Resumo Apesar de ser um procedimento amplamente utilizado em todo o mundo e com elevadas taxas de remissão dos sintomas, o tratamento cirúrgico da síndrome do túnel do carpo pode apresentar resultados não satisfatórios ao paciente. Esse resultado não satisfatório pode se manifestar clinicamente pela não remissão dos sintomas, remissão dos sintomas mas recorrência desses após um período de tempo da cirurgia ou aparecimento de diferentes sintomas após a cirurgia. Diferentes fatores estão relacionados a esse insucesso do tratamento cirúrgico da síndrome do túnel do carpo (ITCSTC). A prevenção pode ser conseguida por meio de minuciosa avaliação clínica do paciente no período pré-operatório. Dessa forma o cirurgião poderá fazer diagnósticos diferenciais ou diagnósticos concomitantes, assim como identificar fatores ligados a insatisfação do paciente. Os fatores per-operatórios incluem a correta identificação das estruturas anatômicas para completa descompressão do nervo mediano. Inúmeros procedimentos têm sido descritos para o tratamento dos fatores que ocorrem no período pós-operatório. Desses o mais comum, a formação de aderências em torno do nervo mediano, tem sido tratado com relativo sucesso utilizando diferentes retalhos vascularizados ou cobertura com o uso de tecido autólogo ou homólogo. Descreveremos a abordagem do ITCSTC com maiores detalhes no texto.

Abstract Despite being a procedure widely used all over the world with high rates of symptom remission, surgical treatment of carpal tunnel syndrome may present unsatisfactory outcomes. Such outcomes may be manifested clinically by non-remission of symptoms, remission of symptoms with recurrence a time after surgery or appearance of different symptoms after surgery. Different factors are related to this unsuccessful surgical treatment of carpal tunnel syndrome. Prevention can be achieved through a thorough preoperative clinical evaluation of the patient. As such, the surgeon will be able to make differential or concomitant diagnoses, as well as determine factors related to patient dissatisfaction. Perioperative factors include the correct identification of anatomical structures for complete median nerve decompression. Numerous procedures have been described for managing postoperative factors. Among them, the most common is adhesion around the median nerve, which has been treated with relative success using different vascularized flaps or autologous or homologous tissue coverage. The approach to cases with unsuccessful surgical treatment of carpal tunnel syndrome is discussed in more detail in the text.

RESUMO Objetivo: Verificar a prevalência de pacientes vítimas de trauma motociclístico que estavam sob efeito de álcool e drogas. Métodos: Estudo observacional e prospectivo, com pacientes internados na Enfermaria de Ortopedia e Traumatologia do Hospital São Paulo (Unifesp), de março de 2015 a março de 2016. Foram incluídos pacientes de ambos os sexos, idade superior a 18 anos, internados por trauma motociclístico e que necessitavam de tratamento cirúrgico ortopédico. Resultados: Durante a pesquisa, foram internados 282 pacientes, dos quais 23,8% eram vítimas de trauma motociclístico. Desses, 49,3% motociclistas referiram o uso de álcool e drogas previamente ao sinistro, enquanto 50,7% negaram o consumo. Na análise do consumo de álcool e drogas nos pacientes de traumas motociclísticos, foi observado que 65% estavam sob efeito apenas de álcool, 16% estavam sob efeito de álcool e drogas, e 19% sob efeito de drogas ilícitas. Conclusão: A incidência de pacientes que sofreram acidentes motociclísticos sob efeito de álcool e drogas foi de 49,3%. Nível de Evidência IV, Série de Casos Prospectivos.

ABSTRACT Objective: To verify the prevalence of patients who were victims of motorcycle trauma who were under the influence of alcohol and drugs. Methods: The study was observational and prospective, with patients hospitalized to the Orthopedics and Traumatology Ward of Hospital São Paulo (UNIFESP), from March 2015 to March 2016. The study included patients of all genders, over 18 years old, hospitalized due to motorcycle trauma and who needed orthopedic surgical treatment. Results: During the research, 282 patients were hospitalized, of which 23.8% were victims of motorcycle trauma. Of these, 49.3% motorcyclists reported the use of alcohol and drugs before the accident, while 50.7% denied their consumption. In the analysis of alcohol and drug consumption in patients with motorcycle injuries, the results showed that: 65% used only alcohol; 16% used both alcohol and drugs; and 19% used only illicit drugs. Conclusion: The incidence of patients who suffered motorcycle accidents under the influence of alcohol and drugs was 49.3%. Level of Evidence IV, Prospective Case Series.

Resumo Objetivo Determinar a frequência do aparecimento de dedo em gatilho (DG) no pós-operatório da síndrome do túnel do carpo (STC) em duas técnicas: aberta (TA) e endoscópica (TE). Como desfecho secundário, comparar as taxas de remissão da parestesia e dor residual entre as duas técnicas. Métodos De forma prospectiva, verificamos o aparecimento de dedo em gatilho e taxa de remissão da parestesia e dor no território do nervo mediano em série de pacientes adultos operados pela TA (n = 34). Comparamos com coorte retrospectiva operada pela TE (n = 33), pela mesma equipe de cirurgiões. A avaliação dos pacientes ocorreu por meio de questionário estruturado em consulta de retorno, com mínimo de 6 meses de pós-operatório. Resultados Sessenta e sete pacientes foram avaliados. Não houve diferença quanto ao aparecimento de dedo em gatilho (TA, 26,5% versus TE, 27,3%; p = 0,94) e dor (TA, 76,5% versus TE, 84.8%; p = 0,38). Os pacientes operados pela TA apresentaram menos queixas de parestesia do que os operados pela TE (TA 5,9% versus TE 24,2%; p = 0,03). Conclusões Em nossa série, a técnica cirúrgica não influenciou o aparecimento de dedos em gatilho e dor residual. Os pacientes operados pela técnica aberta apresentaram menos queixa de parestesia residual pós-operatória.

Abstract Objective The present study aimed to determine the frequency of trigger finger (TF) onset after surgery for carpal tunnel syndrome (CTS) using an open (OT) or an endoscopic technique (ET). As a secondary endpoint, the present study also compared paresthesia remission and residual pain rates in patients submitted to both techniques. Methods Trigger finger onset and remission rates of paresthesia and pain at the median nerve territory was verified prospectively in a series of adult patients submitted to an OT procedure (n = 34). These findings were compared with a retrospective cohort submitted to ET (n = 33) by the same surgical team. Patients were evaluated with a structured questionnaire in a return visit at least 6 months after surgery. Results Sixty-seven patients were evaluated. There was no difference regarding trigger finger onset (OT, 26.5% versus ET, 27.3%; p = 0.94) and pain (OT, 76.5% versus ET, 84.8%; p = 0.38). Patients submitted to OT had fewer paresthesia complaints compared with those operated using ET (OT, 5.9% versus ET, 24.2%; p = 0.03). Conclusions In our series, the surgical technique did not influence trigger finger onset and residual pain rates. Patients submitted to OT had less complaints of residual postoperative paresthesia.

RESUMO Objetivo: Avaliar o índice de cura do cisto sinovial dorsal do punho, com aspiração e escleroterapia percutânea utilizando glicose hipertônica 75%. Métodos: Foram selecionados pacientes maiores de 18 anos, portadores de cisto sinovial dorsal do punho, sem tratamento prévio. Foram submetidos a aspiração e escleroterapia percutânea com glicose hipertônica 75%. Foi realizado no máximo dois procedimentos em cada cisto, em um intervalo de 4 semanas. Foram analisados idade, gênero, lado acometido, história de trauma prévio, goniometria, força de preensão, dor no punho pela escala visual analógica, complicações e os escores dos questionários funcionais. Resultados: Foram avaliados 45 pacientes com 47 cistos, houve perda de seguimento de 3 pacientes (3 cistos). A média de idade foi de 38,2 anos. Na quarta semana após o primeiro procedimento, tivemos cura em 23,4% cistos, 4,3% cistos apresentavam-se palpáveis porém não visíveis e 72,3% cistos se apresentavam palpáveis e visíveis. Os cistos visíveis e palpáveis foram submetidos ao segundo procedimento. Após 24 semanas do primeiro procedimento, 57,4% cistos foram curados e 42,6% cistos apresentaram persistência. Conclusão: O tratamento do cisto sinovial dorsal do punho com escleroterapia percutânea utilizando Glicose Hipertônica 75%, proporcionou cura de 57,4% após 24 semanas. Nível de Evidência IV, Série de casos

ABSTRACT Objective: To evaluate the cure rate for dorsal synovial cysts of the wrist with aspiration and percutaneous sclerotherapy using 75% hypertonic glucose. Methods: We enrolled 45 patients older than 18 years with untreated dorsal synovial cysts of the wrist. They underwent percutaneous aspiration and sclerotherapy with 75% hypertonic glucose 75%. A maximum of two procedures were conducted for each cyst at a 4-week interval. We analyzed age, sex, affected side, history of previous trauma, wrist goniometry, grip strength, wrist pain by the visual analogue scale, complications, and hand function questionnaire scores. Results: We evaluated 45 patients (30 female, 15 male, mean age 38.2 years with 47 cysts). Four weeks after the first procedure, 72.3% cysts were palpable and visible. At 24 weeks after the first procedure, 57.4% cysts evolved to cure and 42.6% persisted. Conclusion: Treatment of dorsal synovial cyst of the wrist with aspiration and percutaneous sclerotherapy using 75% hypertonic glucose achieved a 57.4% cure rate after 24 weeks. Level of Evidence IV, Case series

Resumo Objetivo Avaliar o planejamento terapêutico para o dedo em gatilho por ortopedistas brasileiros. Métodos Estudo transversal, cuja população foi composta por participantes do Congresso Brasileiro de Ortopedia e Traumatologia 2018 (CBOT-2018). Foi aplicado um questionário sobre a conduta adotada no diagnóstico e tratamento do dedo em gatilho. Resultados Foram analisados 243 participantes com média de idade de 37.46 anos, na maioria homens (88%), tempo de experiência de pelo menos 1 ano (55,6%), e da região Sudeste (68.3%). A análise dos questionários evidenciou que há consenso nos seguintes quesitos: diagnóstico somente com exame físico (73,3%), classificação de Quinnell modificada por Green (58,4%), tratamento inicial não cirúrgico (91,4%), infiltração de corticoide com anestésico (61,7%) tempo de tratamento não cirúrgico de 1 a 3 meses (52,3%), tratamento cirúrgico pela via aberta (84,4%), principalmente via aberta transversa (51%), recidiva do engatilhamento como principal complicação não cirúrgica (58%), e o sucesso da cirurgia aberta em > 90% (63%), sendo a sua principal complicação as complicações cicatriciais (54%). Sem consenso nas demais variáveis. De acordo com a experiência, foram observadas diferenças referentes ao tempo de tratamento (p = 0.013) e a taxa de complicação da cirurgia aberta (p = 0.010). Conclusões O ortopedista brasileiro tem preferência pelo diagnóstico do dedo em gatilho apenas com exame físico, classifica segundo Quinnell modificado por Green, tratamento inicial não cirúrgico, infiltrações com corticoide e anestésico local, tempo de tratamento não cirúrgico de 1 a 3 meses, tratamento cirúrgico por via aberta transversa, principal complicação não cirúrgica a recidiva do engatilhamento, e considera o sucesso da cirurgia aberta em > 90% dos casos, tendo como principal complicação as complicações cicatriciais.

Abstract Objective The present paper aims to evaluate the therapeutic planning for trigger finger by Brazilian orthopedists. Methods This is a cross-sectional study with a population composed of participants from the 2018 Brazilian Congress on Orthopedics and Traumatology (CBOT-2018, in the Portuguese acronym), who answered a questionnaire about the conduct adopted for trigger finger diagnosis and treatment. Results A total of 243 participants were analyzed, with an average age of 37.46 years old; most participants were male (88%), with at least 1 year of experience (55.6%) and from Southeast Brazil (68.3%). Questionnaire analysis revealed a consensus on the following issues: diagnosis based on physical examination alone (73.3%), use of the Quinnell classification modified by Green (58.4%), initial nonsurgical treatment (91.4%), infiltration of steroids combined with an anesthetic agent (61.7%), nonsurgical treatment time ranging from 1 to 3 months (52.3%), surgical treatment using the open approach (84.4%), mainly the transverse open approach (51%), triggering recurrence as the main nonsurgical complication (58%), and open surgery success in > 90% of the cases (63%), with healing intercurrences (54%) as the main complication. There was no consensus on the remaining variables. Orthopedists with different practicing times disagree on treatment duration (p = 0.013) and on the complication rate of open surgery (p = 0.010). Conclusions Brazilian orthopedists prefer to diagnose trigger finger with physical examination alone, to classify it according to the Quinnell method modified by Green, to institute an initial nonsurgical treatment, to perform infiltrations with steroids and local anesthetic agents, to sustain the nonsurgical treatment for 1 to 3 months, and to perform the surgical treatment using a transverse open approach; in addition, they state that the main nonsurgical complication was triggering recurrence, and report open surgery success in > 90% of the cases, with healing intercurrences as the main complication.

Resumo Objetivo Definir as principais características epidemiológicas dessas lesões, bem como identificar a causa e a frequência de ferimentos penetrantes no membro superior atendidos no Instituto de Ortopedia e Traumatologia da nossa instituição. Métodos O estudo se baseou em uma amostra de pacientes consecutivos atendidos no Instituto de Ortopedia e Traumatologia dessa instituição, demaio de 2014 amaio de 2016. Os dados foram coletados por contato telefônico, aplicou-se um questionário pré-estruturado sobre os dados e as características das lesões. A análise estatística foi feita de forma descritiva e a comparação das proporções através do teste de quiquadrado, associado ao valor de p, com significância < 5%. Resultados Foramconsiderados 1.648registros inicialmente e, após aplicados os critérios de exclusão e excluídos os duplicados, 598 pacientes foram incluídos na análise final. A maioria dos pacientes era do gênero masculino (77,80%), destros (95,82%), com média no momento do trauma de 37,27 anos. Os trabalhadores manuais foram os mais lesionados (50,00%) e a topografia mais acometida foram os dedos (51,84%). Dentre os agentes etiológicos, destaque para o vidro (33,77%). A prevalência de pacientes comamputação foi maior nos ferimentos por máquinas industriais (p < 0,05) quando comparada com outros agentes etiológicos. Pacientes com menos de 18 anos apresentaram maior frequência de ferimentos ocasionadas por vidro (p < 0,05). Já os pacientes com 60 anos ou mais apresentaram maior prevalência de ferimentos pormáquina de corte (p < 0,05). Mulheres apresentaram maior frequência de ferimentos por lâmina e por vidro (p < 0,05). Os trabalhadores manuais apresentaram maior prevalência de ferimentos por máquinas de corte e industriais (p < 0,05) e maior prevalência de amputações (p < 0,05). Conclusão O agente etiológico mais frequente é o vidro, com relevância maior em menores de 18 anos. Em mulheres e idosos, há grande frequência de lesões causadas por lâminas e máquinas de corte, respectivamente. Lesões de maior gravidade são causadas por máquinas, associadas a atividade laboral.

Abstract Objective To define the major epidemiological features of upper limb penetrating injuries, as well as to identify the causes and the frequency of these lesions at the Instituto de Ortopedia e Traumatologia, a hand surgery center in the city of São Paulo, state of São Paulo, Brazil. Methods The present study was based on a sample of consecutive patients from our orthopedics and traumatology institute from May 2014 to May 2016. Data were collected by telephone, and a prestructured questionnaire regarding data and features of the lesions was applied. Descriptive statistics and proportions comparison with the chi-squared test were performed with a p-value < 5% considered as statistically significant. Results At first, 1,648 records were considered and, after applying the exclusion criteria and eliminating duplicate records, 598 records were included in the present study. Most of the patients weremale (77.8%), right-handed (95.82%), with an average age of 37.27 years old.Manual laborers were the most injured individuals (50.00%), and fingers were the most affected site (51.84%). Glass was the most frequent etiologic agent (33.77%). The prevalence of amputation was higher in industrial machinery injuries (p < 0.05) when compared with other causes. Younger patients (< 18 years old) had more glass-related injuries, while older patients ( 60 years old) had more traumas caused by power tools (p < 0.05). Women had more injuries resulting from razors and glass (p < 0.05). Manual laborers had a higher frequency of power tools and industrial machinery-related injuries (p < 0.05) and a higher prevalence of amputations (p < 0.05). Conclusion Themost frequent etiology was glass, especially in individuals < 18 years old.Women and older patients (> 60 years old) presented a high frequency of traumas caused by razors and power tools, respectively. More severe injuries were caused by machinery and were related with work activity.

OBJECTIVES: Machinery injuries account for a substantial share of traumatic upper limb injuries (TULIs) affecting young active individuals. This study is based on the hypothesis that there is an important relationship between the improper use of power saws and TULIs. The aim of the study is to assess the prevalence and epidemiology of TULIs caused by power saws and determine the risks related to power saw use. METHODS: A cross-sectional evaluation of medical records from a two-year period was performed. Patients sustaining TULIs related to power saws were analyzed. Data on the epidemiology, site of injury, mechanism of trauma, technical specifications of the tool, cutting material, personal protective equipment, time lost and return to work were obtained. RESULTS: A database search retrieved 193 TULI records, of which 104 were related to power saws. The majority of patients were male (102/104; 98.1%), right-handed (97/104; 93.3%), and manual workers (46/104; 44.2%), with an average age of 46.8 years. The thumb was the most frequently injured site (32/93; 34.4%). Most of the injuries were caused by manual saws (85/104; 81.7%), and masonry saws accounted for 68.2% (58/85) of the cases. Masonry saws improperly used for woodwork resulted in 86.2% (50/58) of the injuries. TULI caused by masonry saws was 5 times higher in manual workers than in other patients. In addition, masonry saws had a risk of kickback 15 times higher than that of other saws, and the risk of injury increased by 5.25 times when the saws were used improperly for wood cutting. CONCLUSIONS: The profile of TULIs related to power saws was demonstrated and was mainly associated with manual saws operated by manual workers that inappropriately used masonry saws for woodworking.

RESUMO Objetivo Avaliar a aplicabilidade de ensaios clínicos randomizados e se há fatores que a influenciam (experiência do cirurgião/ impacto do periódico). Métodos Estudo tipo survey. Selecionou-se (via Medline/Pubmed) dentre os anos de 2013 e 2015, 32 ensaios clínicos randomizados consecutivos envolvendo cirurgia da mão (estratificados como alto/ baixo impacto). Estes estudos foram avaliados de forma independente por 20 cirurgiões de mão (mais versus menos de 10 anos de prática), que responderam quatro questões dicotômicas relativas à propensão da aplicabilidade clínicados estudos. A concordância foi avaliada pelo kappa de Cohen e comparação de proporções pelo Qui-quadrado. Constituiu-se como significantes p menores que 5%. Resultados realizou-se 640 avaliações, envolvendo 2560 respostas. Observou-se baixa concordância entre os avaliadores (menos versus mais experientes): Kappa <0,2; alcance 0,119-0,179. A propensão para aplicabilidade foi semelhante entre os menos e mais experientes (p=0,424 e p=0,70). O mesmo ocorre quando estratificados por impacto da revista, não há maior propensão de aplicabilidade para quaisquer dos grupos (p=0,29). Conclusões Há baixa concordância entre os avaliadores quanto à aplicabilidade de estudos randomizados. Experiência do cirurgião e impacto do periódico parecem não influenciar nesta decisão. Nível de Evidência II; Estudo prospectivo comparativo.

ABSTRACT Objective To assess the applicability of randomized clinical trials and whether certain factors (surgeon experience/journal impact factor) influence their applicability. Methods In this survey study we used the Pubmed/Medline database to select 32 consecutive randomized clinical trials published between 2013 and 2015, involving hand surgery (high/low impact). These studies were independently assessed by 20 hand surgeons (with more or less than 10 years of practice) who answered 4 questions regarding their applicability. Agreement was assessed using Cohen’s kappa and comparison of proportions via chi-square statistics. P-value <5% constituted statistical significance. Results A total of 640 evaluations were produced, generating 2560 responses. A weak correlation was observed between less and more experienced respondents (kappa <0.2; range 0.119–0.179). Applicability between the least and most experienced respondents was similar (p = 0.424 and p = 0.70). Stratification by journal impact factor showed no greater propensity of applicability (p = 0.29) for any of the groups. Conclusions Low agreement was found between the respondents for the applicability of the randomized studies. Surgeon experience and journal impact do not seem to influence this decision. Level of Evidence II, Prospective comparative study.

ABSTRACT BACKGROUND: Hierarchy of evidence is an important measurement for assessing quality of literature. Information regarding quality of evidence within the Brazilian hand surgery setting is sparse, especially regarding whether research has improved in either quality or quantity. This study aimed to identify and classify hand surgery studies published in the two most important Brazilian orthopedics journals based on hierarchy of evidence, with comparisons with previously published data. DESIGN AND SETTING: Bibliometric analysis study performed in a federal university. METHODS: Two independent researchers conducted an electronic database search for hand surgery studies published between 2010 and 2016 in Acta Ortopédica Brasileira and Revista Brasileira de Ortopedia. Eligible studies were subsequently classified according to methodological design, based on the Haynes pyramid model (HP) and the JBJS/AAOS levels of evidence and grades of recommendations (LOR). Qualitative and quantitative data were gathered regarding all studies. Previous data were considered to assess whether the proportion of high-quality studies had improved over time (2000-2009 versus 2010-2016). RESULTS: The final analysis included 123 studies, mostly originating from the southeastern region (78.8%) and private institutions (65%), with self-funding (91.8%). Methodological assessment showed that 15.4% were classified as level I/II using HP and 16.4% using LOR. No significant difference in proportions of high-quality studies was found between the two periods of time assessed (5% versus 12%; P = 0.13). CONCLUSION: Approximately 15% of hand surgery studies published in two major Brazilian journals were likely to be classified as high-quality through two different systems. Moreover, no trend towards quality-of-evidence improvement was found over the last 15 years.

RESUMO OBJETIVO: Este estudo teve como objetivo avaliar a correlação entre o escore PRWE com outras medidas já amplamente usadas. MÉTODOS: Estudo transversal prospectivo, de centro único; 68 pacientes consecutivos foram submetidos a tratamento cirúrgico para fratura da extremidade distal do rádio (fixação interna com placa volar bloqueada ou fixação externa transarticular). Foram avaliados, de forma independente, por meio da Patient-Rated Wrist Evaluation (PRWE), do Disabilities of the Arm, Shoulder and Hand (DASH), da escala visual analógica (EVA), da amplitude de movimento, da força e dos critérios radiográficos, no seguimento de um ano. Usaram-se o teste de Mann-Whitney para comparação de variáveis contínuas e a correlação de Spearman para os desfechos de interesse. RESULTADOS: PRWE correlacionou-se significativamente com DASH (p < 0,001) e EVA (p < 0,001). Não houve correlação significativa com as demais medidas de desfecho. CONCLUSÃO: PRWE apresenta correlação significativa moderada apenas com DASH e EVA. As medidas de amplitude de movimento, força e os critérios radiográficos não se correlacionam com PRWE.

ABSTRACT OBJECTIVE: The study aimed to evaluate the correlation between the PRWE score with other measurements that are already widely used. METHODS: This was a prospective, cross-sectional, single-center study. Sixty-eight consecutive patients underwent surgical treatment for distal radius fractures (internal fixation by locked volar plate or transarticular external fixation). They were evaluated independently by PRWE, DASH, VAS range of motion, strength, and radiographic criteria, in one year of follow up. The Mann-Whitney test was used to compare continuous variables and the Spearman correlation to correlate the outcomes of interest. RESULTS: PRWE correlated significantly with DASH (p < 0.001) and VAS (p < 0.001). There were no significant correlations with other outcome measures. CONCLUSION: PRWE presents significant moderate correlation only with DASH and VAS. Range of motion, strength, and radiographic criteria do not interfere in the PRWE outcome.

RESUMO As síndromes compressivas do nervo radial tem apresentação diversa. Não há consenso sobre métodos diagnósticos e terapêuticos. O objetivo desta revisão é sintetizar tais métodos. Este estudo se baseou no método das revisões sistemáticas da literatura. Busca eletrônica de estudos primários utilizando termos correlatos, realizada nas bases de dados (1980 a 2016): Pubmed (via medline), Lilacs (via Scielo) e Google Scholar. Através de protocolo pré-definido, identificou-se estudos relevantes. Não houve restrições de idioma. Excluiu-se relatos de caso. Aspectos do diagnóstico e tratamento foram sintetizados em tabelas. Análises quantitativas foram seguidas de suas variáveis de dispersão, considerando IC de 95%. Incluiu-se catorze estudos foram incluídos. Todos estudos foram considerados como nível IV de evidência. A maioria dos estudos consideram aspectos da história clínica e manobras provocativas como definidores de diagnóstico. Não há consenso sobre utilização da eletroneuromiografia, e os métodos são heterogêneos. Estudos demonstram que o tratamento cirúrgico (liberação muscular e neurólise) apresenta taxa variável de bons resultados, variando de 20-96,5%. Alguns estudos aplicaram escores autorreportados, entretanto a heterogeneidade das populações não permite análises inferenciais sobre o tema. Reportou-se poucas complicações. A maioria dos estudos consideram o diagnóstico da síndromes compressivas do nervo radial eminentemente clínicas. O tratamento cirurgico mais utilizado foi técnica mista de liberação muscular e neurólise, com resultados heterogêneos. Necessita-se de estudos comparativos. Nível de Evidência III, Revisão Sistemática.

ABSTRACT Compressive syndromes of the radial nerve have different presentations. There is no consensus on diagnostic and therapeutic methods. The aim of this review is to summarize such methods. Eletronic searches related terms, held in databases (1980-2016): Pubmed (via Medline), Lilacs (via Scielo) and Google Scholar. Through pre-defined protocol, we identified relevant studies. We excluded case reports. Aspects of diagnosis and treatment were synthesized for analysis and tables. Quantitative analyzes were followed by their dispersion variables. Fourteen studies were included. All studies were considered as level IV evidence. Most studies consider aspects of clinical history and provocative maneuvers. There is no consensus on the use of electromyography, and methods are heterogeneous. Studies have shown that surgical treatment (muscle release and neurolysis) has variable success rate, ranging from 20 to 96.5%. Some studies applied self reported scores, though the heterogeneity of the population does not allow inferential analyzes on the subject. few complications reported. Most studies consider the diagnosis of compressive radial nerve syndromes essentially clinical. The most common treatment was combined muscle release and neurolysis, with heterogeneous results. There is a need for comparative studies . Level of Evidence III, Systematic Review.

OBJECTIVES: We evaluated mRNA expression levels of genes that encode TGF-β1; the TGF-β1 receptor; the collagen-modifying enzymes LOX, PLOD1, and PLOD2; and the extracellular matrix proteins COMP, FN1, TNC and TNXB in synovial/capsule specimens from patients with idiopathic adhesive capsulitis. Possible associations between the measured mRNA levels and clinical parameters were also investigated. METHODS: We obtained glenohumeral joint synovium/capsule specimens from 9 patients with idiopathic adhesive capsulitis who had not shown improvement in symptoms after 5 months of physiotherapy. Adhesive capsulitis was confirmed in all patients by magnetic resonance imaging. We also obtained specimens from 8 control patients who had underwent surgery for acute acromioclavicular joint dislocation and who had radiological indication of glenohumeral capsule alteration based on arthroscopic evaluation. mRNA expression in the synovium/capsule specimens was analyzed by quantitative reverse transcription PCR. The B2M and HPRT1 genes were used as references to normalize target gene expression in the shoulder tissue samples. RESULTS: The synovium/capsule samples from the patients with adhesive capsulitis had significantly higher TNC and FN1 expression than those from the controls. Additionally, symptom duration directly correlated with expression of TGFβ1 receptor I. CONCLUSION: Elevated levels of TNC and FN1 expression may be a marker of capsule injury. Upregulation of TGFβ1 receptor I seems to be dependent on symptom duration; therefore, TGFβ signaling may be involved in adhesive capsulitis. As such, TNC, FN1 and TGFβ1 receptor I may also play roles in adhesive capsulitis by contributing to capsule inflammation and fibrosis.

Objective : To evaluate and compare the behavior of glycosaminoglycans (GAGs) in Dupuytren disease (DD). Methods : This is an experimental study with 23 patients diagnosed with DD. Tissue collected through fasciectomy with incision type Brunner or McCash were evaluated by electrophoresis for identification of GAGs. The quantification was carried out by immunofluorescence and dosage of proteins for different types of glycosaminoglycans. The results were expressed in percentage and statistically evaluated. Results : A significant increase was observed through eletrophoresis in GAGs, as compared to the control (p<0.05). Immunofluorescence of hyaluronic acid was reduced (23 times) when compared to the control (p<0.0001). Conclusion : An increase of sulfated GAGs in Dupuytren's disease, mainly dermatan sulfate, was evident from our results, as well as a pronounced decrease of hyaluronic acid in the palmar aponeurosis from the same patients. Level of Evidence III, Case-Control Study.

OBJECTIVE: To evaluate whether the symptoms relief after local corticoid injection correlate with better results of surgical treatment in carpal tunnel syndrome.METHODS: Between February 2011 and June 2013, 100 wrists of 88 patients were included in the study. All patients were subjected to corticoid injections in the carpal tunnel and evaluated before and after infiltration and surgery. The following parameters were evaluated: visual analog scale (VAS) for pain, Boston questionnaire, sensitivity and strength.RESULTS: Only 28 out of 100 wrists subjected to injection were symptom-free after six months follow up. Sixty out of the 72 patients who did not present relief or relapse symptoms were treated surgically. Surgical results were better regarding VAS, Boston questionnaire and sensitivity in a specific group of patients, which had a longer relief of symptoms after the corticoid injection, with statistical significance.CONCLUSION: Longer relief of symptoms after corticoid injection correlated with better results of surgical treatment.Level of Evidence II, Prognostic Study.

Clinical research is focused in generating evidence that is feasible to be applicable to practitioners. However, translating research-focused evidence into practice may be challenging and often misleading. This article aims is to pinpoint these challenges and suggest some methodological safeguards, taking platelet-rich plasma therapies and knee osteochondral injuries as examples. Studies and systematic reviews involving the following concepts will be investigated: clinically relevant outcomes, systematic errors on sample calculation, internal and external validity. Relevant studies on platelet-rich plasma for muscle-tendon lesions and updates on osteochondral lesions treatment were included in this analysis. Authors and clinicians should consider these concepts for the implementation and application of dissemination of the best evidence. Research results should be challenged by a weighted analysis of its methodological soundness and applicability. Level of Evidence V, Therapeutic Studies - Investigating the Results of Treatment.