{"id":551,"date":"2020-12-20T15:49:50","date_gmt":"2020-12-20T14:49:50","guid":{"rendered":"https:\/\/admsu.org\/?p=551"},"modified":"2020-12-20T16:42:42","modified_gmt":"2020-12-20T15:42:42","slug":"imagerie-n1","status":"publish","type":"post","link":"https:\/\/admsu.org\/w\/imagerie-n1\/","title":{"rendered":"Imagerie n\u00b01"},"content":{"rendered":"\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-9d6595d7 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\" style=\"flex-basis:50%\">\n<p class=\"has-text-align-left\"> La semaine pass\u00e9e, une patiente d\u2019une quarantaine d\u2019ann\u00e9es s\u2019est pr\u00e9sent\u00e9e au SAU pour chute de trottinette sur le cot\u00e9 gauche. Elle pr\u00e9sentait une \u00e9paule gauche traumatique hyper algique. Cliniquement, on ne distinguait pas de d\u00e9formation importante de l&#8217;\u00e9paule. <\/p>\n<\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\" style=\"flex-basis:50%\">\n<figure class=\"wp-block-image size-large is-resized\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/admsu.org\/w\/wp-content\/uploads\/2020\/12\/trotinette.jpg\" alt=\"\" class=\"wp-image-564\" width=\"275\" height=\"184\" srcset=\"https:\/\/admsu.org\/w\/wp-content\/uploads\/2020\/12\/trotinette.jpg 550w, https:\/\/admsu.org\/w\/wp-content\/uploads\/2020\/12\/trotinette-300x200.jpg 300w\" sizes=\"auto, (max-width: 275px) 100vw, 275px\" \/><\/figure>\n<\/div>\n<\/div>\n\n\n\n<p>Elle n\u2019\u00e9tait mobilisable dans aucune des amplitudes : pas de RI , pas d\u2019\u00e9l\u00e9vation-abduction, et encore moins de RE. Pas de franche douleur acromio-claviculaire. Il existait une tr\u00e8s tr\u00e8s discr\u00e8te vacuit\u00e9 de la gl\u00e8ne, tr\u00e8s difficile \u00e0 mettre en \u00e9vidence. Le point douloureux principal \u00e9tait situ\u00e9 sur la partie ant\u00e9rieure de l\u2019\u00e9paule.<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"240\" height=\"320\" src=\"https:\/\/admsu.org\/w\/wp-content\/uploads\/2020\/12\/PastedGraphic-3.png\" alt=\"\" class=\"wp-image-552\" srcset=\"https:\/\/admsu.org\/w\/wp-content\/uploads\/2020\/12\/PastedGraphic-3.png 240w, https:\/\/admsu.org\/w\/wp-content\/uploads\/2020\/12\/PastedGraphic-3-225x300.png 225w\" sizes=\"auto, (max-width: 240px) 100vw, 240px\" \/><\/figure>\n\n\n\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"240\" height=\"320\" src=\"https:\/\/admsu.org\/w\/wp-content\/uploads\/2020\/12\/PastedGraphic-2.png\" alt=\"\" class=\"wp-image-553\" srcset=\"https:\/\/admsu.org\/w\/wp-content\/uploads\/2020\/12\/PastedGraphic-2.png 240w, https:\/\/admsu.org\/w\/wp-content\/uploads\/2020\/12\/PastedGraphic-2-225x300.png 225w\" sizes=\"auto, (max-width: 240px) 100vw, 240px\" \/><\/figure>\n\n\n\n<p><strong>Diagnostic ?<\/strong><\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Comment lire une radiographie de l&#8217;\u00e9paule<\/h2>\n\n\n\n<p>FACE<br>Rotation neutre (t\u00eate non en ampoule comme lors d\u2019une RI)<br>Interligne gl\u00e9no hum\u00e9ral &lt; 6 mm mais il doit \u00eatre visible ou non superpos\u00e9 \u00e0 la gl\u00e8ne<br>Gl\u00e8ne en cupule avec alignement de la ligne ant\u00e9rieure et post\u00e9rieure de la gl\u00e8ne pour n\u2019en former qu\u2019une seule (enfilement)<br>Espace acromio claviculaire&lt; 7 mm<br>Espace sous acromial (acromio- hum\u00e9ral) est entre 10 et 13 mm<\/p>\n\n\n\n<figure class=\"wp-block-image size-large is-resized\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/admsu.org\/w\/wp-content\/uploads\/2020\/12\/lgh-1024x465.png\" alt=\"\" class=\"wp-image-554\" width=\"768\" height=\"349\" srcset=\"https:\/\/admsu.org\/w\/wp-content\/uploads\/2020\/12\/lgh-1024x465.png 1024w, https:\/\/admsu.org\/w\/wp-content\/uploads\/2020\/12\/lgh-300x136.png 300w, https:\/\/admsu.org\/w\/wp-content\/uploads\/2020\/12\/lgh-768x349.png 768w, https:\/\/admsu.org\/w\/wp-content\/uploads\/2020\/12\/lgh-560x254.png 560w, https:\/\/admsu.org\/w\/wp-content\/uploads\/2020\/12\/lgh.png 1118w\" sizes=\"auto, (max-width: 767px) 89vw, (max-width: 1000px) 54vw, (max-width: 1071px) 543px, 580px\" \/><\/figure>\n\n\n\n<p>PROFIL<br>Gl\u00e8ne en face<br>Omoplate en Y<br>T\u00eate hum\u00e9rale en face de la gl\u00e8ne et au milieu de ce Y<\/p>\n\n\n\n<figure class=\"wp-block-image size-large is-resized\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/admsu.org\/w\/wp-content\/uploads\/2020\/12\/lgh_p.png\" alt=\"\" class=\"wp-image-555\" width=\"318\" height=\"390\" srcset=\"https:\/\/admsu.org\/w\/wp-content\/uploads\/2020\/12\/lgh_p.png 636w, https:\/\/admsu.org\/w\/wp-content\/uploads\/2020\/12\/lgh_p-245x300.png 245w, https:\/\/admsu.org\/w\/wp-content\/uploads\/2020\/12\/lgh_p-560x687.png 560w\" sizes=\"auto, (max-width: 318px) 100vw, 318px\" \/><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\">R\u00e9ponse<\/h2>\n\n\n\n<p><strong>c\u2019est une luxation gl\u00e9no hum\u00e9rale post\u00e9rieure<\/strong><\/p>\n\n\n\n<p>La radio de face est en r\u00e9alit\u00e9 en rotation interne ( car la patiente n\u2019a plus de rotation externe due \u00e0 sa luxation) : la t\u00eate hum\u00e9rale est en forme de &#8220;t\u00eate d\u2019ampoule&#8221;, la gl\u00e8ne n\u2019est pas enfil\u00e9e, et l\u2019espace gl\u00e9no hum\u00e9ral est inexistant.<\/p>\n\n\n\n<figure class=\"wp-block-image size-large is-resized\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/admsu.org\/w\/wp-content\/uploads\/2020\/12\/PastedGraphic-3-1.png\" alt=\"\" class=\"wp-image-557\" width=\"180\" height=\"240\" srcset=\"https:\/\/admsu.org\/w\/wp-content\/uploads\/2020\/12\/PastedGraphic-3-1.png 240w, https:\/\/admsu.org\/w\/wp-content\/uploads\/2020\/12\/PastedGraphic-3-1-225x300.png 225w\" sizes=\"auto, (max-width: 180px) 100vw, 180px\" \/><\/figure>\n\n\n\n<p><br>Sur le profil, on peut voir que la t\u00eate et l\u2019axe de la diaphyse sont pass\u00e9s &#8221; en arri\u00e8re \u00bb et sont donc post\u00e9rieurs au Y de la scapula<\/p>\n\n\n\n<figure class=\"wp-block-image size-large is-resized\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/admsu.org\/w\/wp-content\/uploads\/2020\/12\/PastedGraphic-2-1.png\" alt=\"\" class=\"wp-image-558\" width=\"180\" height=\"240\" srcset=\"https:\/\/admsu.org\/w\/wp-content\/uploads\/2020\/12\/PastedGraphic-2-1.png 240w, https:\/\/admsu.org\/w\/wp-content\/uploads\/2020\/12\/PastedGraphic-2-1-225x300.png 225w\" sizes=\"auto, (max-width: 180px) 100vw, 180px\" \/><\/figure>\n\n\n\n<p><strong>Attention donc quand la radiographie de face n\u2019est pas vraiment de face!!!<\/strong><\/p>\n\n\n\n<p>Soit l\u2019incidence est mal faite et dans ce cas la, si vous avez un gros doute clinique il faut demander \u00e0 refaire la radio<br>soit la patiente a perdu toute rotation externe , ne peut donc mettre son \u00e9paule convenablement pour que la radio soit correctement r\u00e9alis\u00e9e et ceci doit vous mettre la puce \u00e0 l\u2019oreille<\/p>\n\n\n\n<p><strong>M\u00e9canisme traumatique important ( conventionnellement crise \u00e9pileptique, gros traumatisme) + perte totale de rotation externe = doivent vous faire suspecter une luxation post\u00e9rieure<\/strong><\/p>\n\n\n\n<p><\/p>\n","protected":false},"excerpt":{"rendered":"<p>bien lire une radiographies de l&#8217;\u00e9paule traumatique<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[92,93],"class_list":["post-551","post","type-post","status-publish","format-standard","hentry","category-non-classe","tag-luxation-gleno-humerale","tag-qualite-dune-radiographie"],"_links":{"self":[{"href":"https:\/\/admsu.org\/w\/wp-json\/wp\/v2\/posts\/551","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/admsu.org\/w\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/admsu.org\/w\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/admsu.org\/w\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/admsu.org\/w\/wp-json\/wp\/v2\/comments?post=551"}],"version-history":[{"count":5,"href":"https:\/\/admsu.org\/w\/wp-json\/wp\/v2\/posts\/551\/revisions"}],"predecessor-version":[{"id":565,"href":"https:\/\/admsu.org\/w\/wp-json\/wp\/v2\/posts\/551\/revisions\/565"}],"wp:attachment":[{"href":"https:\/\/admsu.org\/w\/wp-json\/wp\/v2\/media?parent=551"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/admsu.org\/w\/wp-json\/wp\/v2\/categories?post=551"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/admsu.org\/w\/wp-json\/wp\/v2\/tags?post=551"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}