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Resume Cet article propose une methode de reeducation precoce des tendons calcaneens operes. A partir d’une revue de la litterature, nous rappelons l’evolution de la reeducation des ruptures tendineuses sur les 25 dernieres annees. Nous montrons l’interet d’une telle methode dans l’amelioration de la prise en charge globale des patients. Les avantages sont theoriquement nombreux avec un tissu cicatriciel de meilleure qualite sur le plan biomecanique, un gain plus rapide en amplitude articulaire, une diminution des complications liees a l’immobilisation, une diminution du nombre de seances de kinesitherapie, un retour plus precoce aux activites physiques et professionnelles. Les moyens utilises encadrant cette mobilisation precoce sont des attelles articulees au niveau du cou de pied ou bien des attelles anterieures ou posterieures de jambe. Quel que soit le dispositif, celui-ci permet une mobilisation douce de la cheville, tout en protegeant le montage chirurgical par un systeme de blocage de la flexion dorsale du pied. Ce type de prise en charge doit etre adapte au patient et etroitement surveille par le medecin MPR afin de prevenir la principale complication qu’est la rupture iterative.

Resume Objectifs Analyser le circuit de prescription d’un materiel type fauteuil roulant electrique rembourse part la collectivite, determiner les delais de reponse et indices de satisfaction. Methodes 63 malades ont beneficie d’une consultation specialisee de MPR et d’ergotherapie associee dans le cadre de l’agrement d’un fauteuil roulant electrique (1 re prescription ou renouvellement). Resultats Ont ete delivres 84 % d’avis favorables sans reserve, 6 % avec reserve et 10 % d’avis defavorables. La Caisse d’Assurance Maladie avalisait ces decisions dans 95 % des cas, le fauteuil roulant electrique etant alors disponible 3 mois apres l’initiation de la prescription avec un indice de satisfaction global de 87 %. Conclusion Une consultation specialisee de MPR dans le cadre d’un agrement « fauteuil roulant electrique » permet l’optimisation de la prescription de ce grand appareillage en facilitant l’analyse decisionnelle des medecins de CPAM notamment au regard du rapport cout/benefice.

Resume Nous presentons un cas de syndrome de Tietze survenu 48 heures apres une perfusion de pamidronate (Aredia®), dans le cadre du traitement d’une algodystrophie de genou. Il s’agit d’une complication qui n’a jamais ete repertoriee a ce jour.

Penile neuropathy is a common disease due to lesion of the sensory branch of the pudendal nerve, ie, the dorsal nerve of the penis. Sexual disorders (deterioration of erection) and sensory signs (hypoesthesia or paresthesia of the penis) are noted in patients with penile neuropathy. Electrophysiological recordings help guide the diagnosis (reduction of the sensory velocity of the dorsal nerve of the penis). Many etiologies can be found (traumatic, toxic, compressive), but the most common lesion is neuropathy related to diabetes.

Incidence des complications thrombo-emboliques apres arthroplasties totales de la hanche et du genou : interet de l’exploration doppler postoperatoire systematique L. Have *, M.-G. Tondeur , C. Fournel , O. Jacquin , R. Goldet b a Service de MPR, hopital d’instruction des armees Desgenettes, 108 boulevard Pinel, 69003 Lyon, France b HIA Desgenettes, France *Auteur correspondant. Adresse e-mail : havelaurence@yahoo.fr.

We performed a retrospective study about perioperative pudendal nerve palsy following fracture table tractions.Six palsies were investigated. Mean age was 26 years. All of them presented sensitive and motor dysfunctions secondary to nerve compression following tractions on the fracture table.All of them had complete electrophysiological recordings including perineal electromyogram, measurement of sacral roots latencies, sensory velocity of the dorsal nerve of the penis, somatosensory evoked potentials of the pudendal nerve and measurement of its terminal branches.Neurological symptoms were stereotyped associating sensory signs and sexual disorders, must of them being transient. Perineal electrophysiological examination always confirmed reality of pudendal nerve palsy.We discuss incidence, mechanism, etiology and prevention of this pudendal nerve palsy.Emergence of stereotyped perineal symptoms following orthopaedic surgery, especially after tractions on fracture table, must prevail on physicians to search for pudendal nerve palsy. Usual outcome is good in the six months following surgery, but definitive aftermath does occur. Perineal electrophysiological examination can confirm pudendal nerve palsy and give prognosis elements.

We report 170 cases of perineal neuralgia due to pudendal nerve compression within Alcock canal or by ischiatic spine. 117 women and 53 men were investigated. Mean age was 60.3 years and the follow-up one year. Infiltrations of the pudendal nerve in the ischio-rectal fossa (pudendal canal or Alcock canal) with corticoids under CT-scan guidance, were successful immediately in only 1/3 of the cases. Infiltrations of the nerve near by ischiatic spine (radioscopic guidance) were successful in 57 p. 100, but only in 15 p. 100 of the cas after one year. Surgical treatment (performed in 27 cases) was good (8 or excellent (9). For all treatments, the results are good in 65 p. 100 of the cases. Perineal neurophysiologic examinations are useful to confirm pudendal nerve lesion and propose specific medical and/or surgical treatment.

Penile neuropathy is a common disease due to lesion of the sensory branch of the pudendal nerve, ie, the dorsal nerve of the penis. Sexual disorders (deterioration of erection) and sensory signs (hypoesthesia or paresthesia of the penis) are noted in patients with penile neuropathy. Electrophysiological recordings help guide the diagnosis (reduction of the sensory velocity of the dorsal nerve of the penis). Many etiologies can be found (traumatic, toxic, compressive), but the most common lesion is neuropathy related to diabetes.