I suffer from a dysgraphic dystrophy following my acromioplasty procedure. This worries me because the more I have been off work for more than 6 months while I had been predicting rapid and benign consequences. How is this possible and what are the possible treatments?

Author of the answer : Dr Régis GuinandCatégorie : Générale

Hello Madam, the consequences of a shoulder surgery (members in general), as ‘light’ as it (isolated acromioplasty), can be unfortunately complex and prolonged type of RSD.

The origin is reactive and multifactorial (duration of evolution of pain, notion of chronic pain well printed in the nervous system, female sex, ground of anxiety …).
Your case is not isolated (10 to 20% of operated patients).
This frequency and the potential socio-professional consequences deserve that this risk be addressed during the pre-surgical consultation.

You will find a link to an information sheet concerning the painkillers and its possible treatments, including specific ones offered by pain doctors.
Good luck and do not lose hope!

In physiotherapy for my tendinitis of the headdress I get a massage and then I place electrodes, without any effect … What else can be done?

Author of the answer : Sébastien TraversCatégorie : Générale

Hello, my opinion on the treatment of the shoulder in rehabilitation obviously depends on the reasons of appearance of your tendinitis.
In a very general way, all our team think that the rehabilitation of the shoulder must be mainly manual (not necessarily very long sessions).
As a general rule, a shoulder that goes wrong is decentered and there is no durable solution without manual refocusing.

I suffer from an inflammation of the tendons of the headdress especially at night despite the strengthening of the step-downs advocated by my physiotherapist, is this normal and adapted?

Author of the answer : Sébastien TraversCatégorie : Générale

I am not precise about the exams that you have passed but if your problem is related to a conflict under acromial, you must actually try to lower the humeral head.

Rehabilitation has evolved a lot in recent years and we think that the way to go is not to strengthen the so-called depressing muscles (which are the pectoralis major, the dorsal and the big round) which are already strong naturally and have a
Offset action of the shoulder, but rather to manually refocus your shoulder at first while stabilizing and balancing your shoulder blade which will cause a decrease in your pain related to inflammation.

In a second time, a reinforcement will be necessary but of short muscles which have an action on the diminution of your conflict (infra spinous and small round) and which tend rather to be weak.
I hope to have answered your question. Do not hesitate to contact me by email if you want more information.

Why did not I see my fracture of the humerus after my fall? Have I been badly cared for?

Author of the answer : Dr Régis GuinandCatégorie : Générale

Shoulder trauma is a common reason for consultation in an emergency department.

However, there is no constant parallelism between the pain level (or functional impotence) and the existence of serious lesions.

X-rays of the shoulder may appear normal immediately after the accident, so we can miss an undisposed fracture (just like the scaphoid bone on the wrist).
This is why caution is to offer joint rest, and in case of persistence to re-consult to 8 10 days a doctor may request additional tests to ensure ‘no lesions …

I do not understand anything about the reimbursements of the social security and my mutual concerning the overtaking of fees !!

Author of the answer : Dr Régis GuinandCatégorie : Générale

In the field of orthopedic surgical procedures, social security fully reimburses the ‘base’ cost of an operation (except cosmetic surgery and certain assimilated acts), ie 100% of the safety rate.

So if your mutual shows a support of 100% of the safety rate it does not actually support … nothing at all!

In order for your mutual insurance company to cover a fee overrun, it is necessary that the rate displayed on your insurance or mutual insurance contract be greater than 100% or that the coverage is ‘at actual expense’.

an intervention has a security tariff of 300 euros, the security reimburses 300 euros (100%) …
A surpass of 300 euros is practiced by the surgeon (the doubling of the safety rate), it will be refunded in full by your complementary organization (mutual, insurance) provided that your contract specifies a rate of assumption of 200% (the 100
first% it is the safety that refunds): estimate of 600 euros in total (300 300)

In case of 140% contract you will be refunded the value of 40% of the safety rate is 120 euros, so it will remain 180 euros at your expense …

In general the cards of the body summarizing the care does not specify the support for overruns but are subject to prior agreement on presentation of a quote … which is not to facilitate the task!

An estimate is systematically made for any excess of fees …
It engages you after agreement like any estimate of a craftsman …

My doctor hesitates between an MRI of my shoulder and an arthro-scanner … Which examination to realize? Is not the MRI more modern, precise?

Author of the answer : Dr Régis GuinandCatégorie : Générale

The prescription of such examinations requires a medical consultation so that it is justified in terms of public expenditure …

That being said, these exams are complementary:

– CT arthrography (which includes joint injection of iodine) is still the gold standard for the study of bone, cartilage (osteoarthritis), ligaments (shoulder dislocations) and tendon rupture.
It is easier to obtain but is radiating and invasive …

– MRI mainly gives information on soft tissues, on the presence of inflammation or vascularization (blood flow). Our team prescribes for the assessment of tendinitis, arthritis (joints), muscle lesions, tumors etc … It may also be accompanied by a joint injection to better search tendon ruptures of the cuff including but remains in France a review yet long and difficult to obtain although not irradiating.

I have a sore shoulder and need to consult a specialist, what additional exams to bring in order to save time ??

Author of the answer : Dr Régis GuinandCatégorie : Générale

Without knowing what exactly you are suffering from it is generally advisable to come with simple X-rays of the shoulder.

These basic examinations are often ‘forgotten’ by the doctor or more generally are not reported during the consultation by the patient thinking that they have no interest because they are ‘normal’ …

In fact even normal they bring a lot of information for the surgeon in particular the varieties of forms of the bones (acromion and possible presence of calcification of the cap, osteoarthritis in particular).

An ultrasound is a useful descrambling examination in case of pathology of the tendons of the cuff before a consultation but in general any examination must be motivated by a medical reason and therefore by the doctor performing the consultation.

In the context of an osteoarthritis or dislocation assessment, an arthrotcanner is very useful whereas in the case of tendinitis (after ultrasound does not show tendon rupture) MRI will be preferable …

What is an operation under arthroscopy?

Author of the answer : Dr Régis GuinandCatégorie : Générale

An arthroscopy is a way to explore a joint without opening the skin (surgery through the skin.) It can also be called joint laparoscopy This is a minimally invasive surgery whose purpose is to reduce the morbidity of the surgical procedure itself.

Regarding the shoulder more and more acts are possible under arthroscopy, the approach of the shoulder is radically different because one explores the shoulder effortlessly compared to open surgery.
The latest innovations concern the release of the suprascapular nerve under endoscopy, the acromioclavicular stabilization under endoscopy and recently the abutment under arthroscopy.

What is a surpassing fee, what is sector 2?

Author of the response: Dr. Régis Guinand    Catégorie : Générale

The tariffs of sector 2 doctors with free fees include a part not reimbursed by the social security and therefore at the expense of the patient. This portion can be reimbursed by your mutual or complementary body.
The amount of the excess fee is decided by the doctor legally.

The authorization comes from the political power in the 80s because he did not want to increase the tariffs of the medical acts.
Some doctors have chosen to practice in sector 2 after spending 2 years to improve (former hospital assistant and / or head of clinic hospitals).
The overrun is a supplement to allow the doctors concerned to have rates in line with the reality of what the prices would be today or to be related to the added value of their experience or their medical or surgical expertise .
Ethics requires that they be practiced with ‘tact and measure’ (a vague notion whose limit has recently been specified at 150% of the safe rate of operative acts).