Symptoms :
of the primarily
night pains to the shoulder but also being
able to occur the day after physical
efforts ;
a reduction in
articular mobilities of the shoulder especially
by impossibility of raising the arm, to be
capped... (consecutive of retraction of the
articular capsule which constitutes the envelope
of the articulation which is touched by the
inflammation).
The diagnosis :
X-ray of the shoulder
being able to show calcifications of space
under-acromial translating an evolved, old
form and a reduction height of this space
translating a lesion of the tendons of the
cap of the rotators ;
a MRI giving of
the precise details on the extent and the
intensity of the lesion of the anatomical
elements previously quoted.
The treatment must always be medical initially
acting on the pain and the ignition; when
the drugs are not enough, infiltrations (injection
of a derived product cortisonic in space under-acromial),
or physical rehabilitation and physiotherapy
(using devices such infra-red type or ultrasounds
or laser acting on the pain and the ignition)
can be carried out.
If all these therapeutic did not generate
improvement, the surgery can be discussed.
Its principle consists in removing
:
all inflammatory
tissues being located space under-acromial
and,
osseous surface
being under the acromion which is the seat
of asperities and which is
responsible for a friction with the tendons
of the shoulder (tissue conflict).
the acromio-coracoÕdian
ligament forming a genuine cord in front of
the articulation and participant in this friction.
This operation was carried out with a large
surgical approach using a direct opening of
the shoulder. It can be currently carried
out by endoscopic way (video-surgery) :
principle
: work in the space concerned without direct
opening of the shoulder using the introduction
of an optics connected to a mini-camera projecting
the image on a screen monitor allowing to
locate the lesions and to act using adapted
specific instruments; in particular a rotary
knife to aspire inflammatory tissues and a
rotary cutter to level surface rubbing at
the top of the shoulder (decompression of
space under-acromial).
advantages
: any direct opening of the shoulder thus
the post-operative care are simpler;
rehabilitation is begun at once after the
operation thus potentiating its results; it
is not necessary to immobilize the armÉ
limits
: be likely to be less effective in the advanced
forms and the cases being accompanied by a
wide rupture of the tendons of the shoulder.
In certain cases, this inflammatory disease
can develop in the long run in spite of obtaining
a good result after the endoscopic intervention
and have to require in this case the traditional
intervention.
