmentada extraarticular, también llamada tumor de células gigantes de la vaina tendinosa, es frecuente en la mano, siendo extremadamente rara su localización en la rodilla. Se presenta el caso de un paciente con una bursitis villonodular pigmentada de la bursa de la pata de ganso sin afectación intraarticular. Extra-articular pigmented villonodular synovitis, also called giant cell tumor of the tendon sheath, is common in the hand, being extremely rare in the knee. We present the case of a patient with a pigmented villonodular bursitis of the pes anserine bursa without intraarticular involvement.

Abstract: Extra-articular pigmented villonodular synovitis, also called giant cell tumor of the tendon seath, is common in the hand, being extremely rare in the knee. We present the case of a patient with a pigmented villonodular bursitis of the pes anserine bursa without intraarticular involvement.

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Introducción: Evaluar los resultados de la artrolisis artroscópica seguida de un protocolo de rehabilitación acelerada empleando un catéter interescalénico permanente para tratar rigideces secundarias de hombro.Material y métodos: Revisión retrospectiva de casos intervenidos de artrolisis de hombro con alguna causa identificable de la rigidez. Se emplea un catéter interescalénico para bloqueo nervioso de la extremidad afecta que se mantiene al menos 5 días. El alta hospitalaria se realiza después de la primera sesión de rehabilitación en las siguientes 24 horas tras la intervención. Se evalúa variación de la movilidad articular, mejoría del dolor y de la capacidad funcional.Resultado: Se incluyen 11 pacientes en el estudio. Las causas de la rigidez fueron cirugías previas de osteosíntesis de fracturas de húmero proximal, reparaciones de manguito rotador, reparación de Bankart y traumatismos sin fractura. El seguimiento medio fue de 26.4 (8.3) meses. Se observa una mejoría estadísticamente significativa en la flexión [95.6 (32)º - 153.4 (59)º], rotación externa [33.9 (17)º - 59.2 (32)º], EVA [7.2 (2.9) - 2.1 (1.7)] y Quick-DASH Score [68.2 (33)º - 22.7 (13)º], pero no en la rotación interna ni en la ASES Score. No se registró ninguna complicación. Un paciente precisó una nueva artrolisis por no mejoría de movilidad a los 3 meses. La causa de la rigidez no influyó en los resultados.Conclusión: La artrolisis artroscópica seguida del inicio precoz de la fisioterapia con bloqueo de la extremidad con catéter interescalénico permanente es segura y proporciona buenos resultados funcionales. Tipo de estudio: Serie de Casos. Nivel de Evidencia: IV

Objective: To evaluate outcomes of arthroscopic arthrolysis followed by an early rehabilitation protocol using an indwelling interscalene catheter as treatment of secondary shoulder stiffness.Materials and methods: A retrospective review of cases who had surgery for shoulder stiffness with an identifiable cause is performed. An interscalene catheter is left after surgery for nervous blockade for at least 5 days. Hospital check-out is carried out immediately after first physical therapy session, at 24 hours from surgery. Outcomes are presented as improvement of range of motion, pain and functional status.Results: 11 patients were included in the study. Causes of stiffness were previous surgeries consisting on osteosynthesis for proximal humeral fractures, repair of rotator cuff tears, Bankart repair and trauma without fracture. Mean follow-up was 26.4 (8.3) months. Significant differences on flexion [95.6 (32)º - 153.4 (59)º], external rotation [33.9 (17)º - 59.2 (32)º], VAS [7.2 (2.9) - 2.1 (1.7)] and Quick-DASH Score [68.2 (33)º - 22.7 (13)º] were observed, while no differences on internal rotation and ASES Score. No complications were registered. One case required re-operation at 3 months due to no progression of shoulder motion. Cause of stiffness did not influence outcomes.Conclusion: Arthroscopic arthrolysis followed by early rehabilitation with nervous blockade of the extremity by an indwelling interscalene catheter is safe and provides good functional outcomes. Study type: case report. Level of evidence: IV

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PURPOSE: The purpose of this study is to report the early and midterm functional outcomes and complications of a consecutive series of patients with primary adhesive capsulitis who were treated with isolated anteroinferior arthroscopic capsular release after they did not respond to conservative treatment. METHODS: Thirty-two consecutive patients with idiopathic adhesive capsulitis who did not respond to conservative physiotherapy were included in the study. Arthroscopic anteroinferior capsular release was performed in all cases. The primary outcome was improvement in range of motion in the short- and midterm follow-up. We also evaluated pain relief with the visual analog scale, functional outcomes with the Constant-Murley score, and we registered postoperative complications. RESULTS: The mean age was 49.6 years (range, 33-68 years) and the mean follow-up was 63 months (range, 18-84). Overall, there was significant improvement in the Constant-Murley score from 42.4 to 86 points (P < .001). The visual analog scale decreased by approximately 6.3 points compared with the preoperative value (P < .001). All parameters improved significantly the first 6 months and then remained stable until the end of follow-up (P < .001). There was an additional minor improvement in both parameters between the sixth month and the final follow-up; however, this improvement was less than in the first 6 months and it was not statistically significant. CONCLUSIONS: In patients who don't respond to conservative treatment for primary adhesive capsulitis, isolated anteroinferior capsular release provides a reliable improvement in pain and range of motion that is maintained in the mid-term follow-up. LEVEL OF EVIDENCE: Level IV, therapeutic, case series study.

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Introducción: La bursitis es una causa común en la consulta ortopédica. Su diagnóstico muchas veces se ve dificultado por la inespecificidad de los síntomas. En general, su resolución es de naturaleza incruenta, pero en casos de fallo de esta, el tratamiento quirúrgico es el indicado. El objetivo del presente trabajo es la evaluación retrospectiva de una serie de casos tratados con bursectomía vía artroscópica. Materiales y métodos: Análisis retrospectivo de una serie de casos tratados entre 2001 y 2013, de bursectomía vía endoscópica. Se realizaron 44 procedimientos en nuestro centro. Cuatro casos de bursitis séptica. El seguimiento fue de 6 meses a 13 años. Todos los pacientes recibieron tratamiento incruento (FKT y AINES) previo a la cirugía. Resultados: Todos los pacientes de esta serie volvieron a su actividad habitual dentro de las tres semanas posteriores al acto quirúrgico. No se observaron complicaciones de herida, ni infección de sitio quirúrgico. Con un seguimiento de 6 meses a 13 años no hemos visto aún ningún caso de recidiva. Discusión: La bursectomía por vía endoscópica logra la resección, en forma similar a las cirugía abierta. Además permite ver todo el territorio de la bursa, con las ventajas de una cirugía de mínima invasión, que se puede realizar con anestesia local, no requiere rehabilitación y permite retomar la actividad laboral en pocos días. Nivel de evidencia: IV. Tipo de estudio: Serie de casos.

Introduction: Bursitis is a common cause of musculoskeletal pain and often prompts orthopaedic consultation. Sometimes, the diagnose is difficult to asses due to the inespecific clinical manifestations. Most patients respond to nonsurgical management, but when it fails surgical treatment is the next step. The aim of this study was a review of all patients treated of chronic bursitis by resection of the bursa using endoscopic technique. Material and methods: All patients treated at our institution between 2001 and 2013 of endoscopic resection of the bursa were included and analyzed. From the group of 44 patients, only four had septic bursitis. Follow up was between 6 months and 13 years. Results: All patients were able to return to their activity three weeks after surgery. There were no wound complications or infections. At least follow up there were neither recurrence not persistent pain. Discussion: A complete resection of the bursa can be achieved performing an endoscopic technique, as well as an open technique. Local anesthesia can be used. There is no need for fisiotherapy. Patients can return to normal activities in a few days. Level of evidence: IV. Type of study: Case Series.

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OBJECTIVE: to evaluate the results of arthroscopic treatment of refractory adhesive capsulitis of the shoulder associated as for improved range of motion after a minimum follow up of six years. METHODS: from August 2002 to December 2004, ten patients with adhesive capsulitis of the shoulder resistant to conservative treatment underwent arthroscopic surgery. One interscalene catheter was placed for postoperative analgesia before the procedure. All were in Phase II, with a minimum follow up of two years. The mean age was 52.9 years (39-66), predominantly female (90%), six on the left shoulder. The time between onset of symptoms and surgical treatment ranged from six to 20 months. Four adhesive capsulitis were found to be primary (40%) and six secondary (60%). RESULTS: the preoperative mean of active anterior elevation was 92°, of external rotation was 10.5° of the L5 level internal rotation; the postoperative ones were 149°, 40° and T12 level, respectively. Therefore, the average gain was 57° for the anterior elevation, 29.5° for external rotation in six spinous processes. There was a significant difference in movements' gains between the pre and post-operative periods (p<0.001). By the Constant Score (range of motion), there was an increase of 13.8 (average pre) to 32 points (average post). CONCLUSION: the arthroscopic treatment proved effective in refractory adhesive capsulitis of the shoulder resistant to conservative treatment, improving the range of joint movements of patients evaluated after a minimum follow up of six years.

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OBJECTIVE: to evaluate the results of arthroscopic treatment of refractory adhesive capsulitis of the shoulder associated as for improved range of motion after a minimum follow up of six years. METHODS: from August 2002 to December 2004, ten patients with adhesive capsulitis of the shoulder resistant to conservative treatment underwent arthroscopic surgery. One interscalene catheter was placed for postoperative analgesia before the procedure. All were in Phase II, with a minimum follow up of two years. The mean age was 52.9 years (39-66), predominantly female (90%), six on the left shoulder. The time between onset of symptoms and surgical treatment ranged from six to 20 months. Four adhesive capsulitis were found to be primary (40%) and six secondary (60%). RESULTS: the preoperative mean of active anterior elevation was 92°, of external rotation was 10.5° of the L5 level internal rotation; the postoperative ones were 149°, 40° and T12 level, respectively. Therefore, the average gain was 57° for the anterior elevation, 29.5° for external rotation in six spinous processes. There was a significant difference in movements' gains between the pre and post-operative periods (p<0.001). By the Constant Score (range of motion), there was an increase of 13.8 (average pre) to 32 points (average post). CONCLUSION: the arthroscopic treatment proved effective in refractory adhesive capsulitis of the shoulder resistant to conservative treatment, improving the range of joint movements of patients evaluated after a minimum follow up of six years. .

OBJETIVO: avaliar os resultados do tratamento artroscópico da capsulite adesiva refratária do ombro, relacionados à melhora da amplitude de movimentos, após seguimento mínimo de seis anos. MÉTODOS: do período de agosto de 2002 a dezembro de 2004, dez pacientes com capsulite adesiva do ombro resistentes ao tratamento conservador foram submetidos à cirurgia artroscópica. Foi colocado um cateter interescalênico para analgesia pós-operatória, antes do procedimento. Todos se encontravam na Fase II, com seguimento mínimo de dois anos. A média de idade foi 52,9 anos (39 a 66), com predominância do sexo feminino (90%), sendo seis ombros do lado esquerdo. O tempo entre o aparecimento dos sintomas e o tratamento operatório variou de seis a 20 meses. Foram encontradas quatro capsulites adesivas na forma primária (40%) e seis secundárias (60%). RESULTADOS: a média ativa pré-operatória da elevação anterior foi 92°, da rotação externa 10,5° da rotação interna nível L5 e a média ativa pós-operatória foi 149°, 40° e nível T12, respectivamente. Portanto, os ganhos médios foram de 57° na elevação anterior, 29,5° na rotação externa e seis processos espinhosos. Houve diferença significativa nos ganhos de movimentos entre o pré e o pós-operatório (p<0,001). Pela pontuação de Constant (amplitude de movimentos), houve um aumento de 13,8 (média pré) para 32 pontos (média pós). CONCLUSÃO: o tratamento artroscópico mostrou-se eficaz na capsulite adesiva refratária do ombro, resistente ao tratamento conservador, melhorando a amplitude dos movimentos articulares de pacientes avaliados após seguimento mínimo de seis anos. .

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OBJECTIVE: To evaluate the results of the arthroscopic treatment of refractory adhesive capsulitis of the shoulder with two to nine years of follow-up, comparing the pre-and postoperative range of motion. METHODS: This was an observational study (case series) of 18 patients who underwent arthroscopic capsular release for refractory shoulder stiffness. The mean age was of 53.6 years (range: 39 to 68), with female predominance (77.77%) and nine cases left shoulders. There were 6 primary (33.33%) and 12 secondary cases (66.67%). Arthroscopic capsular release was performed in all patients after a mean of 9.33 months of physical therapy (range: 6 to 20 months) with a minimum follow-up of two years (range: 26 to 110 months). RESULTS: The mean active and passive forward flexion, external rotation and internal rotation increased from 94.4º/103.3º, 11.9º/21.9º, and S1/L5 vertebral level, respectively, to 151.1º/153.8º, 57.2º/64.4º, and T12/T10 vertebral level, respectively. There was a significant difference between the pre-and postoperative range of motion (p < 0.001). according to the constant-murley functional score (rom), the value increased from 14 (preoperative mean) to 30 points (postoperative mean). postoperatively, all patients showed diminished shoulder pain (none or mild/15 or 10 points in the constant-murley score). CONCLUSION: arthroscopic treatment is an effective treatment for refractory shoulder stiffness.

OBJETIVO: Avaliar os resultados do tratamento artroscópico da capsulite adesiva refratária do ombro com dois a nove anos de seguimento, comparando o arco de movimentos pré e pós-operatório. MÉTODOS: Foi realizado um estudo observacional (série de casos) em 18 pacientes com ombros rígidos resistentes a tratamento conservador submetidos à capsulotomia artroscópica. A idade média foi de 53,6 anos (39 a 68), com predomínio do sexo feminino (77,77%) e nove ombros esquerdos. Houve seis primários (33,33%) e 12 secundários (66,67%). A liberação capsular artroscópica foi realizada em todos os pacientes, após uma média de 9,33 meses de fisioterapia (6 a 20 meses), com seguimento mínimo de dois anos (26 a 110 meses). RESULTADOS: A média da elevação anterior, rotação lateral e rotação medial ativa e passiva aumentaram de 94,4º/103,3º, 11,9º/21,9ºe S1/L5 níveis vertebrais para 151,1º/153,8º, 57,2º/64,4ºe T12/T10 níveis vertebrais, respectivamente. Houve uma significativa diferença entre a amplitude de movimentos pré-e pós-operatório (p < 0,001). de acordo com o escore funcional de constant-murley, o valor aumentou de 14 (média pré-operatória) para 30 pontos (média pós-operatória). no pós-operatório, todos os pacientes demonstraram uma diminuição da dor no ombro (nenhuma ou leve/15 ou 10 pontos no escore de constant-murley). CONCLUSÃO: O tratamento artroscópico é eficaz para a rigidez refratária do ombro.

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OBJECTIVE: To evaluate the results of the arthroscopic treatment of refractory adhesive capsulitis of the shoulder with two to nine years of follow-up, comparing the pre- and postoperative range of motion. METHODS: This was an observational study (case series) of 18 patients who underwent arthroscopic capsular release for refractory shoulder stiffness. The mean age was of 53.6 years (range: 39 to 68), with female predominance (77.77%) and nine cases left shoulders. There were 6 primary (33.33%) and 12 secondary cases (66.67%). Arthroscopic capsular release was performed in all patients after a mean of 9.33 months of physical therapy (range: 6 to 20 months) with a minimum follow-up of two years (range: 26 to 110 months). RESULTS: The mean active and passive forward flexion, external rotation and internal rotation increased from 94.4°/103.3°, 11.9°/21.9°, and S1/L5 vertebral level, respectively, to 151.1°/153.8°, 57.2°/64.4°, and T12/T10 vertebral level, respectively. There was a significant difference between the pre- and postoperative range of motion (p < 0.001). According to the Constant-Murley functional score (ROM), the value increased from 14 (preoperative mean) to 30 points (postoperative mean). Postoperatively, all patients showed diminished shoulder pain (none or mild/15 or 10 points in the Constant-Murley score). CONCLUSION: Arthroscopic treatment is an effective treatment for refractory shoulder stiffness.

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