Le 02/12/2022 de 08:00 à 09:30
Procedure de suspensioplastie comme traitement de la subluxation gléno-humérale inferieure sequellaire de AVC: est-elle une option?
Vittoria Casamenti (Montpellier, France), Olivier Bozon (Montpellier, France), Flavia Coroian (Montpellier, France), Bertrand Coulet (Montpellier, France), Isabelle Laffont (Montpellier, France)
Objective : Hemiplegic shoulder pain (HSP) is a common complication of post-stroke. Inferior Glenohumeral subluxation (GHS) represents a cause of HSP. The paretic muscles are unable to hold the head of the humerus, leading painful tension of the lower capsule and ligaments. The purpose of this study is to report our outcomes using the biceps suspension procedure to achieve HSP relief.
Material / Patients and Methods : This retrospective case series collected data of 10 patients who underwent biceps suspension at CHU of Montpellier between 2014 and 2021. All the patients did an orthosis reduction pre-testing, kept an immobilisation orthosis for 6 weeks after the procedure and followed a rehabilitation program. Eight associated botulinum toxin injections. Pain, physical examination and radiographs were evaluated before and at the follow up (FU).
Results : All patients had a non-functional upper limb with HSP. Three were lost at FU. The mean score on numeric pain rate scale before was 6 (4-8), and after intervention 3 (0-7). Mean delay of maximum efficacy 8 month. Four patients still wear an orthosis at the FU. Six patients were satisfied with the outcomes, and 6 patients confirm they would undergo the intervention again. Preoperative and postoperative radiographs demonstrate an improvement of joint position (Dursun classification) in 7 patients.
Discussion - Conclusion : Short and medium term HSP was relief in patients underwent biceps suspension procedure for GHS. Pain tend to relapse at longterm, but described as less intense and more tolerated. Biceps suspension surgery can provide pain relief in hemiplegic patients with painful GHS after upper motoneuron injury.
Keywords : shoulder subluxation, hemiplegic, stroke, arthroscopy, suspensioplasty, pain