Revista Espa?ola de Artroscopia y Cirugía Articular最新文献

The scapulothoracic and acromioclavicular (AC) joints are inter-related to form the shoulder suspensory complex. Therefore, patients with any kind of AC dislocation may present with biomechanical scapular alterations and suffer scapular dyskinesis.

In the present article, the concept of dyskinesis is reviewed, as well as the evaluation criteria and the different types of classifications.

The relationship between acromioclavicular joint dislocation and dyskinesis is also assessed. The anatomic aspects, the increased presence of dyskinesis within the different kind of AC injuries and their causative hypothesis are also reviewed. Finally, the results of the rehabilitation program and the surgical treatment for type III AC dislocations are reviewed in relation to dyskinesis.

The acromioclavicular joint represents the link between the clavicle and the scapula, responsible for the synchronized dynamics of the shoulder girdle. Chronic acromioclavicular joint instability involves the occurrence of changes in the anatomical orientation of the scapula, a situation that leads to changes in muscle kinematics that could result in chronic pain. Several surgical strategies for the management of patients with chronic and symptomatic acromioclavicular joint instability have been described. The range of possibilities includes anatomical and non-anatomical techniques, open and arthroscopy-assisted surgery, and biological and synthetic grafts. Surgical management of chronic acromioclavicular joint instability should involve the reconstruction of the torn ligaments, as it is accepted that after 3 weeks from the injury, these structures lack healing potential.

This paper describes a review of the literature as regards to the management of chronic acromioclavicular instability.

The subcutaneous location of the acromioclavicular joint allows the clinician to evaluate deformities directly and palpate the joint. This is more complicated in the glenohumeral joint. However, pain arising from the joint can irradiate to different areas of the shoulder, arm and neck, and can be misleading. Thus, it is important to be familiar with the spectrum of physical examination tests, specific radiological projections and MRI findings in order to reach an accurate diagnosis.

The aim of this article is to systematically describe the most commonly used physical examination tests for acromioclavicular pathology, including sensitivity, specificity, and predictive values for all of them. Secondly, to analyse the radiological particularities of this joint and to establish the usefulness of the specific projections and imaging techniques.

Despite being a common injury, the treatment of grade iii acromioclavicular joint dislocation remains subject to debate, because there is a lack of consensus regarding its optimal management. The purpose of this article is to defend, based on the existing scientific evidence, the conservative treatment as the most adequate option due to the good results obtained and the low complication rate.

In order to treat acromioclavicular disorders, one should know the anatomy of the joint and the nearby structures that influence it. This knowledge is necessary to know how to diagnose what may be the cause of the disorder, to assess which are the structures that must be rebuilt after a joint injury, and to know which structures should be respected during the surgery. In this article, the bony anatomy, the anatomy and function of the ligaments that act on this joint, biomechanics, and the pathophysiology of the acromioclavicular joint is presented.

There is not enough evidence to recommend a particular surgical technique for the surgical treatment of acromioclavicular joint dislocations. There is a lack of studies in the literature evaluating rehabilitation programs to treat post-operative acromioclavicular dislocations, although enough data can be found to make some recommendations.

Length of immobilisation depends on tissue healing time frames of the surgical procedure. In general, the joint must be protected for the first 3 to 6 weeks to allow the biological healing process. Active range of motion is initiated at 6 to 8 weeks, with resistance strength activities withheld for 12 weeks.

When the brace is removed, the patient can start with passive assisted range of motion exercises. Caution must be used with internal rotation behind the back, cross-body adduction, and end range forward elevation. After 6 weeks, active exercises can be added with support of the limb on a table or wall.

Scapular dyskinesia has been related to acromioclavicular dislocation. For this purpose, closed chain scapular exercises with the hand fixed to a wall or table are recommended in early stages (6 to 8 weeks after surgery). Isotonic strength exercise can be started after 12 weeks, with tubing or cable resistance. Open chain exercises, like Blackburn's, produce stress in the acromioclavicular joint and should be left for an advanced phase of treatment.

There is growing interest to learn more about the complex scapulo-humeral biomechanics in order to apply them for a full and satisfactory recovery of our patients at discharge as well as for their future.

Applying the most appropriate treatment for acromioclavicular dislocations should be based on a clear standardisation when categorising the lesions, and associating a treatment option to each category. To considering this as solved question to date, seems arbitrary, since neither the imaging or clinical classification methods are well defined, and the surgical interventions are adequately compared to the non-surgical option in the literature.

There even appears to be a lack of data in the evaluation of outcomes. If it is considered that scapular dyskinesis puts our patients at risk of suffering a bad recovery after these dislocations, and that our main objective is getting the shoulder back to normal, it should be associated with trying to avoid this condition as far as possible. Thus, it should depend not only on good coordination and muscle training, but also on obtaining strong and stable articular structures that will support the heavy loads that the shoulder will have to bear.

In this review, it is suggested that early indication for surgery of acromioclavicular joint dislocations type iii, from an evidence based point of view, is not possible due to the numerous recommendations against surgery that have been published, and will probably be discussed in another chapter of this journal.

Therefore, this has been structured on a point of view based on reasonable doubts due to the arrival of new surgical techniques, new biomechanics studies on these techniques, and the growing interest in scapular dyskinesis and its importance in shoulder dysfunction.

Acromioclavicular osteoarthritis is a common cause of pain in the anterior part of the shoulder joint, particularly when crossing the arms above the head.

It usually appears in middle-aged men and women, and the suspected diagnosis is based on clinical history and physical examination. The complementary tests and proper and complete therapeutic response to an injection with corticosteroid /anaesthetic solutions confirms their diagnosis.

The instability of this joint is one of the conditions to consider in the differential diagnosis as it presents with a similar clinical picture and similar findings in the physical examination.

There are several treatment options, although initial treatment should be conservative. If there is no clinical response, surgical treatment will be indicated by open or arthroscopic resection of the joint. Meticulous surgical technique in both cases will minimise potential complications and improve the degree of clinical and functional recovery of the patient.

Acromioclavicular dislocations are common injuries of the scapular girdle, especially among young men during sport activities. There is general consensus for non-surgical treatment of Rockwood type i and ii injuries and for surgical treatment of Rockwood type iv, v, vi injuries. Treatment of Rockwood type iii injuries remains controversial because of the lack of evidence that supports best treatment option due to mixed results reported in the literature, although young patients with high physical demand may have a slight advantage with a surgical approach. The main aim of this review article is to present the epidemiology, mechanisms of injury, classification, natural history, and indications for surgery of acromioclavicular dislocations, in order to achieve a better knowledge about them and to be able to get an optimal result after treatment.