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SHOULDER ARTHROSCOPY

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C.H.U. PARIS-OUEST

SHOULDER ARTHROSCOPY

SYNOVIAL AND OSTEOCHONDRAL

PATHOLOGY

C.H.U. PARIS-OUEST

SHOULDER INVOLVEMENT

• COMMON

• INFLAMMATORY ARTHRITIS

• SYNOVITIS

• NONOPERATIVE TREATMENT +++

C.H.U. PARIS-OUEST

SHOULDER INVOLVEMENT

• ARTHROSCOPY – DIAGNOSTIC – BIOPSY – TREATMENT

• ALTERNATIVE TO OPEN TREATMENT

• LAVAGE

• SYNOVECTOMY

• REMOVAL OF LOOSE BODIES

C.H.U. PARIS-OUEST

MOST COMMON SHOULDER INVOLVEMENT

• SERONEGATIVE

SPONDYLOARTHROPATHIES

• SEROPOSITIVE RHEUMATOID ARTHRITIS

• PSEUDOGOUT GOUT

• REITER ’S SYNDROME

• JUVENILE RHEUMATOID ARTHRITIS

C.H.U. PARIS-OUEST

SERONEGATIVE

SPONDYLOARTHROPATHIES

• ANKYLOSING SPONDILITIS

• REACTIVE ARTHROPATHIES

• SACROILIAC JOINT

• LIMITED ROLE FOR ARTHROSCOPY – BIOPSY

– ARTHROLYSIS ??

C.H.U. PARIS-OUEST

RHEUMATOID ARTHRITIS

• SHOULDER INVOLVEMENT – SERIOUS SYSTEMIC DISEASE – BILATERAL

– 90% PATIENTS

• GLENOHUMERAL JOINT

• AC JOINT

• BURSA

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C.H.U. PARIS-OUEST

RHEUMATOID ARTHRITIS

• COMPLETE CUFF TEAR 25 %

• INDICATIONS FOR ARTHROSCOPY – GLENOHUMERAL SYNOVECTOMY – AC JOINT RESECTION

– BURSECTOMY

• EVOLUATED ARTHRITIS

• RARE UNTIL NOW

C.H.U. PARIS-OUEST

POLYMYALGIA RHEUMATICA

• COMMON

• MYALGIA + ARTHRALGIA

• SHOULDER AND PELVIC GIRDLE

• ORAL CORTICOSTEROID

• LIMITED INDICATION FOR SHOULDER ARTHROSCOPY

C.H.U. PARIS-OUEST

CHRYSTALLINE ARTHRITIS

• GOUT

• ELDERLY FEMALES

• ARTHROSCOPY – DIAGNOSTIC – BIOPSY – LAVAGE – DEBRIDEMENT – SYNOVECTOMY

C.H.U. PARIS-OUEST

AMYLOIDOSIS

• EXTRACELLULAR DEPOSIT OF FIBROUS PROTEIN

• PRIMARY SECONDARY

• LONG TERM DIALYSIS – THICKENING OF THE CUFF – GLENOHUMERAL ARTHROPATHY – IMPINGEMENT

• BURSECTOMY AND ASD ???

C.H.U. PARIS-OUEST

PIGMENTED

VILLONODULAR SYNOVITIS

• JOINT + BURSA

• HEMARTHROSIS

• SYNOVECTOMY – ARTHROSCOPY > OPEN

• SECONDARY SYNOVIORTHESIS

C.H.U. PARIS-OUEST

SYNOVIAL

OSTEOCHONDROMATOSIS

• RARE

• BENIGN

• LOOSE BODIES

• MECHANICAL SYMTOMS

• LOOSE BODIES REMOVAL

• SYNOVECTOMY

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C.H.U. PARIS-OUEST

SYNOVIAL

OSTEOCHONDROMATOSIS

• NUMBER SIZE

• BICIPITAL GROOVE

• BURSA

• AXILLARY POUCH

• MODIFIED APPROACH

C.H.U. PARIS-OUEST

HEMOPHILIC ARTHROPATHY

• SPONTANEOUS INTRAARTICULAR HEMORRHAGE

• CHRONIC SYNOVIAL INFLAMMATION

• ARTHROSCOPIC LAVAGE

• LAVAGE

• INTRAOPERATIVE HEMOSTASIS

C.H.U. PARIS-OUEST

GLENOHUMERAL ARTHRITIS

• INTACT CUFF

– LIMITED INDICATIONS – SURPRISE

• C.T.A.

– TENOTOMY OF THE LHB – DEBRIDMENT

– ASD

C.H.U. PARIS-OUEST

HUMERAL HEAD NECROSIS

• RARE INDICATIONS

• BIOPSY

• REMOVAL OF LOOSE BODIES

C.H.U. PARIS-OUEST

MECHANICAL SYNOVITIS

• FREQUENT

• ASSOCIATED

• CUFF TEAR

• CUFF TENDONITIS

• BICEPS TENDONITIS

• ANTEROSUPERIOR

C.H.U. PARIS-OUEST

SEPTIC ARTHRITIS

• SAMPLE

• ADAPTED TO THE STAGE – LAVAGE

– SYNOVECTOMY – OSTEOARTHRITIS = NO

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C.H.U. PARIS-OUEST

CONCLUSION

• LIMITED INDICATIONS

• CONSERVATIVE TREATMENT

• BIOPSY

• LAVAGE

• SYNOVECTOMY – BETTER THAN OPEN

• MORE INDICATIONS IN THE FUTURE

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