www.drgazielly.ch

1. Key takeaways
of 33 years in
shoulder specialization
Dr Dominique-François Gazielly
FMH Orthopaedic Surgeon
www.drgazielly.com

2. 33 years devoted to treat
shoulders exclusively
New-York (1985) Saint-Etienne (1986)
Paris (1999) Genolier (2012)

3. 26,000 shoulders examined
7,600 shoulders operated
70% by arthroscopy (Rotator cuff)
30% by open surgery
15% Athletes’ recurrent dislocation
15% Shoulder replacement

4. I would like to ask you two questions…
1- Who, amongst you, has
or has previously had a
shoulder problem?
2- Do you have joint
hyperlaxilty, are you too
flexible?
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Joint hyperlaxity: external rotation of
the shoulder beyond 85 degrees

5. Review of 33 years
of shoulder surgery
1. The tendons of the rotator cuff age poorly
2. Night pain that keep awake and lead to consultation
3. The “trials and tribulations” of a painful shoulder
4. Arthroscopic surgery has been a revolution
5. Shoulder prostheses nowadays are highly reliable
6. The shoulder does not like being immobilized
7. It takes 20 years to learn when not to operate a
shoulder
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6. « Lesson on shoulder anatomy »
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7. The 4 tendons of the rotator cuff
are the shoulder’s “motors”
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8. 1. The tendons of the rotator cuff age poorly
with professional and/or sporting overuse
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9. The tendons’ ageing process can also be
accelerated by a bone deformity of the anterior
portion of the acromion which “attacks” the
underlying supraspinatus and long head of the
biceps tendons…
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10. The erosion is progressive in time and space
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11. 2. Night pain that keeps awake is the major
symptom of a rotator cuff injury
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Sleeping on the
affected shoulder
is impossible…
“The shoulder
aspirin” brings
relief…

12. The 5 warning signs of rotator cuff
injury
1. Sleeping on the affected shoulder is impossible
2. Pain when reaching for parking ticket (left shoulder)
3. Sign of the “car belt”, (right shoulder)
4. Pain when reaching for wallet
5. Pain when fastening bra
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13. Cortisone injection, performed by a radiologist,
efficiently and safely (except when diabetic)
relieves pain, but the effect is temporary
(3 to 4 months).
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Ultrasound-guided injection into the
subacromial bursa
CT-guided intra-articular injection
for tenosynovitis of the long head
biceps with no full thickness tear

14. Additionally, we have used Mesotherapy for the
past 20 years to treat the inflammation of the
long head of the biceps tendon (LHBT)
- Therapeutic technique using
drugs from the classic
pharmacopeia (never cortisone).
- It consists in injecting a mixture
of drugs under the skin (2 to 4mm
deep).
- It has very few contraindications
and side effects
- Swiss, French, and International
society of Mesotherapy
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Normal intra-articular LHBT
Inflamed LHBT in the bicipital groove

15. 3. The trials and tribulations of
a painful shoulder
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1. A painful shoulder cannot be treated efficiently
without establishing a clinical and anatomic
Diagnosis of the underlying lesion
2. The terms “tendinitis”, “capsulitis”, “periarthritis”
must no longer be used…
3. Even these days, patients still waste too much time
and money before finding out what exactly they are
suffering from
4. Do not hesitate to ask for a second advice

16. How to efficiently treat
a painful shoulder?
1. Take time to listen to the patient
2. Take time to examine the patient
3. Establish a clinical diagnosis
4. Prescribe adequate imaging (Arthro-MRI)
5. Establish an anatomic diagnosis of the lesion
Physiotherapy +- Osteopathy Surgery
Hyper-specialized medical network…
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17. 4. Mini-invasive arthroscopic shoulder surgery
has been a technological revolution in the 1990s
- Less postoperative pain
- Low risk of infection
- Less painful postoperative
mobilization
- Faster functional recovery
- Cosmetic advantages
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General anaesthesia

18. 1993-2018: 25 years of experience in
arthroscopic repair of rotator cuff tear
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19. 1993-2018: 25 years of experience in
arthroscopic repair of rotator cuff tear
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20. Return to sport activities following
arthroscopic repair of a rotator cuff tear
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21. Arthroscopic procedure should be preferred
to ultrasound-guided trituration
to remove calcifications
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22. 5. Shoulder prostheses nowadays are highly
effective in treating osteoarthritis
The distinction must be made between two very
different types of shoulder prostheses:
- “Anatomic” prostheses (1975) are indicated when
the rotator cuff is functional:
“centred” shoulder osteoarthritis
- “Reverse” prostheses (1995) are indicated when
the rotator cuff is no longer functional, or torn and
retracted:
“non-centred” shoulder osteoarthritis
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23. 23
“Anatomic” prostheses have excellent and
long-term functional results and allow patients
to resume their activities

24. “Anatomic” prostheses have excellent and
long-term functional results and allow patients
to play again an instrument or practice non-
contact sports
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www.drgazielly.com (Rehabilitation section)

25. “Reverse” prostheses are recommended to
patients who can no longer elevate their arm
due to a major and irreparable rotator cuff tear
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26. 6. The shoulder does not like
being immobilized…
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27. Operated shoulder is, exceptionally,
immobilized between physiotherapy sessions
At night only after shoulder
replacement or opened
stabilization surgery for athletes’
recurrent dislocation.
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50% of the quality of results depends on the
quality of postoperative physiotherapy
1. Quality of the postoperative surgeon’s follow-up
2. Necessity of a physiotherapist who is used to the
surgeon’s rehabilitation protocols:
- No strict immobilization of the operated shoulder
- Respect of the successive sequences: passive,
a assisted active, muscle strengthening exercises
3. Patient motivation is required to perform the
rehabilitation exercises alone at home.

29. Example of rehabilitation after
arthroscopic rotator cuff repair
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30. Example of rehabilitation after
“anatomic” total shoulder replacement
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31. Example of rehabilitation after
“anatomic” total shoulder replacement
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32. 7. “It takes 20 years to learn
when not to operate a shoulder”
- In most of cases, shoulder surgery is the surgical treatment
of pain
- Every patient has his own pain threshold
- If the patient himself requests a surgery and has the
motivation required for postoperative rehabilitation, then
good results are guaranteed...
- However, one must know when not to suggest a surgery to
a patient who lacks the motivation for the postoperative
rehabilitation, or has other related problems (neck pathology
+++, long past medical history, professional issues) that would
lead to random results…
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33. The Future… What about it?
- Could chondrocyte culture someday avoid using
prostheses?
- Development of information and education of the
patient is necessary to avoid time & money waste.
- Robotic surgery does not, in our opinion, have much of
a future in shoulder surgery, which, despite being
increasingly mini invasive, remains a manual surgery
requiring “craftsmanship”

34. Thank you to our teams who makes it possible
to treat our patients in the safest and most
comfortable environment
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