Estudio comparativo de la distancia coracohumeral en pacientes con patología degenerativa del subescapular y una población voluntaria asintomática

Gabriel Cárdenas; Christian Calderon; Tomas Pineda; Joaquin Avila; Ricardo Pefaur

doi:10.1055/s-0039-1683375

Revista Chilena de Ortopedia y Traumatología, Inhaltsverzeichnis

CC BY-NC-ND 4.0 · Revista Chilena de Ortopedia y Traumatología 2019; 60(01): 009-015
DOI: 10.1055/s-0039-1683375

Original Article | Artículo Original

Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil

Estudio comparativo de la distancia coracohumeral en pacientes con patología degenerativa del subescapular y una población voluntaria asintomática

Comparative Analysis of the Coracohumeral Distance between Patients with Degenerative Subscapularis Tendon Pathology and a Normal Age-matched Population

Gabriel Cárdenas

¹Unidad de Cirugía de Hombro, Departamento de Traumatología y Ortopedia, Instituto de Seguridad del Trabajo (IST), Viña del Mar, Chile

²Fellowship en Cirugía de Hombro, Institut Universitaire Locomoteur et du Sport (iULS), Hôpital Pasteur 2 CHU de Nice, France

,

Christian Calderon

³Departamento de Imagenología Musculoesquelética, Instituto de Seguridad del Trabajo (IST), Viña del Mar, Chile

,

Tomas Pineda

⁴Residente de Traumatología y Ortopedia, Universidad de Chile, Santiago, Chile

,

Joaquin Avila

⁵Interno de Medicina, Universidad de Valparaíso, Valparaíso, Chile

,

Ricardo Pefaur

⁶Departamento de Bioestadística, Pontificia Universidad Católica de Valparaíso, Chile

› Institutsangaben

Abstract

Resumen

Introducción El pinzamiento subcoracoideo secundario a una distancia coracohumeral (DCH) disminuida, ha sido descrito como una posible etiología de las lesiones degenerativas del tendón del Subescapular (SSC), sin embargo, esa teoría aún es controversial.

Objetivo Evaluar si existe una diferencia significativa entre la DCH promedio de pacientes con patología degenerativa del SSC y un grupo control.

Materiales y Métodos Se diseñó un estudio de casos-controles y se estableció un tamaño muestral mínimo de 36 casos por grupo. De nuestra base de datos, y dentro de un periodo de 6 meses, se rescataron 46 Resonancias Magnéticas (RM) de hombro con patología degenerativa avanzada y/o roturas del SSC (grupo SSC). El grupo control fue conformado por 36 RM realizadas a voluntarios asintomáticos sin patología del mango rotador. Se incluyeron en ambos grupos solo pacientes entre 40 y 60 años. Se utilizó prueba de t para determinar las diferencias entre 2 grupos con un nivel de confianza del 95%.

Resultados La edad promedio del grupo SSC fue 50,1 ± 6,1 años y del grupo control 51,7 ± 6,8 años, no existiendo diferencia estadísticamente significativa entre ambos (p = 0.43). La DCH promedio en el grupo SSC fue 8,58 mm [IC: 7,95–9,21 mm], y en el grupo control fue 11,04 mm [IC: 10,05–12,04 mm]. Al comparar la DCH, se encontró una diferencia estadísticamente significativa entre grupos (p = 0,00048).

Conclusión Nuestros resultados respaldan la existencia de una asociación estadísticamente significativa entre una DCH disminuida y la presencia de patología degenerativa del SSC.

Nivel de Evidencia: III (Estudio de casos y controles).

Abstract

Background The incidence of subscapularis tears is increasing as diagnostic imaging and arthroscopic technology improves. Decreased coracohumeral distance (CHD) with associated Subcoracoid Impingement is thought to be one, potential etiology for these lesions.

Objective The purpose of this study was to identify the association between reduced CHD and degenerative pathology of the subscapularis tendon.

Methods A comparative case-control study was performed. The sample size required to determine significance was calculated to be 36 cases. In total, 46 patients with severe degenerative SSC tendinopathy or subscapularis tears on magnetic resonance imaging (MR) were collected consecutively from our database (SSC group). The control group consisted of 36 asymptomatic volunteers undergoing shoulder MR. Only patients between 40 and 60 years of age were included. An independent t-test was used to determine the statistical significance between the two groups (with a 95% level of confidence).

Results No statistically relevant difference was found between the average age of the two groups (50.1 ± 6.1 and 51.7 ± 6.8; p = 0.43). In the control group, the mean CHD was found to be 11.04 mm [CI:10.05–12.04 mm] and was 8.58 mm [CI: 7.95–9.21 mm] in the subscapularis group. The statistical analysis, comparing the CHD showed a significant difference between groups (p = 0.00048).

Conclusion This study supports the conclusion that degenerative subscapularis pathology is associated with narrowed coracohumeral distance, when compared with an asymptomatic age-matched group.

Level of evidence III (case-control study).

Palabras Claves

distancia coracohumeral - pinzamiento subcoracoideo - estenosis subcoracoidea - subescapular - coracoplastía

Keywords

coracohumeral distance - subcoracoid impingement - subscapularis tear - roller-wringer effect - anterior shoulder pain - subcoracoid stenosis - coracoplasty

Volltext

Referenzen

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