Please use this identifier to cite or link to this item: http://repositorio.unicamp.br/jspui/handle/REPOSIP/312462
Type: TESE DIGITAL
Title: Avaliação clínica e radiográfica dos cotovelos dos pacientes lesados medulares = Clinical and radigraphic evaluation of spinal cord injuried patients'elbows
Title Alternative: Clinical and radigraphic evaluation of spinal cord injuried patients'elbows
Author: Casimiro, Fabiana de Godoy, 1981-
Advisor: Cliquet Junior, Alberto, 1957-
Junior, Alberto Cliquet
Abstract: Resumo: O número de pacientes lesados medulares vem aumentando ao longo dos anos, devido ao incremento nos acidentes automobilísticos, violência por armas de fogo e armas brancas. Além disso, a melhoria no atendimento pré-hospitalar permitiu que vítimas graves, que antigamente morriam no local do trauma ou na primeira hora, fossem socorridas e sobrevivessem. No entanto, essas pessoas passaram a apresentar sequelas muitas vezes irreversíveis, como as lesões medulares. Indivíduos lesados medulares usualmente referem dor nos membros superiores em mais de 75,6% dos casos, sendo os ombros os mais afetados, seguidos por punhos, mãos e cotovelos. Esse trabalho teve como objetivo avaliar clínica e radiograficamente os cotovelos dos pacientes lesados medulares e compará-los a indivíduos saudáveis, pertencentes ao grupo controle. Quarenta cotovelos de 20 pacientes ¿ 10 paraplégicos e 10 tetraplégicos ¿ foram avaliados. Foi aplicado um questionário onde perguntava-se abertamente sobre queixas nos cotovelos e um questionário de desempenho onde 4 parâmetros são avaliados: dor, estabilidade, arco de movimento e atividades cotidianas. Os pacientes também foram submetidos a um exame físico onde o arco de movimento (ADM) ativo e passivo foi mensurado com uso do goniômetro. A força muscular foi classificada de 0 a 5 conforme escala padronizada pela American Spinal Injury Association (ASIA). Em seguida, todos os indivíduos foram submetidos a radiografias dos cotovelos e as imagens foram analisadas e classificadas quanto a presença de alterações degenerativas. A média de idade foi 45,4 anos no grupo dos paraplégicos, 39,9 anos no grupo dos tetraplégicos e 32,5 no grupo controle. O tempo médio de lesão foi 15,7 anos nos paraplégicos e 14,1 nos tetraplégicos. Nos pacientes paraplégicos observamos 2 indivíduos com dor leve e 2 com dor moderada. Nos tetraplégicos, 2 referiram dor leve e 1 referiu dor moderada. Quanto ao ADM ativo, notamos que os pacientes tetraplégicos tenderam a apresentar menor ADM quando comparados com os paraplégicos e grupo controle. Na avaliação do ADM passivo não vimos alteração significativa entre os 3 grupos. Referente a avaliação da força muscular, constatamos que os pacientes paraplégicos apresentaram força muscular normal, assim como o grupo controle, e que os tetraplégicos apresentaram uma diminuição do grau de força, bilateralmente. Na avaliação radiográfica dos cotovelos, nenhum indivíduo do grupo controle apresentou alterações nas imagens. Alguns pacientes paraplégicos e tetraplégicos apresentaram alterações radiográficas, sendo o lado esquerdo ligeiramente mais afetado do que o lado direito. Os tetraplégicos apresentaram alterações mais severas. A média do Mayo Elbow Performance Score (MEPS) foi 100 no grupo controle, 99,5 (95-100) nos paraplégicos e 81 (40-100) nos tetraplégicos. Não conseguimos correlacionar a idade com as alterações clínicas e radiográficas encontradas, sugerindo que tais alterações são secundárias à maior demanda funcional nos membros superiores e ao desequilíbrio muscular causado pela lesão medular. Esse trabalho nos mostrou que apesar das poucas queixas nos cotovelos relatadas pelos pacientes lesados medulares, alguns apresentam alterações clínicas e radiográficas que merecem mais estudos para melhor entendimento de sua origem e um suporte clinico mais cuidadoso por parte da equipe multidisciplinar que os acompanham

Abstract: The number of spinal-cord-injured patients has been growing along the years, due to higher motor vehicle accidents, firearms and cold weapons violence. Moreover, an improvement of pre-hospital care has allowed severe trauma victims to be rescued and to survive, which in the past would decease. However, those victims have presented some sequelae in many cases irreversible, such as medular injuries. Spinal-cord-injured patients usually complain of pain in the upper limbs more than 75,6% of the cases, being the shoulders the most affected, followed by wrists, hands and elbows. The objective of our study is to evaluate clinically and radiographically the elbows of spinal cord injured patients and to compare them to the control group. Forty elbows of 20 patients were evaluated ¿ 10 paraplegics and 10 tetraplegics. A questionnaire was applied where it was openly questioned about complains on the elbows. A performance questionnaire was also employed where four parameters were evaluated (pain, stability, range of movement and daily activities). Additionally, the patients were physically examined where the active and passive range of motion were measured using a goniometer. Moreover, the muscular strength was classified from zero (0) to five (5) as a standardized scale from American Spinal Injury Association (ASIA). Then, radiologic images were obtained from all patients elbows and they were evaluated and classified as if they presented or not any degenerative changes. The average age in the paraplegic group was 45,4 years old, in the tetraplegic group was 39,9 years old and the control group was 32,5. The average lesion age was 15,7 years in the paraplegic group, 14,1 in the tetraplegic group. It was observed two patients with mild pain and two others with moderate pain in the paraplegic group. In the tetraplegic group, two patients presented light pain and another one presented moderate pain. Regarding the active range of motion, it was noted that the tetraplegic patients had a smaller range of motion when compared to paraplegic and control groups. There was no difference in passive range of motion evaluation among the three groups. Concerning muscular strength, it was noted that paraplegic patients presented the same muscular strength when compared to the control group; and tetraplegic patients presented bilateral reduced muscular strength. In the elbows radiologic evaluation, no control group individual presented imagery changes. Some paraplegic and tetraplegic patients presented radiologic changes, being the left-hand side slightly more affected than the right-hand side. The tetraplegic patients had more severe clinical changes. The average Mayo Elbow Performance Score (MEPS) was one hundred (100) in the control group, 99.5 in the paraplegic group (range of 95-100) and 81 in the tetraplegic group (40-100). We could not correlate the influence of the age in the findings of clinical and radiographic evaluations, which suggests that those findings were due to overuse of upper limbs and to muscular imbalance. This research showed that in spite of few patients had complained about elbow pain, some of them presented clinical and radiologic changes that deserve further studies for a better understanding of its causes. Additionally, it is necessary a more careful clinical support from the multidisciplinary team involved
Subject: Cotovelo
Traumatismos da medula espinal
Osteoartrite
Dor
Editor: [s.n.]
Date Issue: 2016
Appears in Collections:FCM - Tese e Dissertação

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