Rupture de la coiffe des rotateurs.

Abstract

Spontaneous or traumatic ruptures almost always occur in a cuff that has degenerated due to overuse. Despite the lack of absolute anatomico-clinical correlation, two clinical types can be described: a conflictual, often hyperalgesic shoulder with its painful arch corresponding to a small anterosuperior rupture, or a pseudo-paralytic shoulder betraying a major posterosuperior rupture. Standard radiography with Leclercq's manoeuvre is performed primarily to find out whether the cuff is continent or incontinent. Modern medical imaging (ultrasonography or MRI) adds precision to the lesions when surgery is contemplated. When medical treatment has failed, partial ruptures are treated by arthrolysis; ruptures of the superficial and deep layers of the cuff without calcification benefit from endoscopy; ruptures involving tendons or associated with calcifications are treated by surgery. Small and medium ruptures with a continent cuff require endoscopic or surgical anterior decompression combined, in cases where the intra-articular long head of the biceps is exposed, with repair, usually by suture. Extensive ruptures with an incontinent cuff are treated by muscle transfer alone of combined with arthroplasty, or by semi-constrained total prosthesis when arthrosis of the humeral joint is present.