As roturas do subescapular estão associadas a uma diminuição da distância coracohumeral: estudo de revisão sistemática e meta-Análise

Afonso Santos Salgado de Faria, 2020

Background: Subcoracoid impingement is a syndrome characterized by anterior shoulder pain with narrowed subcoracoid space and rotator cuff pathology. Subscapularis tendon seems to be the most affected by this impingement. Some radiological measures have been studied to decide the best management of rotator cuff injuries. Coracohumeral distance (CHD) and coracoid overlap (CO) are the most used dimensions to characterize the subcoracoid space and to predict subscapularis lesions. 
The objective of this study is to identify, select and resume all scientific evidence on the association between subscapularis tears and the variations in these two radiological measures, CHD and CO.

Methods: We performed a systematic review using the electronic s PubMed, Scopus and Web of Science to obtain all studies that compare CHD and CO in patients with subscapularis tears vs controls without subscapularis tears. A meta-analysis was conducted with the random-effects model.

Results: From the 135 collected papers, 17 were selected for qualitative analysis and 12 of them were included in the meta-analysis. Twelve articles pointed to a significant decrease in CHD in patients with subscapularis tears. Heterogeneous results were achieved in the CO analysis with two studies showing a higher CO in subscapularis tears group, one paper revealing a lower CO in that group and two studies did not find significant differences. Pooled meta-analysis for CHD showed a significant lower CHD in subscapularis tears group (-1.49 [-2.07, -0.92], p < 0.001, n=12 studies). Due to the small number of studies and their heterogeneity, it was not possible to extract valid results from the meta-analysis for CO.
 
Conclusion: Diminished CHD is strongly related to subscapularis tears. The association between CO and subscapularis tears is not well established. The understanding of the dynamic mechanism of subcoracoid impingement will be crucial to reach a consensus about the best treatment. More studies need to be conducted to define the patients that benefit from subcoracoid space release with coracoplasty.

Level of Evidence: Level III; Systematic Review and Meta-Analysis

Keywords: subscapularis tears; subcoracoid impingement; coracohumeral distance; coracoid overlap; shoulder; coracoplasty


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