La relajación distal del deltoides como alternativa para la rotura del manguito en pacientes con baja demanda

Résumé

Background: A rotator cuff is a muscle group of the shoulder involved in the stabilization and mobility of the humeral head. The shoulder joint has an unstable nature which, combined with its overuse, increases the likelihood of injury. Rotator cuff tears cause pain, decreased range of motion, and worsened quality of life. There needs to be a clear consensus on the optimal surgical treatment for this lesion. Scapinelli proposed gravitational decompression of the subacromial space through distal deltoid release from the humerus, which has been used with promising results in elderly patients with low functional demand with irreparable rotator cuff tears. Objective: To evaluate the functional result of the Scapinelli distal deltoid release technique, compared with traditional acromioplasty, in elderly patients with low physical demand who present irreparable rotator cuff tears. As secondary objectives, we set out to evaluate (1) the improvement of pain; (2) quality of life and patient satisfaction; (3) the rate of surgical complications and recurrence of the subacromial syndrome. Material and Methods: Case-control study comparing cohorts of patients treated by distal deltoid release and acromioplasty. Patients who operated at the Sagunto Hospital (Valencia) between 2015 and 2019, over 65 years of age and with low functional demand, were included. The Constant-Murley, quick-DASH, and VAS scores were used to assess the functional, quality of life, and pain, respectively, and a 5-category Likert scale to evaluate patient satisfaction. All statistical analyzes were performed using the IBVM-SPSS v.20 program. Results: Constant-Murley's evaluation at the end of the follow-up was significantly better in the Scapinelli group than in the acromioplasty group (p=0.005); and shoulder flexion (p= 0.034), but abduction and external rotation were not significantly different. The pain measured with the VAS scale at the end of the study was significantly better in the Scapinelli group than in the acromioplasty group (p= 0.001). The quality of life with the DASH scale was not significantly different between IV the groups (p= 0.071). Both groups, had a low rate of complications or need for reoperation. Conclusions: Both techniques provide functional improvement, although this is greater in the Scapinelli group. In this group, there is also less postoperative pain. For older patients with low physical demand expectations, we recommend the Scapinelli technique because it is less demanding for the surgeon, requires less surgical time, is inexpensive, reduces pain during shoulder activities, and increases patient satisfaction.