[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"disease-index":3,"disease-19":121,"navigation-categories":2488,"navigation-categories-fr":2605},{"data":4,"meta":117},[5,11,17,23,28,34,40,46,52,58,64,70,76,82,88,94,100,106,111],{"id":6,"attributes":7},4,{"title":8,"title_en":9,"slug_en":10},"Hernie discale lombaire","Lumbar Disc Herniation","lumbar-disc-herniation",{"id":12,"attributes":13},5,{"title":14,"title_en":15,"slug_en":16},"Prothèse totale de hanche ","Total Hip Replacement","total-hip-replacement",{"id":18,"attributes":19},7,{"title":20,"title_en":21,"slug_en":22},"ménisque","Meniscus","meniscus",{"id":24,"attributes":25},8,{"title":26,"title_en":26,"slug_en":27},"Hallux Valgus","hallux-valgus",{"id":29,"attributes":30},16,{"title":31,"title_en":32,"slug_en":33},"Pathologie dégénérative cheville","Degenerative Ankle Disease","degenerative-ankle-disease",{"id":35,"attributes":36},20,{"title":37,"title_en":38,"slug_en":39},"Prothèse épaule","Shoulder Replacement","shoulder-replacement",{"id":41,"attributes":42},19,{"title":43,"title_en":44,"slug_en":45},"Pathologies de la coiffe des rotateurs ","Rotator Cuff Disorders","rotator-cuff-disorders",{"id":47,"attributes":48},18,{"title":49,"title_en":50,"slug_en":51},"Rupture du tendon d'Achille","Achilles Tendon Rupture","achilles-tendon-rupture",{"id":53,"attributes":54},9,{"title":55,"title_en":56,"slug_en":57},"Le névrome de Morton ","Morton's neuroma","morton-s-neuroma",{"id":59,"attributes":60},22,{"title":61,"title_en":62,"slug_en":63},"L’instabilité d’épaule","Shoulder Instability","shoulder-instability",{"id":65,"attributes":66},23,{"title":67,"title_en":68,"slug_en":69},"Capsulite rétractile","Adhesive Capsulitis (Frozen Shoulder)","adhesive-capsulitis-frozen-shoulder",{"id":71,"attributes":72},11,{"title":73,"title_en":74,"slug_en":75},"La Pathologie Ligamentaire","Ligament Pathology","ligament-pathology",{"id":77,"attributes":78},17,{"title":79,"title_en":80,"slug_en":81},"La 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":2487},{"id":41,"attributes":123},{"title":43,"content":124,"createdAt":1374,"updatedAt":1375,"publishedAt":1376,"summary":607,"seoTitle":607,"seoDescription":607,"author":607,"reviewedBy":607,"medicalReviewer":607,"medicalReviewedAt":607,"associatedAnatomy":607,"title_en":44,"slug_en":45,"summary_en":607,"seoTitle_en":607,"seoDescription_en":607,"content_en":1377,"associatedAnatomy_en":607,"ogImage":2473,"pathologie_par_articulation":2474,"sources":2482,"relatedSurgeries":2483,"possibleTreatments":2485,"signsOrSymptoms":2486},[125,131,135,139,143,147,151,154,158,162,166,169,173,177,181,185,188,192,196,200,204,207,211,215,219,223,226,230,234,238,242,245,249,253,257,261,265,268,272,275,279,283,287,291,295,299,303,307,311,315,319,323,327,330,334,337,341,345,349,352,356,359,363,367,371,375,379,383,387,391,394,398,401,405,409,413,416,420,424,428,432,436,440,444,448,452,455,459,462,466,470,474,478,481,485,488,492,496,500,503,507,510,514,518,522,526,530,533,537,541,545,549,553,557,563,566,570,573,577,581,584,588,592,596,637,670,674,678,682,685,689,692,696,699,703,706,709,713,717,721,725,729,732,736,740,743,747,751,755,759,763,767,771,775,779,783,787,791,795,799,802,806,810,814,817,821,824,828,832,836,840,844,848,851,855,858,862,866,870,874,878,882,886,890,894,898,901,905,908,912,916,920,924,928,931,935,938,942,946,950,954,958,962,966,970,973,976,979,983,987,991,995,999,1032,1065,1069,1073,1077,1081,1085,1089,1093,1097,1101,1104,1108,1111,1115,1119,1123,1127,1131,1135,1139,1143,1147,1151,1154,1187,1191,1211,1215,1219,1223,1227,1231,1234,1238,1242,1246,1249,1253,1256,1260,1264,1268,1272,1276,1280,1284,1288,1292,1296,1300,1303,1307,1310,1314,1318,1322,1326,1330,1334,1337,1341,1344,1348,1352,1356,1359,1363,1366,1370],{"type":126,"children":127},"paragraph",[128],{"text":129,"type":130}," Les os de  La tête de l’humérus se trouve au sommet du bras : elle est ronde, recouverte de cartilage et s’articule avec la glène, zone articulaire plutôt plate de l’omoplate (ou scapula) qui est l’os qui relie le membre supérieur au thorax. L’omoplate se poursuit en arrière par une proéminence osseuse qui revient au dessus des tendons de la coiffe des rotateurs : l’acromion.","text",{"type":126,"children":132},[133],{"text":134,"type":130},"",{"type":126,"children":136},[137],{"text":138,"type":130},"LA COIFFE DES ROTATEURS",{"type":126,"children":140},[141],{"text":142,"type":130},"La coiffe des rotateurs tient son nom de l’aspect des tendons qui recouvrent la tête de l’humérus : ils la recouvrent comme des cheveux recouvrent une tête , d’où le terme « coiffe »",{"type":126,"children":144},[145],{"text":146,"type":130},"Les tendons de la coiffe des rotateurs proviennent de quatre muscles dont les fibres sont accrochées sur l’omoplate : les fibres musculaires se transforment en tendon en se rapprochant de la tête humérale.",{"type":126,"children":148},[149],{"text":150,"type":130},"Il y a quatre muscles (et donc quatre tendons) :",{"type":126,"children":152},[153],{"text":134,"type":130},{"type":126,"children":155},[156],{"text":157,"type":130},"1°) Le muscle sus-épineux (ou supra-épineux ou supraspinatus)",{"type":126,"children":159},[160],{"text":161,"type":130},"– Il tire son nom de sa position au niveau de l’omoplate : il est au dessus d’un élément osseux que l’on appelle l’épine de l’omoplate",{"type":126,"children":163},[164],{"text":165,"type":130},"– C’est le muscle dont le tendon est presque toujours le premier c – Il donne à l’épaule sa puissance par exemple sa capacité à soulever les objets lourds.",{"type":126,"children":167},[168],{"text":134,"type":130},{"type":126,"children":170},[171],{"text":172,"type":130},"2°) Le muscle sous-épineux (ou infra-épineux ou infraspinatus)",{"type":126,"children":174},[175],{"text":176,"type":130},"– Il tire son nom de sa position au niveau de l’omoplate : il est au dessous de l’épine",{"type":126,"children":178},[179],{"text":180,"type":130},"– Son tendon est souvent atteint dans un deuxième temps, après le sus-épineux, dans les tendinites et les ruptures, mais de manière moins importante.",{"type":126,"children":182},[183],{"text":184,"type":130},"– Il est le principal muscle responsable du mouvement de rotation externe de l’épaule : capacité à orienter la main vers l’extérieur lorsque le coude est collé au corps ou capacité à soulever la main vers le haut quand le bras est horizontal",{"type":126,"children":186},[187],{"text":134,"type":130},{"type":126,"children":189},[190],{"text":191,"type":130},"3°) Le muscle sous-scapulaire (ou subscapularis)",{"type":126,"children":193},[194],{"text":195,"type":130},"– Il tire son nom de la zone de l’omoplate où ses fibres s’accrochent : la fosse sous-scapulaire.",{"type":126,"children":197},[198],{"text":199,"type":130},"– Son tendon est plus rarement atteint dans sa totalité que celui du sous-épineux, il est par contre fréquemment atteint dans sa partie supérieure.",{"type":126,"children":201},[202],{"text":203,"type":130},"– Il est partiellement responsable (avec d’autres muscles) du mouvement de rotation interne de l’épaule, notamment la capacité à mettre la main dans le dos.",{"type":126,"children":205},[206],{"text":134,"type":130},{"type":126,"children":208},[209],{"text":210,"type":130},"4°) Le muscle petit rond (ou teres minor)",{"type":126,"children":212},[213],{"text":214,"type":130},"– Il tire son nom de sa forme car il est petit et rond !",{"type":126,"children":216},[217],{"text":218,"type":130},"– Il est exceptionnellement atteint par les tendinites et les ruptures,",{"type":126,"children":220},[221],{"text":222,"type":130},"uniquement dans les formes très évoluées et très anciennes, et seulement une fois que le tendon du muscle sous-épineux a complètement disparu.",{"type":126,"children":224},[225],{"text":134,"type":130},{"type":126,"children":227},[228],{"text":229,"type":130},"A part : le tendon de la longue portion du biceps :",{"type":126,"children":231},[232],{"text":233,"type":130},"– Le biceps, muscle du bras bien connu, comporte deux tendons dans sa partie proximale : l’un est situé hors de l’articulation de l’épaule, l’autre est situé dans l’articulation de l’épaule et passe sous les tendons du sous-scapulaire en avant du bras, puis entre les tendons du sus-épineux et du sous-scapulaire pour venir s’accrocher à l’omoplate.",{"type":126,"children":235},[236],{"text":237,"type":130},"– Il n’est pas considéré comme un tendon de la coiffe des rotateurs car son rôle mécanique au niveau de l’épaule est peu important.",{"type":126,"children":239},[240],{"text":241,"type":130},"– Par contre, il est souvent concerné par la maladie, car dès qu’il est exposé à une inflammation ou à une rupture des tendons de la coiffe, et en particulier des tendons du sus-épineux et du sous-scapulaire, il peut lui même devenir inflammatoire et douloureux pour son propre compte, voir même se rompre également.",{"type":126,"children":243},[244],{"text":134,"type":130},{"type":126,"children":246},[247],{"text":248,"type":130},"LE MUSCLE DELTOÏDE",{"type":126,"children":250},[251],{"text":252,"type":130},"Directement sous la peau, il recouvre la coiffe des rotateurs.",{"type":126,"children":254},[255],{"text":256,"type":130},"C’est le principal muscle moteur de l’épaule.",{"type":126,"children":258},[259],{"text":260,"type":130},"Il n’est jamais atteint dans la pathologie de la coiffe des rotateurs (sauf à la suite d’une chirurgie trop agressive à ciel ouvert), ce qui explique que l’épaule peut bouger malgré une rupture complète de la coiffe des rotateurs : seul le deltoïde permet alors une partie du mouvement, sans toutefois donner la puissance totale de l’épaule.",{"type":126,"children":262},[263],{"text":264,"type":130},"Symptomatologie",{"type":126,"children":266},[267],{"text":134,"type":130},{"type":126,"children":269},[270],{"text":271,"type":130},"LA DOULEUR",{"type":126,"children":273},[274],{"text":134,"type":130},{"type":126,"children":276},[277],{"text":278,"type":130},"C’est le maître symptôme.",{"type":126,"children":280},[281],{"text":282,"type":130},"Elle est toujours présente à un moment ou à un autre de l’évolution de la maladie",{"type":126,"children":284},[285],{"text":286,"type":130},"Elle peut être d’apparition brutale, après un effort ou un traumatisme, même bénin. Elle peut aussi survenir progressivement.",{"type":126,"children":288},[289],{"text":290,"type":130},"Elle est souvent nocturne, parfois même elle empêche de dormir par son intensité ou réveille au milieu de la nuit vers 4H du matin, ce qui traduit son caractère inflammatoire.",{"type":126,"children":292},[293],{"text":294,"type":130},"Dans la journée, elle peut être importante mais aussi ne devenir gênante que dans certains gestes ou à l’effort.",{"type":126,"children":296},[297],{"text":298,"type":130},"Elle peut aussi être présente pendant une période donnée puis disparaître pendant plusieurs mois voire plusieurs années avant de réapparaître à l’occasion d’un effort, d’un geste brusque, parfois spontanément.",{"type":126,"children":300},[301],{"text":302,"type":130},"Au début de la maladie, elle est facilement calmée par les médicaments simples comme les antalgiques ou les anti-inflammatoires. Elle peut finir par résister à tout traitement.",{"type":126,"children":304},[305],{"text":306,"type":130},"Elle peut être liée :",{"type":126,"children":308},[309],{"text":310,"type":130},"– A une tendinite simple.",{"type":126,"children":312},[313],{"text":314,"type":130},"– A une rupture tendineuse.",{"type":126,"children":316},[317],{"text":318,"type":130},"Sa localisation est très variable et il n’y a pas de corrélation directe entre sa position et l’atteinte des tendons.",{"type":126,"children":320},[321],{"text":322,"type":130},"Elle est souvent située « dans l ‘épaule » sans localisation précise, changeant de position avec le temps ou les mouvements.",{"type":126,"children":324},[325],{"text":326,"type":130},"Elle irradie souvent vers le bras, voire vers l’avant-bras et les doigts , pouvant faire confondre l’atteinte de la coiffe des rotateurs avec une atteinte d’origine neurologique comme la Névralgie Cervico-Brachiale. Elle irradie souvent aussi vers le cou et le dos, suivant le trajet du muscle trapèze qui s’insère depuis le haut du cou jusqu’au milieu du dos.",{"type":126,"children":328},[329],{"text":134,"type":130},{"type":126,"children":331},[332],{"text":333,"type":130},"LA PERTE DE FORCE",{"type":126,"children":335},[336],{"text":134,"type":130},{"type":126,"children":338},[339],{"text":340,"type":130},"C’est le premier signe dont on s’aperçoit en général, en dehors de la douleur. Elle traduit l’atteinte du sus-épineux et est d’autant plus importante que l’atteinte musculo-tendineuse est importante et ancienne.",{"type":126,"children":342},[343],{"text":344,"type":130},"Elle est parfois isolée, c’est à dire le seul signe présent, la douleur ayant été calmée par le traitement médical.",{"type":126,"children":346},[347],{"text":348,"type":130},"Elle traduit la plupart du temps une rupture tendineuse et non plus une tendinite simple.",{"type":126,"children":350},[351],{"text":134,"type":130},{"type":126,"children":353},[354],{"text":355,"type":130},"LA PERTE DE MOBILITE",{"type":126,"children":357},[358],{"text":134,"type":130},{"type":126,"children":360},[361],{"text":362,"type":130},"C’est l’incapacité à utiliser le bras pour certains gestes :",{"type":126,"children":364},[365],{"text":366,"type":130},"– Soit nécessitant de la force (atteinte du sus-épineux)",{"type":126,"children":368},[369],{"text":370,"type":130},"– Soit nécessitant un mouvement de rotation externe (atteinte su sous-épineux et du petit rond)",{"type":126,"children":372},[373],{"text":374,"type":130},"– Soit nécessitant un mouvement de rotation interne (atteinte du sous-scapulaire)",{"type":126,"children":376},[377],{"text":378,"type":130},"– Soit nécessitant une combinaison de ces mouvements (atteinte de plusieurs tendons)",{"type":126,"children":380},[381],{"text":382,"type":130},"Cette perte de mobilité a une double signification :",{"type":126,"children":384},[385],{"text":386,"type":130},"Soit elle est présente au début d’une rupture tendineuse, et traduit l’intensité de l’inflammation initiale. Elle est alors souvent souvent récupérable par le traitement médical, notamment par la composante de rééducation du traitement médical.",{"type":126,"children":388},[389],{"text":390,"type":130},"Soit elle est présente tardivement, après une évolution plus ou moins longue de la maladie. Elle résiste alors au traitement médical et traduit souvent une forme évoluée et complète de rupture tendineuse.",{"type":126,"children":392},[393],{"text":134,"type":130},{"type":126,"children":395},[396],{"text":397,"type":130},"AUTRES SYMPTÔMES",{"type":126,"children":399},[400],{"text":134,"type":130},{"type":126,"children":402},[403],{"text":404,"type":130},"– Craquements, pseudo-blocages sont plus rares.",{"type":126,"children":406},[407],{"text":408,"type":130},"– A part : le signe de Popeye : c’est l’apparition d’une boule dans le bras, souvent après une phase douloureuse intense. Il traduit la rupture du tendon de la longue portion du biceps.",{"type":126,"children":410},[411],{"text":412,"type":130},"Examen Clinique",{"type":126,"children":414},[415],{"text":134,"type":130},{"type":126,"children":417},[418],{"text":419,"type":130},"Votre chirurgien commencera d’abord par un interrogatoire pour préciser vos symptômes, leur intensité, leur date d’apparition, leur évolution, leur importance, la gêne occasionnée dans la vie quotidienne, le travail et les loisirs, les divers traitements utilisés jusqu’à présent.",{"type":126,"children":421},[422],{"text":423,"type":130},"L’examen clinique proprement dit permet d’apprécier :",{"type":126,"children":425},[426],{"text":427,"type":130},"– La morphologie musculaire.",{"type":126,"children":429},[430],{"text":431,"type":130},"– La mobilité active et passive de l’épaule.",{"type":126,"children":433},[434],{"text":435,"type":130},"– Les zones douloureuses .",{"type":126,"children":437},[438],{"text":439,"type":130},"– la force et la résistance des divers tendons de la coiffe des rotateurs.",{"type":126,"children":441},[442],{"text":443,"type":130},"A l’issue de l’examen clinique, votre chirurgien prescrira des examens complémentaires radiologiques le plus souvent, ou examinera ceux prescrits par votre médecin traitant.",{"type":126,"children":445},[446],{"text":447,"type":130},"Aucun examen biologique n’est utile dans la pathologie de la coiffe des rotateurs.",{"type":126,"children":449},[450],{"text":451,"type":130},"Examens Complémentaires",{"type":126,"children":453},[454],{"text":134,"type":130},{"type":126,"children":456},[457],{"text":458,"type":130},"LES RADIOGRAPHIES DE L’EPAULE",{"type":126,"children":460},[461],{"text":134,"type":130},{"type":126,"children":463},[464],{"text":465,"type":130},"Elles sont indispensables car elle permettent de mettre en évidence",{"type":126,"children":467},[468],{"text":469,"type":130},"– La morphologie de l’acromion.",{"type":126,"children":471},[472],{"text":473,"type":130},"– L’existence d’une arthrose.",{"type":126,"children":475},[476],{"text":477,"type":130},"Elles sont toutefois souvent normales.",{"type":126,"children":479},[480],{"text":134,"type":130},{"type":126,"children":482},[483],{"text":484,"type":130},"L’ECHOGRAPHIE DE LA COIFFE DES ROTATEURS",{"type":126,"children":486},[487],{"text":134,"type":130},{"type":126,"children":489},[490],{"text":491,"type":130},"Elle nécessite un opérateur très entrainé à la pathologie de la coiffe des rotateurs.",{"type":126,"children":493},[494],{"text":495,"type":130},"Elle est difficilement interprétable par le chirurgien",{"type":126,"children":497},[498],{"text":499,"type":130},"Elle est rarement suffisamment précise pour permettre une décision thérapeutique.",{"type":126,"children":501},[502],{"text":134,"type":130},{"type":126,"children":504},[505],{"text":506,"type":130},"L’IRM (Imagerie par Résonance Magnétique nucléaire)",{"type":126,"children":508},[509],{"text":134,"type":130},{"type":126,"children":511},[512],{"text":513,"type":130},"Souvent bon examen de débrouillage, elle permet un diagnostic parfois suffisamment précis pour la décision thérapeutique.",{"type":126,"children":515},[516],{"text":517,"type":130},"Son interprétation est parfois difficile :",{"type":126,"children":519},[520],{"text":521,"type":130},"* Dans les atteintes tendineuses de petite taille ou partielles.",{"type":126,"children":523},[524],{"text":525,"type":130},"* Dans l’évaluation de l’extension des lésions.",{"type":126,"children":527},[528],{"text":529,"type":130},"L’utilisation de produit de contraste injecté (arthroIRM) permet une plus grande précision et donne des images proches de l’arthroscanner en qualité.",{"type":126,"children":531},[532],{"text":134,"type":130},{"type":126,"children":534},[535],{"text":536,"type":130},"L’ARTHROSCANNER",{"type":126,"children":538},[539],{"text":540,"type":130},"C’est l’examen de référence.",{"type":126,"children":542},[543],{"text":544,"type":130},"Il permet à la fois :",{"type":126,"children":546},[547],{"text":548,"type":130},"* Un diagnostic précis, y compris des lésions partielles ou de petite taille.",{"type":126,"children":550},[551],{"text":552,"type":130},"* Une évaluation aisée de l’extension et de la gravité des lésions : rétraction des tendons, dégénérescence graisseuse, atrophie musculaire.",{"type":126,"children":554},[555],{"text":556,"type":130},"Il est quasiment systématiquement demandé par le chirurgien en préopératoire et parfois en postopératoire pour vérifier la qualité de la cicatrisation tendineuse",{"type":558,"level":559,"children":560},"heading",3,[561],{"text":562,"type":130},"Tendinite de la coiffe",{"type":126,"children":564},[565],{"text":134,"type":130},{"type":126,"children":567},[568],{"text":569,"type":130},"C’est une atteinte inflammatoire du tendon , le plus souvent du sus-épineux, SANS rupture.",{"type":126,"children":571},[572],{"text":134,"type":130},{"type":126,"children":574},[575],{"text":576,"type":130},"Elle survient rarement avant l’âge de 40 ans",{"type":126,"children":578},[579],{"text":580,"type":130},"Elle atteint souvent le membre dominant et est plus fréquente chez les travailleurs de force du membre supérieur ou chez ceux qui utilisent leur épaule dans des gestes répétitifs au delà de l’horizontale.",{"type":126,"children":582},[583],{"text":134,"type":130},{"type":126,"children":585},[586],{"text":587,"type":130},"Elle se traduit par une douleur, rarement par une limitation de mobilité ou une perte de force.",{"type":126,"children":589},[590],{"text":591,"type":130},"Son traitement est d’abord médical (cf traitement ci-dessous). Il est rarement chirurgical.",{"type":558,"level":12,"children":593},[594],{"text":595,"type":130},"Rupture de la coiffe",{"type":597,"image":598,"children":635},"image",{"ext":599,"url":600,"hash":601,"mime":602,"name":603,"size":604,"width":605,"height":606,"caption":607,"formats":608,"provider":633,"createdAt":634,"updatedAt":634,"previewUrl":607,"alternativeText":603,"provider_metadata":607},".jpg","https:\u002F\u002Flircos.org\u002Fapi\u002Fuploads\u002Fcoiffe_1_1c90780a9e.jpg","coiffe_1_1c90780a9e","image\u002Fjpeg","coiffe 1.jpg",34.82,786,393,null,{"small":609,"medium":617,"thumbnail":625},{"ext":599,"url":610,"hash":611,"mime":602,"name":612,"path":607,"size":613,"width":614,"height":615,"sizeInBytes":616},"\u002Fuploads\u002Fsmall_coiffe_1_1c90780a9e.jpg","small_coiffe_1_1c90780a9e","small_coiffe 1.jpg",19.14,500,250,19144,{"ext":599,"url":618,"hash":619,"mime":602,"name":620,"path":607,"size":621,"width":622,"height":623,"sizeInBytes":624},"\u002Fuploads\u002Fmedium_coiffe_1_1c90780a9e.jpg","medium_coiffe_1_1c90780a9e","medium_coiffe 1.jpg",33.62,750,375,33622,{"ext":599,"url":626,"hash":627,"mime":602,"name":628,"path":607,"size":629,"width":630,"height":631,"sizeInBytes":632},"\u002Fuploads\u002Fthumbnail_coiffe_1_1c90780a9e.jpg","thumbnail_coiffe_1_1c90780a9e","thumbnail_coiffe 1.jpg",6.49,245,122,6491,"local","2024-10-13T11:11:24.878Z",[636],{"text":134,"type":130},{"type":597,"image":638,"children":668},{"ext":599,"url":639,"hash":640,"mime":602,"name":641,"size":642,"width":643,"height":644,"caption":607,"formats":645,"provider":633,"createdAt":667,"updatedAt":667,"previewUrl":607,"alternativeText":641,"provider_metadata":607},"https:\u002F\u002Flircos.org\u002Fapi\u002Fuploads\u002Fcoifffe_2_38409090a5.jpg","coifffe_2_38409090a5","coifffe 2.jpg",37.99,832,381,{"small":646,"medium":653,"thumbnail":660},{"ext":599,"url":647,"hash":648,"mime":602,"name":649,"path":607,"size":650,"width":614,"height":651,"sizeInBytes":652},"\u002Fuploads\u002Fsmall_coifffe_2_38409090a5.jpg","small_coifffe_2_38409090a5","small_coifffe 2.jpg",15.82,229,15820,{"ext":599,"url":654,"hash":655,"mime":602,"name":656,"path":607,"size":657,"width":622,"height":658,"sizeInBytes":659},"\u002Fuploads\u002Fmedium_coifffe_2_38409090a5.jpg","medium_coifffe_2_38409090a5","medium_coifffe 2.jpg",30.47,343,30474,{"ext":599,"url":661,"hash":662,"mime":602,"name":663,"path":607,"size":664,"width":630,"height":665,"sizeInBytes":666},"\u002Fuploads\u002Fthumbnail_coifffe_2_38409090a5.jpg","thumbnail_coifffe_2_38409090a5","thumbnail_coifffe 2.jpg",5.69,112,5691,"2024-10-13T11:11:39.748Z",[669],{"text":134,"type":130},{"type":126,"children":671},[672],{"text":673,"type":130},"Elle concerne surtout le sus-épineux, souvent après une phase plus ou moins longue de tendinite.",{"type":126,"children":675},[676],{"text":677,"type":130},"Elle survient surtout après 50 ans et entre alors dans le cadre de la maladie tendineuse de la coiffe des rotateurs (tendinite prolongée puis rupture sur un tendon dégénératif)",{"type":126,"children":679},[680],{"text":681,"type":130},"Exceptionnellement, elle peut être post-traumatique avant 50 ans, le tendon étant alors sain, mais simplement arraché de son insertion osseuse par un mouvement contrarié très violent (chute lors d’un accident à grande vitesse, mouvement contré de l’épaule, etc…)",{"type":126,"children":683},[684],{"text":134,"type":130},{"type":126,"children":686},[687],{"text":688,"type":130},"La douleur est toujours présente, mais peut-être atténuée, notamment par le traitement médical préalable de la tendinite. Elle peut aussi être beaucoup plus intense que lors d’une tendinite : tout est possible à ce niveau.",{"type":126,"children":690},[691],{"text":134,"type":130},{"type":126,"children":693},[694],{"text":695,"type":130},"La perte de force est constante et c’est un très bon signe pour faire la différence entre une tendinite simple et une rupture : il est toutefois nécessaire que votre chirurgien précise ce point car il n’est pas toujours facile de faire un diagnostic soi même !",{"type":126,"children":697},[698],{"text":134,"type":130},{"type":126,"children":700},[701],{"text":702,"type":130},"La perte de mobilité est variable en fonction du caractère ancien ou récent de la rupture, de l’efficacité des traitements déjà effectués, de l’importance de l’atteinte.",{"type":126,"children":704},[705],{"text":134,"type":130},{"type":126,"children":707},[708],{"text":134,"type":130},{"type":126,"children":710},[711],{"text":712,"type":130},"L’évolution de la rupture du sus-épineux se fait toujours vers l’aggravation :",{"type":126,"children":714},[715],{"text":716,"type":130},"– Au niveau du sus-épineux lui –même avec une rétraction du tendon, une atrophie musculaire et une dégénérescence graisseuse du muscle.",{"type":126,"children":718},[719],{"text":720,"type":130},"– Vers l’atteinte",{"type":126,"children":722},[723],{"text":724,"type":130},"* Soit du sous-épineux , qui s’aggrave alors dans le même sens que le sus-épineux, avec une rétraction tendineuse, une atrophie et une dégénérescence graisseuse musculaire : ce sont les ruptures dites « postéro-supérieures » : souvent un peu moins douloureuses et donc détectées à un stade déjà évolué, celui de la perte de mobilité par exemple.",{"type":126,"children":726},[727],{"text":728,"type":130},"* Soit du sous-scapulaire , avec la même évolution : rétraction tendineuse, atrophie et dégénérescence graisseuse. Ce sont les ruptures dites « antéro-supérieures » : souvent plus douloureuses et donc détectées à un stade plus précoce.",{"type":126,"children":730},[731],{"text":134,"type":130},{"type":126,"children":733},[734],{"text":735,"type":130},"– Après quelques temps (de quelques mois à quelques années), l’évolution peut se faire vers une atteinte des 3 tendons (sus épineux, sous-épineux et sous-scapulaire). La tête humérale n’est alors plus retenue par aucun tendon et monte progressivement pour entrer en conflit avec l’acromion. Le cartilage peut alors s’user et on assiste à l’apparition d’une arthrose spécifique de l’évolution des ruptures de la coiffe des rotateurs : « l’omarthrose excentrée » (arthrose de l’épaule avec ascension de la tête du l’humérus)",{"type":126,"children":737},[738],{"text":739,"type":130},"Traitement médical",{"type":126,"children":741},[742],{"text":134,"type":130},{"type":126,"children":744},[745],{"text":746,"type":130},"Il doit toujours être tenté de première intention, notamment dans les tendinites.",{"type":126,"children":748},[749],{"text":750,"type":130},"Il comprend :",{"type":126,"children":752},[753],{"text":754,"type":130},"– Les médicaments : antalgiques et anti-inflammatoires non stéroïdiens. (les corticoïdes per os doivent être évités autant que faire se peut)",{"type":126,"children":756},[757],{"text":758,"type":130},"– La rééducation :",{"type":126,"children":760},[761],{"text":762,"type":130},"* Apprentissage de certains gestes permettant de ne pas surcharger les tendons de la coiffe des rotateurs.",{"type":126,"children":764},[765],{"text":766,"type":130},"* Renforcement de muscles adjacents (deltoïde, muscles dorsaux) * Thérapeutiques adjuvantes : ultrasons, utilisation du froid (cryothérapie)",{"type":126,"children":768},[769],{"text":770,"type":130},"* Certains gestes doivent être évités : travail de type pouliethérapie voire travail de renforcement musculaire, sans contrôle direct du kinésithérapeuthe.",{"type":126,"children":772},[773],{"text":774,"type":130},"– Les infiltrations :",{"type":126,"children":776},[777],{"text":778,"type":130},"* Elles utilisent de manière couplée les anesthésiants locaux et les corticoïdes retards injectables par voie locale.",{"type":126,"children":780},[781],{"text":782,"type":130},"* Elles doivent être effectuées idéalement sous contrôle radiologique afin d’être certain de mettre le produit au bon endroit : entre les tendons de la coiffe des rotateurs et l’acromion : infiltration dite « sous-acromiale »",{"type":126,"children":784},[785],{"text":786,"type":130},"* Elles sont réservées à l’échec du traitement de première intention (médicaments et rééducation)",{"type":126,"children":788},[789],{"text":790,"type":130},"* Elles doivent être limitées à 3 par an au maximum.",{"type":126,"children":792},[793],{"text":794,"type":130},"* Il est préférable de les utiliser en l’absence de rupture tendineuse, donc en cas de tendinite sans rupture, ou lorsque la rupture tendineuse ne peut plus être réparée : il est donc utile de disposer d’une imagerie tendineuse avant de les proposer.",{"type":126,"children":796},[797],{"text":798,"type":130},"Traitement chirurgical",{"type":126,"children":800},[801],{"text":134,"type":130},{"type":126,"children":803},[804],{"text":805,"type":130},"Il est réservé aux échecs du traitement médical mais peut être choisi d’emblée dans certaines circonstances",{"type":126,"children":807},[808],{"text":809,"type":130},"– Rupture traumatique de la coiffe des rotateurs avant 50 ans.",{"type":126,"children":811},[812],{"text":813,"type":130},"– Rupture de la coiffe des rotateurs peu rétractée, avec muscles de bonne qualité, chez un patient actif avec travail de force ou répétitif du membre supérieur, en général avant 65 ans.",{"type":126,"children":815},[816],{"text":134,"type":130},{"type":126,"children":818},[819],{"text":820,"type":130},"L’ANESTHESIE",{"type":126,"children":822},[823],{"text":134,"type":130},{"type":126,"children":825},[826],{"text":827,"type":130},"Lors de la consultation de pré-anesthésie qui doit avoir lieu légalement (sauf urgence) au minimum 48 heures avant l’intervention, l’anesthésiste précisera les modalités de l’anesthésie de l’épaule.",{"type":126,"children":829},[830],{"text":831,"type":130},"L’anesthésie est usuellement mixte :",{"type":126,"children":833},[834],{"text":835,"type":130},"– Une anesthésie loco-régionale : par mise en place, sous anesthésie locale, d’un cathéter autour des nerfs du membre supérieur, au niveau de la base du cou. Ce cathéter est laissé en place de 24 à 48 h après l’intervention et permet de diminuer les douleurs post-opératoires immédiates.",{"type":126,"children":837},[838],{"text":839,"type":130},"– une anesthésie générale : courte et souvent sans intubation complète, grâce à l’efficacité du cathéter ci-dessus, elle reste indispensable compte-tenu *de la durée parfois longue des gestes chirurgicaux,",{"type":126,"children":841},[842],{"text":843,"type":130},"*de la position souvent inconfortable lors de l’intervention,",{"type":126,"children":845},[846],{"text":847,"type":130},"*de la nécessité d’une immobilité absolue de l’épaule lors des gestes techniques du chirurgien.",{"type":126,"children":849},[850],{"text":134,"type":130},{"type":126,"children":852},[853],{"text":854,"type":130},"L’ACROMIOPLASTIE ARTHROSCOPIQUE",{"type":126,"children":856},[857],{"text":134,"type":130},{"type":126,"children":859},[860],{"text":861,"type":130},"Consiste à raboter la surface inférieure de l’acromion au contact de la coiffe des rotateurs.",{"type":126,"children":863},[864],{"text":865,"type":130},"Elle est effectuée",{"type":126,"children":867},[868],{"text":869,"type":130},"– Soit pour le traitement des tendinites, en cas d’échec du traitement médical, lorsque la forme de l’acromion , pointue et développée vers le bas, peut expliquer l’origine de la tendinite.",{"type":126,"children":871},[872],{"text":873,"type":130},"– Soit lors de la réparation de la coiffe des rotateurs, pour permettre au tendon réparé de ne pas être en conflit avec l’acromion lors de la phase de cicatrisation qui s’accompagne toujours d’un épaississement transitoire du tendon réparé.",{"type":126,"children":875},[876],{"text":877,"type":130},"Il est maintenant recommandé que cette acromioplastie soit effectuée par arthroscopie (cf infra)",{"type":126,"children":879},[880],{"text":881,"type":130},"L’hospitalisation est courte : 24 à 48h, parfois en ambulatoire.",{"type":126,"children":883},[884],{"text":885,"type":130},"Dans l’acromioplastie sans réparation tendineuse, l’immobilisation du membre supérieur se fait à l’aide d’une écharpe, amovible pour la toilette, l’habillement et la rééducation, et est de courte durée : 8 à 10 jours.",{"type":126,"children":887},[888],{"text":889,"type":130},"La rééducation post-opératoire est indispensable.",{"type":126,"children":891},[892],{"text":893,"type":130},"L’arrêt de travail est de 45 jours à 3 mois.",{"type":126,"children":895},[896],{"text":897,"type":130},"La récupération d’une épaule normale se fait sur une durée de 3 à 6 mois.",{"type":126,"children":899},[900],{"text":134,"type":130},{"type":126,"children":902},[903],{"text":904,"type":130},"LA TENOTOMIE OU LA TENODESE DU TENDON DE LA LONGUE PORTION DU BICEPS SOUS ARTHROSCOPIE",{"type":126,"children":906},[907],{"text":134,"type":130},{"type":126,"children":909},[910],{"text":911,"type":130},"Elle consiste à couper le tendon du biceps, sous arthroscopie au niveau de l’articulation de l’épaule (ténotomie) et éventuellement à le fixer plus bas (ténodèse",{"type":126,"children":913},[914],{"text":915,"type":130},"Elle est très souvent pratiquée lors de la réparation des tendons de la coiffe des rotateurs.",{"type":126,"children":917},[918],{"text":919,"type":130},"Isolée, elle est rarement utilisée et ne s’adresse qu’à deux cas particuliers :",{"type":126,"children":921},[922],{"text":923,"type":130},"– Tendinite isolée du biceps.",{"type":126,"children":925},[926],{"text":927,"type":130},"– Rupture irréparable des tendons de la coiffe des rotateurs avec tendinite importante du biceps, chez patient de plus de 65 ans, sans arthrose de l’épaule.",{"type":126,"children":929},[930],{"text":134,"type":130},{"type":126,"children":932},[933],{"text":934,"type":130},"LA REPARATION DE LA COIFFE DES ROTATEURS PAR ARTHROSCOPIE",{"type":126,"children":936},[937],{"text":134,"type":130},{"type":126,"children":939},[940],{"text":941,"type":130},"L’arthroscopie a révolutionné la chirurgie de l’épaule.",{"type":126,"children":943},[944],{"text":945,"type":130},"Elle permet une exploration de l’épaule beaucoup plus complète ainsi qu’un certain nombre de gestes impossibles à réaliser à ciel ouvert.",{"type":126,"children":947},[948],{"text":949,"type":130},"Elle diminue notablement :",{"type":126,"children":951},[952],{"text":953,"type":130},"* La durée d’hospitalisation : rarement supérieure à 48h.",{"type":126,"children":955},[956],{"text":957,"type":130},"* Les dégâts musculaires sur le deltoïde : inexistants lors de l’arthroscopie.",{"type":126,"children":959},[960],{"text":961,"type":130},"* Certaines complications : risque d’infection ou risque d’hématome beaucoup moins important.",{"type":126,"children":963},[964],{"text":965,"type":130},"Enfin, mais ce n’est certainement pas le plus important : l’esthétique des cicatrices est naturellement nettement supérieure à la chirurgie à ciel ouvert.",{"type":126,"children":967},[968],{"text":969,"type":130},"Au sein de notre association, toutes les réparations de coiffe sont réalisées sous arthroscopie depuis maintenant 10 ans",{"type":126,"children":971},[972],{"text":134,"type":130},{"type":126,"children":974},[975],{"text":134,"type":130},{"type":126,"children":977},[978],{"text":134,"type":130},{"type":126,"children":980},[981],{"text":982,"type":130},"EN PRATIQUE :",{"type":126,"children":984},[985],{"text":986,"type":130},"Un certains nombre d’incisions de 0,5 à 1,5 cm de long sont réalisées autour de l’épaule.",{"type":126,"children":988},[989],{"text":990,"type":130},"Une fibre optique rigide reliée à une caméra vidéo est introduite par l’une de ces incisions dans l’épaule.",{"type":126,"children":992},[993],{"text":994,"type":130},"Des instruments permettant de manipuler à distance sont introduits par les autres incisions.",{"type":126,"children":996},[997],{"text":998,"type":130},"La réparation des lésions est ainsi réalisée sous contrôle vidéo direct par le chirurgien.",{"type":597,"image":1000,"children":1030},{"ext":599,"url":1001,"hash":1002,"mime":602,"name":1003,"size":1004,"width":1005,"height":1006,"caption":607,"formats":1007,"provider":633,"createdAt":1029,"updatedAt":1029,"previewUrl":607,"alternativeText":1003,"provider_metadata":607},"https:\u002F\u002Flircos.org\u002Fapi\u002Fuploads\u002Fcoiffe_3_406a0c66b4.jpg","coiffe_3_406a0c66b4","coiffe 3.jpg",35.02,820,394,{"small":1008,"medium":1015,"thumbnail":1022},{"ext":599,"url":1009,"hash":1010,"mime":602,"name":1011,"path":607,"size":1012,"width":614,"height":1013,"sizeInBytes":1014},"\u002Fuploads\u002Fsmall_coiffe_3_406a0c66b4.jpg","small_coiffe_3_406a0c66b4","small_coiffe 3.jpg",17.4,240,17399,{"ext":599,"url":1016,"hash":1017,"mime":602,"name":1018,"path":607,"size":1019,"width":622,"height":1020,"sizeInBytes":1021},"\u002Fuploads\u002Fmedium_coiffe_3_406a0c66b4.jpg","medium_coiffe_3_406a0c66b4","medium_coiffe 3.jpg",32.41,360,32414,{"ext":599,"url":1023,"hash":1024,"mime":602,"name":1025,"path":607,"size":1026,"width":630,"height":1027,"sizeInBytes":1028},"\u002Fuploads\u002Fthumbnail_coiffe_3_406a0c66b4.jpg","thumbnail_coiffe_3_406a0c66b4","thumbnail_coiffe 3.jpg",6.48,118,6482,"2024-10-13T11:11:39.689Z",[1031],{"text":134,"type":130},{"type":597,"image":1033,"children":1063},{"ext":599,"url":1034,"hash":1035,"mime":602,"name":1036,"size":1037,"width":1038,"height":1039,"caption":607,"formats":1040,"provider":633,"createdAt":1062,"updatedAt":1062,"previewUrl":607,"alternativeText":1036,"provider_metadata":607},"https:\u002F\u002Flircos.org\u002Fapi\u002Fuploads\u002Fcoiffe_4_bcda4e4202.jpg","coiffe_4_bcda4e4202","coiffe 4.jpg",40.51,798,372,{"small":1041,"medium":1048,"thumbnail":1055},{"ext":599,"url":1042,"hash":1043,"mime":602,"name":1044,"path":607,"size":1045,"width":614,"height":1046,"sizeInBytes":1047},"\u002Fuploads\u002Fsmall_coiffe_4_bcda4e4202.jpg","small_coiffe_4_bcda4e4202","small_coiffe 4.jpg",19.74,233,19736,{"ext":599,"url":1049,"hash":1050,"mime":602,"name":1051,"path":607,"size":1052,"width":622,"height":1053,"sizeInBytes":1054},"\u002Fuploads\u002Fmedium_coiffe_4_bcda4e4202.jpg","medium_coiffe_4_bcda4e4202","medium_coiffe 4.jpg",35.87,350,35874,{"ext":599,"url":1056,"hash":1057,"mime":602,"name":1058,"path":607,"size":1059,"width":630,"height":1060,"sizeInBytes":1061},"\u002Fuploads\u002Fthumbnail_coiffe_4_bcda4e4202.jpg","thumbnail_coiffe_4_bcda4e4202","thumbnail_coiffe 4.jpg",6.59,114,6589,"2024-10-13T11:11:39.761Z",[1064],{"text":134,"type":130},{"type":126,"children":1066},[1067],{"text":1068,"type":130},"Les cicatrices sont alors refermées par un point simple ou de simple petites bandes collantes (steristrip)",{"type":126,"children":1070},[1071],{"text":1072,"type":130},"L’épaule est immobilisée de 4 à 6 semaines en fonction du geste réalisé par une écharpe amovible pour l’habillement, la toilette et la rééducation pendant cette période.",{"type":126,"children":1074},[1075],{"text":1076,"type":130},"A l’issue de cette période d’immobilisation, la première consultation post-opératoire a généralement lieu. Elle permet de :",{"type":126,"children":1078},[1079],{"text":1080,"type":130},"– Procéder à l’ablation définitive de l’écharpe d’immobilisation",{"type":126,"children":1082},[1083],{"text":1084,"type":130},"– Vérifier l’absence de complications immédiates. (cf infra)",{"type":126,"children":1086},[1087],{"text":1088,"type":130},"– Vérifier la qualité des premiers gestes effectués lors de la rééducation.",{"type":126,"children":1090},[1091],{"text":1092,"type":130},"L’arrêt de travail est variable en fonction de la profession exercée et de la nécessité ou non lors de l’activité professionnelle d’exercer des efforts sur les tendons réparés : il varie entre 3 et 6 mois en moyenne.",{"type":126,"children":1094},[1095],{"text":1096,"type":130},"La récupération d’une épaule mobile et indolore est effective au bout de 3 à 6 mois en moyenne. Il est souvent nécessaire d’attendre un an pour récupérer une force normale, similaire à la force de l’épaule avant la rupture tendineuse.",{"type":126,"children":1098},[1099],{"text":1100,"type":130},"Un contrôle de la cicatrisation tendineuse par arthroscanner est généralement demandé au 6ème mois afin de vérifier la qualité de cette cicatrisation.",{"type":126,"children":1102},[1103],{"text":134,"type":130},{"type":126,"children":1105},[1106],{"text":1107,"type":130},"LE TRANSFERT DE TENDONS",{"type":126,"children":1109},[1110],{"text":134,"type":130},{"type":126,"children":1112},[1113],{"text":1114,"type":130},"C’est une chirurgie qui ne concerne que peu de patients : en effet les conditions sont les suivantes :",{"type":126,"children":1116},[1117],{"text":1118,"type":130},"– Rupture irréparable des tendons de la coiffe des rotateurs, avec tendons rétractés et muscles atrophiques.",{"type":126,"children":1120},[1121],{"text":1122,"type":130},"– Patient de moins de 65 ans.",{"type":126,"children":1124},[1125],{"text":1126,"type":130},"– Echec du traitement médical.",{"type":126,"children":1128},[1129],{"text":1130,"type":130},"– Mobilité conservée de l’épaule (au delà de 90°)",{"type":126,"children":1132},[1133],{"text":1134,"type":130},"Elle consiste à transférer à la place des tendons rétractés un ou plusieurs autres tendons voisins de ceux de la coiffe des rotateurs.",{"type":126,"children":1136},[1137],{"text":1138,"type":130},"C’est une chirurgie qui se fait partiellement à ciel ouvert (prélèvement du tendon), le transfert et l’accrochage des tendons à la place des tendons de la coiffe des rotateurs pouvant se faire sous arthroscopie.",{"type":126,"children":1140},[1141],{"text":1142,"type":130},"On distingue :",{"type":126,"children":1144},[1145],{"text":1146,"type":130},"– Le transfert du tendon du muscle grand pectoral : pour les ruptures irréparables du sous-scapulaire.",{"type":126,"children":1148},[1149],{"text":1150,"type":130},"– Le transfert du tendon du muscle grand dorsal : pour les ruptures irréparables du sus et du sous-épineux",{"type":126,"children":1152},[1153],{"text":134,"type":130},{"type":597,"image":1155,"children":1185},{"ext":599,"url":1156,"hash":1157,"mime":602,"name":1158,"size":1159,"width":1160,"height":1161,"caption":607,"formats":1162,"provider":633,"createdAt":1184,"updatedAt":1184,"previewUrl":607,"alternativeText":1158,"provider_metadata":607},"https:\u002F\u002Flircos.org\u002Fapi\u002Fuploads\u002Fcoiffe_5_a09d8aeda6.jpg","coiffe_5_a09d8aeda6","coiffe 5.jpg",60.67,987,418,{"small":1163,"medium":1170,"thumbnail":1177},{"ext":599,"url":1164,"hash":1165,"mime":602,"name":1166,"path":607,"size":1167,"width":614,"height":1168,"sizeInBytes":1169},"\u002Fuploads\u002Fsmall_coiffe_5_a09d8aeda6.jpg","small_coiffe_5_a09d8aeda6","small_coiffe 5.jpg",21.69,212,21690,{"ext":599,"url":1171,"hash":1172,"mime":602,"name":1173,"path":607,"size":1174,"width":622,"height":1175,"sizeInBytes":1176},"\u002Fuploads\u002Fmedium_coiffe_5_a09d8aeda6.jpg","medium_coiffe_5_a09d8aeda6","medium_coiffe 5.jpg",39.44,318,39444,{"ext":599,"url":1178,"hash":1179,"mime":602,"name":1180,"path":607,"size":1181,"width":630,"height":1182,"sizeInBytes":1183},"\u002Fuploads\u002Fthumbnail_coiffe_5_a09d8aeda6.jpg","thumbnail_coiffe_5_a09d8aeda6","thumbnail_coiffe 5.jpg",6.94,104,6943,"2024-10-13T11:11:47.017Z",[1186],{"text":134,"type":130},{"type":126,"children":1188},[1189],{"text":1190,"type":130},"Une chirurgie de transfert tendineux donne des résultats satisfaisants sur la diminution de la douleur et la récupération de la mobilité mais ne permet pas une récupération de force aussi bonne que dans une réparation des tendons.",{"type":597,"image":1192,"children":1209},{"ext":599,"url":1193,"hash":1194,"mime":602,"name":1195,"size":1196,"width":1197,"height":1198,"caption":607,"formats":1199,"provider":633,"createdAt":1208,"updatedAt":1208,"previewUrl":607,"alternativeText":1195,"provider_metadata":607},"https:\u002F\u002Flircos.org\u002Fapi\u002Fuploads\u002Fcoiffe_6_725663cf98.jpg","coiffe_6_725663cf98","coiffe 6.jpg",23.98,405,464,{"thumbnail":1200},{"ext":599,"url":1201,"hash":1202,"mime":602,"name":1203,"path":607,"size":1204,"width":1205,"height":1206,"sizeInBytes":1207},"\u002Fuploads\u002Fthumbnail_coiffe_6_725663cf98.jpg","thumbnail_coiffe_6_725663cf98","thumbnail_coiffe 6.jpg",4.63,136,156,4630,"2024-10-13T11:11:39.406Z",[1210],{"text":134,"type":130},{"type":126,"children":1212},[1213],{"text":1214,"type":130},"LA PROTHESE INVERSEE",{"type":126,"children":1216},[1217],{"text":1218,"type":130},"Utilisée en cas d’omarthrose excentrée (arthrose de l’épaule avec ascension de la tête du l’humérus)",{"type":126,"children":1220},[1221],{"text":1222,"type":130},"On ne la propose qu’au delà de 65 ans en cas de rupture irréparable des tendons de la coiffe des rotateurs associée à une arthrose importante.",{"type":126,"children":1224},[1225],{"text":1226,"type":130},"Dans certains cas exceptionnels, on peut la proposer en l’absence d’arthrose, au delà de 65 ans, en cas de rupture irréparable des tendons de la coiffe des rotateurs et d’impotence fonctionnelle importante de l’épaule (mouvements \u003C 90°)",{"type":126,"children":1228},[1229],{"text":1230,"type":130},"Complications",{"type":126,"children":1232},[1233],{"text":134,"type":130},{"type":126,"children":1235},[1236],{"text":1237,"type":130},"Malgré les progrès réalisés par l’arthroscopie, la chirurgie de la coiffe des rotateurs n’est pas exempte de complications.",{"type":126,"children":1239},[1240],{"text":1241,"type":130},"Celles-ci sont peu fréquentes et la plupart guérissent sans séquelles et sans nécessité d’une nouvelle intervention chirurgicale.",{"type":126,"children":1243},[1244],{"text":1245,"type":130},"Certaines sont toutefois plus sérieuses et peuvent nécessiter une voire plusieurs nouvelles interventions chirurgicales pour obtenir une guérison.",{"type":126,"children":1247},[1248],{"text":134,"type":130},{"type":126,"children":1250},[1251],{"text":1252,"type":130},"1°) La récidive de la rupture tendineuse",{"type":126,"children":1254},[1255],{"text":134,"type":130},{"type":126,"children":1257},[1258],{"text":1259,"type":130},"C’est la principale complication en terme de pourcentage.",{"type":126,"children":1261},[1262],{"text":1263,"type":130},"Elle est d’autant plus fréquente que :",{"type":126,"children":1265},[1266],{"text":1267,"type":130},"– L’état des tendons est initialement mauvais : tendons rétractés, muscles atrophiés.",{"type":126,"children":1269},[1270],{"text":1271,"type":130},"– Les tendons sont trop fins et peu mobilisables à la traction lors de l’intervention.",{"type":126,"children":1273},[1274],{"text":1275,"type":130},"– L’immobilisation n’est pas respectée.",{"type":126,"children":1277},[1278],{"text":1279,"type":130},"La récidive est ainsi rare (\u003C10%) pour une rupture relativement récente, peu rétractée, où la réparation s’est effectuée sur un tendon épais et facilement mobilisable.",{"type":126,"children":1281},[1282],{"text":1283,"type":130},"Elle peut aller jusqu’à 40, voire 50%, en cas de rupture opérée trop tardivement, avec un tendon rétracté, fin et difficilement mobilisable et des muscles atrophiés.",{"type":126,"children":1285},[1286],{"text":1287,"type":130},"Une récidive de rupture tendineuse ne donne pas toujours les mêmes symptômes qu’avant l’intervention, notamment en terme de douleurs et parfois seule une perte de force partielle est constatée. Une nouvelle intervention n’est alors pas nécessaire.",{"type":126,"children":1289},[1290],{"text":1291,"type":130},"Seule la réapparition de la douleur, non calmée par le traitement médical, peut amener à proposer un nouveau geste chirurgical :",{"type":126,"children":1293},[1294],{"text":1295,"type":130},"– Soit une nouvelle tentative de réparation si l’état du tendon et des muscles au contrôle arthroscanner le permettent.",{"type":126,"children":1297},[1298],{"text":1299,"type":130},"– Soit d’autres thérapeutiques chirurgicales : transferts tendineux, prothèse inversée.",{"type":126,"children":1301},[1302],{"text":134,"type":130},{"type":126,"children":1304},[1305],{"text":1306,"type":130},"2°) La capsulite rétractile",{"type":126,"children":1308},[1309],{"text":134,"type":130},{"type":126,"children":1311},[1312],{"text":1313,"type":130},"C’est la deuxième complication en fréquence : elle survient dans 3 à 6% des cas.",{"type":126,"children":1315},[1316],{"text":1317,"type":130},"Complication imprévisible et indépendante de l’état du tendon, du type de chirurgie, du chirurgien, elle est directement liée à une réaction « excessive » de l’épaule à l’intervention chirurgicale.",{"type":126,"children":1319},[1320],{"text":1321,"type":130},"Elle prolonge le délai de récupération, le multipliant souvent par 2 ou 3, avec une récupération pouvant nécessiter parfois 18 mois ou plus.",{"type":126,"children":1323},[1324],{"text":1325,"type":130},"Elle n’a pas d’incidence directe sur la cicatrisation tendineuse.",{"type":126,"children":1327},[1328],{"text":1329,"type":130},"Les séquelles sont très rares parfois à type de raideur partielle de l’épaule dans les gestes amples, plus rarement à type de douleurs résiduelles.",{"type":126,"children":1331},[1332],{"text":1333,"type":130},"Le traitement repose sur la lutte contre la douleur et la rééducation douce",{"type":126,"children":1335},[1336],{"text":134,"type":130},{"type":126,"children":1338},[1339],{"text":1340,"type":130},"3°) Infection",{"type":126,"children":1342},[1343],{"text":134,"type":130},{"type":126,"children":1345},[1346],{"text":1347,"type":130},"Exceptionnelle dans la chirurgie arthroscopique, elle est – Superficielle : dans 0,1 à 0,3% des cas, ne nécessitant qu’un traitement par antibiothérapie courte et soins locaux.",{"type":126,"children":1349},[1350],{"text":1351,"type":130},"– Profonde : dans moins de 0,1% des cas, nécessitant alors une nouvelle intervention chirurgicale et une antibiothérapie prolongée. Le résultat final dépend alors de la possibilité de garder ou non le matériel de réparation et donc de la vitesse de réaction face à cette complication.",{"type":126,"children":1353},[1354],{"text":1355,"type":130},"Les signes cliniques étant les mêmes dans les deux cas : fièvre, aspect inflammatoire des cicatrices, écoulement anormal, gonflement de l’épaule, seul votre chirurgien pourra faire la différence entre infection superficielle et profonde.",{"type":126,"children":1357},[1358],{"text":134,"type":130},{"type":126,"children":1360},[1361],{"text":1362,"type":130},"4°) Beaucoup plus exceptionnelles :",{"type":126,"children":1364},[1365],{"text":134,"type":130},{"type":126,"children":1367},[1368],{"text":1369,"type":130},"– Les complications nerveuses : paralysie partielle et transitoire de certains muscles de la main ou du membre supérieur, rares (0,15% des cas), le plus souvent liées à l’anesthésie loco-régionale.",{"type":126,"children":1371},[1372],{"text":1373,"type":130},"– Les complications vasculaires : rarissimes, liées à l’anesthésie le plus souvent. ","2024-10-13T11:13:51.515Z","2024-10-19T13:49:21.414Z","2024-10-13T11:13:55.233Z",[1378,1382,1385,1389,1393,1397,1401,1404,1408,1412,1416,1419,1423,1427,1431,1435,1438,1442,1446,1450,1454,1457,1461,1465,1469,1473,1476,1480,1484,1488,1492,1495,1499,1503,1507,1511,1515,1518,1522,1525,1529,1533,1537,1541,1545,1549,1553,1557,1561,1565,1569,1573,1577,1580,1584,1587,1591,1595,1599,1602,1606,1609,1613,1617,1621,1625,1629,1633,1637,1641,1644,1648,1651,1655,1659,1663,1666,1670,1674,1678,1682,1686,1690,1694,1698,1702,1705,1709,1712,1716,1720,1724,1728,1731,1735,1738,1742,1746,1750,1753,1757,1760,1764,1768,1772,1776,1780,1783,1787,1791,1795,1799,1803,1807,1811,1814,1818,1821,1825,1829,1832,1836,1840,1844,1852,1860,1864,1868,1872,1875,1879,1882,1886,1889,1893,1896,1899,1903,1907,1911,1915,1919,1922,1926,1930,1933,1937,1941,1945,1949,1953,1957,1961,1965,1969,1973,1977,1981,1985,1989,1992,1996,2000,2004,2007,2011,2014,2018,2022,2026,2030,2034,2038,2041,2045,2048,2052,2056,2060,2064,2068,2072,2076,2080,2084,2088,2091,2095,2098,2102,2106,2110,2114,2118,2121,2125,2128,2132,2136,2140,2144,2148,2152,2156,2160,2163,2166,2169,2173,2177,2181,2185,2189,2197,2205,2209,2213,2217,2221,2225,2229,2233,2237,2241,2244,2248,2251,2255,2259,2263,2267,2271,2275,2279,2283,2287,2291,2294,2302,2306,2312,2316,2320,2324,2328,2331,2334,2338,2342,2346,2349,2353,2356,2360,2364,2368,2372,2376,2380,2384,2388,2392,2396,2400,2403,2407,2410,2414,2418,2422,2426,2430,2434,2437,2440,2443,2447,2451,2455,2458,2462,2465,2469],{"type":126,"children":1379},[1380],{"text":1381,"type":130},"The bones of The head of the humerus is located at the top of the arm: it is round, covered with cartilage and articulates with the glenoid, a rather flat joint area of ​​the scapula (or scapula) which is the bone which connects the upper limb to the thorax. The scapula continues posteriorly with a bony prominence which returns above the tendons of the rotator cuff: the acromion.",{"type":126,"children":1383},[1384],{"text":134,"type":130},{"type":126,"children":1386},[1387],{"text":1388,"type":130},"THE ROTATOR CAP",{"type":126,"children":1390},[1391],{"text":1392,"type":130},"The rotator cuff takes its name from the appearance of the tendons that cover the head of the humerus: they cover it like hair covers a head, hence the term “cuff”",{"type":126,"children":1394},[1395],{"text":1396,"type":130},"The rotator cuff tendons come from four muscles whose fibers are attached to the scapula: the muscle fibers transform into tendons as they approach the humeral head.",{"type":126,"children":1398},[1399],{"text":1400,"type":130},"There are four muscles (and therefore four tendons):",{"type":126,"children":1402},[1403],{"text":134,"type":130},{"type":126,"children":1405},[1406],{"text":1407,"type":130},"1°) The supraspinatus muscle (or supraspinatus or supraspinatus)",{"type":126,"children":1409},[1410],{"text":1411,"type":130},"– It takes its name from its position at the level of the scapula: it is above a bony element called the spine of the scapula",{"type":126,"children":1413},[1414],{"text":1415,"type":130},"– It is the muscle whose tendon is almost always the first c – It gives the shoulder its power, for example its ability to lift heavy objects.",{"type":126,"children":1417},[1418],{"text":134,"type":130},{"type":126,"children":1420},[1421],{"text":1422,"type":130},"2°) The infraspinatus muscle (or infraspinatus or infraspinatus)",{"type":126,"children":1424},[1425],{"text":1426,"type":130},"– It takes its name from its position at the level of the shoulder blade: it is below the spine",{"type":126,"children":1428},[1429],{"text":1430,"type":130},"– Its tendon is often affected secondly, after the supraspinatus, in tendinitis and ruptures, but to a lesser extent.",{"type":126,"children":1432},[1433],{"text":1434,"type":130},"– It is the main muscle responsible for the external rotation movement of the shoulder: ability to direct the hand outwards when the elbow is glued to the body or ability to lift the hand upwards when the arm is horizontal",{"type":126,"children":1436},[1437],{"text":134,"type":130},{"type":126,"children":1439},[1440],{"text":1441,"type":130},"3°) The subscapularis muscle (or subscapularis)",{"type":126,"children":1443},[1444],{"text":1445,"type":130},"– It takes its name from the area of ​​the shoulder blade where its fibers attach: the subscapular fossa.",{"type":126,"children":1447},[1448],{"text":1449,"type":130},"– Its tendon is more rarely affected in its entirety than that of the infraspinatus, however it is frequently affected in its upper part.",{"type":126,"children":1451},[1452],{"text":1453,"type":130},"– It is partially responsible (along with other muscles) for the internal rotation movement of the shoulder, including the ability to place the hand behind the back.",{"type":126,"children":1455},[1456],{"text":134,"type":130},{"type":126,"children":1458},[1459],{"text":1460,"type":130},"4°) The teres minor muscle (or teres minor)",{"type":126,"children":1462},[1463],{"text":1464,"type":130},"– It takes its name from its shape because it is small and round!",{"type":126,"children":1466},[1467],{"text":1468,"type":130},"– It is exceptionally affected by tendonitis and ruptures,",{"type":126,"children":1470},[1471],{"text":1472,"type":130},"only in very evolved and very old forms, and only once the tendon of the infraspinatus muscle has completely disappeared.",{"type":126,"children":1474},[1475],{"text":134,"type":130},{"type":126,"children":1477},[1478],{"text":1479,"type":130},"Aside: the tendon of the long head of the biceps:",{"type":126,"children":1481},[1482],{"text":1483,"type":130},"– The biceps, a well-known arm muscle, has two tendons in its proximal part: one is located outside the shoulder joint, the other is located in the shoulder joint and passes under the subscapularis tendons in front of the arm, then between the supraspinatus and subscapularis tendons to attach to the scapula.",{"type":126,"children":1485},[1486],{"text":1487,"type":130},"– It is not considered as a rotator cuff tendon because its mechanical role in the shoulder is not very important.",{"type":126,"children":1489},[1490],{"text":1491,"type":130},"– On the other hand, it is often affected by disease, because as soon as it is exposed to inflammation or rupture of the cuff tendons, and in particular the supraspinatus and subscapularis tendons, it can itself become inflammatory and painful on its own account, or even rupture as well.",{"type":126,"children":1493},[1494],{"text":134,"type":130},{"type":126,"children":1496},[1497],{"text":1498,"type":130},"THE DELTOID MUSCLE",{"type":126,"children":1500},[1501],{"text":1502,"type":130},"Directly under the skin, it covers the rotator cuff.",{"type":126,"children":1504},[1505],{"text":1506,"type":130},"It is the main driving muscle of the shoulder.",{"type":126,"children":1508},[1509],{"text":1510,"type":130},"It is never affected in rotator cuff pathology (except following overly aggressive open surgery), which explains why the shoulder can move despite a complete tear of the rotator cuff: only the deltoid then allows part of the movement, without however providing the total power of the shoulder.",{"type":126,"children":1512},[1513],{"text":1514,"type":130},"Symptomatology",{"type":126,"children":1516},[1517],{"text":134,"type":130},{"type":126,"children":1519},[1520],{"text":1521,"type":130},"PAIN",{"type":126,"children":1523},[1524],{"text":134,"type":130},{"type":126,"children":1526},[1527],{"text":1528,"type":130},"This is the master symptom.",{"type":126,"children":1530},[1531],{"text":1532,"type":130},"It is always present at one point or another during the course of the disease.",{"type":126,"children":1534},[1535],{"text":1536,"type":130},"It can appear suddenly, after effort or trauma, even mild. It can also occur gradually.",{"type":126,"children":1538},[1539],{"text":1540,"type":130},"It is often nocturnal, sometimes it even prevents you from sleeping due to its intensity or wakes you up in the middle of the night around 4 a.m., which reflects its inflammatory nature.",{"type":126,"children":1542},[1543],{"text":1544,"type":130},"During the day, it can be important but also only become annoying during certain gestures or during exercise.",{"type":126,"children":1546},[1547],{"text":1548,"type":130},"It can also be present for a given period then disappear for several months or even several years before reappearing during an effort, a sudden movement, sometimes spontaneously.",{"type":126,"children":1550},[1551],{"text":1552,"type":130},"At the start of the disease, it is easily calmed by simple medications such as analgesics or anti-inflammatories. It may end up resisting any treatment.",{"type":126,"children":1554},[1555],{"text":1556,"type":130},"It can be linked:",{"type":126,"children":1558},[1559],{"text":1560,"type":130},"– Has simple tendinitis.",{"type":126,"children":1562},[1563],{"text":1564,"type":130},"– Has a tendon rupture.",{"type":126,"children":1566},[1567],{"text":1568,"type":130},"Its location is very variable and there is no direct correlation between its position and tendon damage.",{"type":126,"children":1570},[1571],{"text":1572,"type":130},"It is often located “in the shoulder” without precise location, changing position with time or movement.",{"type":126,"children":1574},[1575],{"text":1576,"type":130},"It often radiates towards the arm, or even towards the forearm and the fingers, which can cause rotator cuff damage to be confused with an attack of neurological origin such as Cervico-Brachial Neuralgia. It often also radiates towards the neck and back, following the path of the trapezius muscle which inserts from the top of the neck to the middle of the back.",{"type":126,"children":1578},[1579],{"text":134,"type":130},{"type":126,"children":1581},[1582],{"text":1583,"type":130},"LOSS OF STRENGTH",{"type":126,"children":1585},[1586],{"text":134,"type":130},{"type":126,"children":1588},[1589],{"text":1590,"type":130},"This is the first sign we generally notice, apart from pain. It reflects the damage to the supraspinatus and is all the more important as the musculotendinous damage is significant and long-standing.",{"type":126,"children":1592},[1593],{"text":1594,"type":130},"It is sometimes isolated, that is to say the only sign present, the pain having been calmed by medical treatment.",{"type":126,"children":1596},[1597],{"text":1598,"type":130},"Most of the time it reflects a tendon rupture and no longer simple tendonitis.",{"type":126,"children":1600},[1601],{"text":134,"type":130},{"type":126,"children":1603},[1604],{"text":1605,"type":130},"LOSS OF MOBILITY",{"type":126,"children":1607},[1608],{"text":134,"type":130},{"type":126,"children":1610},[1611],{"text":1612,"type":130},"It is the inability to use the arm for certain gestures:",{"type":126,"children":1614},[1615],{"text":1616,"type":130},"– Either requiring force (affects the supraspinatus)",{"type":126,"children":1618},[1619],{"text":1620,"type":130},"– Or requiring an external rotation movement (involvement of the infraspinatus and teres minor)",{"type":126,"children":1622},[1623],{"text":1624,"type":130},"– Or requiring an internal rotation movement (damage to the subscapularis)",{"type":126,"children":1626},[1627],{"text":1628,"type":130},"– Either requiring a combination of these movements (damage to several tendons)",{"type":126,"children":1630},[1631],{"text":1632,"type":130},"This loss of mobility has a double meaning:",{"type":126,"children":1634},[1635],{"text":1636,"type":130},"Either it is present at the start of a tendon rupture, and reflects the intensity of the initial inflammation. It is then often recoverable by medical treatment, in particular by the rehabilitation component of medical treatment.",{"type":126,"children":1638},[1639],{"text":1640,"type":130},"Either it is present late, after a more or less long course of the disease. It then resists medical treatment and often reflects an advanced and complete form of tendon rupture.",{"type":126,"children":1642},[1643],{"text":134,"type":130},{"type":126,"children":1645},[1646],{"text":1647,"type":130},"OTHER SYMPTOMS",{"type":126,"children":1649},[1650],{"text":134,"type":130},{"type":126,"children":1652},[1653],{"text":1654,"type":130},"– Cracking, pseudo-blockages are rarer.",{"type":126,"children":1656},[1657],{"text":1658,"type":130},"– Aside: the Popeye sign: it is the appearance of a lump in the arm, often after an intense painful phase. It reflects the rupture of the tendon of the long head of the biceps.",{"type":126,"children":1660},[1661],{"text":1662,"type":130},"Clinical Examination",{"type":126,"children":1664},[1665],{"text":134,"type":130},{"type":126,"children":1667},[1668],{"text":1669,"type":130},"Your surgeon will first begin with a questioning to clarify your symptoms, their intensity, their date of appearance, their evolution, their importance, the discomfort caused in daily life, work and leisure, the various treatments used until now.",{"type":126,"children":1671},[1672],{"text":1673,"type":130},"The actual clinical examination allows us to assess:",{"type":126,"children":1675},[1676],{"text":1677,"type":130},"– Muscle morphology.",{"type":126,"children":1679},[1680],{"text":1681,"type":130},"– Active and passive mobility of the shoulder.",{"type":126,"children":1683},[1684],{"text":1685,"type":130},"– Painful areas.",{"type":126,"children":1687},[1688],{"text":1689,"type":130},"– the strength and resistance of the various rotator cuff tendons.",{"type":126,"children":1691},[1692],{"text":1693,"type":130},"At the end of the clinical examination, your surgeon will most often prescribe additional radiological examinations, or will examine those prescribed by your attending physician.",{"type":126,"children":1695},[1696],{"text":1697,"type":130},"No biological examination is useful in rotator cuff pathology.",{"type":126,"children":1699},[1700],{"text":1701,"type":130},"Additional Examinations",{"type":126,"children":1703},[1704],{"text":134,"type":130},{"type":126,"children":1706},[1707],{"text":1708,"type":130},"SHOULDER RADIOGRAPHS",{"type":126,"children":1710},[1711],{"text":134,"type":130},{"type":126,"children":1713},[1714],{"text":1715,"type":130},"They are essential because they allow us to highlight",{"type":126,"children":1717},[1718],{"text":1719,"type":130},"– The morphology of the acromion.",{"type":126,"children":1721},[1722],{"text":1723,"type":130},"– The existence of osteoarthritis.",{"type":126,"children":1725},[1726],{"text":1727,"type":130},"However, they are often normal.",{"type":126,"children":1729},[1730],{"text":134,"type":130},{"type":126,"children":1732},[1733],{"text":1734,"type":130},"ULTRASOUND OF THE ROTATOR CUFFER",{"type":126,"children":1736},[1737],{"text":134,"type":130},{"type":126,"children":1739},[1740],{"text":1741,"type":130},"It requires an operator who is highly trained in rotator cuff pathology.",{"type":126,"children":1743},[1744],{"text":1745,"type":130},"It is difficult to interpret by the surgeon",{"type":126,"children":1747},[1748],{"text":1749,"type":130},"It is rarely sufficiently precise to allow a therapeutic decision.",{"type":126,"children":1751},[1752],{"text":134,"type":130},{"type":126,"children":1754},[1755],{"text":1756,"type":130},"MRI (Nuclear Magnetic Resonance Imaging)",{"type":126,"children":1758},[1759],{"text":134,"type":130},{"type":126,"children":1761},[1762],{"text":1763,"type":130},"Often a good screening test, it allows a diagnosis that is sometimes sufficiently precise for the therapeutic decision.",{"type":126,"children":1765},[1766],{"text":1767,"type":130},"Its interpretation is sometimes difficult:",{"type":126,"children":1769},[1770],{"text":1771,"type":130},"* In small or partial tendon damage.",{"type":126,"children":1773},[1774],{"text":1775,"type":130},"* In the evaluation of the extension of lesions.",{"type":126,"children":1777},[1778],{"text":1779,"type":130},"The use of injected contrast product (arthroMRI) allows greater precision and provides images close to arthrography in quality.",{"type":126,"children":1781},[1782],{"text":134,"type":130},{"type":126,"children":1784},[1785],{"text":1786,"type":130},"THE ARTHROSCANNER",{"type":126,"children":1788},[1789],{"text":1790,"type":130},"This is the reference exam.",{"type":126,"children":1792},[1793],{"text":1794,"type":130},"It allows both:",{"type":126,"children":1796},[1797],{"text":1798,"type":130},"* Accurate diagnosis, including partial or small lesions.",{"type":126,"children":1800},[1801],{"text":1802,"type":130},"* Easy assessment of the extent and severity of lesions: tendon retraction, fatty degeneration, muscle atrophy.",{"type":126,"children":1804},[1805],{"text":1806,"type":130},"It is almost systematically requested by the surgeon preoperatively and sometimes postoperatively to check the quality of tendon healing.",{"type":558,"level":559,"children":1808},[1809],{"text":1810,"type":130},"Cuff tendinitis",{"type":126,"children":1812},[1813],{"text":134,"type":130},{"type":126,"children":1815},[1816],{"text":1817,"type":130},"It is an inflammatory condition of the tendon, most often the supraspinatus, WITHOUT rupture.",{"type":126,"children":1819},[1820],{"text":134,"type":130},{"type":126,"children":1822},[1823],{"text":1824,"type":130},"It rarely occurs before the age of 40",{"type":126,"children":1826},[1827],{"text":1828,"type":130},"It often affects the dominant limb and is more common in upper limb strength workers or in those who use their shoulder in repetitive movements beyond the horizontal.",{"type":126,"children":1830},[1831],{"text":134,"type":130},{"type":126,"children":1833},[1834],{"text":1835,"type":130},"It results in pain, rarely in a limitation of mobility or a loss of strength.",{"type":126,"children":1837},[1838],{"text":1839,"type":130},"Its treatment is primarily medical (see treatment below). It is rarely surgical.",{"type":558,"level":12,"children":1841},[1842],{"text":1843,"type":130},"Cuff rupture",{"type":597,"image":1845,"children":1850},{"ext":599,"url":600,"hash":601,"mime":602,"name":603,"size":604,"width":605,"height":606,"caption":607,"formats":1846,"provider":633,"createdAt":634,"updatedAt":634,"previewUrl":607,"alternativeText":603,"provider_metadata":607},{"small":1847,"medium":1848,"thumbnail":1849},{"ext":599,"url":610,"hash":611,"mime":602,"name":612,"path":607,"size":613,"width":614,"height":615,"sizeInBytes":616},{"ext":599,"url":618,"hash":619,"mime":602,"name":620,"path":607,"size":621,"width":622,"height":623,"sizeInBytes":624},{"ext":599,"url":626,"hash":627,"mime":602,"name":628,"path":607,"size":629,"width":630,"height":631,"sizeInBytes":632},[1851],{"text":134,"type":130},{"type":597,"image":1853,"children":1858},{"ext":599,"url":639,"hash":640,"mime":602,"name":641,"size":642,"width":643,"height":644,"caption":607,"formats":1854,"provider":633,"createdAt":667,"updatedAt":667,"previewUrl":607,"alternativeText":641,"provider_metadata":607},{"small":1855,"medium":1856,"thumbnail":1857},{"ext":599,"url":647,"hash":648,"mime":602,"name":649,"path":607,"size":650,"width":614,"height":651,"sizeInBytes":652},{"ext":599,"url":654,"hash":655,"mime":602,"name":656,"path":607,"size":657,"width":622,"height":658,"sizeInBytes":659},{"ext":599,"url":661,"hash":662,"mime":602,"name":663,"path":607,"size":664,"width":630,"height":665,"sizeInBytes":666},[1859],{"text":134,"type":130},{"type":126,"children":1861},[1862],{"text":1863,"type":130},"It mainly concerns the supraspinatus, often after a more or less long phase of tendinitis.",{"type":126,"children":1865},[1866],{"text":1867,"type":130},"It occurs especially after the age of 50 and is then part of rotator cuff tendon disease (prolonged tendinitis then rupture of a degenerative tendon)",{"type":126,"children":1869},[1870],{"text":1871,"type":130},"Exceptionally, it can be post-traumatic before the age of 50, the tendon then being healthy, but simply torn from its bony insertion by a very violent opposing movement (fall during a high-speed accident, countered movement of the shoulder, etc.)",{"type":126,"children":1873},[1874],{"text":134,"type":130},{"type":126,"children":1876},[1877],{"text":1878,"type":130},"The pain is still present, but may be reduced, in particular by prior medical treatment of the tendinitis. It can also be much more intense than with tendinitis: anything is possible at this level.",{"type":126,"children":1880},[1881],{"text":134,"type":130},{"type":126,"children":1883},[1884],{"text":1885,"type":130},"The loss of strength is constant and this is a very good sign to differentiate between simple tendinitis and a rupture: it is however necessary for your surgeon to clarify this point because it is not always easy to make a diagnosis yourself!",{"type":126,"children":1887},[1888],{"text":134,"type":130},{"type":126,"children":1890},[1891],{"text":1892,"type":130},"The loss of mobility varies depending on the old or recent nature of the rupture, the effectiveness of the treatments already carried out, and the extent of the damage.",{"type":126,"children":1894},[1895],{"text":134,"type":130},{"type":126,"children":1897},[1898],{"text":134,"type":130},{"type":126,"children":1900},[1901],{"text":1902,"type":130},"The progression of the supraspinatus rupture always becomes worse:",{"type":126,"children":1904},[1905],{"text":1906,"type":130},"– At the level of the supraspinatus itself with retraction of the tendon, muscular atrophy and fatty degeneration of the muscle.",{"type":126,"children":1908},[1909],{"text":1910,"type":130},"– Towards achieving",{"type":126,"children":1912},[1913],{"text":1914,"type":130},"* Either of the infraspinatus, which then worsens in the same direction as the supraspinatus, with tendon retraction, atrophy and muscular fatty degeneration: these are the so-called “postero-superior” ruptures: often a little less painful and therefore detected at an already advanced stage, that of loss of mobility for example.",{"type":126,"children":1916},[1917],{"text":1918,"type":130},"* Either of the subscapularis, with the same evolution: tendon retraction, atrophy and fatty degeneration. These are the so-called “antero-superior” ruptures: often more painful and therefore detected at an earlier stage.",{"type":126,"children":1920},[1921],{"text":134,"type":130},{"type":126,"children":1923},[1924],{"text":1925,"type":130},"– After some time (from a few months to a few years), the development can lead to damage to the 3 tendons (supraspinatus, infraspinatus and subscapularis). The humeral head is then no longer held by any tendon and gradually rises to come into conflict with the acromion. The cartilage can then wear out and we witness the appearance of osteoarthritis specific to the development of rotator cuff tears: “eccentric oarthrosis” (osteoarthritis of the shoulder with rise of the head of the humerus)",{"type":126,"children":1927},[1928],{"text":1929,"type":130},"Medical treatment",{"type":126,"children":1931},[1932],{"text":134,"type":130},{"type":126,"children":1934},[1935],{"text":1936,"type":130},"It should always be tried as first intention, especially in tendinitis.",{"type":126,"children":1938},[1939],{"text":1940,"type":130},"It includes:",{"type":126,"children":1942},[1943],{"text":1944,"type":130},"– Medications: analgesics and non-steroidal anti-inflammatories. (oral corticosteroids should be avoided as much as possible)",{"type":126,"children":1946},[1947],{"text":1948,"type":130},"– Rehabilitation:",{"type":126,"children":1950},[1951],{"text":1952,"type":130},"* Learning certain gestures to avoid overloading the rotator cuff tendons.",{"type":126,"children":1954},[1955],{"text":1956,"type":130},"* Strengthening of adjacent muscles (deltoid, back muscles) * Adjuvant therapies: ultrasound, use of cold (cryotherapy)",{"type":126,"children":1958},[1959],{"text":1960,"type":130},"* Certain actions should be avoided: pulley therapy type work or even muscle strengthening work, without direct control of the physiotherapist.",{"type":126,"children":1962},[1963],{"text":1964,"type":130},"– Infiltrations:",{"type":126,"children":1966},[1967],{"text":1968,"type":130},"* They use a combination of local anesthetics and locally injectable depot corticosteroids.",{"type":126,"children":1970},[1971],{"text":1972,"type":130},"* They should ideally be carried out under radiological control in order to be sure to put the product in the right place: between the tendons of the rotator cuff and the acromion: so-called “subacromial” infiltration",{"type":126,"children":1974},[1975],{"text":1976,"type":130},"* They are reserved for failure of first-line treatment (medications and rehabilitation)",{"type":126,"children":1978},[1979],{"text":1980,"type":130},"* They must be limited to 3 per year maximum.",{"type":126,"children":1982},[1983],{"text":1984,"type":130},"* It is preferable to use them in the absence of tendon rupture, therefore in cases of tendonitis without rupture, or when the tendon rupture can no longer be repaired: it is therefore useful to have tendon imaging before offering them.",{"type":126,"children":1986},[1987],{"text":1988,"type":130},"Surgical treatment",{"type":126,"children":1990},[1991],{"text":134,"type":130},{"type":126,"children":1993},[1994],{"text":1995,"type":130},"It is reserved for failures of medical treatment but can be chosen immediately in certain circumstances",{"type":126,"children":1997},[1998],{"text":1999,"type":130},"– Traumatic rotator cuff tear before age 50.",{"type":126,"children":2001},[2002],{"text":2003,"type":130},"– Rupture of the slightly retracted rotator cuff, with good quality muscles, in an active patient with strength or repetitive work of the upper limb, generally before the age of 65.",{"type":126,"children":2005},[2006],{"text":134,"type":130},{"type":126,"children":2008},[2009],{"text":2010,"type":130},"ANESTHESIA",{"type":126,"children":2012},[2013],{"text":134,"type":130},{"type":126,"children":2015},[2016],{"text":2017,"type":130},"During the pre-anesthesia consultation which must legally take place (except in an emergency) at least 48 hours before the operation, the anesthesiologist will specify the procedures for shoulder anesthesia.",{"type":126,"children":2019},[2020],{"text":2021,"type":130},"Anesthesia is usually mixed:",{"type":126,"children":2023},[2024],{"text":2025,"type":130},"– Loco-regional anesthesia: by placing, under local anesthesia, a catheter around the nerves of the upper limb, at the base of the neck. This catheter is left in place for 24 to 48 hours after the operation and helps reduce immediate post-operative pain.",{"type":126,"children":2027},[2028],{"text":2029,"type":130},"– general anesthesia: short and often without complete intubation, thanks to the effectiveness of the catheter above, it remains essential given *the sometimes long duration of surgical procedures,",{"type":126,"children":2031},[2032],{"text":2033,"type":130},"*often uncomfortable position during the procedure,",{"type":126,"children":2035},[2036],{"text":2037,"type":130},"*the need for absolute immobility of the shoulder during the surgeon's technical actions.",{"type":126,"children":2039},[2040],{"text":134,"type":130},{"type":126,"children":2042},[2043],{"text":2044,"type":130},"ARTHROSCOPIC ACROMIOPLASTY",{"type":126,"children":2046},[2047],{"text":134,"type":130},{"type":126,"children":2049},[2050],{"text":2051,"type":130},"Consists of planing the lower surface of the acromion in contact with the rotator cuff.",{"type":126,"children":2053},[2054],{"text":2055,"type":130},"It is carried out",{"type":126,"children":2057},[2058],{"text":2059,"type":130},"– Either for the treatment of tendinitis, in the event of failure of medical treatment, when the shape of the acromion, pointed and developed downwards, can explain the origin of the tendinitis.",{"type":126,"children":2061},[2062],{"text":2063,"type":130},"– Either during the repair of the rotator cuff, to allow the repaired tendon not to be in conflict with the acromion during the healing phase which is always accompanied by a transient thickening of the repaired tendon.",{"type":126,"children":2065},[2066],{"text":2067,"type":130},"It is now recommended that this acromioplasty be performed arthroscopically (see below)",{"type":126,"children":2069},[2070],{"text":2071,"type":130},"Hospitalization is short: 24 to 48 hours, sometimes on an outpatient basis.",{"type":126,"children":2073},[2074],{"text":2075,"type":130},"In acromioplasty without tendon repair, immobilization of the upper limb is done using a sling, removable for washing, dressing and rehabilitation, and is short-lived: 8 to 10 days.",{"type":126,"children":2077},[2078],{"text":2079,"type":130},"Post-operative rehabilitation is essential.",{"type":126,"children":2081},[2082],{"text":2083,"type":130},"The work stoppage is 45 days to 3 months.",{"type":126,"children":2085},[2086],{"text":2087,"type":130},"Recovery of a normal shoulder takes place over a period of 3 to 6 months.",{"type":126,"children":2089},[2090],{"text":134,"type":130},{"type":126,"children":2092},[2093],{"text":2094,"type":130},"TENOTOMY OR TENODESIS OF THE LONG PORTION OF THE BICEPS UNDER ARTHROSCOPY",{"type":126,"children":2096},[2097],{"text":134,"type":130},{"type":126,"children":2099},[2100],{"text":2101,"type":130},"It consists of cutting the biceps tendon, under arthroscopy at the level of the shoulder joint (tenotomy) and possibly fixing it lower (tenodesis).",{"type":126,"children":2103},[2104],{"text":2105,"type":130},"It is very often performed during rotator cuff tendon repair.",{"type":126,"children":2107},[2108],{"text":2109,"type":130},"Isolated, it is rarely used and is only intended for two particular cases:",{"type":126,"children":2111},[2112],{"text":2113,"type":130},"– Isolated biceps tendonitis.",{"type":126,"children":2115},[2116],{"text":2117,"type":130},"– Irreparable rupture of the rotator cuff tendons with significant biceps tendinitis, in patients over 65 years old, without shoulder osteoarthritis.",{"type":126,"children":2119},[2120],{"text":134,"type":130},{"type":126,"children":2122},[2123],{"text":2124,"type":130},"ARTHROSCOPY REPAIR OF THE ROTATOR CUFFER",{"type":126,"children":2126},[2127],{"text":134,"type":130},{"type":126,"children":2129},[2130],{"text":2131,"type":130},"Arthroscopy has revolutionized shoulder surgery.",{"type":126,"children":2133},[2134],{"text":2135,"type":130},"It allows a much more complete exploration of the shoulder as well as a certain number of gestures impossible to perform in the open.",{"type":126,"children":2137},[2138],{"text":2139,"type":130},"It significantly decreases:",{"type":126,"children":2141},[2142],{"text":2143,"type":130},"* Length of hospitalization: rarely more than 48 hours.",{"type":126,"children":2145},[2146],{"text":2147,"type":130},"* Muscle damage to the deltoid: non-existent during arthroscopy.",{"type":126,"children":2149},[2150],{"text":2151,"type":130},"* Certain complications: risk of infection or much less risk of hematoma.",{"type":126,"children":2153},[2154],{"text":2155,"type":130},"Finally, but certainly not the most important: the aesthetics of scars are naturally significantly superior to open surgery.",{"type":126,"children":2157},[2158],{"text":2159,"type":130},"Within our association, all cuff repairs have been carried out arthroscopically for 10 years now.",{"type":126,"children":2161},[2162],{"text":134,"type":130},{"type":126,"children":2164},[2165],{"text":134,"type":130},{"type":126,"children":2167},[2168],{"text":134,"type":130},{"type":126,"children":2170},[2171],{"text":2172,"type":130},"IN PRACTICE:",{"type":126,"children":2174},[2175],{"text":2176,"type":130},"A certain number of incisions 0.5 to 1.5 cm long are made around the shoulder.",{"type":126,"children":2178},[2179],{"text":2180,"type":130},"A rigid optical fiber connected to a video camera is introduced through one of these incisions in the shoulder.",{"type":126,"children":2182},[2183],{"text":2184,"type":130},"Instruments allowing remote manipulation are introduced through the other incisions.",{"type":126,"children":2186},[2187],{"text":2188,"type":130},"The repair of the lesions is thus carried out under direct video control by the surgeon.",{"type":597,"image":2190,"children":2195},{"ext":599,"url":1001,"hash":1002,"mime":602,"name":1003,"size":1004,"width":1005,"height":1006,"caption":607,"formats":2191,"provider":633,"createdAt":1029,"updatedAt":1029,"previewUrl":607,"alternativeText":1003,"provider_metadata":607},{"small":2192,"medium":2193,"thumbnail":2194},{"ext":599,"url":1009,"hash":1010,"mime":602,"name":1011,"path":607,"size":1012,"width":614,"height":1013,"sizeInBytes":1014},{"ext":599,"url":1016,"hash":1017,"mime":602,"name":1018,"path":607,"size":1019,"width":622,"height":1020,"sizeInBytes":1021},{"ext":599,"url":1023,"hash":1024,"mime":602,"name":1025,"path":607,"size":1026,"width":630,"height":1027,"sizeInBytes":1028},[2196],{"text":134,"type":130},{"type":597,"image":2198,"children":2203},{"ext":599,"url":1034,"hash":1035,"mime":602,"name":1036,"size":1037,"width":1038,"height":1039,"caption":607,"formats":2199,"provider":633,"createdAt":1062,"updatedAt":1062,"previewUrl":607,"alternativeText":1036,"provider_metadata":607},{"small":2200,"medium":2201,"thumbnail":2202},{"ext":599,"url":1042,"hash":1043,"mime":602,"name":1044,"path":607,"size":1045,"width":614,"height":1046,"sizeInBytes":1047},{"ext":599,"url":1049,"hash":1050,"mime":602,"name":1051,"path":607,"size":1052,"width":622,"height":1053,"sizeInBytes":1054},{"ext":599,"url":1056,"hash":1057,"mime":602,"name":1058,"path":607,"size":1059,"width":630,"height":1060,"sizeInBytes":1061},[2204],{"text":134,"type":130},{"type":126,"children":2206},[2207],{"text":2208,"type":130},"The scars are then closed with a simple stitch or simple small sticky strips (steristrip)",{"type":126,"children":2210},[2211],{"text":2212,"type":130},"The shoulder is immobilized for 4 to 6 weeks depending on the action performed by a removable sling for dressing, washing and rehabilitation during this period.",{"type":126,"children":2214},[2215],{"text":2216,"type":130},"At the end of this period of immobilization, the first post-operative consultation generally takes place. It allows you to:",{"type":126,"children":2218},[2219],{"text":2220,"type":130},"– Proceed with the definitive removal of the immobilization sling",{"type":126,"children":2222},[2223],{"text":2224,"type":130},"– Check for the absence of immediate complications. (see below)",{"type":126,"children":2226},[2227],{"text":2228,"type":130},"– Check the quality of the first actions carried out during rehabilitation.",{"type":126,"children":2230},[2231],{"text":2232,"type":130},"The work stoppage varies depending on the profession exercised and whether or not it is necessary during professional activity to exert effort on the repaired tendons: it varies between 3 and 6 months on average.",{"type":126,"children":2234},[2235],{"text":2236,"type":130},"Recovery of a mobile and painless shoulder is effective after 3 to 6 months on average. It is often necessary to wait a year to recover normal strength, similar to the strength of the shoulder before the tendon rupture.",{"type":126,"children":2238},[2239],{"text":2240,"type":130},"A check of tendon healing by CT arter is generally requested at the 6th month in order to check the quality of this healing.",{"type":126,"children":2242},[2243],{"text":134,"type":130},{"type":126,"children":2245},[2246],{"text":2247,"type":130},"TENDON TRANSFER",{"type":126,"children":2249},[2250],{"text":134,"type":130},{"type":126,"children":2252},[2253],{"text":2254,"type":130},"It is a surgery that only concerns a few patients: in fact the conditions are as follows:",{"type":126,"children":2256},[2257],{"text":2258,"type":130},"– Irreparable rupture of the rotator cuff tendons, with retracted tendons and atrophic muscles.",{"type":126,"children":2260},[2261],{"text":2262,"type":130},"– Patient under 65 years old.",{"type":126,"children":2264},[2265],{"text":2266,"type":130},"– Failure of medical treatment.",{"type":126,"children":2268},[2269],{"text":2270,"type":130},"– Preserved mobility of the shoulder (beyond 90°)",{"type":126,"children":2272},[2273],{"text":2274,"type":130},"It consists of transferring in place of the retracted tendons one or more other tendons close to those of the rotator cuff.",{"type":126,"children":2276},[2277],{"text":2278,"type":130},"It is a surgery that is done partially open (removal of the tendon), the transfer and attachment of the tendons in place of the rotator cuff tendons can be done arthroscopically.",{"type":126,"children":2280},[2281],{"text":2282,"type":130},"We distinguish:",{"type":126,"children":2284},[2285],{"text":2286,"type":130},"– Transfer of the pectoralis major muscle tendon: for irreparable ruptures of the subscapularis.",{"type":126,"children":2288},[2289],{"text":2290,"type":130},"– Transfer of the latissimus dorsi muscle tendon: for irreparable ruptures of the supraspinatus and infraspinatus",{"type":126,"children":2292},[2293],{"text":134,"type":130},{"type":597,"image":2295,"children":2300},{"ext":599,"url":1156,"hash":1157,"mime":602,"name":1158,"size":1159,"width":1160,"height":1161,"caption":607,"formats":2296,"provider":633,"createdAt":1184,"updatedAt":1184,"previewUrl":607,"alternativeText":1158,"provider_metadata":607},{"small":2297,"medium":2298,"thumbnail":2299},{"ext":599,"url":1164,"hash":1165,"mime":602,"name":1166,"path":607,"size":1167,"width":614,"height":1168,"sizeInBytes":1169},{"ext":599,"url":1171,"hash":1172,"mime":602,"name":1173,"path":607,"size":1174,"width":622,"height":1175,"sizeInBytes":1176},{"ext":599,"url":1178,"hash":1179,"mime":602,"name":1180,"path":607,"size":1181,"width":630,"height":1182,"sizeInBytes":1183},[2301],{"text":134,"type":130},{"type":126,"children":2303},[2304],{"text":2305,"type":130},"Tendon transfer surgery gives satisfactory results in reducing pain and restoring mobility but does not allow recovery of strength as good as in tendon repair.",{"type":597,"image":2307,"children":2310},{"ext":599,"url":1193,"hash":1194,"mime":602,"name":1195,"size":1196,"width":1197,"height":1198,"caption":607,"formats":2308,"provider":633,"createdAt":1208,"updatedAt":1208,"previewUrl":607,"alternativeText":1195,"provider_metadata":607},{"thumbnail":2309},{"ext":599,"url":1201,"hash":1202,"mime":602,"name":1203,"path":607,"size":1204,"width":1205,"height":1206,"sizeInBytes":1207},[2311],{"text":134,"type":130},{"type":126,"children":2313},[2314],{"text":2315,"type":130},"THE REVERSE PROSTHESIS",{"type":126,"children":2317},[2318],{"text":2319,"type":130},"Used in cases of eccentric osteoarthritis (shoulder osteoarthritis with ascension of the head of the humerus)",{"type":126,"children":2321},[2322],{"text":2323,"type":130},"It is only offered over the age of 65 in the event of irreparable rupture of the rotator cuff tendons associated with significant osteoarthritis.",{"type":126,"children":2325},[2326],{"text":2327,"type":130},"In certain exceptional cases, it can be offered in the absence of osteoarthritis, over the age of 65, in the event of irreparable rupture of the rotator cuff tendons and significant functional impotence of the shoulder (movements \u003C 90°)",{"type":126,"children":2329},[2330],{"text":1230,"type":130},{"type":126,"children":2332},[2333],{"text":134,"type":130},{"type":126,"children":2335},[2336],{"text":2337,"type":130},"Despite advances in arthroscopy, rotator cuff surgery is not free of complications.",{"type":126,"children":2339},[2340],{"text":2341,"type":130},"These are uncommon and most heal without after-effects and without the need for further surgical intervention.",{"type":126,"children":2343},[2344],{"text":2345,"type":130},"However, some are more serious and may require one or more new surgical procedures to achieve a cure.",{"type":126,"children":2347},[2348],{"text":134,"type":130},{"type":126,"children":2350},[2351],{"text":2352,"type":130},"1°) Recurrence of tendon rupture",{"type":126,"children":2354},[2355],{"text":134,"type":130},{"type":126,"children":2357},[2358],{"text":2359,"type":130},"This is the main complication in terms of percentage.",{"type":126,"children":2361},[2362],{"text":2363,"type":130},"It is all the more common when:",{"type":126,"children":2365},[2366],{"text":2367,"type":130},"– The condition of the tendons is initially poor: retracted tendons, atrophied muscles.",{"type":126,"children":2369},[2370],{"text":2371,"type":130},"– The tendons are too thin and difficult to move under traction during the procedure.",{"type":126,"children":2373},[2374],{"text":2375,"type":130},"– Immobilization is not respected.",{"type":126,"children":2377},[2378],{"text":2379,"type":130},"Recurrence is thus rare (\u003C10%) for a relatively recent rupture, not very retracted, where the repair was carried out on a thick and easily movable tendon.",{"type":126,"children":2381},[2382],{"text":2383,"type":130},"It can go up to 40, or even 50%, in the event of a rupture operated too late, with a retracted tendon, thin and difficult to move and atrophied muscles.",{"type":126,"children":2385},[2386],{"text":2387,"type":130},"A recurrence of tendon rupture does not always give the same symptoms as before the intervention, particularly in terms of pain and sometimes only a partial loss of strength is noted. A new intervention is then not necessary.",{"type":126,"children":2389},[2390],{"text":2391,"type":130},"Only the reappearance of pain, not calmed by medical treatment, can lead to a new surgical procedure:",{"type":126,"children":2393},[2394],{"text":2395,"type":130},"– Or a new attempt at repair if the condition of the tendon and muscles on arthroscopy allows it.",{"type":126,"children":2397},[2398],{"text":2399,"type":130},"– Or other surgical therapies: tendon transfers, reverse prosthesis.",{"type":126,"children":2401},[2402],{"text":134,"type":130},{"type":126,"children":2404},[2405],{"text":2406,"type":130},"2°) Adhesive capsulitis",{"type":126,"children":2408},[2409],{"text":134,"type":130},{"type":126,"children":2411},[2412],{"text":2413,"type":130},"It is the second most common complication: it occurs in 3 to 6% of cases.",{"type":126,"children":2415},[2416],{"text":2417,"type":130},"An unpredictable complication independent of the condition of the tendon, the type of surgery, or the surgeon, it is directly linked to an “excessive” reaction of the shoulder to the surgical procedure.",{"type":126,"children":2419},[2420],{"text":2421,"type":130},"It extends the recovery time, often multiplying it by 2 or 3, with recovery sometimes requiring 18 months or more.",{"type":126,"children":2423},[2424],{"text":2425,"type":130},"It has no direct impact on tendon healing.",{"type":126,"children":2427},[2428],{"text":2429,"type":130},"The after-effects are very rare, sometimes like partial stiffness of the shoulder in large movements, more rarely like residual pain.",{"type":126,"children":2431},[2432],{"text":2433,"type":130},"The treatment is based on the fight against pain and gentle rehabilitation",{"type":126,"children":2435},[2436],{"text":134,"type":130},{"type":126,"children":2438},[2439],{"text":1340,"type":130},{"type":126,"children":2441},[2442],{"text":134,"type":130},{"type":126,"children":2444},[2445],{"text":2446,"type":130},"Exceptional in arthroscopic surgery, it is – Superficial: in 0.1 to 0.3% of cases, requiring only treatment with short antibiotic therapy and local care.",{"type":126,"children":2448},[2449],{"text":2450,"type":130},"– Deep: in less than 0.1% of cases, requiring further surgical intervention and prolonged antibiotic therapy. The final result then depends on the possibility of keeping the repair equipment or not and therefore on the speed of reaction to this complication.",{"type":126,"children":2452},[2453],{"text":2454,"type":130},"The clinical signs being the same in both cases: fever, inflammatory appearance of the scars, abnormal discharge, swelling of the shoulder, only your surgeon will be able to differentiate between superficial and deep infection.",{"type":126,"children":2456},[2457],{"text":134,"type":130},{"type":126,"children":2459},[2460],{"text":2461,"type":130},"4°) Much more exceptional:",{"type":126,"children":2463},[2464],{"text":134,"type":130},{"type":126,"children":2466},[2467],{"text":2468,"type":130},"– Nervous complications: partial and transient paralysis of certain muscles of the hand or upper limb, rare (0.15% of cases), most often linked to loco-regional anesthesia.",{"type":126,"children":2470},[2471],{"text":2472,"type":130},"– Vascular complications: extremely rare, most 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