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- ItemAcesso aberto (Open Access)Avaliação da função do ombro e da qualidade de vida de pacientes com lesão do manguito rotador: estudo de casos(Universidade Federal de São Paulo (UNIFESP), 2010) Saito, André Kenzo [UNIFESP]; Peccin, Maria Stella [UNIFESP]; Sgarbi, Maurício Wanderley Moral [UNIFESP]; http://lattes.cnpq.br/7327834846139708; http://lattes.cnpq.br/0428199048138850; http://lattes.cnpq.br/0517773415803195; Universidade Federal de São Paulo (UNIFESP)Introdução: O ombro é a articulação mais móvel e de grande importância para o ser humano porque permite que coloque a mão em diversos locais no espaço para realizar suas atividades de vida diária. Por ser altamente móvel e instável depende de estabilizadores dinâmicos, o manguito rotador. Uma afecção nessa articulação compromete toda a cintura escapular, diminuindo a funcionalidade do ombro, afetando a qualidade de vida do individuo. As lesões do manguito rotador podem ter diferentes etiologias – degenerativa ou traumática –, tendo como opções o tratamento conservador ou cirúrgico. Objetivos: Avaliar a qualidade de vida e funcionalidade do ombro pré e pós-operatório utilizando os questionários SF-36, WORC (ambos para qualidade de vida) e o UCLA para funcionalidade. Métodos: Foram avaliados pacientes com ruptura de manguito rotador que procuraram o serviço de ortopedia da Santa Casa de Santos entre março e setembro de 2010, totalizando três pacientes entre 46 e 66 anos de idade. Todos permaneceram imobilizados por 45 dias em tipóia americana e foram avaliados e orientados – sendo fornecidos cadernos de exercícios para realizar em domicílio – periodicamente durante o tratamento e realizaram fisioterapia supervisionada em clínica de sua preferência. Resultados: Apenas um paciente apresentou resultados bons na ultima reavaliação. Dois pacientes evoluíram com ombro rígido durante todo o período de reabilitação, o que continuou interferindo nas atividades de vida diária desses pacientes e na qualidade de vida. Conclusão: A fisioterapia pós-operatória é fundamental para que a cirurgia realizada tenha seu valor, uma vez que, se o paciente não realiza fisioterapia, pode evoluir com rigidez articular e afetar a funcionalidade do membro operado e a qualidade de vida do indivíduo. Dois pacientes evoluíram com ombro rígido e não alcançaram a ADM completa em quatro meses de pós-operatório, sendo que o com a pior ADM estava afastado do serviço pelo INSS, o que deve ser levado em conta durante a reabilitação, já que ele pode buscar empregos informais para complementar sua renda e, consequentemente, retardar a reabilitação. Talvez se os pacientes tivessem realizado fisioterapia precocemente os resultados fossem melhores, porém o serviço não disponibilizava esse tipo de atendimento, o que pode ser considerado como uma falha no sistema de saúde.
- ItemSomente MetadadadosComparison of the responsiveness of the Brazilian version of the Western Ontario Rotator Cuff Index (WORC) with DASH, UCLA and SF-36 in patients with rotator cuff disorders(Clinical & Exper Rheumatology, 2009-09-01) Lopes, Andréa Diniz [UNIFESP]; Ciconelli, Rozana Mesquita [UNIFESP]; Carrera, Eduardo Frota [UNIFESP]; Griffin, S.; Faloppa, Flávio [UNIFESP]; Reis, Fernando Baldy dos [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Univ Western OntarioObjectiveTo investigate the responsiveness of the Brazilian version of the Western Ontario Rotator Cuff Index (WORC) and compare it with the Disabilities of At-tit, Shoulder and Hand questionnaire (DASH), the University of California Los Angeles Shoulder Rating Scale (UCLA), and the Short-Form 36 questionnaire (SF-36) in patients with rotator cliff disorders.MethodsThe four questionnaires were administered to 30 patients tit baseline and 3 months after treatment (physiotherapy or surgery). The patients were divided into two groups: those who improved after treatment (n=20) and those who did not (n=10) based oil an anchor-based strategy to distinguish between the two groups and assess responsiveness. The t-test, the t-value of the paired t-test, the effect size (ES), and the standardized response mean (SRM) were calculated.ResultsAll four questionnaires registered statistically significant changes (p<0.05) in the improved group between baseline and 3 months after treatment, and no changes in patients who did not improve. All four instruments showed higher ES and SRM values for the patients who improved than those who did not. WORC registered moderate to high ES and SRM values for the improved group, (is did the UCLA and DASH. The ES and SRM values Measured by the SF-36 ranged from small to large, the physical subscales being more responsive than the other subscales.ConclusionThe Brazilian version of the WORC (like UCLA, DASH and SF-36 physical subscales) proved responsive to change and suitable for use in the short-term follow-up of patients after rotator cuff interventions.
- ItemAcesso aberto (Open Access)Functional outcomes of traumatic and non-traumatic rotator cuff tears after arthroscopic repair(Baishideng Publishing Group Inc, 2017) Kitagaki Abechain, Jose Jorge [UNIFESP]; Godinho, Glaydson Gomes; Matsunaga, Fabio Teruo [UNIFESP]; Netto, Nicola Archetti [UNIFESP]; Daou, Julia Pozzetti [UNIFESP]; Sugawara Tamaoki, Marcel Jun [UNIFESP]AIM To compare the functional outcomes of traumatic and non-traumatic rotator cuff tears after arthroscopic repair. METHODS Eighty-seven patients with rotator cuff tears following arthroscopic treatment were divided into traumatic and non-traumatic tear groups. Postoperative muscle strength and outcomes using the modified University of California, Los Angeles score were evaluated. Sex, age, affected limb and dominant limb were correlated between groups. Muscle strength of the repaired and unaffected shoulders was compared. Rotator cuff injury size was measured. RESULTS Of the 87 patients who underwent rotator cuff repairs, 35 had traumatic tears and 52 had non-traumatic tears. In patients with non-traumatic tears, the average age was 59 years, 74.5% were female, 96.1% were righthand dominant and 92.3% had their dominant shoulder affected. Patients with traumatic tears were 59.5 years hand dominant and 88.5% had their dominant shoulder affected. No difference existed in the mean modified University of California, Los Angeles score between patients with traumatic tears (33.7) compared with those with non-traumatic tears (32.8). No strength differences were observed between groups: The strength difference between the non-affected and affected sides was 1.21 kg in the non-traumatic group and 1.39 kg in the traumatic group (P = 0.576), while the strength ratio between the non-affected/affected sides was 0.805 in the nontraumatic group and 0.729 in the traumatic group (P = 0.224). CONCLUSION The functional results of traumatic rotator cuff repairs are similar to non-traumatic tears. Both outcomes are satisfactory.
- ItemAcesso aberto (Open Access)Quality of life after antegrade intramedullary nail fixation of humeral fractures: a survey in a selected cohort of Brazilian patients(Biomed Central Ltd, 2018) Cocco, Luiz Fernando [UNIFESP]; Cohen, Moises [UNIFESP]; Reis, Fernando Baldy dos [UNIFESP]; Ejnisman, Benno [UNIFESP]; Belangero, Paulo Santoro [UNIFESP]Background: The treatment of humeral fractures remains controversial. Systematic reviews demonstrate similar results between dynamic compression plating and locked intramedullary nailing in the surgical treatment of these fractures. However, it appears that antegrade intramedullary nailing causes higher residual pain in the shoulder. The proposal of this work is to evaluate through the WORC protocol (Western Ontario Rotator Cuff Index) the consequences in the quality of life of patients submitted to osteosynthesis of the humerus with antegrade locked intramedullary nailing. Methods: This work is a cohort retrospective study in addition to the application of a questionnaire for self-rated quality of life with its 05 domains (WORC - Western Ontario Rotator Cuff Index) for patients (N = 26) classified in the Trauma Sector of the Department of Orthopedics and Traumatology of the Federal University of Sao Paulo (DOT/UNIFESP) submitted to Humerus Osteosynthesis with Antegrade Locked Intramedullary Nailing. There was also the inclusion of data related to the time since surgery, age, sex, surgical laterality, dominance among members and work leave, which were not considered in the original protocol. After, the data were statistically assessed to evaluate the association between numerical and categorical variables. Results: The overall WORC score was 82.75 +/- 17.00 (Mean +/- SD) and was not different considering sex, age and postoperative period. Among the WORC domains, both Work and Sport / Recreation Protocols were the most unfavorable factors in the evaluation of patients. Although not statistically significant, those who had the procedure on the dominant side presented a lower quality of life score than those who had the surgery on the non-dominant side. Although non-significant again, those who were away from work had an overall lower quality of life score than those who were not. Conclusions: The WORC Quality of Life Protocol shows good results for evaluating patients submitted to humerus osteosynthesis with antegrade locked intramedullary nailing. The data stratified by domains were good, however, Work and Sport/Recreation domains showed the lowest means compared to the other domains.
- ItemAcesso aberto (Open Access)Utilização do ORC( Western Ontário Rotator Cuff Index) e ultrassonografia do ombro para avaliação de qualidade de vida de pacientes submetidos à osteossìntese do úmero com haste intramedular bloqueada com acesso anterógrado(Universidade Federal de São Paulo (UNIFESP), 2018-03-20) Cocco, Luiz Fernando [UNIFESP]; Ejnisman, Benno [UNIFESP]; http://lattes.cnpq.br/1124807952912223; http://lattes.cnpq.br/1189720669269169; Universidade Federal de São Paulo (UNIFESP)Background: This study evaluates the quality of life through the WORC Protocol (Western Ontario Rotator Cuff Index --- Validated for Brazil) for 5 different domains (Physical Symptoms, Sports / Recreation, Work, Lifestyle, Emotions) from patients submitted to humeral fractures fixation with antegrade locked intramedullary nailing. The study demonstrates the consequences after the implantation of the rotator cuff transfixation and helps in decision making for treatments of these fractures. Methods: Search and Call of patients (N=26) were submitted to Humerus Osteosynthesis with Antegrade Locked Intramedullary Nailing for evaluation of the quality of life through the WORC Protocol. Mann---Whitney test was used to evaluate the association between numerical variables (age, last surgery and quality of life scores) and the Chi---Square and Fisher tests for the categorical variables (sex, laterality, dominance, work leave). We used p <0.05 for significance. Results: The overall WORC score was 82.75 ± 17.00 (Mean + SD) and was not different considering sex, age and postoperative period. Among the WORC domains, both Work and Sport / Recreation Protocols were the most unfavorable factors in the evaluation of patients, with a mean of 10.54 ± 9.00 and 7.36 ± 8.44, respectively. Although not statistically significant, those who had the procedure on the dominant side presented a lower quality of life score (78.1 ±18.9) than those who had surgery on the non---dominant side (86.7 ± 13.9, p = 0.20). Although non significant again, those who were away from work had an overall lower quality of life score (69.2 ± 21.1) than those who were not (85.9 ± 14.2, p = 0.10). Conclusions: Intramedullary nailing with antegrade access can be used to treat fractures of thehumerus without compromising the quality of life of patients. Although it is a safe implant option, considerations for its indication regarding work return and sports or recreational practices should be considered.