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Background/Purpose: Overhead athletes are at high risk of developing shoulder injuries due to the repeated throwing movements, which put a lot of constraints on this joint complex. The most commonly reported pathologies are sub-acromial impingement and pain, which scapular alteration is one of the symptoms. The objective of this literature review is to analyze the effects of scapular rehabilitation on pain and sports performances, in the overhead athlete suffering from sub-acromial pain. Methods: Searches were conducted from August to November 2021 on scientific databases such as Pubmed, Cochrane or GoogleScholar. Studies were included according to defined criteria and assessed for their methodological quality.Results and analyses: Four studies were included, including one case series. Within the studies, two were dealing with active scapular rehabilitation and the others with kinesiotaping. On the whole, a decrease in pain and disability as well as an increase in muscle activity were observed. However, the small sample size and the lack of a comparator for some studies did not allow to confirm the effectiveness of the treatments.Discussion: It would be interesting to add these two types of rehabilitation to other exercises as well as conducting future researches to evaluate their effects. Further experiments would be needed to evaluate the effects of scapular rehabilitation in addition to a typical sports training and/or to the kinetic chain of throwing.; Introduction/Objectif : les athlètes de lancer sont à haut risque de développer des blessures aux épaules dues aux mouvements d’armé et lancé répétés, sollicitant fortement ce complexe articulaire. Les pathologies le plus souvent rapportées sont les conflits et la douleur sub-acromiale, dont un des symptômes est une altération scapulaire. L’objectif de cette revue de littérature est d’analyser les effets de la rééducation scapulaire sur la douleur et les performances sportives, chez l’athlète de lancer souffrant de douleur sub-acromiale. Méthodologie de recherche : des recherches ont été faites d’août à novembre 2021 sur des bases de données scientifiques telles que Pubmed, Cochrane ou encore GoogleScholar. Les études ont été incluses selon des critères définis et évaluées sur leur qualité méthodologique. Résultats et analyse : quatre études ont été incluses dont une série de cas. Au sein de ces études, deux traitent de la rééducation scapulaire et les deux autres du kinésio-taping. Globalement on a pu observer une diminution de la douleur et du handicap ainsi qu’une augmentation de l’activité musculaire. Néanmoins, la taille d’échantillon trop faible et l’absence de comparateur pour certaines études ne nous ont pas permis d’attester de l’efficacité des traitements. Discussion : il serait intéressant d’incorporer ces deux types de rééducation à d’autres exercices et de réaliser de futures recherches pour en évaluer les effets. De nouvelles expérimentations seraient nécessaire pour évaluer les effets d’un travail scapulaire en complément d’un entraînement sportif type et/ou à la chaîne cinétique du mouvement de lancer

The survey appears in the setting of the politics of improvement for prevention of professional risks in hospital environment in Ivory Coast.To identify the influence factors of the coif of rotators pathology among dentist surgeons and to improve the preventive measures.It was a prospective case/witness survey type. It had for setting, public hospitals and private clinics in Abidjan.We enrolled two types of population (case/witness) comparable with the criteria's of age, sex, bodily mass indication (BMI) and laterality. The data have been collected on a standardized questionnaire named "Nordic questionnaire" and have been enriched. That informed on the bodily mass indication calculated according to the method: weight/T2 (m), on the epidemiological data and the specifics data of the shoulder and the coif of the rotators. The statistical tests have been done by the test of the Khi2 of Pearson, the test of T Student, the exact test of Fischer and the test of the gap reduces.The study included 100 cases and as many witnesses. The middle age of apparition of the tendinitis of the shoulder was of 38,83 years. Age, sex, bodily mass and professional experience didn't have any influence on the apparition of the lesion of the shoulder. The analysis of the results established that the professional seniority encourages the apparition of the lesion of the shoulder. The length on average some seniority is of 12,7 years with extremes of 2 and 30 years. This observation rests on the fact that the risks of intervening of musculo-skeletal unrests of the superior member is equal to the length of work (effort, repetitive acts and stance) returned to the functional capacities.The tendinitis of the shoulder, because of its importance must be recognized and repaired as an indemnisable professional disease.

To describe osseous, chondral and tendinous lesions associated with fissures of the posterior labrum. To better understand the pathological processes leading to fissure of the posterior labrum. Materials and methods. Retrospective study of 43 CT arthrograms performed in 43 patients that showed a fissure of the posterior labrum. The following associated lesions were noted: osseous and chondral remodeling of the humeral head and/or glenoid and articular surface fissures of the rotator cuff. Based on type of associated lesions, patients were separated into one of four pathological subgroups: posterior instability, posterosuperior or internal impingement, anterior instability and isolated fissure of the posterior labrum.Sixteen patients (37.2%) of patients showed posterior instability, 12 (27.9%) showed lesions of internal impingement, and 11 (25.6%) showed lesions of anterior instability. Only 4 patients (9.3%) had an isolated fissure of the posterior labrum.Posterior instability, internal impingement and anterior instability are the main pathologies leading to fissure of the posterior labrum, which seldom occurs in isolation. Evaluation of these associated lesions allows understanding of the underlying pathological processes leading to fissure of the posterior labrum.

To analyze the shoulder joint complex in high level swimmers. We formulated the assumption that high level swimming weakens this complex, resulting in laxity of the anterior-inferior capsuloligamentous structures with atraumatic anterior instability, impingement with rotator cuff tendonitis and muscle imbalance of the rotator cuff muscles.Two 20-subject groups took part in this study (a group of high level swimmers and a group of sedentary people). The swimmers were all national-level front crawl specialists. The evaluations included clinical examination and isokinetic testing of the shoulder.Isokinetic testing (at 60 degrees /s) revealed that the swimmers have an external rotation/internal rotation ratio that is unbalanced (right shoulder: 0.52) and significantly lower than that seen in sedentary subjects (right shoulder: 0.75). Even though swimming is a symmetrical sport, our data confirm that intensive front crawl swimming involves asymmetry, with a stronger shoulder (right shoulder: 61.2+/-10.2 Nm; left shoulder: 52.8+/-9.8 Nm). The results of the clinical examination showed that 55% of the swimmers presented scapular protraction and that 35% were positive for mechanical impingement. These clinical elements were not observed in the control group. Laxity of the anterior-inferior capsuloligamentous structures was also noted in 67% of the swimmers.high level swimming ineluctably weakens the shoulder joint complex.

Different interventional radiology techniques used in the management of the painful shoulder will be reviewed in this article. The etiology of shoulder pain is variable, and several image guided procedures are available, from simple to more complex. US and fluoroscopy guided intra-articular and bursal infiltration techniques will be described. Percutaneous needle removal of calcific deposits and capsular distension/infiltration of adhesive capsulitis will be discussed. Cysts in the spinoglenoid or suprascapular notch may cause impingement of the suprascapular nerve and may be aspirated under US guidance. Finally, percutaneous radio-frequency treatment of symptomatic bone metastases under CT guidance may at times be performed. Musculoskeletal radiologists should be familiar with this spectrum of image guided interventional procedures.

The goals of this article are: 1) to review the different radiographic projections commonly used at the time of initial imaging evaluation of patients presenting with traumatic injuries of the shoulder; 2) to review the indications and findings of cross-sectional imaging modalities in the assessment of shoulder trauma; 3) to recognize the main anatomical lesions secondary to traumatic injuries of the shoulder.

In 1983, Ellman reported the first subacromial decompression by arthroscopy as an alternative to open acromioplasty which described by Neer in 1972. Subacromial decompression combinates a removing of the antero lateral part of the acromion, a release of the coraco acromial ligament and a subacromial bursectomy. The principal indication is a chronic anterior impingement after failure to medical treatment. This subacromial decompression can be associated to cuff debridement, cuff repair, tenotomy or tenodesis of the biceps tendon or repair intraarticular lesion (SLAP, labrum...). The contraindications are massive cuffs tear with a superior migration of the humeral head or if the acromion is flat. Then, acromioplasty and release of the CA ligament could create a superior and anterior migration of the humeral head responsable to a pseudo paralytic shoulder. If we compare to open acromioplasty, arthroscopic decompression has some advantages; no split deltoid or desinsertion of anterior deltoid fibers, small cicatrices, less postoperative pain allowing immediate physiotherapy and possibility to explorate and to repair intra articular lesion during the same operation.

Classically, the shoulder joint is thought to age more by its tendons than by its cartilages, the incidence of rotator cuff tears being considered to increase with age. The purpose of this work was to assess the natural history of the shoulder joint based on a clinical and radiological study of 200 patients aged 70 to 101 years.The cohort was composed of 48 men (34%) and 152 women (76%), aged 84.25 +/- 6.7 years. All patients underwent a physical examination and the Constant score was established. The radiographic examination included an AP view in neutral rotation of both shoulders. The Hamada classification was used to stage full thickness cuff tears. The glenohumeral compartment was analyzed to search for osteophyte formation and joint narrowing.The subacromial height was greater than 6 mm, mean 9.89 +/- 2 mm, in 349 shoulders (87.25%), corresponding to stage I in the Hamada classification; it measured less than 6 mm, mean 3.08 +/- 1.7 mm in 51 shoulders (12.75%) in 38 subjects (19% of the total cohort). The Hamada classification for the other shoulders was stage II (n = 21 shoulders, 5.25%), and stage III (n = 16 shoulders, 4%), stage IV (n = 5, 1.25%) and stage V (n = 5, 1.25%). The Hamada stage could not be determined for four shoulders. There was a strong statistical correlation between the Constant score and Hamada stage. The glenohumeral space was normal in 288 shoulders (72%). Ninety-three shoulders (23.25%) in 62 patients (31%) presented humeral and/or inferior glenoid osteophytes without glenohumeral impingement and 19 shoulders (4.75% in 14 patients (7%) presented complete glenohumeral impingement. There was a significant correlation between the Constant score and severity of the glenohumeral degradation. The proportion of subacromial impincement increased significantly and regularly with degradation of the glenohumeral space (p104). For half of the shoulders, glenohumeral impingement was associated with subacromial impingement (eccentric osteoarthritis).The results of this study confirm that the frequency of rotator cuff tears increases with age. One out of five patients aged 70-90 years presented subacromial impingement versus one out of three among patients aged over 90 years. Clinical tolerance of subacromial impingement or subacromial osteoarthritis is good. Glenohumeral impingement, associated or not with subacromial impingement, is poorly tolerated, the patients presenting shoulder pain and marked stiffness.Our results demonstrate that the natural history of the shoulder does not exhibit a regular linear relationship with the Hamada radiological classification.

The painful shoulder is a well-recognized clinical entity in throwers although the pathogenic mechanisms involved are still debated. In 1991 Walch then Jobe developed the concept of posterosuperior impingement to explain lesions observed arthroscopically. This impingement between the deep aspect of the supraspinatus tendon and the glenoid occurs during loaded arm movements. The purpose of this work was to study the different types of lesions observed arthroscopically and to analyse outcome after arthroscopic debridement.Our series included 75 thrower athletes who had shoulder pain for loaded arm movements. Pain was situated in the dominant shoulder in all cases. Clinically, the Jobe manipulation provoked pain in 52 patents, expression of a supraspinous disorder. After failure of conservative treatment, the patients underwent arthroscopy for assessment and debridement. At the time of arthroscopy, the patients had suffered pain for two years (mean 22.3 months). All 75 patients were seen for clinical and radiological assessment at least two years after arthroscopy.Among the 75 arthroscopies, there were 67 (89%) partial tears involving the deep aspect of the cuff, associated in 90% of the cases with a labral lesion. Tears involved the supraspinatus in 40 cases, the supraspinatus and the infraspinatus in 24 and the infraspinatus alone in three. Eight patients were free of tendon lesions at arthroscopy. There were no full thickness tears. The labrum had a meniscal (45%) or non-meniscal aspect (55%) and appeared normal (18%), fringed (38%) or fissured (52%). The very large majority of the labral fissures were found behind the biceps insertion. Fissures of the labrum were found in front of the biceps insertion in only three cases (slap lesion). Arthroscopy demonstrated glenoid damage (soft cartilage, fissure, abrasion, wear). The humeral head also exhibited lesions of the cartilage facing the insertion of the infraspinatus. At last follow-up (minimum2 years), eight patients were very satisfied, 22 were satisfied and 45 were disappointed. Twelve patients had resumed their sports activities at their former level with loaded arm movement and one patient had interrupted all sports activities. At last follow-up, 22 patient had undergone another surgical procedure: 20 derotation osteotomies of the humerus, one anterior stabilization, one acromioplasty.The notion of posterosuperior impingement is increasingly recognized as the cause of pain in thrower athletes. Loaded arm movements produce a physiological contact between the posteriorsuperior edge of the glenoid cavity and the deep aspect of the rotator cuff. Injury results from repeated loaded arm movements in throwers. In our series, all the patients had at least one lesion, either involving the cuff or the labrum. According to the Snyder classification, 80% of the supraspinatus lesions were grade 1 or grade 2. We did not have any full thickness tears. All patients with a normal cuff were found to have a lesion of the posterosuperior labrum. At arthroscopy, dynamic assessment evidenced an impingement between the supraspinatus (or the infraspinatus) and the labrum or the bony edge of the glenoid cavity. Only three patients had a labral lesion anterior to the biceps insertion that could be considered a type 1 or 2 slap lesion. Unlike earlier reports by others, we had disappointing results after debridement: 60% of the patients were disappointed after the procedure and only 40% were satisfied (22 patients) or very satisfied (8 patients). Patient satisfaction depended greatly on the level of sports activity attained after arthroscopy, the eight very satisfied patients had resumed their former level. None of the professional athletes or those competing at the international level were very satisfied with arthroscopic debridement. There was an inverse relationship between level of competition and patient satisfaction after debridement.

Specific pathologies of the shoulder include instabilities in young patients and tendinopathies in older patients. The choice of imaging modality depends on the information expected from each technique. In case of instability, plain films demonstrate bone abnormalities such as Hill Sachs and/or Bankart lesions. Arthro-CT or arthro-MRI need not be in all cases but can provide additional information performed about the intraarticular structures and the glenoid labrum. The rotator cuff is initially evaluated by plain films which demonstrate anatomical conditions resulting in impingement syndrome as well as indirect signs of tendinopathy. Direct visualization of tendons may be achieved by US, arthro-CT, arthro-MRI. US is a dynamic, non invasive and accurate technique for evaluation of rotator cuff tear but is very operator-dependent. Arthro-CT is more reproductive and reveals accurately partial tear as well as anterior tears involving biceps or subscapularis tendons. MRI is very useful to visualize the rotator cuff and adjacent bony structures. Nevertheless, MRI is still limited by its cost, accessibility and variable quality.

The authors present the case of a displaced fracture of the coracoid process associated with a displaced fracture of the acromion, an undisplaced fracture of the clavicule and fractures of the first to fifth ribs. Open reduction of the coracoid process fracture was performed. At the last follow-up, the coracohumeral distance was restored (10 mm), but the acromiohumeral distance in the sagittal place was decreased (5 mm). The authors recommend open reduction of displaced fractures around the rotator cuff to limit the risk of impingement between the cuff and the coracoid process or the acromion.

The authors report the results of a retrospective study of 59 arthroscopic acromioplasties. Objective shoulder assessment was made following the relative Constant score and UCLA rating scale. Subjective satisfaction of the patient was assessed on an analogic scale. The patients were divided into 3 groups, according to the subacromial pathology treated. The first group (27 shoulders in 23 patients) included patients with subacromial impingement without a complete rotator cuff tear. The objective result, between 80 and 90%, was close to results in others series reported. Distinction between patients with no tear or partial tear of the cuff showed better results for patients with partial tears. This surprising finding may be at least partially explained by the fact that these patients were older than those without a cuff tear. The results of this study, and the review of the literature, confirmed the value of subacromial decompression as a treatment for impingement without complete cuff tear resistant to at least 6 months of conservative treatment; comparison between surgical and arthroscopic series showed similar results. The second group (19 shoulders in 19 patients) included patients with impingement and complete cuff tear. The objective results and the literature review led us to specify indications. Subacromial decompression with debridment of the tear has given excellent results in older patients--over 60 for most authors--when the tear was limited. In our study, the function of the shoulder at revision was good when the tear was limited to the supraspinatus and part of the infraspinatus. The third group (13 shoulders in 10 patients) included patients with calcifying tendinitis. Arthroscopic acromioplasty was performed in every case; excision of the calcification was performed in less than half of the cases and did not influence the final result. The calcifications had disappeared at revision in all cases. This may suggest that the treatment of the associated impingement was the most important procedure in these cases.