RESUMO
INTRODUCTION: Subacromial injections are therapeutic options for rotator cuff injuries, with consistent results not well established yet for each drug applied. The objective of this systematic review and meta-analysis is to analyse the effectiveness of the substances used in subacromial injections for the treatment of rotator cuff injuries and shoulder impingement syndrome, considering the functional gain and pain improvement of the shoulder. METHODS AND ANALYSIS: Beginning in November 2022, we will perform a detailed search using the MEDLINE/PubMed, EMBASE, Cochrane Central Register of Controlled Trials and LILACS databases. Relevant grey literature (reference lists, conference abstracts and academic papers) will also be included.Two reviewers will independently screen and extract the information from the literature. Bias and quality of the included studies will be evaluated using the risk of bias assessment tool provided by the Cochrane Collaboration. Statistical analyses will be performed using Review Manager V.5.4 software. ETHICS AND DISSEMINATION: Approval and patient informed consent are not required because we will only include published literature. The results of this research will be disseminated in a peer-reviewed journal and likely through other scientific events. PROSPERO REGISTRATION NUMBER: CRD42020199292.
Assuntos
Lesões do Manguito Rotador , Síndrome de Colisão do Ombro , Humanos , Manguito Rotador , Lesões do Manguito Rotador/tratamento farmacológico , Dor de Ombro/tratamento farmacológico , Síndrome de Colisão do Ombro/tratamento farmacológico , Projetos de Pesquisa , Metanálise como Assunto , Revisões Sistemáticas como AssuntoRESUMO
ABSTRACT BACKGROUND: Shoulder pain is considered to be the third largest cause of musculoskeletal functional alterations in individuals presenting pain during movement. OBJECTIVE: The purpose of this synthesis of evidence was to identify the clinical effectiveness of conservative and surgical treatments reported in Cochrane systematic reviews among individuals diagnosed with rotator cuff disease. DESIGNAND SETTING: Review of systematic reviews, conducted in the Federal University of São Paulo (Universidade Federal de São Paulo, UNIFESP). METHODS: This synthesis of evidence included systematic reviews that had been published in the Cochrane database. The inclusion criteria were that these systematic reviews should involve individuals aged ≥ 16 years with rotator cuff disease, comparing surgical procedures with or without associated nonsurgical procedures versus placebo, no treatment or other nonsurgical interventions. RESULTS: Thirty-one systematic reviews were included, involving comparisons between surgical procedures and conservative treatment; procedures either combined or not combined with drugs, versus other procedures; and procedures involving exercises, manual therapy and electrothermal or phototherapeutic resources. CONCLUSIONS: The findings suggest that strengthening exercises, with or without associated manual therapy techniques and other resources, were the interventions with greatest power of treatment over the medium and long terms, for individuals with shoulder pain. These had greater therapeutic power than surgical procedures, electrotherapy or photobiomodulation. Protocol registration number in the PROSPERO database: ID - CRD42018096578.
Assuntos
Humanos , Medicina Baseada em Evidências , Lesões do Manguito Rotador/terapia , Fototerapia/métodos , Exercício Físico , Resultado do Tratamento , Dor de Ombro/terapia , Manejo da Dor/métodos , Lesões do Manguito Rotador/cirurgia , Lesões do Manguito Rotador/tratamento farmacológico , Tratamento Conservador/métodos , Revisões Sistemáticas como AssuntoRESUMO
BACKGROUND: Shoulder pain is considered to be the third largest cause of musculoskeletal functional alterations in individuals presenting pain during movement. OBJECTIVE: The purpose of this synthesis of evidence was to identify the clinical effectiveness of conservative and surgical treatments reported in Cochrane systematic reviews among individuals diagnosed with rotator cuff disease. DESIGNAND SETTING: Review of systematic reviews, conducted in the Federal University of São Paulo (Universidade Federal de São Paulo, UNIFESP). METHODS: This synthesis of evidence included systematic reviews that had been published in the Cochrane database. The inclusion criteria were that these systematic reviews should involve individuals aged ≥ 16 years with rotator cuff disease, comparing surgical procedures with or without associated nonsurgical procedures versus placebo, no treatment or other nonsurgical interventions. RESULTS: Thirty-one systematic reviews were included, involving comparisons between surgical procedures and conservative treatment; procedures either combined or not combined with drugs, versus other procedures; and procedures involving exercises, manual therapy and electrothermal or phototherapeutic resources. CONCLUSIONS: The findings suggest that strengthening exercises, with or without associated manual therapy techniques and other resources, were the interventions with greatest power of treatment over the medium and long terms, for individuals with shoulder pain. These had greater therapeutic power than surgical procedures, electrotherapy or photobiomodulation.Protocol registration number in the PROSPERO database: ID - CRD42018096578.
Assuntos
Medicina Baseada em Evidências , Lesões do Manguito Rotador/terapia , Tratamento Conservador/métodos , Exercício Físico , Humanos , Manejo da Dor/métodos , Fototerapia/métodos , Lesões do Manguito Rotador/tratamento farmacológico , Lesões do Manguito Rotador/cirurgia , Dor de Ombro/terapia , Revisões Sistemáticas como Assunto , Resultado do TratamentoRESUMO
PURPOSE: The aim of this study is to evaluate in vivo the level of apoptosis in human rotator cuff tears and the relationship it might have with tendon degeneration. METHODS: Rotator cuff biopsies from 19 male and female patients, ages between 38 and 68 years, with and without previous corticosteroid infiltrations were collected via arthroscopy. Biopsies from seven patients with healthy rotator cuffs were used as a control group. An in situ terminal deoxynucleotidyl transferase dUTP nick end labeling assay was performed to detect the level of apoptosis, which was expressed as a percentage of apoptotic cells (PAC). RESULTS: PAC in patients with corticosteroid infiltrations was 76.97 ± 16.99 in all tendon rupture zones, in non-infiltrated patients was 35.89 ± 22.96, whereas in control patients was 14.48 ± 8.15. Likewise, the tendency of PAC reveals that apoptosis in control and non-infiltrated groups was different and dispersed in all tear zones; while in corticosteroid treated patients, the tendency was similar in all rupture sites. CONCLUSIONS: This investigation leads us to conclude that the administration of corticosteroid is associated with a higher amount of apoptosis at the insertion site of the rotator cuff (rupture edge).
Assuntos
Corticosteroides/administração & dosagem , Corticosteroides/uso terapêutico , Apoptose , Lesões do Manguito Rotador/tratamento farmacológico , Lesões do Manguito Rotador/patologia , Manguito Rotador/patologia , Adolescente , Corticosteroides/farmacologia , Adulto , Idoso , Apoptose/efeitos dos fármacos , Feminino , Humanos , Injeções Intra-Articulares , Masculino , Pessoa de Meia-Idade , Manguito Rotador/efeitos dos fármacos , Adulto JovemRESUMO
BACKGROUND: The severity and progression of rotator cuff tears have forced research on new treatment pathways such as metalloprotease inhibition, which has shown a reduction in healing time and improvement in the structure of collagen fibers. OBJECTIVE: To evaluate the use of doxycycline as a healing enhancer in rotator cuff tears after surgical treatment. MATERIAL AND METHODS: 20 patients were included; they were divided into two groups, 10 with the use of doxycycline and 10 without it after arthroscopic repair with one-year follow-up. Doxycycline was given orally, 100 mg once a day for one month. Every subject in the test was diagnosed with rotator cuff tear confirmed by MRI with Patte and Goutallier scores below 2. We used the arthroscopic double row technique. Post-op follow-up was 12 months with clinical scales (UCLA, Constant and forward flexion strength). RESULTS: Both groups reported almost complete healing of rotator cuff tears after surgical treatment during the twelve months of follow-up; forward flexion strength was the only score that reported improvement in the doxycycline group during every check-up. DISCUSSION: Doxycycline use after arthroscopic cuff tear repair could improve the clinical outcome, but we do not know how yet; however larger sample and randomized trials should be developed.
ANTECEDENTES: La severidad y progresión inevitable de la lesión del manguito rotador ha llevado a experimentar con adyuvantes terapéuticos para disminuir el tiempo de recuperación postquirúrgica, así como mejorar la estructura del tendón en recuperación al inhibir la matriz de metaloproteasas. OBJETIVO: Evaluar el uso de la doxiciclina como adyuvante en la cicatrización de lesiones hueso-tendón en la reparación quirúrgica del manguito rotador. MATERIAL Y MÉTODOS: Se reclutaron 20 pacientes con lesión del manguito rotador corroborada por imagen con retracción del supraespinoso grado II (Patte) e infiltración grasa de 50% (Goutallier). Fueron divididos en dos grupos: a 10 se les administró doxiciclina, 100 mg cada 24 horas durante un mes, y el resto fueron un grupo control sin doxiciclina. Ambos fueron tratados quirúrgicamente con técnica de doble hilera vía artroscópica, con seguimiento periódico hasta 12 meses mediante escalas de UCLA, Constant y potencia de flexión anterógrada. RESULTADOS: Se encontró recuperación clínica de la lesión en ambos grupos a los 12 meses, mayor potencia de flexión anterógrada en cada uno de los intervalos de medición para el grupo donde se administró la doxiciclina. Durante la evolución del estudio, se mantuvo constante Constant y UCLA; se encontró mejoría considerable con la potencia de flexión anteró grada como valor independiente. DISCUSIÓN: El uso de doxiciclina podría mejorar de una forma considerable el pronóstico clínico de la reparación artroscópica de mango rotador con el uso de doble hilera, pero aún no sabemos cómo, aunque deberán realizarse estudios adicionales con una muestra mayor.
Assuntos
Antibacterianos , Doxiciclina , Lesões do Manguito Rotador , Antibacterianos/uso terapêutico , Artroscopia , Doxiciclina/uso terapêutico , Seguimentos , Humanos , Imageamento por Ressonância Magnética , Manguito Rotador , Lesões do Manguito Rotador/tratamento farmacológico , Lesões do Manguito Rotador/cirurgia , Resultado do TratamentoRESUMO
Resumen: Antecedentes: La severidad y progresión inevitable de la lesión del manguito rotador ha llevado a experimentar con adyuvantes terapéuticos para disminuir el tiempo de recuperación postquirúrgica, así como mejorar la estructura del tendón en recuperación al inhibir la matriz de metaloproteasas. Objetivo: Evaluar el uso de la doxiciclina como adyuvante en la cicatrización de lesiones hueso-tendón en la reparación quirúrgica del manguito rotador. Material y métodos: Se reclutaron 20 pacientes con lesión del manguito rotador corroborada por imagen con retracción del supraespinoso grado II (Patte) e infiltración grasa de 50% (Goutallier). Fueron divididos en dos grupos: a 10 se les administró doxiciclina, 100 mg cada 24 horas durante un mes, y el resto fueron un grupo control sin doxiciclina. Ambos fueron tratados quirúrgicamente con técnica de doble hilera vía artroscópica, con seguimiento periódico hasta 12 meses mediante escalas de UCLA, Constant y potencia de flexión anterógrada. Resultados: Se encontró recuperación clínica de la lesión en ambos grupos a los 12 meses, mayor potencia de flexión anterógrada en cada uno de los intervalos de medición para el grupo donde se administró la doxiciclina. Durante la evolución del estudio, se mantuvo constante Constant y UCLA; se encontró mejoría considerable con la potencia de flexión anterógrada como valor independiente. Discusión: El uso de doxiciclina podría mejorar de una forma considerable el pronóstico clínico de la reparación artroscópica de mango rotador con el uso de doble hilera, pero aún no sabemos cómo, aunque deberán realizarse estudios adicionales con una muestra mayor.
Abstract: Background: The severity and progression of rotator cuff tears have forced research on new treatment pathways such as metalloprotease inhibition, which has shown a reduction in healing time and improvement in the structure of collagen fibers. Objective: To evaluate the use of doxycycline as a healing enhancer in rotator cuff tears after surgical treatment. Material and methods: 20 patients were included; they were divided into two groups, 10 with the use of doxycycline and 10 without it after arthroscopic repair with one-year follow-up. Doxycycline was given orally, 100 mg once a day for one month. Every subject in the test was diagnosed with rotator cuff tear confirmed by MRI with Patte and Goutallier scores below 2. We used the arthroscopic double row technique. Post-op follow-up was 12 months with clinical scales (UCLA, Constant and forward flexion strength). Results: Both groups reported almost complete healing of rotator cuff tears after surgical treatment during the twelve months of follow-up; forward flexion strength was the only score that reported improvement in the doxycycline group during every check-up. Discussion: Doxycycline use after arthroscopic cuff tear repair could improve the clinical outcome, but we do not know how yet; however larger sample and randomized trials should be developed.