Reliability of forced internal rotation and active internal rotation to assess lateral instability of the biceps pulley

Purpose: the aim of this study was to investigate the relationship between positive painful forced internal rotation (FIR) and lateral pulley instability in the presence of a pre-diagnosed posterosuperior cuff tear. The same investigation was conducted for painful active internal rotation (AIR). Methods: a multicenter prospective study was conducted in a series of patients scheduled to undergo arthroscopic posterosuperior cuff repair. Pain was assessed using a visual analog scale (VAS) and the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH) was administered. The VAS score at rest, DASH score, and presence/absence of pain on FIR and AIR were recorded and their relationships with lesions of the lateral pulley, cuff tear patterns and shape of lesions were analyzed. Results: the study population consisted of 115 patients (mean age: 55.1 years) recruited from 12 centers. The dominant arm was affected in 72 cases (62.6%). The average anteroposterior extension of the lesion was 1.61 cm. The mean preoperative VAS and DASH scores were 6.1 and 41.8, respectively. FIR and AIR were positive in 94 (81.7%) and 85 (73.9%) cases, respectively. The lateral pulley was compromised in 50 cases (43.4%). Cuff tears were partial articular in 35 patients (30.4%), complete in 61 (53%), and partial bursal in 19 (16.5%). No statistical correlation between positive FIR or AIR and lateral pulley lesions was detected. Positive FIR and AIR were statistically associated with complete lesions. Negative FIR was associated with the presence of partial articular tears. Conclusions: painful FIR in the presence of a postero-superior cuff tear does not indicate lateral pulley instability. When a cuff tear is suspected, positive FIR and AIR are suggestive of full-thickness tear patterns while a negative FIR suggests a partial articular lesion. Level of evidence: level I, validating cohort study with good reference standards

In situ | Ex situ. L'arte di esporre l'arte: relazioni nel contesto spaziale tra arte e architettura

La quinta giornata internazionale di studi dottorali del Rome Art History Network, svoltasi in collaborazione con la University of Notre Dame Rome Global Gateway e l'Accademia Nazionale di San Luca, propone una riflessione teorica e metodologica sulle relazioni e sulle strategie di collocazione delle opere d’arte e d’architettura, all’interno o all’esterno dei rispettivi contesti spaziali d’origine. Risulta evidente che l’opera d’arte non possa che relazionarsi con lo spazio circostante. Le strategie e le modalità di esposizione delle opere in situ / ex situ risultano, infatti, al centro del dibattito contemporaneo. Ma in che modo si altera la percezione di un’opera, o l’organicità di un sistema architettonico, attraverso la manipolazione dei contesti spaziali originari? Quali caratteri specifici vengono posti in luce al variare di un determinato layout? Quali nuovi significati assume l’opera a seguito del cambio di contesto? In rapporto a questioni di museologia o museografia, sono ancora validi i concetti della storiografia tradizionale? La de-contestualizzazione delle opere può “salvare” l’arte in casi critici o implica l’alterazione dei suoi contenuti? La giornata di studio intende incoraggiare un dibattito interdisciplinare e cronologicamente trasversale sulla questione della collocazione e relazione spaziale tra le opere d’arte e d’architettura ed i reciproci scambi tra i due ambiti disciplinari