Arthroscopie de l'épaule, installation, voies d'abord et exploration normale

RésuméL'arthroscopie de l'épaule est un acte chirurgical qui permet de traiter la plupart des affections de l'épaule. Pratiquée sous anesthésie générale et/ou sous bloc interscalénique, le patient est installé en décubitus latéral ou en position demi-assise. L'arthroscopie de l'articulation glénohumérale étudie l'ensemble des structures intra-articulaires (cartilages de la tête humérale et de la glène, bourrelet, longue portion du biceps, tendon du subscapulaire, ligaments glénohuméraux). L'exploration de la bourse sous acromiale analyse le ligament coracoacromial, l'articulation acromioclaviculaire, la face inférieure de l'acromion, la face endobursale des tendons de la coiffe des rotateurs.

Arthroscopy has been established as a valuable technique in diagnosis and treatment of the injured and deseased shoulder. Arthroscopy is not a new diagnostic tool but offers new approaches to the surgical treatment of shoulder pathology. Shoulder arthroscopy is usally performed under general anesthesia or/with scalene block. The patient is positioned in opposite lateral decubitus position or in beach chair position. Diagnostic arthroscopic is initiated with insertion of the arthroscope from the posterior portal into the gleno humeral joint. Inspection should be organized systematic visualization of the entire joint (articular surfaces of the glenoid and humeral head, glenoid labrum, long head of the biceps tendon, sub scapularis tendon, axillary pouch, capsular ligaments, synovial membrane). Then endoscopic visualization of the subacromail space is a valuable and essential adjunct to the gleno humeral arthroscopy (impingement syndrome, rotator cuff tears, calcific tendinitis, acromio-calvicular joint disorders).