Síndromes Compressivas do Ombro e Cotovelo Flashcards Preview

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Flashcards in Síndromes Compressivas do Ombro e Cotovelo Deck (15):
1

Quais são as estruturas comprimidas na síndrome do espaço quadrangular?

compression of the axillary nerves and posterior humeral circumlex artery in the quadrilateral space

2

Qual é a epidemiologia da síndrome do espaço quadrangular?

The syndrome usually afects the dominant arm of young adults, particularly athletes involved in overhead sports, 20 to 35 years old and is characterized by poorly localized anterior and lateral shoulder pain and point tenderness over the quadrilateral space near the teres minor insertion.

3

Como reproduzir clinicamente os sintomas da síndrome do espaço quadrangular?

Symptoms are reproduced by holding the arm abducted and externally rotated for 1 minute.

4

Qual achado radiológico é altamente sugestivo da síndrome do espaço quadrangular?

Selective atrophy of the teres minor muscle, which is innervated by the axillary nerve, can be seen on MRI and is highly suggestive of quadrilateral space syndrome.

5

Qual achado da arteriografia na síndrome do espaço quadrangular?

Arteriography shows occlusion of the posterior humeral circumlex artery with the arm in abduction and external rotation, but the artery appears normal with the arm at the side.

6

Quais estruturas comprimem o nervo e a artéria no espaço quadrangular?

The lesion seems to consist of oblique fibrous bands that compress the nerve and artery with the shoulder in abduction and external rotation. These bands can be lysed at surgery through a posterior approach with good results. Occasionally, a paralabral cyst from the posterior labrum may cause compression of the nerve.

7

Como tratar a síndrome do espaço quadrangular?

Nonoperative treatment, including activity modification, NSAIDs, cortisone injections, and physical therapy for rotator cuff muscle strengthening, is indicated initially for all patients. If symptoms persist after 3 to 6 months of nonoperative treatment, a posterior approach to the area with lysis of the fibrous bands usually results in symptom relief.

8

Qual é a origem do nervo suprascapular no plexo braquial?

The suprascapular nerve is derived from the upper trunk of the brachial plexus formed by the roots of C5 and C6 at the Erb point.

9

Quais estruturas são inervadas pelo nervo suprascapular?

After passing through the notch, the nerve supplies the supraspinatus and the shoulder capsule and the glenohumeral and acromioclavicular joints. The nerve turns around the lateral margin of the scapular spine to innervate the infraspinatus.

10

Em qual local o nervo supraescapular é comprimido?

Most suprascapular nerve entrapments occur at the suprascapular notch. The nerve can be injured at the suprascapular notch as a result of compression by the overlying transverse scapular ligament. A narrow notch or a calcified ligament has been shown to be associated with an increased risk of injury to the suprascapular nerve.

11

Quais são as causa de compressão do ramo inferior do nervo suprascapular isoladas?

Lipomas and ganglion cysts have been described compressing the inferior branch of the suprascapular nerve and leading to isolated infraspinatus atrophy. These usually are found at the spinoglenoid notch and can be seen on MRI.

12

Em qual posição o ligamento espinoglenoidal comprime o nervo supraescapular?

The nerve may be compressed by the spinoglenoid ligament, also known as the inferior transverse scapular ligament, which arises from the lateral aspect of the root of the spine of the scapula and inserts at the margin of the glenoid with ibers to the posterior gleno-humeral capsule. This ligament tightens with cross-body adduction and internal rotation, compressing the nerve.

13

Qual o exame utilizado para confirmar compressão do nervo supraescapular?

Eletroneuromiografia

14

Quais são as queixas habituais de um paciente com compressão do nervo supraescapular?

Patients usually complain of deep, aching, difuse pain and may complain of weakness of external rotation and abduction with overhead activities. Muscle atrophy may or may not be present. Painless atrophy is more common with compression of the nerve at the spinoglenoid notch.

15

Quais são os limites do espaço quandrangular?

the teres major and minor muscles, the humeral shat, and the long head of the triceps