{"id":7203,"date":"2025-12-26T11:48:27","date_gmt":"2025-12-26T10:48:27","guid":{"rendered":"https:\/\/kineaphp.fr\/?p=7203"},"modified":"2025-12-27T14:17:21","modified_gmt":"2025-12-27T13:17:21","slug":"instabilite-depaule","status":"publish","type":"post","link":"https:\/\/kineaphp.fr\/?p=7203","title":{"rendered":"Instabilit\u00e9 d&rsquo;\u00e9paule"},"content":{"rendered":"\n<h2 class=\"wp-block-heading\">Introduction<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\">D\u00e9finition<\/h3>\n\n\n\n<p>L&rsquo;\u00e9paule, articulation du corps humain, poss\u00e8de la plus grande amplitude de mouvement et n\u00e9cessite donc un \u00e9quilibre d\u00e9licat entre stabilit\u00e9 et mobilit\u00e9. L&rsquo;articulation gl\u00e9nohum\u00e9rale pr\u00e9sente deux principales cat\u00e9gories d&rsquo;instabilit\u00e9&nbsp;: macro-instabilit\u00e9 et micro-instabilit\u00e9. <\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>La macro-instabilit\u00e9 peut \u00eatre traumatique ou atraumatique, avec une luxation ant\u00e9rieure ou post\u00e9rieure de la t\u00eate hum\u00e9rale.<\/li>\n\n\n\n<li>La micro-instabilit\u00e9 rel\u00e8ve de l&rsquo;instabilit\u00e9 acquise, plus large, survenant dans une \u00e9paule sursollicit\u00e9e par des contraintes articulaires r\u00e9p\u00e9t\u00e9es. <\/li>\n\n\n\n<li>L&rsquo;instabilit\u00e9 traumatique ant\u00e9rieure est la plus fr\u00e9quente et une l\u00e9sion relativement courante chez les jeunes et les sportifs.&nbsp;<sup data-fn=\"a2456558-b972-409a-9b7a-1d26f1256d4a\" class=\"fn\"><a href=\"#a2456558-b972-409a-9b7a-1d26f1256d4a\" id=\"a2456558-b972-409a-9b7a-1d26f1256d4a-link\">1<\/a><\/sup><\/li>\n<\/ul>\n\n\n\n<p>L&rsquo;instabilit\u00e9 de l&rsquo;\u00e9paule correspond \u00e0 la s\u00e9paration de la t\u00eate hum\u00e9rale de la fosse gl\u00e9no\u00efde. L&rsquo;objectif de la r\u00e9\u00e9ducation est de r\u00e9tablir la mobilit\u00e9, la force et le fonctionnement sans douleur.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Les composantes de l&rsquo;instabilit\u00e9<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Les patient peuvent ressentir des sympt\u00f4mes sans instabilit\u00e9<\/li>\n\n\n\n<li>Ils peuvent \u00eatre hyperlaxe en \u00e9tant asymptomatique<\/li>\n\n\n\n<li>Ils peuvent pr\u00e9senter une subluxation de l&rsquo;\u00e9paule sans sympt\u00f4mes<\/li>\n<\/ul>\n\n\n\n<p>Par cons\u00e9quent, pour que la d\u00e9finition de l&rsquo;instabilit\u00e9 soit remplie, les patients doivent ressentir une g\u00eane et une sensation de rel\u00e2chement, de glissement ou de d\u00e9bo\u00eetement de l&rsquo;\u00e9paule <sup data-fn=\"e6a8ff1e-f0fb-4f00-bc17-ec9b9ce594be\" class=\"fn\"><a href=\"#e6a8ff1e-f0fb-4f00-bc17-ec9b9ce594be\" id=\"e6a8ff1e-f0fb-4f00-bc17-ec9b9ce594be-link\">2<\/a><\/sup><\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Les facteurs d&rsquo;un fonctionnement optimal de l&rsquo;\u00e9paule<\/h3>\n\n\n\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\">\n<p>Une \u00e9paule optimale d\u00e9pend de l&rsquo;intrication interd\u00e9pendante de plusieurs facteurs :<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Mobilit\u00e9<\/li>\n\n\n\n<li>Force<\/li>\n\n\n\n<li>Stabilit\u00e9<\/li>\n\n\n\n<li>Contr\u00f4le moteur<\/li>\n\n\n\n<li>Facteurs psycho-sociaux <sup data-fn=\"b7a97d66-014d-426b-8a34-3d22cd2bfb73\" class=\"fn\"><a href=\"#b7a97d66-014d-426b-8a34-3d22cd2bfb73\" id=\"b7a97d66-014d-426b-8a34-3d22cd2bfb73-link\">3<\/a><\/sup><\/li>\n<\/ul>\n<\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"371\" height=\"309\" src=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/12\/image-42.png\" alt=\"\" class=\"wp-image-7216\" srcset=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/12\/image-42.png 371w, https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/12\/image-42-300x250.png 300w\" sizes=\"auto, (max-width: 371px) 100vw, 371px\" \/><\/figure>\n<\/div>\n<\/div>\n\n\n\n<h3 class=\"wp-block-heading\">Diff\u00e9rence entre laxit\u00e9 et instabilit\u00e9<\/h3>\n\n\n\n<p><strong>Laxit\u00e9<\/strong> <\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Asymptomatique<\/li>\n\n\n\n<li>Physiologique<\/li>\n\n\n\n<li>Cong\u00e9nitale ou acquise<\/li>\n\n\n\n<li>Laxit\u00e9 ligamentaire g\u00e9n\u00e9ralis\u00e9e (syndrome d&rsquo;Ehler-Danlos) diagnostiqu\u00e9 par le <a href=\"https:\/\/yvancudem.wordpress.com\/wp-content\/uploads\/2022\/12\/score-de-beighton.pdf\">score de Beighton<\/a><\/li>\n\n\n\n<li>Peut d\u00e9pendre du genre, d\u00e9veloppement musculaire, facteurs g\u00e9n\u00e9tiques, \u00e2ge\u2026<\/li>\n<\/ul>\n\n\n\n<p><strong>Instabilit\u00e9<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Symptomatique (douleurs, faiblesse\u2026)<\/li>\n\n\n\n<li>Mouvement anormal de l\u2019\u00e9paule menant \u00e0 la douleur, la subluxation, la luxation<\/li>\n\n\n\n<li>Acquise<\/li>\n\n\n\n<li>D\u00e9ficit des \u00e9l\u00e9ments stabilisateurs actifs et\/ou passifs de la GH<\/li>\n\n\n\n<li>Unidirectionnelle, multidirectionnelle<\/li>\n<\/ul>\n\n\n\n<p>Laxit\u00e9 et instabilit\u00e9 = exc\u00e8s de translation de la t\u00eate hum\u00e9rale sur la gl\u00e8ne<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Patho-m\u00e9canisme de l\u2019instabilit\u00e9 d\u2019\u00e9paule<\/h3>\n\n\n\n<p><strong>2 m\u00e9canismes principaux conduisant \u00e0 l\u2019instabilit\u00e9 d\u2019\u00e9paule<\/strong> <\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>un \u00e9pisode traumatique franc (chute sur le bras)<\/li>\n\n\n\n<li>une r\u00e9p\u00e9tition de microtraumatismes (souvent dans les sports au-dessus de la t\u00eate)<\/li>\n<\/ul>\n\n\n\n<p><strong>Pour une apparition des sympt\u00f4mes, il faut une perturbation structurelle et\/ou non-structurelle<\/strong> <\/p>\n\n\n\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\">\n<h4 class=\"wp-block-heading\">Perturbation structurelle <\/h4>\n\n\n\n<p>Atteinte de la coiffe des rotateurs, du complexe capsulo-labral, de la congruence osseuse<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>L\u00e9sion du labrum ant\u00e9rieur (L\u00e9sion de Bankart) avec d\u00e9tachement du ligament gl\u00e9no-hum\u00e9ral inf\u00e9rieur<\/li>\n\n\n\n<li>La l\u00e9sion \u00ab Bankart invers\u00e9e \u00bb : luxations post\u00e9rieures avec l\u00e9sion du labrum post\u00e9rieur<\/li>\n\n\n\n<li>La l\u00e9sion SLAP (Superior Labrum Anterior and Posterior) : l\u00e9sion du labrum sup\u00e9rieur qui emporte l\u2019insertion du long biceps.<\/li>\n<\/ul>\n<\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"438\" height=\"341\" src=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/12\/image-43.png\" alt=\"\" class=\"wp-image-7229\" srcset=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/12\/image-43.png 438w, https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/12\/image-43-300x234.png 300w\" sizes=\"auto, (max-width: 438px) 100vw, 438px\" \/><\/figure>\n<\/div>\n<\/div>\n\n\n\n<h4 class=\"wp-block-heading\">Perturbation non-structurelle<\/h4>\n\n\n\n<p>Alt\u00e9ration du syst\u00e8me nerveux (central ou p\u00e9riph\u00e9rique) : instabilit\u00e9 sans \u00e9v\u00e9nement traumatique <\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Contexte de laxit\u00e9<\/li>\n\n\n\n<li>Contr\u00f4le musculaire non-efficient<\/li>\n\n\n\n<li>Hyperlaxit\u00e9 (g\u00e9n\u00e9ralis\u00e9e ou cong\u00e9nitale)<\/li>\n\n\n\n<li>Pathologies neurologiques<\/li>\n\n\n\n<li>Facteurs psychologiques et\/ou \u00e9motionnels (anxi\u00e9t\u00e9, stress, facteurs cognitifs)<\/li>\n<\/ul>\n\n\n\n<h5 class=\"wp-block-heading\">D\u00e9faut d\u2019activation musculaire <\/h5>\n\n\n\n<p>Il fait potentiellement suite \u00e0 une douleur, un d\u00e9rangement interne (e.g. labrum), une fatigue musculaire, un d\u00e9s\u00e9quilibre de tension musculaires, une alt\u00e9ration de m\u00e9canisme due \u00e0 un d\u00e9ficit en rotation interne gl\u00e9no-hum\u00e9rale, ou une compensation pathologique due \u00e0 l\u2019instabilit\u00e9 chronique. Ce d\u00e9faut d\u2019activation musculaire peut aussi survenir dans le cadre d\u2019une instabilit\u00e9 traumatique ayant n\u00e9cessit\u00e9 une immobilisation et donc une faiblesse musculaire. Il se traduit g\u00e9n\u00e9ralement par l\u2019inhibition des muscles subscapulaires, supra-\u00e9pineux, dentel\u00e9 ant\u00e9rieur et trap\u00e8ze inf\u00e9rieur, ainsi qu\u2019une augmentation de recrutement des muscles grand dorsal, grand et petit pectoral.<br>L\u2019augmentation anormale de l\u2019activit\u00e9 du grand pectoral cause une translation ant\u00e9rieure de la t\u00eate hum\u00e9rale, pouvant aller jusqu\u2019\u00e0 produire une luxation ant\u00e9rieure. Le delto\u00efde est un stabilisateur inf\u00e9rieur majeur. Sa fonction est d\u2019autant plus importante lorsque l\u2019\u00e9paule devient instable. Par cons\u00e9quent, lorsque le grand pectoral et le grand dorsal d\u00e9s\u00e9quilibrent le complexe en faveur d\u2019une translation ant\u00e9rieure, le delto\u00efde post\u00e9rieur va tenter de compenser ce d\u00e9s\u00e9quilibre. Parfois, cette suractivation occasionne une instabilit\u00e9 post\u00e9rieure.<\/p>\n\n\n\n<h5 class=\"wp-block-heading\">D\u00e9ficit de contr\u00f4le musculaire et dyskin\u00e9sies de la scapula<\/h5>\n\n\n\n<p>Les instabilit\u00e9s gl\u00e9no-hum\u00e9rale ont initialement des alt\u00e9rations de position des scapulas ou<br>des dyskin\u00e9sies scapulaires. Le sch\u00e9ma de contraction induit une protraction de la scapula (augmentation de la sonnette m\u00e9diale, de l\u2019abduction et du tilt ant\u00e9rieur de la scapula) lors de l\u2019\u00e9l\u00e9vation de l\u2019\u00e9paule. Ceci a pour cons\u00e9quences de diminuer la compression de la t\u00eate hum\u00e9rale et favoriser l\u2019instabilit\u00e9.<br>En effet, une position anormale de la scapula due \u00e0 un contr\u00f4le musculaire pathologique a, possiblement, des r\u00e9percussions sur les structures passives de l\u2019articulation gl\u00e9no-hum\u00e9rale, telle qu\u2019une augmentation de charge sur les ligaments ou une compression plus importante du labrum.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Les classifications<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\">La classification de Stanmore<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>L&rsquo;instabilit\u00e9 de l&rsquo;\u00e9paule peut \u00eatre due \u00e0 des facteurs \u00e0 la fois structurels et non structurels. La classification, et par cons\u00e9quent la prise en charge, doit tenir compte de ces facteurs pour garantir une stabilit\u00e9 fonctionnelle. <\/li>\n\n\n\n<li>3 types d&rsquo;instabilit\u00e9 de l&rsquo;\u00e9paule sont propos\u00e9es, prenant en compte les composantes structurelles et non structurelles et soulignant le continuum entre les pathologies. <\/li>\n\n\n\n<li>Les causes structurelles peuvent \u00eatre trait\u00e9es chirurgicalement, tandis que les causes non structurelles, telles qu&rsquo;une alt\u00e9ration du contr\u00f4le neuromusculaire au sein de la coiffe des rotateurs, doivent \u00eatre abord\u00e9es de mani\u00e8re conservatrice.&nbsp;<sup data-fn=\"8f86975e-47b6-451d-a48e-18866fc196b5\" class=\"fn\"><a href=\"#8f86975e-47b6-451d-a48e-18866fc196b5\" id=\"8f86975e-47b6-451d-a48e-18866fc196b5-link\">4<\/a><\/sup><\/li>\n<\/ul>\n\n\n\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:66.66%\">\n<ul class=\"wp-block-list\">\n<li>Type I (Instabilit\u00e9 structurelle)<\/li>\n\n\n\n<li>Type II (instabilit\u00e9 atraumatique)<\/li>\n\n\n\n<li>Type III (dysfonctionnement neurologique ou sch\u00e9ma musculaire)<\/li>\n<\/ul>\n<\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\" style=\"flex-basis:33.33%\">\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"300\" height=\"223\" src=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/12\/image-40.png\" alt=\"\" class=\"wp-image-7212\"\/><\/figure>\n<\/div>\n<\/div>\n\n\n\n<h3 class=\"wp-block-heading\">Classification FEDs<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>F = fr\u00e9quence : Unique : 1 \u00e9pisode \/ Occasionnel : 2-5 \u00e9pisodes \/ Fr\u00e9quent : &gt; 5 \u00e9pisodes<\/li>\n\n\n\n<li>E = \u00e9tiologie : Traumatique \/ Atraumatique<\/li>\n\n\n\n<li>D = direction : Ant\u00e9rieure \/ Post\u00e9rieure \/ Inf\u00e9rieure<\/li>\n\n\n\n<li>S = s\u00e9v\u00e9rit\u00e9- Subluxation (garde encore un contact articulaire) \/ Luxation (plus de contact articulaire)<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\">Luxation ant\u00e9rieure<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\">\u00c9pid\u00e9miologie<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Age entre 20 et 30 ans, pic en fin d\u2019adolescence<\/li>\n\n\n\n<li>Subluxation ant\u00e9rieure : 80%- Traumatisme (95%)<\/li>\n\n\n\n<li>Jeunes athl\u00e8tes et population active : 18x + de chance<\/li>\n\n\n\n<li>H &gt; F<\/li>\n\n\n\n<li>R\u00e9cidive : si 1\u00e8re luxation en dessous de 20 ans, il y a 80 \u00e0 100% de risque d\u2019avoir un second \u00e9pisode dans les 2 ann\u00e9es \u00e0 venir<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">M\u00e9canisme l\u00e9sionnel<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>ABD-RE contr\u00e9e\/forc\u00e9e<\/li>\n\n\n\n<li>Choc direct avec une chute sur le bras<\/li>\n\n\n\n<li>Force post\u00e9rieure de l\u2019hum\u00e9rus<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">L\u00e9sions associ\u00e9es<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>L\u00e9sion de Bankart = l\u00e9sion du labrum et de la capsule<\/li>\n\n\n\n<li>L\u00e9sion osseuse : \u00ab encoche de Malgaigne \u00bb<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Diagnostic<\/h3>\n\n\n\n<h4 class=\"wp-block-heading\">Imagerie<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Radio : confirmer la r\u00e9duction \/ voir les l\u00e9sions associ\u00e9es<\/li>\n\n\n\n<li>Arthroscanner : permet d\u2019opacifier la cavit\u00e9 articulaire \/ Met en \u00e9vidence une fissure profonde ou d\u00e9sinsertion compl\u00e8te du bourrelet gl\u00e9no\u00efdien<\/li>\n\n\n\n<li>IRM : met en \u00e9vidence l\u2019\u00e9tat de la CDR<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">Tests<\/h4>\n\n\n\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\">\n<p><a href=\"https:\/\/www.piriforme.fr\/bdd\/orthopedie\/epaule\/relocation\">Test de recentrage (\u00ab\u00a0Jobe&rsquo;s relocation test\u00a0\u00bb)<\/a> : patient en d\u00e9cubitus dorsal, bras en R3 avec t\u00eate hum\u00e9rale pouss\u00e9e ant\u00e9rieurement (position du <a href=\"https:\/\/www.piriforme.fr\/bdd\/orthopedie\/epaule\/apprehension\">test d&rsquo;appr\u00e9hension ant\u00e9rieure<\/a>). Si cette position reproduit la douleur, le MK applique une pouss\u00e9e de la t\u00eate hum\u00e9rale post\u00e9rieurement. Le test est positif si cette pouss\u00e9e soulage les sympt\u00f4mes du patient.<\/p>\n<\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/www.piriforme.fr\/sites\/default\/files\/inline-images\/epaule-apprehension-ant.png\" alt=\"\"\/><\/figure>\n<\/div>\n<\/div>\n\n\n\n<h3 class=\"wp-block-heading\">Traitements<\/h3>\n\n\n\n<h4 class=\"wp-block-heading\">Chirurgie<\/h4>\n\n\n\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:66.66%\">\n<h5 class=\"wp-block-heading\">Chirurgie de Latarjet<\/h5>\n\n\n\n<p>Consiste \u00e0 pr\u00e9lever le processus coraco\u00efde et le d\u00e9placer pr\u00e8s de la gl\u00e8ne pour cr\u00e9er une but\u00e9e osseuse. Chirurgie permet :<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Triple verrouillage\n<ul class=\"wp-block-list\">\n<li>Augmentation de la surface articulaire par la pose du pr\u00e9l\u00e8vement de la coraco\u00efde affleurante \u00e0 la gl\u00e8ne<\/li>\n\n\n\n<li>Le tendon conjoint du court brachial et coraco-brachial qui vient crocheter la t\u00eate hum\u00e9rale en avant pourf ormer une ceinture de s\u00e9curit\u00e9 dans la position d\u2019ABD et RE \u00e0 90\u00b0<\/li>\n\n\n\n<li>Renfort ant\u00e9rieur par le ligament coraco-acromial<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>Taux de r\u00e9cidive faible : 0% \u00e0 9,6%, mais reprise tr\u00e8s difficile<\/li>\n\n\n\n<li>Complications possibles : douleurs, lyse de la but\u00e9e, pseudarthrose<\/li>\n<\/ul>\n<\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\" style=\"flex-basis:33.33%\">\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"484\" height=\"506\" src=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/12\/image-44.png\" alt=\"\" class=\"wp-image-7243\" srcset=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/12\/image-44.png 484w, https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/12\/image-44-287x300.png 287w\" sizes=\"auto, (max-width: 484px) 100vw, 484px\" \/><\/figure>\n<\/div>\n<\/div>\n\n\n\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:66.66%\">\n<h5 class=\"wp-block-heading\">Chirurgie de Bankart<\/h5>\n\n\n\n<ul class=\"wp-block-list\">\n<li>R\u00e9paration anatomique : coudre le labrum \u00e0 la gl\u00e8ne<\/li>\n\n\n\n<li>Taux r\u00e9cidive : 6,3%-35,3%<\/li>\n\n\n\n<li>FDR de r\u00e9cidive : fracture de la gl\u00e8ne.<\/li>\n<\/ul>\n<\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\" style=\"flex-basis:33.33%\">\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"data:image\/jpeg;base64,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\" alt=\"\"\/><\/figure>\n<\/div>\n<\/div>\n\n\n\n<h3 class=\"wp-block-heading\">R\u00e9\u00e9ducation<\/h3>\n\n\n\n<h4 class=\"wp-block-heading\">Instabilit\u00e9 non op\u00e9r\u00e9e<\/h4>\n\n\n\n<h5 class=\"wp-block-heading\">Principes<\/h5>\n\n\n\n<ul class=\"wp-block-list\">\n<li>R\u00e9duire les douleurs<\/li>\n\n\n\n<li>Normaliser la cin\u00e9matique articulaire<\/li>\n\n\n\n<li>Restaurer la stabilit\u00e9 de l\u2019\u00e9paule : coaptation de la GH + scapula<\/li>\n\n\n\n<li>Reprogrammer le complexe neuro-musculaire de l\u2019\u00e9paule<\/li>\n\n\n\n<li>Retrouver confiance de son \u00e9paule.<\/li>\n<\/ul>\n\n\n\n<h5 class=\"wp-block-heading\">Protocole Watson <\/h5>\n\n\n\n<ul class=\"wp-block-list\">\n<li>D\u00e9velopp\u00e9 plus sp\u00e9cifiquement pour l\u2019instabilit\u00e9 multidirectionnelle d\u2019\u00e9paule <sup data-fn=\"70a1aa2a-9237-4627-9dd3-bd4477cd32bf\" class=\"fn\"><a href=\"#70a1aa2a-9237-4627-9dd3-bd4477cd32bf\" id=\"70a1aa2a-9237-4627-9dd3-bd4477cd32bf-link\">5<\/a><\/sup> caract\u00e9ris\u00e9e par un mauvais positionnement de la scapula sur toute l&rsquo;amplitude du mouvement et une alt\u00e9ration du sch\u00e9ma musculaire<\/li>\n\n\n\n<li>Principe : renforcement des muscles de l&rsquo;omoplate et de la coiffe des rotateurs compense le manque de stabilit\u00e9 passive et contribue au contr\u00f4le actif de l&rsquo;\u00e9paule.<\/li>\n\n\n\n<li>Le programme Watson repose principalement sur la r\u00e9\u00e9ducation et le maintien d&rsquo;un bon contr\u00f4le des omoplates et de la main, \u00e0 travers six \u00e9tapes. La position corrective qui am\u00e9liore le plus les sympt\u00f4mes du patient est celle qui est r\u00e9apprise et adopt\u00e9e tout au long du programme Watson.<\/li>\n\n\n\n<li>Correction de la scapula et\/ou de la t\u00eate hum\u00e9rale. La correction scapulaire est r\u00e9alis\u00e9e en soutenant l&rsquo;omoplate du patient sous l&rsquo;aisselle, soit pendant l&rsquo;amplitude des mouvements, soit lors d&rsquo;un test de force isom\u00e9trique\n<ul class=\"wp-block-list\">\n<li>a) la scapula lors d&rsquo;une RL en R1<\/li>\n\n\n\n<li>b) Correction post\u00e9ro-ant\u00e9rieure de la t\u00eate hum\u00e9rale lors de la flexion<\/li>\n\n\n\n<li>c) Correction ant\u00e9ro-post\u00e9rieure de la t\u00eate hum\u00e9rale lors d&rsquo;une RL r\u00e9sist\u00e9e en R3<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/cdn.ncbi.nlm.nih.gov\/pmc\/blobs\/7967\/5023053\/b6481083800f\/10.1177_1758573216652086-fig1.jpg\" alt=\"\"\/><\/figure>\n\n\n\n<p><strong>Les 6 \u00e9tapes<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Etape 1 \n<ul class=\"wp-block-list\">\n<li>phase de la scapula\n<ul class=\"wp-block-list\">\n<li>But : d\u00e9velopper la stabilit\u00e9 de la scapula pour centrer la t\u00eate hum\u00e9rale<\/li>\n\n\n\n<li>Exercices\n<ul class=\"wp-block-list\">\n<li>Abduction \u00e0 20-30\u00b0. Atteindre 3 x 20 r\u00e9p\u00e9tition contre r\u00e9sistance 1kg<\/li>\n\n\n\n<li>Exercices \u00e0 ma\u00eetriser avant de passer \u00e0 la phase suivante<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>phase de l&rsquo;arc du mouvement\n<ul class=\"wp-block-list\">\n<li>Abduction dans une amplitude de 45\u00b0<\/li>\n\n\n\n<li>Extension, RM et RL en isom\u00e9trique puis isotonique contre r\u00e9sistance<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>Etape 2 : d\u00e9veloppement de la musculature post\u00e9rieure\n<ul class=\"wp-block-list\">\n<li>But : pr\u00e9venir une translation post\u00e9rieure de la t\u00eate hum\u00e9rale<\/li>\n\n\n\n<li>Exercices\n<ul class=\"wp-block-list\">\n<li>RL et renfo du delto\u00efde post\u00e9rieur<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>Etape 3 : \u00a0contr\u00f4le de la flexion de 0\u00b0 \u00e0 45\u00b0 d\u2019\u00e9l\u00e9vation, renfo du dentel\u00e9 ant\n<ul class=\"wp-block-list\">\n<li>Phase de la scapula : contr\u00f4le dans le plan sagittal<\/li>\n\n\n\n<li>Phase arc du mouvement : contr\u00f4le dans le plan sagittal<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<figure class=\"wp-block-image size-large is-resized\"><img decoding=\"async\" src=\"https:\/\/cdn.ncbi.nlm.nih.gov\/pmc\/blobs\/6171\/5441614\/28896d37cda9\/10.1177_1758573216652087-fig1.jpg\" alt=\"\" style=\"width:292px;height:auto\"\/><\/figure>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Etape 4 : contr\u00f4le des plans sagittal et coronal de 45\u00b0 \u00e0 90\u00b0 d\u2019\u00e9l\u00e9vation\n<ul class=\"wp-block-list\">\n<li>Phase de la scapula : contr\u00f4le de la scapula jusqu&rsquo;\u00e0 90\u00b0 d&rsquo;abduction<\/li>\n\n\n\n<li>Phase arc du mouvement : contr\u00f4le de mouvement \u00e0 90\u00b0 d&rsquo;abd<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/cdn.ncbi.nlm.nih.gov\/pmc\/blobs\/6171\/5441614\/8402e1a708ae\/10.1177_1758573216652087-fig2.jpg\" alt=\"\"\/><\/figure>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Etape 5 : force des muscles delto\u00efdes post\u00e9rieur, moyen et ant\u00e9rieur<\/li>\n<\/ul>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/cdn.ncbi.nlm.nih.gov\/pmc\/blobs\/6171\/5441614\/c7132d77fe2c\/10.1177_1758573216652087-fig4.jpg\" alt=\"\"\/><\/figure>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Etape 6\n<ul class=\"wp-block-list\">\n<li>Arc de contr\u00f4le de mouvement > 90\u00b0 Abd\/flexion<\/li>\n\n\n\n<li>Entra\u00eenement partiel \u00e0 la fonction et \u00e0 l&rsquo;int\u00e9gration dans les t\u00e2ches sportives\/fonctionnelles<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<h5 class=\"wp-block-heading\">Protocole Rockwood<\/h5>\n\n\n\n<p>Exercices de renforcement de la coiffe des rotateurs<\/p>\n\n\n\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\">\n<p>Exercices \u00e0 faire sans douleur<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><a href=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/12\/image-45.png\">Etirement crois\u00e9 du bras<\/a> : 5 x 30s<\/li>\n\n\n\n<li><a href=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/12\/image-46.png\">Chair push-up<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/12\/image-47.png\">Wall Push-up<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/training.fit\/wp-content\/uploads\/2020\/02\/shrugs-fittnessband.png\">Shoulder shrugs contre r\u00e9sistance \u00e9lastique<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/12\/image-48.png\">Scapula adduction contre r\u00e9sistance<\/a><\/li>\n\n\n\n<li>Extension d&rsquo;\u00e9paule contre r\u00e9sistance<\/li>\n\n\n\n<li>El\u00e9vation d&rsquo;\u00e9paule contre r\u00e9sistance<\/li>\n\n\n\n<li>Abduction<\/li>\n\n\n\n<li>Rotation m\u00e9diale<\/li>\n\n\n\n<li>Rotation lat\u00e9rale<\/li>\n<\/ul>\n\n\n\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"800\" height=\"1024\" src=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/12\/image-49-800x1024.png\" alt=\"\" class=\"wp-image-7291\" srcset=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/12\/image-49-800x1024.png 800w, https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/12\/image-49-234x300.png 234w, https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/12\/image-49-768x983.png 768w, https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/12\/image-49.png 934w\" sizes=\"auto, (max-width: 800px) 100vw, 800px\" \/><\/figure>\n<\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<figure class=\"wp-block-embed is-type-video is-provider-youtube wp-block-embed-youtube wp-embed-aspect-16-9 wp-has-aspect-ratio\"><div class=\"wp-block-embed__wrapper\">\n<iframe loading=\"lazy\" title=\"The Rockwood Program\" width=\"925\" height=\"520\" src=\"https:\/\/www.youtube.com\/embed\/2YfS3QcPuPU?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe>\n<\/div><\/figure>\n<\/div>\n<\/div>\n\n\n\n<h4 class=\"wp-block-heading\">R\u00e9\u00e9ducation apr\u00e8s Latarjet<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Phase 1 : Protection &lt; 3-4S<\/li>\n\n\n\n<li>Phase 2 : Endurance S4 \u00e0 S6<\/li>\n\n\n\n<li>Phase 3 : Renforcement S6 \u00e0 S12-15<\/li>\n\n\n\n<li>Phase 4 : Puissance S12-15<\/li>\n\n\n\n<li>Phase 5 : Retour au sport<\/li>\n<\/ul>\n\n\n\n<p>Lors de la r\u00e9\u00e9ducation, plusieurs approches r\u00e9alisables : <\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>r\u00e9\u00e9ducation en chaine cin\u00e9tique avec int\u00e9gration des membres inf\u00e9rieurs<\/li>\n\n\n\n<li>renforcement des muscles de la coiffe des rotateurs et le travail de leur action de pr\u00e9r\u00e9glage, souvent perdue ou diminu\u00e9e dans l\u2019\u00e9paule instable (ces muscles servant \u00e0 comprimer la t\u00eate hum\u00e9rale contre la gl\u00e8ne lors du mouvement pour plus de stabilit\u00e9)<\/li>\n\n\n\n<li>travail proprioceptif<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\">Bibliographie<\/h2>\n\n\n<ol class=\"wp-block-footnotes\"><li id=\"a2456558-b972-409a-9b7a-1d26f1256d4a\"><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/32447469\/\">Imaging of shoulder instability<\/a> <a href=\"#a2456558-b972-409a-9b7a-1d26f1256d4a-link\" aria-label=\"Aller \u00e0 la note de bas de page 1\">\u21a9\ufe0e<\/a><\/li><li id=\"e6a8ff1e-f0fb-4f00-bc17-ec9b9ce594be\"><a href=\"https:\/\/bjsm.bmj.com\/content\/44\/5\/341.long\">J. Kuhne, A new classification system for shoulder instability<\/a> <a href=\"#e6a8ff1e-f0fb-4f00-bc17-ec9b9ce594be-link\" aria-label=\"Aller \u00e0 la note de bas de page 2\">\u21a9\ufe0e<\/a><\/li><li id=\"b7a97d66-014d-426b-8a34-3d22cd2bfb73\"><a href=\"http:\/\/files.medhyg.ch\/images%20lison\/Mains%20libres\/article_Srour.pdf\">Les tests orthop\u00e9diques de l\u2019\u00e9paule : validit\u00e9 et utilit\u00e9 dans le cadre du raisonnement clinique<br>en physioth\u00e9rapie, F. Sour<\/a> <a href=\"#b7a97d66-014d-426b-8a34-3d22cd2bfb73-link\" aria-label=\"Aller \u00e0 la note de bas de page 3\">\u21a9\ufe0e<\/a><\/li><li id=\"8f86975e-47b6-451d-a48e-18866fc196b5\"><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/20371558\/\">Rehabilitation for shoulder instability, A.Jaggi<\/a> <a href=\"#8f86975e-47b6-451d-a48e-18866fc196b5-link\" aria-label=\"Aller \u00e0 la note de bas de page 4\">\u21a9\ufe0e<\/a><\/li><li id=\"70a1aa2a-9237-4627-9dd3-bd4477cd32bf\"><a href=\"https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC5023053\/\">L. Watson, The treatment of multidirectional instability of the shoulder with a rehabilitation program: Part 1<\/a> <a href=\"#70a1aa2a-9237-4627-9dd3-bd4477cd32bf-link\" aria-label=\"Aller \u00e0 la note de bas de page 5\">\u21a9\ufe0e<\/a><\/li><\/ol>","protected":false},"excerpt":{"rendered":"<p>Introduction D\u00e9finition L&rsquo;\u00e9paule, articulation du corps humain, poss\u00e8de la plus grande amplitude de mouvement et n\u00e9cessite donc un \u00e9quilibre d\u00e9licat entre stabilit\u00e9 et mobilit\u00e9. L&rsquo;articulation gl\u00e9nohum\u00e9rale pr\u00e9sente deux principales cat\u00e9gories d&rsquo;instabilit\u00e9&nbsp;: macro-instabilit\u00e9 et micro-instabilit\u00e9. L&rsquo;instabilit\u00e9&hellip;<\/p>\n<p class=\"more-link-wrapper\"><a href=\"https:\/\/kineaphp.fr\/?p=7203\" class=\"more-link\">Continue Reading<span class=\"screen-reader-text\"> \u00ab\u00a0Instabilit\u00e9 d&rsquo;\u00e9paule\u00a0\u00bb<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":"[{\"content\":\"<a href=\\\"https:\/\/pubmed.ncbi.nlm.nih.gov\/32447469\/\\\">Imaging of shoulder instability<\/a>\",\"id\":\"a2456558-b972-409a-9b7a-1d26f1256d4a\"},{\"content\":\"<a href=\\\"https:\/\/bjsm.bmj.com\/content\/44\/5\/341.long\\\">J. Kuhne, A new classification system for shoulder instability<\/a>\",\"id\":\"e6a8ff1e-f0fb-4f00-bc17-ec9b9ce594be\"},{\"content\":\"<a href=\\\"http:\/\/files.medhyg.ch\/images%20lison\/Mains%20libres\/article_Srour.pdf\\\">Les tests orthop\u00e9diques de l\u2019\u00e9paule : validit\u00e9 et utilit\u00e9 dans le cadre du raisonnement clinique<br>en physioth\u00e9rapie, F. Sour<\/a>\",\"id\":\"b7a97d66-014d-426b-8a34-3d22cd2bfb73\"},{\"content\":\"<a href=\\\"https:\/\/pubmed.ncbi.nlm.nih.gov\/20371558\/\\\">Rehabilitation for shoulder instability, A.Jaggi<\/a>\",\"id\":\"8f86975e-47b6-451d-a48e-18866fc196b5\"},{\"content\":\"<a href=\\\"https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC5023053\/\\\">L. Watson, The treatment of multidirectional instability of the shoulder with a rehabilitation program: Part 1<\/a>\",\"id\":\"70a1aa2a-9237-4627-9dd3-bd4477cd32bf\"}]"},"categories":[359],"tags":[],"class_list":["post-7203","post","type-post","status-publish","format-standard","hentry","category-pathologie-epaule"],"_links":{"self":[{"href":"https:\/\/kineaphp.fr\/index.php?rest_route=\/wp\/v2\/posts\/7203","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/kineaphp.fr\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/kineaphp.fr\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/kineaphp.fr\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/kineaphp.fr\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=7203"}],"version-history":[{"count":42,"href":"https:\/\/kineaphp.fr\/index.php?rest_route=\/wp\/v2\/posts\/7203\/revisions"}],"predecessor-version":[{"id":7292,"href":"https:\/\/kineaphp.fr\/index.php?rest_route=\/wp\/v2\/posts\/7203\/revisions\/7292"}],"wp:attachment":[{"href":"https:\/\/kineaphp.fr\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=7203"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/kineaphp.fr\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=7203"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/kineaphp.fr\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=7203"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}