¿PORQUÉ SE ROMPE EL SUPRAESPINOSO CON LA EDAD?

[vc_row][vc_column][vc_custom_heading text=»¿Porqué se rompe el supraespinoso con la edad?» font_container=»tag:p|font_size:30|text_align:left|color:%231e1e1e» google_fonts=»font_family:Open%20Sans%3A300%2C300italic%2Cregular%2Citalic%2C600%2C600italic%2C700%2C700italic%2C800%2C800italic|font_style:600%20bold%20italic%3A600%3Aitalic»][ultimate_spacer height=»30″ height_on_tabs=»15″ height_on_tabs_portrait=»15″ height_on_mob_landscape=»15″ height_on_mob=»15″][vc_column_text]

Es curioso que el supraespinoso tenga unos niveles de daños tan exagerados en edades avazandas, concretamente en personas por encima de 80 años el 80% presenta roturas en el manguito, ver (La eppidemia del hombro: el síndrome subacromial). Entre los factores que favorecen la aparición del síndrome subacromial tenemos uno que está muy relacionado con la degeneración que se asocia a la edad, la hipovascularidad. Y un grupo de investigadores han desarrollado una teoría que trata de explicar el mecanismo general que produce esa degeneración con tanta frecuencia, se trata de la TEORÍA DE FIRAT.

Con la Evolución de la especie, al pasar de la marcha cuadrúpeda a la bipedestación, el ancestro del ser humano tuvo que modificar sus apoyos, convirtiendo el miembro superior en una extremidad en suspensión destinada a la prensión en lugar de un miembro sometido a la presión. Los cambios anatómicos en la escápula, en la orientación de la cabeza humeral y en las funciones musculares han alterado la biomecánica del hombro, que quizá no está todavía completamente adaptado a todos los movimientos que se esperan de él^19,21,57.

Al estar supendido el miembro superior, esto provoca un aumento de la fuerza de la gravedad²¹. La influencia de la gravedad a lo largo de la vida va produciendo un aumento progresivo de la longitud de las sarcómeras del supraespinoso, lo que conlleva un descenso de la microvascularidad por estrechamiento de los capilares. La longitud óptima de un sarcómera es 2.6µm (micrometros)^41,42, y cuando aumenta por encima de 2.9µm, se compromete el flujo sanguíneo^33,50,57, imaginad un tubo elástico que estiramos y reducimos su diámetro; y el músculo del cuerpo humano con la longitud de sarcómera más grande es el supraespinoso con 3,23µm.

Los dolores del hombro pueden tener un origen muscular a causa de una actividad excesiva⁵⁵. Podrían vincularse a la presencia de las «fibras de Cenicienta» descritas por Hagg, sobre todo en los trapecios superiores²⁷. Estas fibras, cuyo nombre indica que son «las primeras en levantarse y las últimas en acostarse», estarían continuamente en acción pero con un nivel de actividad muy bajo

Atendiendo a los dos últimos factores que influyen en la hipovascularidad (La evolución de la especie y la gravedad), que son quizás los grandes olvidados cuando se explica este síndrome, se nos ocurre una solución infalible para no formar parte de la gran Epidemia mundial del hombro:

Es tan fácil como irnos al espacio o dejar de ser humanos. Pero para los que no podemos hacer ninguna de esas dos cosas, siempre nos queda la opción de aumentar el espacio subacromial, trabajar excéntricamente el supraespinoso, mejorar la discinesia escapular, reducir el DRIG,…. ¡A cuidar esos hombros! Que vamos a vivir muchos años, y los hombros también merecen disfrutar de la jubilación.

BIBLIOGRAFÍA:

1. Abboud JA, Kim JS. The effect of hypercholesterolemia on rotator cuff disease. Clin Orthop Relat Res 2010;468:1493–7.
2. Arslan G, Apaydin A, Kabaalioglu A, Sindel T, Lu¨leci E (1999) Sonographically detected subacromial/subdeltoid bursal effusion and biceps tendon sheath fluid: reliable signs of rotator cuff tear? J Clin Ultrasound 27(6):335–339.
3. Balyk R, Luciak-Corea C, Otto D, Baysal D, Beaupre L. Do outcomes differ after rotator cuff repair for patients receiving workers’ compensation? Clin Orthop Relat Res. 2008;466(12):3025-3033.
4. Baumgarten KM, Gerlack D, Galatz LM, et al. Cigarette smoking increases the risk for rotator cuff tears. Clin Orthop Relat Res 2010;468:1534–41.
5. Beason DP, Abboud JA, Kuntz AF, Bassora R, Soslowsky LJ. Cumulative effects of hypercholesterolemia on tendon biomechanics in a mouse model. J Orthop Res. 2011;29:380—3.
6. Bigliani, L.U., Ticker, J.B., Flatow, E.L., Soslowsky, L.J., Mow, V.C., 1991. The relationship of acromial architecture to rotator cuff disease. Clinics in Sports Medicine 10, 823–838.
7. Blevins F, Djurasovic M, Flatow E, et al. Biology of the rotator cuff. Orthop Clin North Am 1997;28:1–15.
8. Borstad JD, Ludewig PM. The effect of long versus short pectoralis minor resting length on scapular kinematics in healthy individuals. J Orthop Sports Phys Ther 2005;35:227–38.
9. Borstad JD. Resting position variables at the shoulder: evidence to support a posture-impairment association. Phys Ther 2006;86:549–57.
10. Brewer BJ. Aging of the rotator cuff, American Journal of Sports Medicine 7 (1979) 102–110.
11. Bullock MP, Foster NE, Wright CC. Shoulder impingement: the effect of sitting posture on shoulder pain and range of motion. Man Ther 2005;10:28-37.
12. Carbone S, Gumina S, Arceri V, et al. The impact of preoperative smoking habit on rotator cuff tear: cigarette smoking influences rotator cuff tear sizes. J Shoulder Elbow Surg 2012;21:56–60.
13. Carpenter JE, Thomopoulos S, Flanagan CL, DeBano CM, Soslowsky LJ. Rotator cuff defect healing: a biomechanical and histologic analysis in an animal model. J Shoulder Elbow Surg. 1998;7:599-605
14. Chansky HA, Iannotti JP. The vascularity of the rotator cuff, Clinics in Sports Medicine 10 (1991) 807–822.
15. Cools AM, Witvrouw EE, Mahieu NN, Danneels LA. Isokinetic scapular muscle performance in overhead athletes with and without impingement symptoms. J Athl Train 2005;40:104-10.
16. Cowan JB, Bedi A, Carpenter JE, Robbins CB, Gagnier JJ, Miller BS. Evaluation of American Academy of Orthopaedic Surgeons Appropriate Us Criteria for the management of fullthickness rotator cuff tears. J Shoulder Elbow Surg. 2016;25: 1100—6.
17. Diercks, R. et al. Guideline for diagnosis and treatment of subacromial pain syndrome: A multidisciplinary review by the Dutch Orthopaedic Association. Acta Orthop. 85, 314–322 (2014).
18. Draghi F, Scudeller L, Draghi AG, Bortolotto C. Prevalence of subacromial-subdeltoid bursitis in shoulder pain: an ultrasonographic study. J Ultrasound. 2015 Apr 2;18(2):151-8.
19. Dufour M, Pillu M. Biomécanique fonctionnelle. Paris: Masson; 2005.
20. Escamilla, R., Hooks, T. & Wilk, K. Optimal management of shoulder impingement syndrome. Open Access J. Sports Med. 13 (2014).
21. Fırat T, Türker T. Is the long sarcomere length responsible for non-traumatic supraspinatus tendinopathy? Potential novel pathophysiology and implications for physiotherapy. 2012 Jun;19(3):179-83.
22. Frost P, Bonde JP, Mikkelsen S, Andersen JH, Fallentin N, Kaergaard A, et al. Risk of shoulder tendinitis in relation to shoulder loads in monotonous repetitive work. Am J Ind Med 2002;41:11-8.
23. Galatz LM, Silva JM, Rothermich SY, et al. Nicotine delays tendon-to-bone healing in a rat shoulder model. J Bone Joint Surg Am 2006;88(9):2027–34.
24. Guckel C, Nidecker A. Diagnosis of tears in rotator-cuff-injuries, European Journal of Radiology 25 (1997) 168–176.
25. Guerini H, Fermand M, Godefroy D et al (2012) US appearance of partial-thickness supraspinatus tendon tears: application of the string theory. Pictorial essay. J Ultrasound 15(1):7–15.
26. Gwilym SE, Watkins B, Cooper CD, et al. Genetic influences in the progression of tears of the rotator cuff. J Bone Joint Surg Br 2009;91(7):915–7.
27. Hagg G. Static workloads and occupational myalgia: a new explanation model. En: Anderson P, Hobart DJ, Danoff JV, editores. Electromyographical Kinesiology. Amserdam: Elsevier; 1991. p. 441–4.
28. Haik MN, Alburquerque-Sendín F, Moreira RF, Pires ED, Camargo PR. Effectiveness of physical therapy treatment of clearly defined subacromial pain: a systematic review of randomised controlled trials. Br J Sports Med. 2016 Sep;50(18):1124-34.
29. Harrington S, Meisel C, Tate A. A cross-sectional study examining shoulder pain and disability in Division I female swimmers. J Sport Rehabil 2014;23:65–75.
30. Harvie P, Ostlere SJ, Teh J, et al. Genetic influences in the aetiology of tears of the rotator cuff. Sibling risk of a full-thickness tear. J Bone Joint Surg Br 2004;86(5): 696–700.
31. Hegedus EJ, Cook C, Brennan M, Wyland D, Garrison JC, Driesner D. Vascularity and tendon 699 pathology in the rotator cuff: a review of literature and implications for rehabilitation and 700 surgery. Br J Sports Med. 2010;44:838-847.
32. Hodgson RJ, O’Connor PJ, Hensor EM, Barron D, Robinson P (2012) Contrast-enhanced MRI of the subdeltoid, subacromial bursa in painful and painless rotator cuff tears. Br J Radiol 85(1019):1482–1487.
33. Kagaya A, Muraoka Y. Muscle architecture and its relationship to muscle circulation, International Journal of Sport and Health Science 3 (2005) 171–180.
34. Katzer A, Wening JV, Becker-Mannich HU, et al. Rotator cuff rupture. Vascular supply and collagen fiber processes as pathogenetic factors. Unfallchirurgie 1997;23:52–9.
35. Kibler WB. Scapular involvement in impingement: signs and symptoms. Instr Course Lect 2006;55:35-43.
36. Kim S, Bleakney R, Boynton E, et al. Investigation of the static and dynamic musculotendinous architecture of supraspinatus, Clinical Anatomy 23 (2010) 48–55.
37. Koppenhaver SL, Embry R, Ciccarello J, Waltrip J, Pike R, Walker M, Fernández-de-las-Peñas C, Croy T, Flynn T, Effects of Dry Needling to the Symptomatic versus Control Shoulder in Patients with Unilateral Subacromial Pain Syndrome, Manual Therapy (2016);26:62-69.
38. Leong HT, Hug F, Fu SN. Increased Upper Trapezius Muscle Stiffness in Overhead Athletes with Rotator Cuff Tendinopathy. PLoS One. 2016 May 9;11(5):e0155187.
39. Lewis JS, Green A, Wright C. Subacromial impingement syndrome: the role of posture and muscle imbalance. J Shoulder Elbow Surg 2005;14:385-92.
40. Lewis JS. Rotator cuff tendinopathy/subacromial impingement syndrome: is it time for a new method of assessment? Br J Sports Med. 2009;43:259-264.
41. Lieber RL, Friden J. Functional and clinical significance of skeletal muscle architecture, Muscle and Nerve 23 (2000) 1647–1666.
42. Lieber RL, Friden J. Implications of muscle design on surgical reconstruction of upper extremities, Clinical Orthopaedics and Related Research (2004) 267–279
43. Lin JJ, Hanten WP, Olson SL, et al. Functional activity characteristics of individuals with shoulder dysfunctions. J Electromyogr Kinesiol 2005;15:576–86.
44. Ling SC, Chen CF, Wan RX. A study on the vascular supply of the supraspinatus tendon, Surgical and Radiologic Anatomy 12 (1990) 161–165.
45. Ludewig PM, Cook TM. Alterations in shoulder kinematics and associated muscle activity in people with symptoms of shoulder impingement. Phys Ther 2000;80:276-91.
46. Mallon WJ, Misamore G, Snead DS, et al. The impact of preoperative smoking habits on the results of rotator cuff repair. J Shoulder Elbow Surg 2004;13(2): 129–32.
47. Milgrom C, Schaffler M, Gilbert S, van Holsbeeck M. Rotator-cuff changes in asymptomatic adults. The effect of age, hand dominance and gender. The Journal of bone and joint surgery. British volume. 1995;77:296-298.
48. Miranda H, Viikari-Juntura E, Martikainen R, Takala EP, Riihimaki H. A prospective study of work related factors and physical exercise as predictors of shoulder pain. Occup Environ Med 2001;58:528-34.
49. Mosley LH, Finseth F. Cigarette smoking: impairment of digital blood flow and wound healing in the hand. Hand 1977;9:97–101.
50. Nakao M, Segal SS. Muscle length alters geometry of arterioles and venules in hamster retractor, American Journal of Physiology 268 (1995) 336–344.
51. Neer CS 2nd. Impingement lesions. Clin Orthop Relat Res. 1983;173:70-77.
52. Neyton L, Godeneche A, Nove-Josserand L, Carrillon Y, Clechet J, Hardy MB. Arthroscopic suture-bridge repair for small to medium size supraspinatus tear: healing rate and retear pattern. Arthroscopy. 2013;29(1):10-17.
53. Ngomo S, Mercier C, Bouyer LJ, Savoie A, Roy JS. Alterations in central motor representation increase over time in individuals with rotator cuff tendinopathy. Clinical Neurophysiology. 2015;126:365-371
54. Osma-Rueda JL, Carreño-Mesa FA. Manguito de los rotadores: epidemiología, factores de riesgo, historia natural de la enfermedad y pronóstico. Revisión de conceptos actuales. Revista Colombiana de Ortopedia y Traumatología, 2016; 30(1):2-12.
55. Péninou G, Tixa S. Les tensions musculaires: du diagnostic au traitement. Paris: Masson; 2009.
56. Perry J. Anatomy and biomechanics of the shoulder in throwing, swimming, gymnastics, and tennis, Clinics in Sports Medicine 2 (1983) 247–270
57. Poole DC, Musch TI, Kindig CA. In vivo microvascular structural and functional consequences of muscle length changes, American Journal of Physiology 272 (1997) 2107–2114.
58. Preuschoft H, Hohn B, Scherf H, Schmidt M, Krause C, Witzel U. Functional analysis of the primate shoulder. Int J Primatol 2010;31:301–20.
59. Rechardt M, Shiri R, Karppinen J, Jula A, Heliövaara M, Viikari-Juntura E. Lifestyle and metabolic factors in relation to shoulder pain and rotator cuff tendinitis: a population-based study. BMC musculoskeletal disorders. 2010;11:165.
60. Reijneveld EA, Noten S, Michener LA, Cools A, Struyf F. Clinical outcomes of a scapular-focused treatment in patients with subacromial pain syndrome: a systematic review. Br J Sports Med. 2016 Jun 1.
61. Struyf F, Cagnie B, Cools A, et al. Scapulothoracic muscle activity and recruitment timing in patients with shoulder impingement symptoms and glenohumeral instability. J Electromyogr Kinesiol 2014;24:277–84.
62. Struyf F, Nijs J, Baeyens JP, et al. Scapular positioning and movement in unimpaired shoulders, shoulder impingement syndrome, and glenohumeral instability. Scand J Med Sci Sports 2011;21:352–8.
63. Tashjian RZ, Farnham JM, Albright FS, et al. Evidence for an inherited predisposition contributing to the risk for rotator cuff disease. J Bone Joint Surg Am 2009; 91(5):1136–42.
64. Tempelhof S., Rudd S., R. S. Age-related prevalence of rotator cuff tears in asymptomatic shoulders. Journal of shoulder and elbow surgery / American Shoulder and Elbow Surgeons … [et al.]. 1999;8:296-299.
65. Tyler TF, Nicholas SJ, Roy T, Gleim GW. Quantification of posterior capsule tightness and motion loss in patients with shoulder impingement. Am J Sports Med 2000;28:668-73.
66. Virk MS, Cole BJ. Proximal Biceps Tendon and Rotator Cuff Tears. Clin Sports Med. 2016 Jan;35(1):153-61.
67. Yamamoto A, Takagishi K, Osawa T, Yanagawa T, Nakajima D, Shitara H, Kobayashi T. Prevalence and risk factors of a rotator cuff tear in the general population. J Shoulder Elbow Surg. 2010 Jan;19(1):116-20.

[/vc_column_text][/vc_column][/vc_row][vc_row][vc_column][ultimate_spacer height=»20″ height_on_tabs=»10″ height_on_tabs_portrait=»10″ height_on_mob_landscape=»10″ height_on_mob=»10″][vc_custom_heading text=»CURSOS RELACIONADOS» font_container=»tag:p|font_size:22|text_align:left|color:%23d36200″ google_fonts=»font_family:Open%20Sans%3A300%2C300italic%2Cregular%2Citalic%2C600%2C600italic%2C700%2C700italic%2C800%2C800italic|font_style:600%20bold%20italic%3A600%3Aitalic»][ultimate_spacer height=»20″ height_on_tabs=»10″ height_on_tabs_portrait=»10″ height_on_mob_landscape=»10″ height_on_mob=»10″][dt_portfolio_carousel dis_posts_total=»» posts_offset=»0″ content_alignment=»center» image_sizing=»proportional» image_border_radius=»3px» image_scale_animation_on_hover=»disabled» image_hover_bg_color=»disabled» slides_on_wide_desk=»3″ item_space=»20″ link_lead=»follow_link» post_date=»n» post_category=»n» post_author=»n» post_comments=»n» post_content=»off» read_more_button=»off» show_link=»n» show_zoom=»n» show_details=»n» project_icon_border_width=»0px» project_icon_color=»#ffffff» project_icon_color_hover=»#ffffff» arrow_bg_width=»36x» arrow_border_width=»0px» r_arrow_icon_paddings=»0px 0px 0px 0px» r_arrow_v_offset=»0px» l_arrow_icon_paddings=»0px 0px 0px 0px» l_arrow_v_offset=»0px» category=»1286, 2160″][vc_separator border_width=»2″][/vc_column][/vc_row]