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 Sujet du message : instabilité de l'épaule
 Message  Publié : 06 Nov 2005 12:22 
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Discret
Discret

Inscription : 17 Oct 2005 16:27
Message(s) : 8
Bonjour,
je cherche (mais ne trouve pas) les incidences à effectuer en cas d'une instabilité de l'épaule.
Si quelqu'un peu m'aider, merci d'avance!
seb.


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 Sujet du message :
 Message  Publié : 06 Nov 2005 12:47 
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Fidèle
Fidèle
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Inscription : 28 Juin 2005 14:16
Message(s) : 104
Si par instabilité tu veux parler de luxation de l'épaule il faut réaliser l'incidence de BERNAGEAU

Nicoco


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 Sujet du message :
 Message  Publié : 06 Nov 2005 15:43 
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Baratineur
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Inscription : 06 Oct 2005 11:51
Message(s) : 56
tu peux également effectuer un cliché trans thoracique


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 Sujet du message :
 Message  Publié : 06 Nov 2005 17:13 
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Rang 666
Rang 666
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Inscription : 02 Mars 2004 17:09
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Moi je ne trouve pas du tout nécessaire de faire un transtho pour un bilan d'instabilité. Pour une luxation avec impotence fonctionnelle, c'est un excellent cliché de débrouillage, mais pour un bilan il y a mieux et le Bernageau en fait partie.
Les incidences à réaliser pourraient être :

1. Incidence de face en position indifférente ou neutre

Image
1 trochiter, 2 trochin, 3 gouttière bicipitale, 4 espace sous-acromial (10 mm),5 apophyse coracoïde, 6 acromion, 7 clavicule, 8 articulation acromio-claviculaire, 9 articulation scapulo-humérale, 10 rebord glénoïdien antérieur, 11 rebord glénoïdien postérieur, 12 col de l'omoplate.

Indication
L'incidence de face en rotation indifférente analyse l'interligne scapulo-huméral, le trochiter et l'espace sous-acromial ou articulation acromio-humérale occupée par le tendon du sus-épineux.

Cette incidence doit figurer dans tout bilan d'épaule traumatique ou rhumatologique.

Technique

Le bras est le long du corps avec la paume de la main contre la cuisse ou avec l'avant-bras placé perpendiculairement au plan de la table, le coude fléchi à 90°. Le rayon directeur est centré sur le tiers inférieur de l'articulation scapulo-humérale.

Résultats

La face supérieure du trochiter est dégagée avec une corticale régulière et dense (zone d'insertion du sus-épineux).Le trochin est vu de face et la gouttière bicipitale se projette en situation paramédiane externe sur la tête humérale. L'interligne scapulo-humérale est déterminée par le rebord glénoïdien antérieur et le contour interne de la tête humérale. Le rebord glénoïdien postérieur plus externe que l'antérieur peut se superposer légèrement à la partie interne de la tête humérale. La portion externe de l'apophyse coracoïde se superpose avec le segment supérieur de l'interligne gléno-huméral; le pied de l'apophyse coracoïde apparaît comme une image pseudo-lacunaire.


2. Profil glénoïdien ou profil de Bernageau

Image
1 rebord antéro-inférieur de glène, 2 rebord antéro-supérieur de glène, 3 apophyse coracoïde, 4 acromion, 5 clavicule, 6 tête humérale.

Indications

Étude du rebord glènoïdien antérieur et inférieur dans les luxations récidivantes antérieures de l'épaule ou dans les syndrômes douloureux antérieurs (syndrôme du bourrelet, instabilité antérieure).

Technique

Le patient est placé en oblique antérieure (40 à 50°) pour amener l'épaule à examiner contre la table; le bras est levé et plaqué contre la table. Le rayon directeur est descendant d'environ 30°, centré sur le moignon de l'épaule.

Résultats

Les deux tiers inférieurs du rebord glènoïdien antérieur se dégagent en avant du tiers supérieur formant un éperon osseux à angle aigü qui prolonge en avant la cavité glénoïde.


3. Profil de Bloom-Obata ou profil descendant rétro-huméral

Image
1 articulation scapulo-humérale, 2 tête humérale, 3 apophyse coracoïde, 4 acromion, 5 glène, 6 clavicule.

Indications

Cette incidence est utile dans le bilan des luxations antérieures et surtout postérieures de la tête humérale avec la recherche d'une fracture-tassement du segment antéro-supérieur de la tête (fracture de Mac Laughin).

Technique

Le patient coude au corps, est en hyperlordose avec l'épaule traumatisée en rétropulsion. Le rayon directeur descendant est vertical et la cassette est disposée à plat sur la table mise à l'horizontale.

Il existe une variante technique: le profil rétro-huméral ascendant (Cochin). La cassette est posée sur le moignon de l'épaule; le rayon directeur est ascendant et légèrement oblique. L'agrandissement de la tête humérale et de la glène est limité ainsi que le flou cinétique.

Résultats

La tête humérale est en rotation interne; l'apophyse coracoïde se projette sur la glène vue de profil; l'écaille de l'omoplate et l'acromion sont déplacés en arrière.


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 Sujet du message :
 Message  Publié : 08 Nov 2005 14:03 
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Discret
Discret

Inscription : 17 Oct 2005 16:27
Message(s) : 8
merci c'est parfait!
voila ce que certains manip m'ont dit:
Bernageau
un face neutre, un avec rotation externe et un interne.
(dans le cadre de luxation a répétition).
a+


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 Sujet du message :
 Message  Publié : 09 Nov 2005 09:59 
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Rang 666
Rang 666
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Inscription : 02 Mars 2004 17:09
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Moi je ne vois pas trop l'intéret de faire les rotations : j'avais gardé à l'esprit que les rotations c'était pour les calcifications, les ruptures de coiffe des rotateurs ... :?:


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 Sujet du message :
 Message  Publié : 09 Nov 2005 14:09 
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Discret
Discret

Inscription : 17 Oct 2005 16:27
Message(s) : 8
je me suis aussi posé la question de l'intérêt des 3 faces mais apparement elles sont demandées avant chirurgie.


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 Sujet du message :
 Message  Publié : 09 Nov 2005 18:28 
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Baratineur
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Inscription : 06 Oct 2005 11:51
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ok c2k :Panneau08:


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 Sujet du message : Re: instabilité de l'épaule
 Message  Publié : 01 Sep 2017 04:52 
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Grand maître
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 Sujet du message : 20180120caihuali
 Message  Publié : 20 Jan 2018 06:12 
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 Sujet du message : Re: instabilité de l'épaule
 Message  Publié : 21 Mars 2018 10:40 
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