Purpose of the study: The purpose of the study was to present the clinical and arthroscan results obtained in a prospective series of 32 patients who underwent Bankart arthroscopy. We wanted to identify concrete applications.

Material and methods: These 32 patients presented unidirectional anterior shoulder instability with a history of true dislocation. Unstable painful shoulders, multidirectional dislocations, and HAGL injuries were excluded as well as rotator cuff tears. An arthroscopic treatment was used in all cases, followed by the same rehabilitation protocol. All patients were reviewed at six months. External rotation (RE1 and RE2) and Gagey hyperabduction were noted as well as the Walch-Duplay, Rowe, and ISIS scores. Plain x-rays and an arthroscan were obtained preoperatively and postoperatively. Attention was focused on passage bone lesions, healing, and changes in volume of the inferior recessus after surgery.

Results: Mean follow-up was 17.1 months (range 6.5–31.3), mean age 26.3 years (range 17–46), sex-ration predominantly male: 4.3/1. Hyperlaxity was noted for 53.1% of the shoulders. The overall subjective result was unchanged since the conclusions at the 1993 SFA while the overall objective result improved. There was a significantly favourable absence of preoperative passage bone lesions. The negation of the Gagey sign and the decrease in external rotation were signs of restoration of effective capsule tension (p< 0.05) which was ofen associated with a decline in the volume of the inferior recessus, although the difference has not yet reached the level of significance.

Discussion: The very favourable results in cases free of preoperative bone lesions are in favour of early surgery, perhaps after a first dislocation. Negation of the Gagey sign and decreased external rotation are two simple reproducible postoperative signs useful for assessing the efficacy of anterior and inferior capsule tension; complementary imaging may not be necessary. Evaluation of the volume of the inferior recessus needs to be continued using a precise reproducible protocol taking into account for the rotation of the upper limb and the quantity of contrast product injected into the joint.

Conclusion: This study demonstrated results comparable with publications in the literature allowing a direct clinical application for postoperative assessment. Inclusion of new cases should confirm the pertinence of arthroscan measurement of the volume of the inferior recessus.

Purpose of the study: The objective was to analyse shoulder motion, particularly abduction and anterior elevation, in patients with an reversed prosthesis. A radiocinematographic study enable an analysis of the movements of the prosthesis it self and movements due to scapulothoracic participation.

Material and methods: This study was based on the analysis of 33 patients with an reversed shoulder prosthesis. A videoscopic recording (25 images per second) of anterior elevation from a workstation used for abduction arteriography was used. The Constant score was noted and a standard x-ray work-up (four views) was obtained for all patients.

Results: The cohort was a homogeneous continuous series of 21 women and 12 men, mean age 72.5 years (range 39–84). Two modes of motion were observed. The first (group 12, n=17 shoulders) was «monoarticular»: shoulder motion was almost exclusively related to movement of the scapulothoracic junction. Abduction did not exceed 90°. The second mode (group 2, n=16 shoulders) was «bi-articular»: joint motion began with the prosthesis (50° on average) followed by scapulothoracic participation (50° on average). The implant then was involved in the final part of the motion (in six of the 16 shoulders in group 2) to complete the range of motion exceeding 120° abduction and anterior elevation.

Discussion: This study confirmed the presence of an initial intrinsic mobility of the prosthesis followed by scapulothoracic participation. It was noted however, that for the majority of cases, the intrinsic mobility of the prosthesis was limited. In all cases, the range of motion recorded by clinical examination was greater than the range of motion measured objectively by radiocinematography.

Discussion: This study demonstrated the in vivo mobility of the reversed prosthesis. However, a range of motion greater than 100° anterior elevation and abduction is exceptional. Clinical findings reflect imperfectly the real mobility of this type of prosthesis.

Purpose of the study: Morton neurinoma is a well defined anatomic entity despite certain questions about the pathogenic mechanisms. Diagnosis of the metatarsalgia sometimes produced can be difficult due to the frequency of an associated static metatarsalgia. Magnetic resonance imaging has not met expectations. We have oriented our research towards ultrasonography which can provide high quality information with good reliability.

Material and methods: We reviewed the files of 11 patients with Morton neurinoma which led to 14 operations (bilateral cases or two localizations on the same foot). The series included three men and eight women, mean age 56 years. The operation was conducted under locoregional anesthesia and consisted in tumor resection via the plantar commissure, with removal of the entire neurinoma. Ultrasonography used a high-frequency probe (6–13 MHz linear scan). The compartments were studied via the plantar aspect and the dorsal aspect using static and stress positions. MRI had been performed in two patients before the ultrasound.

Results: Eight of the eleven patients had an associated syndrome (hallux valgus, disharmonious length with mid metatarsal weight bearing). Objective signs (Mudler’s sign, hyoesthesia), were noted in seven patients. The neurinoma was confirmed in all cases at surgery; in two cases, ultrasonography demonstrated a neurinoma where the MRI had been negative. The operative specimen was typical. Two compartments were explored because of the ultrasound results which were highly suggestive; two tumors were demonstrated at surgery. Clinical outcome at mean seven months was good in ten patients and fair in one.

Discussion: Ultrasonography should no longer be considered as «operator-dependent». It enables the detection of mid-sized neurinomas measuring about 2 cm. Magnetic resonance imaging has been less productive for diagnosis; many studies have been reported without surgical confirmation of MRI-negative cases. False negatives are frequent and patient follow-up is insufficient to determine whether the symptoms persist or resolve after surgery.

Conclusion: Ultrasonography is a simple examination devoid of iatrogenic risk. The use of stress images has greatly improved performance. This low cost examination may not however be necessary because the diagnosis of Morton is basically clinical.