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prothèse totale de genou ","Total Knee Replacement","total-knee-replacement",{"id":83,"attributes":84},24,{"title":85,"title_en":86,"slug_en":87},"Principes de rééducations ","Principles of rehabilitation","principles-of-rehabilitation",{"id":89,"attributes":90},14,{"title":91,"title_en":92,"slug_en":93},"Pathologie de la Rotule","Patellar Disorders","patellar-disorders",{"id":95,"attributes":96},21,{"title":97,"title_en":98,"slug_en":99},"Fracture épaule","Shoulder Fracture","shoulder-fracture",{"id":101,"attributes":102},15,{"title":103,"title_en":104,"slug_en":105},"Pathologie ligamentaire cheville","Ankle Ligament Pathology","ankle-ligament-pathology",{"id":107,"attributes":108},6,{"title":109,"title_en":110,"slug_en":110},"coxarthrose ","coxarthrosis",{"id":112,"attributes":113},10,{"title":114,"title_en":115,"slug_en":116},"Griffes d’orteils et métatarsalgies ","Toe claws and metatarsalgia","toe-claws-and-metatarsalgia",{"pagination":118},{"page":119,"pageSize":120,"pageCount":119,"total":41},1,100,{"data":122,"meta":1128},{"id":65,"attributes":123},{"title":67,"content":124,"createdAt":620,"updatedAt":621,"publishedAt":622,"summary":623,"seoTitle":623,"seoDescription":623,"author":623,"reviewedBy":623,"medicalReviewer":623,"medicalReviewedAt":623,"associatedAnatomy":623,"title_en":68,"slug_en":69,"summary_en":623,"seoTitle_en":623,"seoDescription_en":623,"content_en":624,"associatedAnatomy_en":623,"ogImage":1114,"pathologie_par_articulation":1115,"sources":1123,"relatedSurgeries":1124,"possibleTreatments":1126,"signsOrSymptoms":1127},[125,131,137,140,144,148,151,155,158,162,166,169,173,176,180,184,187,191,194,198,202,206,210,213,217,220,224,228,232,236,239,243,246,250,254,258,261,265,268,272,277,280,284,287,291,294,298,301,305,308,312,315,319,322,326,329,333,336,340,343,347,350,354,357,361,364,368,371,375,379,382,386,389,393,396,400,403,407,410,414,417,421,424,428,431,435,438,442,445,449,452,456,459,463,466,470,473,477,480,484,487,491,494,498,501,505,508,512,515,519,522,526,529,533,536,540,544,547,551,554,558,561,565,568,572,575,579,582,586,590,594,598,602,606,609,613,616],{"type":126,"children":127},"paragraph",[128],{"text":129,"type":130},"","text",{"type":132,"level":133,"children":134},"heading",2,[135],{"text":136,"type":130},"Qu’est-ce-que la capsulite rétractile ?",{"type":126,"children":138},[139],{"text":129,"type":130},{"type":126,"children":141},[142],{"text":143,"type":130},"a capsulite rétractile est une limitation douloureuse de la mobilité de l’épaule dans tous les secteurs du mouvement, aussi bien en actif (le patient essaye de bouger son épaule lui-même) qu’en passif (le praticien ou le kinésithérapeuthe tentent de bouger l’épaule).",{"type":132,"level":12,"children":145},[146],{"text":147,"type":130},"Pourquoi fait-on une capsulite rétractile ?",{"type":126,"children":149},[150],{"text":129,"type":130},{"type":132,"level":6,"children":152},[153],{"text":154,"type":130},"1 °) Certaines causes sont connues",{"type":126,"children":156},[157],{"text":129,"type":130},{"type":126,"children":159},[160],{"text":161,"type":130},"Ce sont des pathologies que l’on trouve plus fréquemment associées à la capsulite rétractile.",{"type":126,"children":163},[164],{"text":165,"type":130},"Le mécanisme de la capsulite et la raison de la liaison avec ces pathologies sont encore mal connus.",{"type":126,"children":167},[168],{"text":129,"type":130},{"type":126,"children":170},[171],{"text":172,"type":130},"a) Médicaments",{"type":126,"children":174},[175],{"text":129,"type":130},{"type":126,"children":177},[178],{"text":179,"type":130},"– Gardenal, médicament antiépileptique",{"type":126,"children":181},[182],{"text":183,"type":130},"– Isoniazide, médicament anticancéreux",{"type":126,"children":185},[186],{"text":129,"type":130},{"type":126,"children":188},[189],{"text":190,"type":130},"b) Maladies",{"type":126,"children":192},[193],{"text":129,"type":130},{"type":126,"children":195},[196],{"text":197,"type":130},"-Diabète",{"type":126,"children":199},[200],{"text":201,"type":130},"-Dyslipidémies (anomalies des graisses)",{"type":126,"children":203},[204],{"text":205,"type":130},"-Dysthyroïdies (maladies de la thyroÏde)",{"type":126,"children":207},[208],{"text":209,"type":130},"-Infarctus du myocarde",{"type":126,"children":211},[212],{"text":129,"type":130},{"type":126,"children":214},[215],{"text":216,"type":130},"c) Chirurgie",{"type":126,"children":218},[219],{"text":129,"type":130},{"type":126,"children":221},[222],{"text":223,"type":130},"– de l’épaule",{"type":126,"children":225},[226],{"text":227,"type":130},"– du sein",{"type":126,"children":229},[230],{"text":231,"type":130},"– du cœur",{"type":126,"children":233},[234],{"text":235,"type":130},"– du thorax",{"type":126,"children":237},[238],{"text":129,"type":130},{"type":126,"children":240},[241],{"text":242,"type":130},"d) Lésions de l’épaule",{"type":126,"children":244},[245],{"text":129,"type":130},{"type":126,"children":247},[248],{"text":249,"type":130},"-Coiffe des rotateurs (rupture ou tendinite)",{"type":126,"children":251},[252],{"text":253,"type":130},"-Tendinite calcifiante",{"type":126,"children":255},[256],{"text":257,"type":130},"-Fractures (de et autour de l’épaule)",{"type":126,"children":259},[260],{"text":129,"type":130},{"type":132,"level":12,"children":262},[263],{"text":264,"type":130},"2°) Dans certains cas, on ne retrouve aucune cause :",{"type":126,"children":266},[267],{"text":129,"type":130},{"type":126,"children":269},[270],{"text":271,"type":130},"Il s’agit alors d’une capsulite rétractile idiopathique.",{"type":132,"level":273,"children":274},3,[275],{"text":276,"type":130},"Comment évolue une capsulite rétractile ?",{"type":126,"children":278},[279],{"text":129,"type":130},{"type":132,"level":12,"children":281},[282],{"text":283,"type":130},"1°) Le premier signe à apparaître est la DOULEUR : il s’agit de la phase I (douleur isolée)",{"type":126,"children":285},[286],{"text":129,"type":130},{"type":126,"children":288},[289],{"text":290,"type":130},"Elle est souvent assez intense, mal calmée par les antalgiques usuels (paracétamol).",{"type":126,"children":292},[293],{"text":129,"type":130},{"type":126,"children":295},[296],{"text":297,"type":130},"Cette phase I est de durée très variable, de quelques semaines à 9 mois.",{"type":126,"children":299},[300],{"text":129,"type":130},{"type":126,"children":302},[303],{"text":304,"type":130},"La douleur peut diffuser à l’ensemble du membre supérieur ou au cou.",{"type":126,"children":306},[307],{"text":129,"type":130},{"type":126,"children":309},[310],{"text":311,"type":130},"Elle peut s’accompagner d’un oedème, d’une pâleur ou au contraire d’une rougeur ou d’un aspect moite de la peau.",{"type":126,"children":313},[314],{"text":129,"type":130},{"type":126,"children":316},[317],{"text":318,"type":130},"La diffusion à l’ensemble du membre supérieur des signes cliniques représente le syndrome épaule-main, plus fréquent après un infarctus par exemple.",{"type":126,"children":320},[321],{"text":129,"type":130},{"type":126,"children":323},[324],{"text":325,"type":130},"La présence d’autres signes (notamment cutanés) et leur diffusion , peut faire évoquer le tableau d’algodystrophie (ou algoneurodystrophie) qui est un peu différent de la capsulite qui, elle, ne touche que l’épaule.",{"type":126,"children":327},[328],{"text":129,"type":130},{"type":132,"level":6,"children":330},[331],{"text":332,"type":130},"2°) L’apparition de la RAIDEUR, associée à la DOULEUR, signe l’entrée en Phase II (douleur et raideur)",{"type":126,"children":334},[335],{"text":129,"type":130},{"type":126,"children":337},[338],{"text":339,"type":130},"Cette phase est également de durée variable : 4 à 9 mois.",{"type":126,"children":341},[342],{"text":129,"type":130},{"type":126,"children":344},[345],{"text":346,"type":130},"C’est souvent la phase la plus éprouvante pour le patient, qui a l’impression de « s’enfoncer » littéralement dans la spirale de la maladie, malgré les traitements et qui peut alors douter de l’évolution de sa maladie et de l’efficacité des thérapeutiques.",{"type":126,"children":348},[349],{"text":129,"type":130},{"type":132,"level":6,"children":351},[352],{"text":353,"type":130},"3°) La DISPARITION progressive de la DOULEUR avec persistance puis atténuation également de la raideur fait évoquer la Phase III (raideur isolée)",{"type":126,"children":355},[356],{"text":129,"type":130},{"type":126,"children":358},[359],{"text":360,"type":130},"C’est la phase la plus longue : elle peut durer de 5 à 26 mois.",{"type":126,"children":362},[363],{"text":129,"type":130},{"type":126,"children":365},[366],{"text":367,"type":130},"L’évolution se fait ensuite, en particulier dans les capsulites rétractiles idiopathiques, vers la guérison et un retour à une épaule normale dans la grande majorité des cas (90% des cas)",{"type":126,"children":369},[370],{"text":129,"type":130},{"type":126,"children":372},[373],{"text":374,"type":130},"Les séquelles, essentiellement à type de raideur persistante, sont rares mais possibles, (10% des cas), en particulier en cas de causes traumatiques ou chirurgicales",{"type":132,"level":273,"children":376},[377],{"text":378,"type":130},"Quels sont les principes du traitement ?",{"type":126,"children":380},[381],{"text":129,"type":130},{"type":126,"children":383},[384],{"text":385,"type":130},"Ils reposent sur plusieurs éléments que l’on peut associer :",{"type":126,"children":387},[388],{"text":129,"type":130},{"type":132,"level":6,"children":390},[391],{"text":392,"type":130},"1°) La rééducation",{"type":126,"children":394},[395],{"text":129,"type":130},{"type":126,"children":397},[398],{"text":399,"type":130},"Le principe de la rééducation est d’être douce, infradouloureuse, c’est à dire ne cherchant pas à « forcer » l’épaule.",{"type":126,"children":401},[402],{"text":129,"type":130},{"type":126,"children":404},[405],{"text":406,"type":130},"Elle est présente dans tous les phases de la maladie.",{"type":126,"children":408},[409],{"text":129,"type":130},{"type":126,"children":411},[412],{"text":413,"type":130},"La balnéothérapie est un atout indispensable dans le traitement (alternance froid-chaud, douches tièdes….)",{"type":126,"children":415},[416],{"text":129,"type":130},{"type":132,"level":6,"children":418},[419],{"text":420,"type":130},"2°) Les médicaments contre la douleur",{"type":126,"children":422},[423],{"text":129,"type":130},{"type":126,"children":425},[426],{"text":427,"type":130},"Ils restent indispensables également à toutes les phases de la maladie.",{"type":126,"children":429},[430],{"text":129,"type":130},{"type":126,"children":432},[433],{"text":434,"type":130},"Ils peuvent être plus ou moins forts selon l’importance de la douleur, qui est souvent évaluée par le patient lui-même sur une petite échelle graduée de 0 à 10 (Echelle Visuelle Analogique)",{"type":126,"children":436},[437],{"text":129,"type":130},{"type":132,"level":6,"children":439},[440],{"text":441,"type":130},"3°) Les infiltrations",{"type":126,"children":443},[444],{"text":129,"type":130},{"type":126,"children":446},[447],{"text":448,"type":130},"Elles sont soit sous-acromiales, soit intra-articulaires, avec alors une tentative de « distracter » l’articulation.",{"type":126,"children":450},[451],{"text":129,"type":130},{"type":126,"children":453},[454],{"text":455,"type":130},"On ne les utilise pas toujours, et pas dans toutes les phases de la maladie.",{"type":126,"children":457},[458],{"text":129,"type":130},{"type":126,"children":460},[461],{"text":462,"type":130},"Elles permettent parfois de passer un cap douloureux particulièrement aigu.",{"type":126,"children":464},[465],{"text":129,"type":130},{"type":132,"level":6,"children":467},[468],{"text":469,"type":130},"4°) Les blocs à la Reserpine",{"type":126,"children":471},[472],{"text":129,"type":130},{"type":126,"children":474},[475],{"text":476,"type":130},"Il s’agit d’injection de Reserpine, produit inhibiteur de certaines transmissions nerveuses, au contact de certains récepteurs centraux (médullaires et cérébraux) de la douleur dont on pense qu’il sont concernés par la maladie.",{"type":126,"children":478},[479],{"text":129,"type":130},{"type":126,"children":481},[482],{"text":483,"type":130},"Ces blocs sont effectués sous anesthésie locale, au bloc opératoire, par les anesthésistes, en ambulatoire.",{"type":126,"children":485},[486],{"text":129,"type":130},{"type":126,"children":488},[489],{"text":490,"type":130},"L’efficacité, quand elle se manifeste, est toujours retardée de quelques jours voire de quelques semaines.",{"type":126,"children":492},[493],{"text":129,"type":130},{"type":126,"children":495},[496],{"text":497,"type":130},"Ils ne sont pas non plus proposés à toutes les phases de la capsulite.",{"type":126,"children":499},[500],{"text":129,"type":130},{"type":132,"level":6,"children":502},[503],{"text":504,"type":130},"5°) La chirurgie",{"type":126,"children":506},[507],{"text":129,"type":130},{"type":126,"children":509},[510],{"text":511,"type":130},"Elle reste une éventualité rare, mais toujours possible, en particulier en cas de raideur persistante, alors que la douleur a disparu ou s’est nettement attenuée.",{"type":126,"children":513},[514],{"text":129,"type":130},{"type":126,"children":516},[517],{"text":518,"type":130},"Elle consiste à introduire une caméra dans l’épaule (il s’agit donc d’une arthroscopie avec de toutes petites cicatrices) et par une autre voie d’abord, d’aller sectionner les brides rétractiles dans l’articulation et les zones rétractées de la capsule.",{"type":126,"children":520},[521],{"text":129,"type":130},{"type":126,"children":523},[524],{"text":525,"type":130},"Elle nécessite une prise en charge quotidienne dans les suites, médicale puis médicale et de rééducation.",{"type":126,"children":527},[528],{"text":129,"type":130},{"type":126,"children":530},[531],{"text":532,"type":130},"La rééducation intensive nécessaire en post-opératoire, impose souvent un centre de rééducation qui est mieux à même de pouvoir conserver les résultats acquis en peropératoire.",{"type":126,"children":534},[535],{"text":129,"type":130},{"type":126,"children":537},[538],{"text":539,"type":130},"Elle est proposée à des moments variables d’évolution de la maladie, le plus souvent en phase III.",{"type":132,"level":273,"children":541},[542],{"text":543,"type":130},"Quel est le traitement le plus adapté ?",{"type":126,"children":545},[546],{"text":129,"type":130},{"type":126,"children":548},[549],{"text":550,"type":130},"Le premier élément à comprendre est que chaque patient est différent et donc que chaque traitement est différent et associera plusieurs des thérapeutiques citées ci-dessus, à un rythme variable et adapté à chaque patient.",{"type":126,"children":552},[553],{"text":129,"type":130},{"type":126,"children":555},[556],{"text":557,"type":130},"De nombreuses questions se posent encore sur l’utilité ou le « timing optimal » de certains traitements.",{"type":126,"children":559},[560],{"text":129,"type":130},{"type":126,"children":562},[563],{"text":564,"type":130},"Ces questions sont encore couramment débattues au sein de la communauté médicale et font l’objet d’études scientifiques poussées.",{"type":126,"children":566},[567],{"text":129,"type":130},{"type":126,"children":569},[570],{"text":571,"type":130},"Votre médecin ou votre chirurgien vous demanderont peut-être dans ce cadre de participer à l’élaboration et l’évaluation de votre traitement.",{"type":126,"children":573},[574],{"text":129,"type":130},{"type":126,"children":576},[577],{"text":578,"type":130},"Celui-ci est personnalisé et peut faire intervenir plusieurs médecins 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rétractile.",{"type":126,"children":614},[615],{"text":129,"type":130},{"type":126,"children":617},[618],{"text":619,"type":130},"Elle s’engage donc également pour votre traitement personnel et tous les moyens seront mis en œuvre afin de vous faire comprendre l’évolution de cette maladie et d’obtenir une thérapeutique adaptée à votre cas. ","2024-10-13T12:34:24.596Z","2024-10-13T12:37:52.682Z","2024-10-13T12:34:36.265Z",null,[625,628,632,635,639,643,646,650,653,657,661,664,668,671,675,679,682,686,689,693,697,701,705,708,712,715,719,723,727,731,734,738,741,745,749,753,756,760,763,767,771,774,778,781,785,788,792,795,799,802,806,809,813,816,820,823,827,830,834,837,841,844,848,851,855,858,862,865,869,873,876,880,883,887,890,894,897,901,904,908,911,915,918,922,925,929,932,936,939,943,946,950,953,957,960,964,967,971,974,978,981,985,988,992,995,999,1002,1006,1009,1013,1016,1020,1023,1027,1030,1034,1038,1041,1045,1048,1052,1055,1059,1062,1066,1069,1073,1076,1080,1084,1088,1092,1096,1100,1103,1107,1110],{"type":126,"children":626},[627],{"text":129,"type":130},{"type":132,"level":133,"children":629},[630],{"text":631,"type":130},"What is adhesive capsulitis?",{"type":126,"children":633},[634],{"text":129,"type":130},{"type":126,"children":636},[637],{"text":638,"type":130},"Adhesive capsulitis is a painful limitation of shoulder mobility in all areas of movement, both active (the patient tries to move his shoulder himself) and passive (the practitioner or physiotherapist tries to move the shoulder).",{"type":132,"level":12,"children":640},[641],{"text":642,"type":130},"Why do we have adhesive capsulitis?",{"type":126,"children":644},[645],{"text":129,"type":130},{"type":132,"level":6,"children":647},[648],{"text":649,"type":130},"1°) Some causes are known",{"type":126,"children":651},[652],{"text":129,"type":130},{"type":126,"children":654},[655],{"text":656,"type":130},"These are pathologies that are more frequently found associated with adhesive capsulitis.",{"type":126,"children":658},[659],{"text":660,"type":130},"The mechanism of capsulitis and the reason for the link with these pathologies are still poorly understood.",{"type":126,"children":662},[663],{"text":129,"type":130},{"type":126,"children":665},[666],{"text":667,"type":130},"a) 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