The ambition of this book is to present the current state of knowledge and the latest concepts and approaches in both arthroscopic and arthroplastic shoulder surgery, as well as in fractures of the proximal humerus. This book, «Shoulder Concepts 2012», is based on the talks presented by a group of shoulder experts and friends in Nice, on June 7, 8, 9, during the Nice Shoulder Course 2012.
These world leaders in shoulder surgery have accepted to share their knowledge with you. Let me thank them for the efforts they have made and the time they took from their practices, and more importantly from their families. The quality of instruction given at the Nice Shoulder Course is clearly determined by their enthusiasm and experience.
We have tried to present the latest and more relevant information in anterior instability, posterior instability, acromio-clavicular joint separation, rotator cuff tears, muscle-tendons transfer, proximal humerus fractures, reverse prosthesis.
It is our hope that this book will help you to give the best care to your patients. We hope to convince all the participants of the course and all the readers of this book that shoulder surgery is really a «nice surgery»!
This book is based on the talks presented by a group of experts in Nice, on May 8, 9, 10, during the Nice Shoulder Course 2008. There is probably no other field in orthopaedic surgery where knowledge in anatomy, pathogenesis, diagnosis and treatment has expanded so greatly in the last 20 years. The diagnosis and treatment of patients with shoulder pathologies remain both challenging and exciting. Surgeons are now capable to perform true shoulder repairs and reconstructions using sophisticated implants (anatomical and non anatomical) as well as videosurgery for mini-invasive approaches.
There are, of course, many (maybe too many) different methods to treat shoulder lesions. Today, the problem that surgeons face is not a «lack of information», but a real «intoxication», due to the explosion of techniques, instruments, implants and devices available for both arthroscopic and arthroplastic procedures. The orthopaedic surgeons who want to gap the bridge between traditional operations and newer approaches are often lost «deep in the jungle». This is why the Nice Shoulder Course continues to be organized on a two-year basis.
The ambition of the Nice Shoulder Course, and therefore of this book, is to present the current state of knowledge and the latest concepts in both arthroscopic and arthroplastic shoulder surgery. There is no better way to find your way in the jungle than to follow «experimented guides»: these guides are world leaders in shoulder surgery who can make the difference between necessary and superfluous, between myths and facts.
I have been fortunate to assemble such a group of experimented guides, of whom many are close friends of mine. Their task has been to reveal to you the state of the art of shoulder arthroscopy and arthroplasty. All of them are international experts who have made major contributions to diagnosis, techniques, implant design and engineering principles in the shoulder. They all try to make shoulder pathology more understable and shoulder surgery more reproducible and more beneficial to patients. They have all accepted to share their knowledge without any restriction to help you to make the right diagnosis for your patients, to understand why certain reconstructive shoulder procedures should be performed and some others should not and, finally how those procedures should be performed in a more reliable way.
Let me thank them for the efforts they have made and the time they took from their practices, and more importantly their families, to help you to find your way in the jungle ! Let me thank you for joining us ! Let's follow them ! Let's begin our journey !
Time flies! If I think that two years have passed since the last edition of the Nice Shoulder Course, and more than ten since the first edition, I can hardly believe it. Time flies when a lot of interesting things happen, and there is no time to stop or slow down, because things change and go ahead.
And when I look back on the more than ten years since the first edition, I am happy to see that things have changed, and that we were able to say new things that have become common practice today.
This is what keeps the Nice Shoulder Course a thrilling experience each and every edition. That we have the chance and honor to gather the opinion leaders of our specialty around a relatively small event compared to large international congresses.
Judging from the feedback of our particpants, our aim has been attained for both the participants and the faculty, both tell us that they go home having learned (yes, even the Faculty). All say that they particularly appreciate the high level of exchange, the density and the proximity of the course.
In keeping with our traditions, this new edition will again be very intense. It will be as intense as it's preparation was.
I am very grateful to our Faculty, that they have agreed to share their knowledge with us, my assistants and colleagues who have spent long (and intense) hours behind the scientific work, to all our collaborators and the small, but very efficient team that manages the oh, so many and diverse aspects of this event, and without whom this course would not be what it is.
Thank you, our participants, for your faithfulness and continuing interest. It is always with great joy that we see names that have become familiar over the years, and it is with just as much joy that we see the new ones. The number of names that have become familiar grows each year and this year we had to close the registrations well before the course.
Last but not least, thank you to all the patients who presented to us with some shoulder pathology ; they all taught us something through all these years!
I do hope that you will enjoy the course, as much as reading this book!
Finding the right treatment for a young patient (< 60 years) with glenohumeral osteoarthritis is still a challenge. In case of failure of conservative therapy, surgical treatment must be considered. The indications for a surgical treatment depend not only on the radiological findings but also on the explicit age of the patients, their occupation, activity level, duration of symptoms, comorbidities and concomitant shoulder pathology.
Arthroscopic management of glenohumeral arthritis includes capsular release, removal of loose bodies, subacromial decompression, axillary nerve neurolysis, biceps tenodesis, chondroplasty, microfracturing, and humeral osteophyte resection. This can result in pain relief, but usually does not improve shoulder motion. However, these effects are temporary and results are unpredictable.
Furthermore, these techniques do not provide a definitive solution for advanced-stage glenohumeral arthritis. Osteotomy or bone graft in case of glenoid dysplasia has yielded disappointing results as well.
Today, an unacceptable compromise in quality of life may constitute a valid indication for shoulder replacement in young patients who seek so-called «high-performance shoulders» to attain their expectations and aspirations. Initial pain relief and functional improvement are usually excellent after shoulder arthroplasty; however, these gains are short-lived in the younger population, with a dramatic decline in functional outcome and survival rate at mid- to long-term follow-up. The concerns about shoulder arthroplasty in this population are mainly due to the higher demands on the operated shoulder, the higher expectations regarding the surgical result, and the longevity of the prosthetic shoulder due to increased life expectancy.
Younger patients who receive a total shoulder arthroplasty have a higher rate of glenoid component loosening and rotator cuff tears, likely related to higher activity levels, and therefore, alternative strategies have been sought. Hemiarthroplasty has been used as an alternative, with limited benefit in the long term, likely due to unaddressed glenoid disease and a substantial rate of glenoid erosion. Biologic resurfacing of the glenoid in conjunction with hemiarthroplasty has led to disappointing results. Reverse shoulder arthroplasty is sometimes needed in younger patients in specific and difficult cases, like failed cuff repair, failed instability surgery or posttraumatic arthritis. However, long-term results of this semi-constrained prosthesis remain to be proven in the younger population.
We have invited colleagues and friends from different continents to report their surgical experience in this difficult field, and whom I thank for having accepted our invitation. We have also built a database including more than 1500 young patients with glenohumeral arthritis. The aim of the Nice multicenter study was to evaluate mid- to long-term outcomes following shoulder arthroplasty in patients younger than 60 years at the time of surgery. We have studied the results of shoulder arthroplasty in this challenging patient population according to the different etiologies, according to patients' age and have looked for complications. This study could not have been conducted without the hard work and motivation of all those who participated in it: surgeons, assistants, fellows, residents, staff, nurses, secretaries, and last but not least, our patients.
We hope that the material presented here will help surgeons to better understand and resolve the difficult problem of glenohumeral arthritis in younger patients.
The arthroscopic Bankart procedure can be very successful in preventing recurrent shoulder instability and has a low complication rate. However, even if the surgeon masters this procedure, there are cases where the success is limited. Besides patients who have true recurrence of instability, some others remain with "shoulder apprehension", while others abandon their sport in the months or years following the procedure.
Those are mainly cases with bony lesions, mostly of the glenoid, and to a lesser degree, of the humeral head. Glenoid deficiencies are becoming increasingly recognized in patients with anterior recurrent instability. In these cases, open bone block stabilization using the coracoid process (Bristow, Latarjet) or an iliac crest bone graft (Eden-Hybbinette) are regarded as the "gold standard". Criticism against the arthroscopic bone block procedures is based on reports of complications and failures.
It is true that performing an arthroscopic Latarjet can be very dangerous if the surgeon does not master all details perfectly. The use of screws has also been associated most of the complications reported. On the other hand, nothing will stop the development of arthroscopic shoulder surgery. This is why, for more than fifteen years we have been working on the development of arthroscopic techniques that would be safe, reproducible, and using a means of fixation other than screws to fix the bone block on the glenoid neck.
This Arthroscopic Shoulder Manual has been written to be a guide for surgeons whose goal is to master these safe arthroscopic techniques.
L'endocrinologie du développement est au coeur de l'endocrinologie périnatale. Initiée dès la fécondation, elle se poursuit pendant la vie foetale. Elle permet au nouveau-né de s'adapter à la vie extra-utérine puis à l'enfant de s'épanouir. Chez la femme enceinte, certaines endocrinopathies vont modifier le fonctionnement du système endocrinien foetal et néonatal.
Cet ouvrage intègre les différents domaines de l'endocrinologie, les interactions entre les hormones de la mère et du foetus via le placenta, et les pathologies endocriniennes du développement foetal et néonatal. Son originalité réside dans le fait est qu'il est pluridisciplinaire et transversal. Les particularités de la prise en charge diagnostique et thérapeutique des pathologies endocriniennes de la femme enceinte, du foetus et du nouveau-né y sont détaillées.
Cet ouvrage intéressera les endocrinologues, obstétriciens, pédiatres, néonatologistes, radiologues, généticiens, chirurgiens et sages-femmes qui interviennent dans le diagnostic prénatal et la prise en charge initiale du nouveau-né.