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Elle donne régulièrement de très bons résultats cliniques (environ 95%). Le principe est de placer une butée osseuse à l’endroit où « passe » la tête humérale, cette butée étant prélevée par la même incision (voire schéma). Cette intervention nécessite deux à trois jours d’hospitalisation, le patient sort à son domicile le membre supérieur immobilisé par une attelle pendant trois semaines, mais la rééducation est entreprise immédiatement afin de récupérer au plus vite l’ensemble des mobilités articulaires. La reprise du sport est autorisée au troisième mois post opératoire. Le patient est revu en consultation pour le suivi post opératoire au 45° j, puis à 3 mois et à 6 mois.",{"type":153,"image":154,"children":191},"image",{"ext":155,"url":156,"hash":157,"mime":158,"name":159,"size":160,"width":161,"height":162,"caption":163,"formats":164,"provider":189,"createdAt":190,"updatedAt":190,"previewUrl":163,"alternativeText":159,"provider_metadata":163},".jpg","https:\u002F\u002Flircos.org\u002Fapi\u002Fuploads\u002Finsta_3_d68228d620.jpg","insta_3_d68228d620","image\u002Fjpeg","insta 3.jpg",42.08,870,623,null,{"small":165,"medium":173,"thumbnail":181},{"ext":155,"url":166,"hash":167,"mime":158,"name":168,"path":163,"size":169,"width":170,"height":171,"sizeInBytes":172},"\u002Fuploads\u002Fsmall_insta_3_d68228d620.jpg","small_insta_3_d68228d620","small_insta 3.jpg",18.13,500,358,18127,{"ext":155,"url":174,"hash":175,"mime":158,"name":176,"path":163,"size":177,"width":178,"height":179,"sizeInBytes":180},"\u002Fuploads\u002Fmedium_insta_3_d68228d620.jpg","medium_insta_3_d68228d620","medium_insta 3.jpg",33.27,750,537,33268,{"ext":155,"url":182,"hash":183,"mime":158,"name":184,"path":163,"size":185,"width":186,"height":187,"sizeInBytes":188},"\u002Fuploads\u002Fthumbnail_insta_3_d68228d620.jpg","thumbnail_insta_3_d68228d620","thumbnail_insta 3.jpg",4.72,218,156,4719,"local","2024-10-13T12:28:10.465Z",[192],{"text":140,"type":130},{"type":126,"children":194},[195],{"text":196,"type":130},"b- Stabilisation arthroscopique",{"type":126,"children":198},[199],{"text":140,"type":130},{"type":126,"children":201},[202],{"text":203,"type":130},"Les méthodes de stabilisation par arthroscopie sont très récentes. Le principe est de réparer directement par voie intra articulaire les ligaments de l’épaule qui ont été déchirés par les luxations. Les voies d’abord sont réduites : un point d’entrée de 5 mm à la face postérieure de l’épaule et un ou deux points d’entrée antérieurs un peu plus grands. En plus du caractère ésthétique, elles présentent l’avantage de ne léser aucun muscle et permettent donc une récupération plus complète. L’exploration de l’articulation est complète et permet d’affiner le diagnostic. Les ligaments sont ensuite rattachés au bord antérieur de la glène en les retendant par des ancres. L’hospitalisation est de 48 h, et l’immobilisation est de 45 jours par une attelle coude au corps. La reprise du sport est autorisée au 6° mois. Le suivi post-opératoire est le même.",{"type":126,"children":205},[206],{"text":207,"type":130},"Les taux de succès sont encore inférieurs à ceux des techniques classiques, mais en affinant les indications, s’améliorent régulièrement : moins de 3 luxations, peu de lésions osseuses sur les radiographies et le scanner pré-opératoires.",{"type":153,"image":209,"children":248},{"ext":155,"url":210,"hash":211,"mime":158,"name":212,"size":213,"width":214,"height":215,"caption":163,"formats":216,"provider":189,"createdAt":247,"updatedAt":247,"previewUrl":163,"alternativeText":212,"provider_metadata":163},"https:\u002F\u002Flircos.org\u002Fapi\u002Fuploads\u002Finsta_4_ddd8020df9.jpg","insta_4_ddd8020df9","insta 4.jpg",26.58,1063,306,{"large":217,"small":225,"medium":232,"thumbnail":239},{"ext":155,"url":218,"hash":219,"mime":158,"name":220,"path":163,"size":221,"width":222,"height":223,"sizeInBytes":224},"\u002Fuploads\u002Flarge_insta_4_ddd8020df9.jpg","large_insta_4_ddd8020df9","large_insta 4.jpg",24.15,1000,288,24145,{"ext":155,"url":226,"hash":227,"mime":158,"name":228,"path":163,"size":229,"width":170,"height":230,"sizeInBytes":231},"\u002Fuploads\u002Fsmall_insta_4_ddd8020df9.jpg","small_insta_4_ddd8020df9","small_insta 4.jpg",8.96,144,8956,{"ext":155,"url":233,"hash":234,"mime":158,"name":235,"path":163,"size":236,"width":178,"height":237,"sizeInBytes":238},"\u002Fuploads\u002Fmedium_insta_4_ddd8020df9.jpg","medium_insta_4_ddd8020df9","medium_insta 4.jpg",16.02,216,16015,{"ext":155,"url":240,"hash":241,"mime":158,"name":242,"path":163,"size":243,"width":244,"height":245,"sizeInBytes":246},"\u002Fuploads\u002Fthumbnail_insta_4_ddd8020df9.jpg","thumbnail_insta_4_ddd8020df9","thumbnail_insta 4.jpg",3.03,245,71,3033,"2024-10-13T12:28:10.360Z",[249],{"text":140,"type":130},{"type":126,"children":251},[252],{"text":253,"type":130},"Epaule douloureuse",{"type":126,"children":255},[256],{"text":140,"type":130},{"type":126,"children":258},[259],{"text":260,"type":130},"Il s’agit de douleurs antéro-externes de l’épaule survenant chez des sujets jeunes et sportifs lors des mouvements d’armé. Les patients ne se plaignent pas ou peu d’instabilité mais de douleurs, et il faut donc savoir y penser. Les examens pré opératoires (Radiographies et surtout arthroscanner) permettent le plus souvent de confirmer le diagnostic.",{"type":126,"children":262},[263],{"text":140,"type":130},{"type":126,"children":265},[266],{"text":267,"type":130},"Là encore la seule possibilité thérapeutique est chirurgicale . Les techiniques utilisées sont les mêmes , mais ces cas sont souvent les plus accessibles à un traitement arhtroscopique .",{"type":132,"level":133,"children":269},[270],{"text":271,"type":130},"Luxation postérieure",{"type":126,"children":273},[274],{"text":140,"type":130},{"type":126,"children":276},[277],{"text":278,"type":130},"Beaucoup plus rares, elles ne représentent que 5% des luxations de l’épaule, et surviennent le plus souvent dans des contextes particuliers. Le diagnostic est plus difficile et souvent fait à retardement. La encore les examens sont surtout les radiographies simples et l’arthroscanner",{"type":126,"children":280},[281],{"text":140,"type":130},{"type":126,"children":283},[284],{"text":285,"type":130},"En cas de luxation récidivante le seul traitement est là aussi chirurgical : butée ou retension ligamentaires par voie classique ou arthroscopique ","2024-10-13T12:29:31.190Z","2024-10-19T13:44:41.771Z","2024-10-13T12:29:55.532Z",[290,294,298,301,305,308,312,320,324,327,331,335,344,348,351,355,358,362,366,369,373,376],{"type":126,"children":291},[292],{"text":293,"type":130},"Shoulder instability can cause several clinical manifestations: repeated dislocations, pain, subdislocations or jerks.",{"type":132,"level":133,"children":295},[296],{"text":297,"type":130},"Recurrent dislocation",{"type":126,"children":299},[300],{"text":140,"type":130},{"type":132,"level":6,"children":302},[303],{"text":304,"type":130},"a- The Latarjet technique",{"type":126,"children":306},[307],{"text":140,"type":130},{"type":126,"children":309},[310],{"text":311,"type":130},"This classic method is proven. It regularly gives very good clinical results (around 95%). The principle is to place a bony stop at the place where the humeral head “passes”, this stop being removed through the same incision (see diagram). This procedure requires two to three days of hospitalization, the patient leaves home with the upper limb immobilized by a splint for three weeks, but rehabilitation is undertaken immediately in order to recover all joint mobility as quickly as possible. Resumption of sport is authorized in the third month postoperatively. The patient is seen again in consultation for postoperative follow-up on day 45, then at 3 months and 6 months.",{"type":153,"image":313,"children":318},{"ext":155,"url":156,"hash":157,"mime":158,"name":159,"size":160,"width":161,"height":162,"caption":163,"formats":314,"provider":189,"createdAt":190,"updatedAt":190,"previewUrl":163,"alternativeText":159,"provider_metadata":163},{"small":315,"medium":316,"thumbnail":317},{"ext":155,"url":166,"hash":167,"mime":158,"name":168,"path":163,"size":169,"width":170,"height":171,"sizeInBytes":172},{"ext":155,"url":174,"hash":175,"mime":158,"name":176,"path":163,"size":177,"width":178,"height":179,"sizeInBytes":180},{"ext":155,"url":182,"hash":183,"mime":158,"name":184,"path":163,"size":185,"width":186,"height":187,"sizeInBytes":188},[319],{"text":140,"type":130},{"type":126,"children":321},[322],{"text":323,"type":130},"b- Arthroscopic stabilization",{"type":126,"children":325},[326],{"text":140,"type":130},{"type":126,"children":328},[329],{"text":330,"type":130},"Arthroscopic stabilization methods are very recent. The principle is to repair directly intra-articularly the shoulder ligaments which have been torn by dislocations. The approach routes are reduced: a 5 mm entry point on the posterior side of the shoulder and one or two slightly larger anterior entry points. In addition to the aesthetic nature, they have the advantage of not damaging any muscles and therefore allow a more complete recovery. The exploration of the joint is complete and allows the diagnosis to be refined. The ligaments are then attached to the anterior edge of the glenoid by tightening them with anchors. Hospitalization is 48 hours, and immobilization is 45 days with an elbow brace on the body. Resumption of sport is authorized at the 6th month. Post-operative follow-up is the same.",{"type":126,"children":332},[333],{"text":334,"type":130},"The success rates are still lower than those of traditional techniques, but by refining the indications, they are improving regularly: fewer than 3 dislocations, few bone lesions on the pre-operative x-rays and CT scan.",{"type":153,"image":336,"children":342},{"ext":155,"url":210,"hash":211,"mime":158,"name":212,"size":213,"width":214,"height":215,"caption":163,"formats":337,"provider":189,"createdAt":247,"updatedAt":247,"previewUrl":163,"alternativeText":212,"provider_metadata":163},{"large":338,"small":339,"medium":340,"thumbnail":341},{"ext":155,"url":218,"hash":219,"mime":158,"name":220,"path":163,"size":221,"width":222,"height":223,"sizeInBytes":224},{"ext":155,"url":226,"hash":227,"mime":158,"name":228,"path":163,"size":229,"width":170,"height":230,"sizeInBytes":231},{"ext":155,"url":233,"hash":234,"mime":158,"name":235,"path":163,"size":236,"width":178,"height":237,"sizeInBytes":238},{"ext":155,"url":240,"hash":241,"mime":158,"name":242,"path":163,"size":243,"width":244,"height":245,"sizeInBytes":246},[343],{"text":140,"type":130},{"type":126,"children":345},[346],{"text":347,"type":130},"Painful shoulder",{"type":126,"children":349},[350],{"text":140,"type":130},{"type":126,"children":352},[353],{"text":354,"type":130},"This is anterolateral shoulder pain occurring in young and athletic subjects during arm movements. Patients complain little or not of instability but of pain, and we must therefore know how to think about it. Pre-operative examinations (X-rays and especially CT arthrography) most often confirm the diagnosis.",{"type":126,"children":356},[357],{"text":140,"type":130},{"type":126,"children":359},[360],{"text":361,"type":130},"Here again the only therapeutic possibility is surgical. The techniques used are the same, but these cases are often the most accessible to arthroscopic treatment.",{"type":132,"level":133,"children":363},[364],{"text":365,"type":130},"Posterior dislocation",{"type":126,"children":367},[368],{"text":140,"type":130},{"type":126,"children":370},[371],{"text":372,"type":130},"Much rarer, they represent only 5% of shoulder dislocations, and most often occur in specific contexts. The diagnosis is more difficult and often made late. 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