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      Shoulder Arthroplasty: Tenotomy of the Subscapularis Tendon versus the Lesser Tuberosity Osteotomy

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          Abstract

          Objective  To evaluate and compare subscapular muscle function among patients undergoing subscapular tenotomy (Group A) and lesser tuberosity osteotomy (Group B), in patients treated with total and partial anatomic shoulder arthroplasty for primary osteoarthrosis.

          Methods  Retrospective study of patients with primary glenohumeral osteoarthrosis surgically undergoing total or partial anatomic shoulder prosthesis implant, evaluated by clinical examination, imaging exams, analogue pain scale and Constant and Murley functional score. A total of 28 patients were evaluated, totalizing a sample of 32 operated shoulders. The minimum follow-up was of 12 months (mean 47.45 months).

          Results  Among patients submitted to subscapularis tendon tenotomy, 10 had an ultrasound with total rupture of its thickness (56%). All of the patients of the group B showed lesser tuberosity healing. There was no difference between groups comparing strength evaluated by Belly press and Bear hug tests as well as clinical outcome, through the Constant and Murley score.

          Conclusions  We did not find differences between Groups A and B evidenciated by comparing strength in the Lift-off test, in the Belly press and Bear hug tests and through he Constant and Murley score.

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          A review of the Constant score: modifications and guidelines for its use.

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            Isolated rupture of the tendon of the subscapularis muscle. Clinical features in 16 cases.

            Traumatic rupture of the tendon of the subscapularis muscle was documented as an isolated lesion in the shoulders of 16 men. The injury was caused either by forceful hyperextension or external rotation of the adducted arm. The patients complained of anterior shoulder pain and weakness of the arm when it was used above and below the shoulder level. They did not experience shoulder instability. The injured shoulders exhibited increased external rotation and decreased strength of internal rotation. A simple clinical manoeuvre called the 'lift-off test', reliably diagnosed or excluded clinically relevant rupture of the subscapularis tendon. Confirmation of the clinical diagnosis was best achieved by ultrasonography or MRI, but arthrography or CT arthrography were also useful. Surgical exploration confirmed the diagnosis in every case. Repair of the ruptured tendon was technically demanding and required good exposure to identify and protect the axillary nerve.
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              The bear-hug test: a new and sensitive test for diagnosing a subscapularis tear.

              It was our intent to devise a new clinical test that would more accurately diagnose subscapularis tears than the current clinical tests. This new test is called the bear-hug test. The purpose of this study was to assess the bear-hug test and compare it with the current tests of subscapularis function (lift-off, belly-press, and Napoleon tests). Between January 2004 and March 2004, 68 consecutive patients scheduled for an arthroscopic procedure were evaluated preoperatively; the preoperative clinical examination findings were then correlated with arthroscopic findings. Lift-off, belly-press, Napoleon, and bear-hug tests were included in the examination. Furthermore, for the belly-press and bear-hug tests, the strength was precisely quantified by means of an electronic digital tensiometer (Kern HBC). Diagnostic arthroscopy was the reference that determined the actual pathologic lesions. Subscapularis tears occurred with a prevalence rate of 29.4%. Of the subscapularis tears, 40% were not predicted by preoperative assessment by use of all of the tests. The bear-hug test was found to be the most sensitive test (60%) of all of those studied (belly-press test, 40%; Napoleon test, 25%; and lift-off test, 17.6%). In contrast, all 4 tests had a high specificity (lift-off test, 100%; Napoleon test, 97.9%; belly-press test, 97.9%; and bear-hug test, 91.7%). No statistically significant difference was found between the area under the receiver operating characteristic curve of the bear-hug test and that of the belly-press test in diagnosing a torn subscapularis. However, the areas under the receiver operating characteristic curve for both the bear-hug test and the belly-press test were significantly greater than those for the lift-off and Napoleon tests (P < .05). Positive bear-hug and belly-press tests suggest a tear of at least 30% of the subscapularis, whereas a positive Napoleon test indicates that greater than 50% of the subscapularis is torn. Furthermore, a positive lift-off test is not found until at least 75% of the subscapularis is torn. The bear-hug test optimizes the chance of detecting a tear of the upper part of the subscapularis tendon. Moreover, because the bear-hug test represents the most sensitive test, it can be considered to be the most likely clinical test to alert the surgeon to a possible subscapularis tear. Performing all of the subscapularis tests is useful in predicting the size of the tear. Level I, diagnostic study: testing of previously developed criteria in a series of consecutive patients with arthroscopy used as the criterion standard.
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                Author and article information

                Journal
                Rev Bras Ortop (Sao Paulo)
                Rev Bras Ortop (Sao Paulo)
                10.1055/s-00042410
                Revista Brasileira de Ortopedia
                Sociedade Brasileira de Ortopedia e Traumatologia. Published by Thieme Revinter Publicações Ltda (Rio de Janeiro, Brazil )
                0102-3616
                1982-4378
                August 2020
                29 May 2020
                : 55
                : 4
                : 463-469
                Affiliations
                [1 ]Grupo de Cirurgia do Ombro e Cotovelo, Hospital Ortopédico BH, Belo Horizonte, MG, Brasil
                [2 ]Grupo de Cirurgia do Ombro e Cotovelo, Hospital Lifecenter, Belo Horizonte, MG, Brasil
                [3 ]Grupo de Cirurgia do Ombro e Cotovelo, Hospital Belo Horizonte, Belo Horizonte, MG, Brasil
                Author notes
                Endereço para correspondência Flávio de Oliveira França, MD, MSc Hospital Belo Horizonte e Hospital Lifecenter Rua Prof. Otávo Coelho de Magalhães, 111 - Mangabeiras, Belo Horizonte, MG, 30210-300Brazil flavio.franca29@ 123456gmail.com
                Author information
                http://orcid.org/0000-0002-2775-2312
                Article
                180196pt
                10.1055/s-0039-3402469
                7494375
                a7974b83-3e2d-4838-998f-f0ff78e23c50
                The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. ( https://creativecommons.org/licenses/by-nc-nd/4.0/ ).

                This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License, which permits unrestricted reproduction and distribution, for non-commercial purposes only; and use and reproduction, but not distribution, of adapted material for non-commercial purposes only, provided the original work is properly cited.

                History
                : 10 April 2018
                : 12 February 2019
                Categories
                Artigos Originais
                Ombro e Cotovelo

                shoulder prosthesis,arthrosis,rotator cuff,prótese de ombro,artrose,manguito rotador

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