Reprise du sport après prothèse totale d’épaule

Introduction

Shoulder arthroplasty is a common intervention and functional demands evolve with the improvement of outcomes. There is no consensus to answer demands of patients wishing to return to sport after total shoulder arthroplasty (TSA).

Traitement du premier épisode de luxation antéro-médiale du sujet jeune

Progression to a chronic condition is the main complication of anterior dislocation of the shoulder joint. All studies have demonstrated the high risk of recurrence in the young population. Therapeutic advances have been achieved over the last years, both in terms of rehabilitation as in terms of immobilisation after a first dislocation holding the shoulder in lateral rotation or early repair of the glenoid rim and the joint capsule. Outcome remains superior after conservative surgical treatment, but no difference can be demonstrated between conventional and arthroscopic procedures. The question remains open as to whether surgery should be proposed after a first dislocation since it is well known that certain patients will never need surgery and that rehabilitation after a first dislocation would be sufficient. Conversely, is it acceptable to leave a patient suffering from residual symptoms and functional disability related to a first dislocation and propose surgical stabilisation only for true recurrent instability? In other words, are we ready to operate because of a notion of risk?     

Luxation antérieure bilatérale des épaules chez le bodybuilder (à propos d’un cas)

Bilateral glenohumeral joint dislocations are rare. The most common occurrences are posterior during epileptic convulsions. Bilateral simple anterior glenohumeral dislocations are uncommon. We report a case of bilateral anterior shoulder dislocation in a young bodybuilder.     

Traumatismes de l'épaule chez les joueurs français de rugby de haut niveau

Aim of the study

Specify the frequency and the type of injuries of the shoulder arising during the practice of professional rugby in France. Outcomes were studied according to the treatments performed.

Materials and methods

It is a matter of a retrospective study on 154 players of high level. Any shoulder injury endured during the practice of rugby was registered. The age of the player, his experience, his position on the field, the type of injury, the game phase, the treatment and eventual residual disability were specified.

Results

Ninety-eight players (64%) reported at least one injury of the shoulder. Thirty (19%) reported at least two injuries on the same shoulder. The acromio-clavicular joint injuries were the most frequent (49%). The treatment was medical in most of the cases. A rest of 17 days in average was noted. All the players came back to their better level. Instability of the gleno-humeral joint was retrieved by 15% of the players. A secondary treatment by surgical stabilization was noted in more than half of the cases. The rest was in average of one week after the injury. It was in average of 4 months after surgery. A significant persistent discomfort was retrieved by 43% of the non operated cases and by 27% of the operated cases.Different other injuries were noted: 17 clavicular fractures, 6 sterno-clavicular sprains, 5 rotator cuff injuries and 4 muscular contusions.

Discussion

Injuries of the shoulder are frequent among high level rugby players and represent an important source of morbidity. Injuries of the acromio-clavicular joint are the most frequent. The medical treatment allows a quick return to sport without level loss in mostly cases. Gleno-humeral instability represents the second traumatism in terms of frequency. A secondary treatment by surgical stabilization is preferable.     

Chirurgie arthroscopique de l’épaule et complications ischémiques cérébrales

The authors report three cases in which cerebral ischemia occurred during arthroscopic shoulder surgery performed in beach chair position under general anaesthesia and interscalene plexus block. Several similar cases have been published in the literature. This rare but extremely severe complication is related to the decrease in cerebral perfusion pressure (CPP). Monitoring of CPP in the beach chair position using the measurement of arterial pressure and taking into account the hydrostatic gradient is essential. Prevention includes correction of preoperative hypovolaemia, treatment of postural arterial hypotension, adequate installation of the patient's head, aggressive treatment of perioperative arterial hypotension (whatever the cause) and avoidance of deliberate perioperative arterial hypotension. Routine use of non-invasive monitoring of cerebral oxygenation has been advocated to avoid this accident but its usefulness has to be confirmed by clinical studies.