Force isocinétique des muscles rotateurs de l’épaule dans l’instabilité chronique antérieure

Given the role of dynamic stabilization means in shoulder recurrent anterior instability, due to the failure of passive stabilization means, a better understanding of the role of internal (IR) and external (ER) rotators muscle strength, and their agonist/antagonist balance, could be of interest in the therapeutic arsenal around this disease. In the light of the literature, a deficit of IR and ER muscle strength seems associated with unoperated recurrent anterior instability. After surgical stabilization using the Bristow-Latarjet procedure, there appears a transitional post-surgical deficit of the IR and ER muscle strength compared to preoperative values during 3 to 6 months post-surgery, but the preoperative deficit compared to contralateral shoulder seems to persist despite the surgical procedure and the postoperative rehabilitation care. Evaluation of IR and ER isokinetic muscle strength is relevant in monitoring patients with shoulder recurrent anterior instability, unoperated and post-surgery, in order to determine the orientation of rehabilitation, to help the decision for continuing or not strength rehabilitation, and to help the decision when deciding upon an appropriate time for return to sports.     

L’apport du muscle pectoralis minor dans le traitement de l’instabilité antérieure de l’épaule

The surgical stabilization of the shoulder knew many technical improvements energy. We propose a preliminary study about an engineering change by the addition of a fourth muscular bolt for the treatment of former instabilities of the shoulder. Our study is prospective gathering 16 patients having a stabilization of the shoulder by a quadruple locking using an osseous thrust by the coaracoid process, a tendineux bolt by a hammock applied thanks to the coaraco-biceps tendon to the lower bank of the sub-scapularis, a capsular bolt by joining the acromio-coracoid ligament to the glenohumeral capsule and a fourth bolt by the joining of the pectoral small tendon to the coraco-biceps. Our results evaluated by the score of Dupaly after 18 months show that the average retreat are satisfactory with an early resumption of the activity (2 months on average). The techniques of former stabilization of the shoulder are currently allowing that triple locking is indicated among all patients whose score ISIS exceeds five points. The addition of small pectoral as fourth bolt seems to us as well interesting because of the good preliminary results.     

Adaptation de la force isocinétique des muscles rotateurs de l’épaule à la pratique sportive

Physiological, anatomy and biomechanical adaptations of the shoulder joint to the stresses induced by the throwing gesture, which allow performance, could be the cause of “desadaptation” that can lead to injury by microtrauma. Thus, exploration of any adaptations or changes in internal (IR) and external (ER) muscle strength (and/or agonist/antagonist balance represented by the ratio ER/IR) to solicitations sports is relevant in order to better understand the pathophysiology of shoulder injury. Many studies have focused on identifying patterns of IR and ER muscle strength according to the practice of overhead sports. Despite the methodological limitations, although an increase in the IR strength of the dominant side was reported, it does not seem to exist an “imbalance” in muscle strength between the IR and ER, induced by overhead sports, which could be a “desadaptaion” in the origin of shoulder pathologies. There is no imbalance that could be implicated as a risk factor predisposing to shoulder pathologies.     

Les instabilités antérieures de l’épaule. Á propos de 50 cas

We performed 54 consecutive Latarjet procedures for the treatment of recurrent anterior instability of the shoulder between 1996 and 2005. We retrospectively reviewed the clinical and radiographic results of the procedure. The procedure was performed for the treatment of recurrent anterior dislocation in 51 shoulders, painful recurrent anterior subluxation in two cases and painful shoulder in one case. All patients had a radiographic evaluation before the operation and at the latest follow-up examination. At the time of the latest follow-up, none of the patients had recurrent dislocation. According to the system of Rowe, 51 (94 %) of the 54 shoulders had an excellent or good result. Fifty-one shoulders had no glenohumeral osteoarthrosis.     

Arrachements des épines iliaques antérosupérieures et antéro-inférieures chez l’enfant et l’adolescent sportifs. À propos de dix cas

The avulsions of anterior-iliac spines in child and adolescent athletes are rare injuries. All children have been treated as orthopaedic with strict rest, nonsteroidal anti-inflammatory substances and dispensation of sport for three months. No subsequent sequelae has been reported, all patients who got back to a sporting activity identical to that practiced before accident. It seems that the orthopaedic treatment among adolescents and children victims of avulsions of anterior-iliac apophysis, superior or inferior, is sufficient and does not involve any subsequent sequelae.     

Instabilité d’épaule et isocinétisme : apport de l’isocinétisme dans une situation clinique complexe

Introduction

The treatment of shoulder instability is codified. In case of a resistant instability to a well-conducted rehabilitation, the surgery can be proposed with good results. Sometimes, the situation can be more complex, and the case report presents the interest of isokinetics as an alternative therapeutic.

Case report

A man of 36 years, operated of Latarjet for recurrent anterior dislocation of the shoulder, presented in postoperation an infectious osteoarthritis. After recovery of the infectious episode, in a painful and stiffness shoulder, shoulder instability repeated with a clinical examination agreeing and an evocative context: failure of the surgical treatment, osseous postinfectious rehandlings. The surgery having been excluded and traditional rehabilitation having shown its limits. A rehabilitation oriented by the research of a muscular imbalance in isokinetic evaluation permitted a functional improvement with disappearance of the instability feeling.

Discussion

In complex clinical situations, isokinetic evaluation showed an interest to adapt and to optimize rehabilitation. A practical application of isokinetics is in the pathologies of articular instability and in particular the shoulder instability. The positions of evaluation will be adapted to the patients. That opens new prospects in rehabilitation.

Conclusion

This case report illustrates isokinetic interest for an objective and rigorous assessment of muscular strength and so an adaptation and optimization of the rehabilitation.     

Fracture-avulsion de l’épine iliaque antéro-inférieure et du petit trochanter chez un jeune adolescent

The avulsion fractures of the anterior-inferior iliac spine and lesser trochanter are rare. They occur most often in adolescents during sports activities. The forms in adults are rare. We report a case in a young 15-year-old teenager. He had consulted for pelvic trauma with groin pain and functional impotence of the right lower limb occurred during a recent game in triple jump. Physical examination revealed pain in the mobilization of the right hip in extension. Standard radiography of the pelvis has highlighted an avulsion fracture of the anterior-inferior iliac spine avulsion of the right with small trochanter, which has been confirmed by computed tomography. The patient has been treated orthopedically by rest and landfilling lower limb trauma, evolution was marked the disappearance of pain a few weeks later and resumption of the sporting activity in order to 6 months.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.     

Luxation antérieure de l’épaule associée à une fracture de la diaphyse humérale homolatérale (à propos d’un cas)

The association of shoulder dislocation with ipsilateral humeral shaft fracture remains rare. Is presented along with a review of the literature regarding 18 reported cases. The prognosis depends on that of the shoulder. The authors report a case of shoulder dislocation with ipsilateral humeral shaft fracture at a patient of 34 years an accident of sport (cyclocross). After closed reduction of the anterior shoulder dislocation. The treatment was surgical, required open reduction of the humeral fracture with compression plating. At recession of one year, the clinical examination finds amplitudes comparable to the shoulder controlatéral without instability.     

L’embrochage en palmier de Kapandji dans le traitement des fractures de l’extrémité proximale de l’humérus

Over a 7-year period (January 2003–December 2009), 18 patients have been treated for proximal humeral fractures after sport injuries using Kapandji's method of internal fixation. Neer classification was used to classify the fractures. Various indications were found, with a majority of two and three part fractures. Complications were not rare, but the functional results following Constant score are very good.     

Contrôle de l’équilibre et port unilatéral d’une orthèse rigide de cheville. Partie I : effets sur des sujets sains évalués debout en unipédie

In order to assess the effects induced by wearing a rigid ankle orthosis, 14 healthy adults, without traumatic previous injuries at this level, were tested in a one-legged postural task. The subjects stood upright on a force platform and were required to remain still, eyes open. Ten trials lasting 32 s were recorded in a random order in two conditions: with a rigid orthosis model worn at the ankle level of the supporting leg (Thuasne, Ligastrap Immo^®) and with an elastic stocking. Balance strategies have been quantified by studying the centre of pressure (CP) trajectories, that is, the successive positions of the resultant reaction forces, and processed through a frequency analysis. The results indicate that slight decreases occur for the CP displacements intervening along the medio-lateral axis whereas statistically significant trends were found for those intervening along the anteroposterior one. This finding a priori suggests that wearing a rigid orthosis affects one-legged standing in healthy individuals but mainly along an axis not usually weakened by sprained ankles.     

Coalitions du tarse ou « fausses entorses » de l’enfant et de l’adolescent. À propos d’un cas

Tarsal coalitions, also called synostoses, are a cause of pain and gait disturbance in children and adolescents. They are often diagnosed as tarsal sprains, leading to an inappropriate functional prognosis. This is the case of an 8-year-old child with talo-calcaneum synostosis, presenting pain, hind-foot stiffness and marked disability in daily life activities and sports.     

Modification de l’article 37 du code de déontologie médicale : pourquoi la commission d’éthique de la SRLF s’est-elle battue pour un adverbe ?

Recently, French parliament's committee, which was in charge of the evaluation of the law about patients’ rights at end of life, proposed that medical deontological code should be modified in order to promote terminal sedation. Even though supporting this idea, SRLF's ethical committee collaborated with French Society of palliative care in order to modify the text that was proposed by the French medical association. The aim of this text is to explain the reasons of this intervention.     

Influence du type d’orthèse de genou sur l’évolution clinique postopératoire d’une chirurgie du ligament croisé antérieur chez le sportif

Objectives

To establish the influence of the type of brace on the postoperative clinical evolution after anterior cruciate ligament (ACL) surgery in competitive sportspeople.

Methods

The authors prospectively followed the evolution of three populations of ACL reconstruction: one who received a functional brace, the other a rigid brace and last no brace. The three groups followed the same rehabilitation program. The clinical parameters of evaluation were pain, perimeter patellar joint, range of motion, muscular atrophy, locking the quadriceps, and the quality of walking. We also used the IKDC subjective Knee Evaluation Form and PPLP scoring scale.

Results

There is no clinically significant difference at about a month of surgery between the three groups (407 patients). There is no difference with the PPLP scoring scale. No repeat rupture is occurred postoperatively. There is a significant difference in the IKDC subjective (P = 0.03) between the group with functional brace and rigid brace.

Conclusion

With the same active rehabilitation program, the clinical evolution is identical with or without brace. The only difference is subjective (IKDC subjective Knee Evaluation Form).