Mickael Ropars

Is MRI useful to assess labral reduction following acute anterior shoulder dislocation

INTRODUCTION Better knowledge of the anatomical lesions following primary anterior dislocation of the shoulder could help to resolve the issue of the recommended position of immobilization. The aim of this study was to describe such early lesions and to evaluate labral reducibility in both external and internal rotation of the arm. PATIENTS AND METHODS Fifteen shoulders were investigated by MRI without intra-articular injection. The 15 patients (14 men and one woman) had a mean age of 28 years (range: 17-42 years). Labral lesions were classified on a system based on Gleyze and Habermeyers endoscopic assessment and reducibility was assessed on Itois criteria. RESULTS Constant hemarthrosis allowed an arthrogram type effect. The Hill-Sachs lesion was small in five cases, medium in eight cases and large in two. There were seven labral lesions of type I, seven of type II and one of type III. External rotation (mean: 30.6 degrees; range: 15 degrees-65 degrees), reduced the labrum in six cases (40%). DISCUSSION The present study failed to confirm the constant reduction of the labrum reported by Itoi, perhaps because external rotation was less than that obtained in his study (m=52 degrees; range: 35 degrees-81 degrees). Reduction was partly due to posterior migration of the hemarthrosis obtained by external rotation. CONCLUSION MRI assessment of labral reducibility after primary anterior shoulder dislocation may be considered for patients at high risk of recurrence, in order to decide the ideal position of immobilization. LEVEL OF EVIDENCE Level IV. Retrospective diagnostic study.

Hip involvement in hereditary hemochromatosis: a clinical-pathologic study.

Joint involvement occurs in about half the patients with hereditary hemochromatosis and may constitute the presenting manifestation. Joint damage is now the main cause of quality-of-life alterations in patients with hereditary hemochromatosis. The most common sites of involvement are the metacarpophalangeal joints and the hip. We report a case that illustrates the clinical, imaging-study, and pathological characteristics of hip disease in hereditary hemochromatosis.

The human acromion viewed from an evolutionary perspective

The high prevalence of rotator cuff tendinopathy in modern humans may be partly related to the shape acquired by the scapula as species changed throughout evolution. Here, we compared the anatomic features of the scapula across members of the Hominoid group. The results support the hypothesis that the scapula of Homo sapiens sapiens exhibits distinctive anatomic characteristics compared to that of other Hominoids. We studied 89 scapulae from five species. For each scapula, we measured eight parameters and determined six index. We then compared the results across species. We identified two distinctive characteristics of the lateral aspect of the human scapula, namely, a lateral orientation of the glenoid cavity and a narrow coraco-acromial arch. Similar to the gorilla acromion, the human one is steeply sloped and, above all, larger and squarer than the acromion of other Hominoids. These features may explain, in part at least, the pathogenesis of rotator cuff tendinopathy in modern man.

Volumetric definition of shoulder range of motion and its correlation with clinical signs of shoulder hyperlaxity. A motion capture study

BACKGROUND Shoulder hyperlaxity (SHL) is assessed with clinical signs. Quantification of SHL remains difficult, however, because no quantitative definition has yet been described. With use of a motion capture system (MCS), the aim of this study was to categorize SHL through a volumetric MCS-based definition and to compare this volume with clinical signs used for SHL diagnosis. METHOD Twenty-three subjects were examined with passive and active measurement of their shoulder range of motion (SROM) and then with an MCS protocol, allowing computation of the shoulder configuration space volume (SCSV). Clinical data of SHL were assessed by the sulcus sign, external rotation with the arm at the side (ER1) >85° in a standing position, external rotation >90° in a lying position, and Beighton score for general joint laxity. Active and passive ER1, EIR2 (sum of external and internal rotation at 90° of abduction), flexion-extension, and abduction were also measured and correlated to SCSV. RESULTS Except for the sulcus sign, SCSV was significantly correlated with all clinical signs used for SHL. Passive examination of the different SROMs was better correlated to SCSV than active examination. In passive examination, the worst SROM was ER1 (R = 0.36; P = .09), whereas EIR2, flexion, and abduction were highly correlated to SCSV (P < .01). CONCLUSION SCSV appears to be an appealing tool for evaluation of SHL regarding its correlation with clinical signs used for SHL diagnosis. The sulcus sign and ER1 >85° in a standing position appear less discriminating and should be replaced by EIR2 measurement for SHL diagnosis.

Development of a novel index of shoulder's mobility based on the configuration space volume and its link to mono-axial amplitudes

At first sight, shoulder mobility is frequently evaluated through mono-axial amplitude. Interestingly, for diagnosing shoulder hyperlaxity or frozen shoulder, external rotation of the arm whilst at the side (ER1) is commonly used. However, by definition, a mono-axial amplitude does not fully reflect shoulder global mobility. Our goal was to propose a novel index for measuring shoulder global mobility and secondly to evaluate the link between main mono-axial amplitudes and this new index. Twenty-eight female subjects (mean age 24.8 years) without upper limb pathology participated in the study. The movements of their right dominant arm were measured with an opto-electronic motion capture system. They performed 5 mono-axial maximal amplitude motions (axial rotations in three different postures, flexion/extension and abduction from rest) and a global range of motion exploring all the reachable space around the three axes of rotation. From this, we computed the correlation coefficient between the volume of the reachable space and each possible linear combination of the 5 mono-axial amplitudes. Even though ER1 is often chosen to assess global mobility, it demonstrated the lowest correlation with measured joint mobility. To assess shoulder global mobility, clinical routine examination should more take into account external/internal rotation with the shoulder abducted, then abduction and finally flexion/extension. However, further clinical testing in other populations has to be done to evaluate the potential generalization of this result.

How long should arthroscopic clavicular resection be in acromioclavicular arthropathy? A radiological-clinical study (with computed tomography) of 18 cases at a mean 4 years' follow-up.

INTRODUCTION Endoscopic clavicular resection is a common procedure, but few studies have analyzed predictive factors for outcome. HYPOTHESES 1) Computed tomography (CT) of clavicular resection is reproductible; 2) Functional outcome correlates with resection length; 3) Other factors also influence outcome. MATERIAL AND METHODS Patients operated on between 2005 and 2010 were called back to establish functional scores (Constant, Simple Shoulder Test [SST], satisfaction) and undergo low-dose bilateral comparative computed tomography (CT) centered on the acromioclavicular joints. The assessment criteria were resection edge parallelism and resection length, measured using OsiriX software. Radiological and clinical data were correlated. RESULTS 18 out of 21 patients (85%: 3 female, 15 male) were assessed. Mean age at surgery was 49 years (range, 40-62 yrs); mean follow-up was 4.2 years (1.6-7.2 yrs). Mean Constant score rose from 57.7 (25-85) to 70.2 (30-96); mean postoperative SST was 9.3 (3-12). 11 patients had very good and 4 poor results. CT resection length was reproducible, with intraclass, intra- and interobserver correlation coefficients >95%. There was no significant correlation between articular resection length on CT and functional scores (P=0.2). Functional scores were negatively influenced by an occupational pathologic context (P<0.01) and by associated tendinopathy. DISCUSSION AND CONCLUSION Low-dose CT enabled reproducible analysis of clavicular resection. The hypothesized correlation between resection length and functional result was not confirmed. Work accidents and occupational disease emerged as risk factors. LEVEL OF EVIDENCE Single-center retrospective analytic cohort study. Level 4, guideline grade C.

A review of main anatomical and sonographic features of subcutaneous nerve injuries related to orthopedic surgery

Lesion to subcutaneous nerves is a well-known risk of orthopedic surgery and a significant cause of postoperative pain and dissatisfaction in patients. High-resolution ultrasound can be used to visualize the vast majority of small subcutaneous nerves of the upper and lower limbs. Ultrasound detects nerve abnormalities such as focal hypoechoic thickening, stump neuroma, and scar encasement, and provides information not only about the peripheral nerve itself but also about its relationship to adjacent anatomical structures. The purpose of this review is to provide an overview of the anatomy of the main subcutaneous nerves damaged during orthopedic surgery, recall at-risk procedures, and offer useful anatomic landmarks to help the sonographer identify and follow the nerves when an iatrogenic lesion is suspected.

Popeye sign: Frequency and functional impact

INTRODUCTION There is currently no consensus on the choice between tenotomy and tenodesis of the long head of the biceps tendon in rotator cuff repair. The Popeye sign is often seen as a drawback of tenotomy. The main objective of the present study was to determine the frequency and clinical impact of the Popeye sign. HYPOTHESIS The Popeye sign is rarely found clinically, and shows little functional impact following tenotomy. MATERIALS AND METHODS A single-center non-randomized prospective study was conducted between February and October 2015 in all patients undergoing rotator cuff surgery. Patients without surgery on the long head of the biceps tendon were excluded. The rate of Popeye sign was assessed 6 months postoperatively. Tenotomy patients with and without Popeye sign were compared in terms of pain on visual analog scale≤3, gain in range of motion, improvement in subjective shoulder value, discomfort or cramps and gain in Constant score. RESULTS Seven of the 55 patients included (15.2%) showed postoperative Popeye sign. There were no differences between the groups with and without Popeye sign on any of the assessment criteria except for a significantly greater improvement in mean Constant range of motion score in the Popeye group: gain of 13.8 versus 3.8 points; p=0.01. DISCUSSION The Popeye sign was relatively rarely observed. Functional impact in the present study was slight. Longhead of the biceps tenotomy is a justifiable treatment option in case of associated rotator cuff tear repair. LEVEL OF EVIDENCE IV, prospective non-randomized.

Intraarticular synovial osteochondromatosis of the elbow joint with radial nerve palsy

Joint Bone Spine - In Press.Proof corrected by the author Available online since jeudi 4 octobre 2018

Echography-Guided Pinning for Prevention of Iatrogenic Injuries to the Radial Nerve during Fixation of Extra-articular Distal Radius Fracture: An Anatomical Study

&NA; This study assesses the usefulness and feasibility of an osteosynthesis of the lower end of the radius under ultrasound imaging to avoid the superficial branch of the radial nerve (SBRN). A single operator performed an initial echography of the wrist of 12 cadaveric upper limbs to identify the three main branches of the SBRN and the tendons. Then, three pins were placed according to Kapandjis procedure, avoiding the structures spotted under ultrasound imaging. After dissection, the safety distances for the branches of the SBRN, dorsal extensor tendons, and veins were measured, and injuries to these structures were noted. No lesion of the SBRN was found with an average safety distance of 8.1 for the third branch of the radial nerve (SR3) and 1.3 mm for the first and the second branches of the radial nerve (SR1‐2). Three tendons were spiked. The average operative time was 38.3 minutes. Ultrasound secures percutaneous surgery to avoid the branches of the SBRN but requires a learning curve.