EXPERIENCIA CLINICA EN PROTESIS REVERSA DE HOMBRO EN CENTRO MEDICO NAVAL

Problem Statement: The total reverse arthroplasty of man is a suitable therapeutic option for shoulder osteoarthritis associated with cuff rotator tear, massive rotator cuff tear mainly, medializing the rotation center of the shoulder joint, thus replacing the supraspinatus, recovering degree of freedom of movement of the shoulder with the promising clinical results described in the literature, interest has arisen on the part of the traumatology and orthopedics service to evaluate the clinical evolution of the patients operated with this procedure, and generate the knowledge that can be integrated later in studies of May scientific validity. Objective: Objective: to describe the clinical outcome of patients undergoing surgery, with total reverse shoulder arthroplasty, after 6 months of surgery in a naval medical center. Methodology: Type of study: an observational, cross-sectional, retrospective study was carried out. Population: 8 patients que fueron intervenidos quirúrgicamente con artroplastia total reversa de hombro. The DASH, Constan and Simple Shoulder Test tests were applied, which were applied preoperatively and after 6 months of the surgical intervention, and the description and analysis of data was carried out with a statistical program. Results: there was clinical improvement in most patients on the DASH scale with average disability improvement of 59% to 36%, Constan scale from 25.7 to 49.6, Simple Shoulder Test from 3.1 to 5.6. Conclusion. The total reverse shoulder prosthesis is a suitable alternative with adequate clinical results for patients with rotator cuff tear, massive rotator cuff tear.

Development and Multi-Site Assessment of a Novel Shoulder Motion Joint Simulator

Background: Multiple biomechanical shoulder simulators have been described in the literature, with a trend toward increasing complexity to better simulate clinical scenarios. Our objective was to develop an advanced, novel shoulder joint simulator and compare outcomes at two separate institutions, for a typical shoulder joint motion simulation. Methods: Identical shoulder simulators were developed & deployed at both institutions. Eight cadaveric upper extremities were tested by simulating actively controlled, arm elevation in the plane of the scapula for two sequential test conditions (intact and non-destructive simulated cuff-tear), each repeated for a total of five trials. Muscle forces and joint translations were recorded for both conditions. The intact condition was repeated following simulated cuff-tear to assess effect of testing order. Statistical analyses were aimed at assessing repeatability and reproducibility of results within specimens, between specimens, and between institutions. Results: The highest average forces were observed for the middle deltoid (233N or 32.5% body weight), followed by infraspinatus (99.0N), and posterior deltoid (93.7N) muscles. Differentiation between test conditions was unhindered by variability between repeated trials. Data from testing repeated over time, and between the two institutions were not significantly different. Conclusions: The novel shoulder simulator produced repeatable results with low trial-to-trial variation and outcomes were comparable between the two institutions. The results demonstrated a consistent response in muscle forces and humeral translation for the simulated rotator cuff tear condition. Such advanced shoulder simulators could thus be used for evaluating and optimizing surgical interventions and implant strategies.

Shoulder rehabilitation exercises with kinematic biofeedback after arthroscopic rotator cuff repair: proposal for treatment (Preprint)

UNSTRUCTURED Background: The recovery of scapular and gleno-humeral physiological kinematic parameters, as well as sensorimotor control of movement, plays a primary role in the rehabilitation after arthroscopic rotator cuff repair. A highly customized rehabilitation approach is required to achieve this aim. Biofeedback can be a useful tool but there is poor evidence of its use in the rehabilitation after arthroscopic rotator cuff tear repair. Objective: This article describes an exercise-based program (ISEO-Program) for the recovery of scapular kinematics of patients arthroscopically treated for rotator cuff tear. Methods: The program integrates a conventional rehabilitation program with the use of the ISEO (INAIL Shoulder and Elbow Outpatient protocol), a motion analysis system based on inertial wearable sensors positioned over the thorax, scapula, humerus and forearm. ISEO can return a visual biofeedback of humerus angles over time or of the scapula-humeral coordination, with the possible overlap of patient-specific or asymptomatic subjects’ reference values. Results and conclusions: A set of 12 progressive exercises were defined, divided in four groups based on humerus and scapula movements, each comprising from two to four drills of increasing complexity. Exercises can require the use of ball, stick, rubber band and towels. For each drill, the neuromotor goal and type of visual biofeedback is specified.