Place de l'échographie dans la prise en charge de la scapulalgie en rhumatologie à l'hôpital de Dreux / Place of ultrasound in management of shoulder pain in the Rheumatology Department of Dreux Hospital

Contexte & objectif. Les données sur la prise en charge des épaules en rhumatologie sont très limitées. L'objectif de la présente étude était de décrire la place de l'échographie dans la prise en charge des épaules douloureuses en rhumatologie. Méthodes. C'était une étude transversale sur les scapulalgies, suivies en rhumatologie de l'hôpital de Dreux ; entre janvier et mars 2018. Tous les participants avaient réalisé une échographie. Résultats. Au total 40 patients ont été enrôlés. Leur âge moyen était de 61,7 ans, et le sex ratio M/F de 0,29. A l'examen clinique, un conflit sous acromial (67,6%) et un syndrome acromio-claviculaire (32,4 %) étaient souvent observés. Les manœuvres de Jobe (76,5%), Patte (20,6%), et Gerber (14,7%) étaient parfois positives. A l'échographie, on observait les lésions des tendons de la coiffe (82,5%), du long biceps (25%), une bursite sous acromio-deltoïdienne (BSAD : 55%), une arthropathie gléno-humérale (30%), acromio-claviculaire (30%) ou sterno-claviculaire (2,5%). Une infiltration sous échographie était réalisée dans 85% des cas : BSAD (67,5%), gaine du long biceps (7,5%), articulation acromio-claviculaire (7,5%) et sterno- claviculaire (2,5%). Conclusion. L'échographie est très importante dans la prise en charge des scapulalgies dans le département de rhumatologie de l'hôpital de Dreux. Elle permet un diagnostic précis et la réalisation des gestes échoguidées.

Context and objective. Knowledge on management of shoulder pain is limited. The objective of the study was to describe the place of ultrasound in the management of shoulder pain in the Rheumatology Department of Dreux Hospital. Methods. A cross-sectional study was conducted on patients attending Rheumatology Department for shoulder pain from January to March 2018. All participants performed an ultrasound. Results. The mean age of the 40 patients included in the study was 61.7 years and the sex ratio was 0.29. On clinical examination, subacromial conflict (67.6%) and acromioclavicular syndrome (32.4%) were often observed. The Jobe (76.5%), Patte (20.6%), and Gerber (14.7%) tests were sometimes positive. Ultrasound lesions involved the rotator cuff (82.5%), subacromio-deltoid bursitis (55%), the long biceps tendon (25%), the glenohumeral joint (30%), the acromioclavicular joint (30%), or the sternoclavicular joint (2.5%). Ultrasound-guided infiltration was performed in 85% of cases. It concerned subacromio-deltoid bursitis (67.5%), long biceps sheath (7.5%), acromioclavicular joint (7.5%), and sterno-clavicular joint (2.5%). Conclusion. Ultrasound is very important in the management of shoulder pain in the Rheumatology Department of Dreux Hospital. It allows a precise diagnosis and the realization of echo-guided injections.

Traitement par la technique de Latarjet des instabilités antérieures de l'épaule au centre hospitalier de l'Ordre Malte de Dakar

Introduction : Le but de cette étude était d'évaluer les résultats cliniques et radiologiques des patients ayant une instabilité antérieure traitée par la technique de Latarjet. Patients et méthodes : Dans cette étude rétrospective 14 patients (15 épaules) ont été opérés entre janvier 2013 et décembre 2016 pour une luxation récidivante de l'épaule selon la technique de Latarjet à foyer ouvert. La fonction de l'épaule a été appréciée selon les cotations de Rowe, Duplay , et WOSI (the Western Ontario ShoulderInstability). Les résultats radiographiques ont concerné la consolidation du greffon et la position de la butée. Résultats : Le recul moyen était de 34 mois (7- 64). Douze patients étaient très satisfaits de la stabilité et de la fonction de leur épaules. il n'y avait pas de récidive. Selon la cotation de Walch et Duplay les résultats étaient bons (n=13) et moyen (n=1). Selon Rowe ils étaient bons (n=13) et mauvais ( n=1). Selon la cotation WOSI ils étaient excellents ( n=8), bons ( n=4), et moyens (n=2). Toutes les butées ont consolidées. Elles étaient sous l'équateur. Elles étaient affleurantes (n=14), médiale (n=1). Conclusion : Ce travail suggère que la technique de Latarjet réalisée à foyer ouvert offre aux patients une stabilisation de l'épaule, des mobilités quasi-normales, et la possibilité de reprendre dans de bonnes conditions des activités professionnelles et sportives

Infection ostéo articulaire à pneumocoque chez un sujet apparemment sain

Les infections ostéo-articulaires (IOA) àStreptococcus pneumoniae sont rares chez les adultessains et elles surviennent, souvent, sur un terraind'immunodépression ou de pathologie articulaire.Nous rapportons ici un cas d'arthrite septiquesubaiguë de l'épaule à Streptococcus pneumoniaeobjectivée chez un sujet âgé, sain et chez qui on n'apas objectivé de pathologies sous jacentes qui enpourraient être responsable. Ainsi, le Streptococcuspneumoniae doit être évoqué devant toute infectionostéo articulaire, essentiellement chez les vieillards,même en l'absence des facteurs favorisantsclassiquement associés

Are Shoulder Surgeons any good at Diagnosing Rotator Cuff tears using Ultrasound ? A Comparative Analysis of Surgeon vs Radiologist

High-resolution ultrasound has gained increasing popularity as an aid in the diagnosis of rotator cuff pathology. With the advent of portable machines; ultrasound has become accessible to clinicians. Aim: This study was conducted to evaluate the accuracy and reliability of ultrasound in diagnosing rotator cuff tears by a shoulder surgeon and comparing their ability to that of a musculoskeletal radiologist. Materials and Methods: Seventy patients undergoing shoulder arthroscopy for rotator cuff pathology underwent preoperative ultrasonography (US). All patients were of similar demographics and pathology. The surgeon used a Sonosite Micromax portable ultrasound machine with a 10-MHz high frequency linear array transducer and the radiologist used a 9-12 MHz linear array probe on a Siemens Antares machine. Arthroscopic diagnosis was the reference standard to which ultrasound findings were compared. Results: The sensitivity in detecting full thickness tears was similar for both the surgeon (92) and the radiologist (94). The radiologist had 100sensitivity in diagnosing partial thickness tears; compared to 85.7for the surgeon. The specificity for the surgeon was 94and 85for the radiologist. Discussion: Our study shows that the surgeons are capable of diagnosing rotator cuff tears with the use of high-resolution portable ultrasound in the outpatient setting. Conclusion: Office ultrasound; by a trained clinician; is a powerful diagnostic tool in diagnosing rotator cuff tears and can be used effectively in running one-stop shoulder clinics

The CT-arthrography in the antero-inferior glenoid labral lesion: Pictorial presentation and diagnostic value

Objective: To present the Computed Tomography (CT)-Arthrography appearance of the most common types of anterior labral lesion and to assess the diagnostic value of this technique in the detection and classification of the antero-inferior labral tears in glenohumeral joint instability. Materials and Methods: The pre-operative CT-Arthrography records of 43 patients; who underwent surgery for anterior shoulder instability; were retrospectively evaluated independently by two radiologists. The data were compared with arthros- copic results and the diagnostic accuracy of CT-Arthrography was calculated to detect the labral lesion and the agreement between the CT-Arthrography lesions classification and the arthroscopy classification. Results: The CT-Arthrography sensitivity; specificity and accuracy were: 92/ 89(reader 1/reader 2); 86/ 86and 91/ 88respectively. The CT-Arthrography classification was correct in 86of cases. Conclusions: CT-Arthrography appears to be an accurate means for identification and classification of the anterior labral tears and; identifying the labral degeneration; this technique can be very helpful in the selection of patient for arthroscopic stabilization of the shoulder

An optimised method for quantifying glenoid orientation

A robust quantification method is essential for inter-subject glenoid comparison and planning of total shoulder arthroplasty. This study compared various scapular and glenoid axes with each other in order to optimally define the most appropriate method of quantifying glenoid version and inclination. Six glenoid and eight scapular axes were defined and quantified from identifiable landmarks of twenty-one scapular image scans. Pathology independency and insensitivity of each axis to inter-subject morphological variation within its region was tested. Glenoid version and inclination were calculated using the best axes from the two regions. The best glenoid axis was the normal to a least-square plane fit on the glenoid rim, directed approximately medio-laterally. The best scapular axis was the normal to a plane formed by the spine root and lateral border ridge. Glenoid inclination was 15.7° ± 5.1° superiorly and version was 4.9° ± 6.1°, retroversion. The choice of axes in the present technique makes it insensitive to pathology and scapular morphological variabilities. Its application would effectively improve inter-subject glenoid version comparison, surgical planning and design of prostheses for shoulder arthroplasty

Modified Arthroscopic Double Row Repair of Partial Thickness Ttear of the Rotator Cuff Involving Articular and Bursal Side

Partial thickness of rotator cuff tears is considered as a common cause of shoulder disability. Various techniques for arthroscopic repair of partial thickness tear of rotator cuff have been reported in the literature. These techniques have addressed the articular side partial thickness cuff tear. We present an arthroscopic repair of partial thickness tear of rotator cuff involving both articular and bursal surfaces without converting into a full thickness tear. Each side of the tear was repaired with suture anchors separately

Pulmonary embolism following rotator cuff repair

Background: Previous studies have provided data on the incidence of pulmonary embolism following shoulder arthroplasty and repair of fractures of the proximal humerus. However; there is no information on the risk of pulmonary embolism following the surgical management of rotator cuff tears. Methods: We performed a review of 1176 patients who underwent operative procedures for rotator cuff tears between January 1 st ; 2001 and December 31 st ; 2005 to identify all patients who developed a symptomatic pulmonary embolism postoperatively. Results: Three patients developed pulmonary embolisms that were diagnosed with computed tomography angiography. The overall incidence was calculated to be 0.26. None of the patients died as a result of the pulmonary embolism. Conclusions: The data from this review indicates that the risk of pulmonary embolism following surgery for rotator cuff repair is low; but not nonexistent. The most common presenting symptoms of pulmonary embolism were chest pain; shortness of breath; and hypoxia. This study should raise surgeons' awareness about this possible complication following rotator cuff repair surgery

An Unusual Variation of Deltoid Muscle

An unusual anatomic variation of the deltoid muscle was found in a 45-year-old female cadaver during dissection of the right upper extremity. The posterior fibers of the right deltoid muscle were enclosed in a distinct fascial sheet and the deltoid muscle was seen to arise from the middle 1/3 of the medial border of the scapula. There was no accompanying vascular or neural anomaly of the deltoid muscle. To the best of our knowledge; unilateral posterior separation of the deltoid muscle with a distinct fascia has not been described previously. While dissecting deltoid; posterior deltoid; or scapular flaps; the surgeon needs to look out for this variation because it may cause confusion

Diagnostic and Therapeutic Injection of the Shoulder Region

The shoulder is the site of multiple injuries and inflammatory conditions that lend themselves to diagnostic and therapeutic injection. Joint injection should be considered after other therapeutic interventions such as non-steroidal anti-inflammatory drugs; physical therapy; and activity-modification have been tried. Indications for glenohumeral joint injection include osteoarthritis; adhesive capsulitis; and rheumatoid arthritis. For the acromioclavicular joint; injection may be used for diagnosis and treatment of osteoarthritis and distal clavicular osteolysis. Subacromial injections are useful for a range of conditions including adhesive capsulitis; subdeltoid bursitis; impingement syndrome; and rotator cuff tendinosis. Scapulothoracic injections are reserved for inflammation of the involved bursa. Persistent pain related to inflammatory conditions of the long head of the biceps responds well to injection in the region. The proper technique; choice and quantity of pharmaceuticals; and appropriate follow-up are essential for effective outcomes

The management of shoulder pain of musculo-sekeletal origin using Feldene gel (PIROXICAM)

From the results of this research study; it can be concluded that topical application of Feldene gel (i.e. Piroxicam) in conjunction with other physiotherapeutic modalities such as short-wave diathermy; ultrasonic therapy and physical exercise is very effective in the relief of shoulder pain of musculo-skeletal origin