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CLINICAL EXAMINATION OF THE SHOULDER IN DISORDERS OF THE ROTATOR CUFF
Ch. Dumontier, L. Doursounian | MO n°168
November 2007 |  Disorders of the rotator cuff are the main source of pain in the shoulder and despite recent progress in shoulder imaging, clinical examination remains a fundamental stage in evaluating pain in the region of the scapula. The rotator cuff of the shoulder consists of the tendons of insertion of the subscapularis, supraspinatus, infraspinatus, and teres minor muscles in the humerus, combined with the intra articular portion along the biceps. In this article, we will deal with lesions which are part of the blurred notion of impingement syndrome between the cuff and the coracoacromial arch. There are in fact two types of impingement (Dumontier et al., 1999): anterointernal impingement and superoexternal impingement.• Anterointernal impingement is rare and occurs in the coracohumeral space at the junction between the supraspinatus and subscapularis ...
Ch. Dumontier, L. Doursounian |
MANAGING PARALYSIS OF INTRINSIC MUSCLES OF THE THUMB
F. Chaise 1.2.3, Ph. Bellemere 1.2, B. Chabaud 3.4. | MO n°165
June 2007 |  Paralysis of the intrinsic muscles of the thumb will change the opposition function which is the result of a movement made up of three components: extension, adduction and pronation. The full movement of opposition is only possible if all the local anatomic structures are functional. A thumb with paralysis of the intrinsic muscles will be dependent on the extrinsic muscles which will progressively lead to major functional imbalance with the final result being a thumb stiffened in adduction and retroposition with an interphalangeal joint fixed in flexion. Early medical care must be undertaken before these complications arise because their treatment is difficult, the results uncertain and often disappointing. Re-education, fitting of prosthesis and physiotherapy must all be an essential part of this protocol prior to any surgical reconstruction. ...
F. Chaise 1.2.3, Ph. Bellemere 1.2, B. Chabaud 3.4. |
INTRAPROSTHETIC DISLOCATION: A RARE COMPLICATION IN DUAL MOBILITY CUPS
M.H. Fessy | MO n°152
March 2006 |  The main problem with dual mobility cups in the medium term is intraprosthetic dislocation. The head comes out of the polyethylene through wear of the retentive rim. The head then lodges itself in the metalback shell which can be seen by a characteristic view on x.ray. . Alas this type of incident is reported in all the literature on series of dual mobility cups, which is an indicator of this sad reality.We were able to conduct an exhaustive retrospective analysis of all the cases of intraprosthetic dislocation in our departments care between 1991 and 2002. 63 cases were analysed. For each of these 63 cases we had complete medical, surgical and radiological files. Average age at implantation was 51 years. In 30 cases the stem implanted opposite was a PF. This was a screw in stem with a modular monoblock polished stainless steel neck with ...
M.H. Fessy |
TRIBUTE - GILLES BOUSQUET, Surgeon and technician
A. Rambert | MO n°152
March 2006 |  In 1969 I was running an applied mechanics laboratory at the Ecole Catholique des Arts at Métiers – ECAM - in Lyon. A phone call from one of my suppliers in scientific materials, informed me that one of his cousins, Head of Clinic in Orthopaedics at the Hospices Civils de Lyon, was looking for an engineer to work on an innovative project; making a knee prosthesis. Naturally I hesitated before meeting this surgeon given my lack of knowledge in anatomy, but accepted to meet with him for a first contact a few days later. The surgeon was Gilles Bousquet, he was Head of Clinic in Professor Albert Trillats department, and had just presented a thesis on knee laxities. Professor Albert Trillat had an international reputation and combined with his exceptional surgical qualities a particular liking for mechanics and mathematics. When he was young ...
A. Rambert |
DUAL MOBILITY: A Stéphanois Concept (St Etienne area, France)
M.H. Fessy | MO n°152
March 2006 |  It was Gilles Bousquet who has the merit of having first defined the original concept of dual mobility. The prosthetic head is mobile within a retentive polyethylene which is free to move within a metalback cup . Figure 1 : The principle of dual mobility The first drafts of the project began in the early 1970s. The first implantations started in 1975. The finalisation of the project was due to the meeting of three men. - Gilles Bousquet, Professor in Orthopaedics at the University Hospital of St Etienne - Jean Rieu, Professor of teaching at the Ecole des Mines in St Etienne, and director of the biomaterials department - André Rambert, engineer and Professor in mechanical engineering at the ECAM school in Lyon Gilles Bousquet proposed the concept, Jean Rieu brought his knowledge in biomaterials and especially in surface finishing and ...
M.H. Fessy |
THE USE OF A REVERSE SHOULDER SYSTEM FOR THE TREATMENT OF MASSIVE IRREPARABLE ROTATOR CUFF TEARS
M. Juvenspan, G. Nourissat, L. Doursounian | MO n°148
October 2005 |  Management of massive irreparable rotator cuff tears is challenging, indeed, and remains a subject of controversy. Several therapeutic options are available, but none of them is fully satisfactory. Deltoid or latissimus dorsi flaps should be reserved for young patients (< 65 years) with intact subscapularis tendon and low-grade osteoarthritis (Fukuda <3 ). In older patients, surgical arthrolysis (alone or in association with acromioplasty or tenotomy of the long head of the biceps) has shown its limitations. It is effective in relieving pain but has little effect on range of motion and no effect at all on strength. In the 1970s, some surgeons thought that constrained shoulder replacement would be the answer. But, in view of the high rate of complications associated with this technique : glenoid fracture, glenoid component loosening, component ...
M. Juvenspan, G. Nourissat, L. Doursounian |
SURGICAL TREATMENT FOR ACHILLES TENDINOPATHY IN ATHLETES
E. Rolland, G. Lorton, G. Saillant | MO n°138
November 2004 |  Operative management of Achilles tendinopathy is still considered in the orthopaedic world as minor and poorly coded surgery, due to the wide variety of anatomopathological forms and lack of accuracy of the techniques available. However, as any surgical repair, it requires careful assessment of the lesions and the use of an appropriate surgical technique to ensure a successful outcome. Surgical treatment for Achilles tendinopathy began to develop in the 1980s, after Jenkins' experiments in sheep using carbon fiber and the experimental work done on horses by the veterinary team from Chantilly. The early techniques advocated by Kvist involved isolated synovectomy. After that, other techniques were introduced which included longitudinal tenotomy and use of carbon fibres (Lemaire), and variants using autografts. Kouvalchouk, in 1987 (Cahiers ...
E. Rolland, G. Lorton, G. Saillant |
ARTHROSCOPIC ROTATOR CUFF REPAIR USING A TENSION BAND SUTURE TECHNIQUE
P. Boileau, N. Brassard, C. Trojani, F. Balg | MO n°137
October 2004 |  INTRODUCTIONArthroscopic rotator cuff repair is a recently developed technique that is gaining increased popularity. To make arthroscopic rotator cuff repair a straightforward, standardized procedure, we have designed a special technique based on the tension band principle, using between 2 and 5 inverted horizontal mattress sutures placed through the tendon and anchors placed in the lateral cortex of the greater tuberosity . Figure 1 : Tension band principle : AP and lateral PATIENT POSITIONING - ENTRY PORTALSSurgery can be performed with the patient in a beach chair position or a lateral decubitus position. The patient's arm rests on a draped U-shaped support (Trillat support). We personally are not using traction ; this ensures the freedom of motion of open surgery, performing rotation/abduction or lift-off of the patient's ...
P. Boileau, N. Brassard, C. Trojani, F. Balg |
TREATMENT OPTIONS FOR GIANT-CELL TUMOR
B. Tomeno | MO n°136
August 2004 |  This decision has been carefully thought through : as a giant-cell tumor can be benign or malignant, an in-depth study of GCT provides the essence of what one needs to know about tumors and their variants, as well as the technical tricks regarding curettage & bone-grafting which is the classical treatment for all benign intraosseous tumors. An overview of the malignant forms of GCT gives an idea of the resection-reconstruction techniques and associated therapies (radiation therapy and chemotherapy). GCT is an ideal "model" for educational purposes. Giant cell tumor is a frequent occurrence. It accounts for 15 to 20% of all bone tumors. However, its histogenesis remains unclear (it is thought to originate from connective tissue precursor cells). GCT is mostly found in the limbs (90%) and sometimes in the trunk. The giant cell tumors described ...
B. Tomeno |
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