{"id":5038,"date":"2025-02-28T16:48:14","date_gmt":"2025-02-28T16:48:14","guid":{"rendered":"https:\/\/ciehaufr1i.wpdns.site\/nouvelles\/la-car-collabore-avec-choisir-avec-soin-et-des-specialistes-en-vue-de-nouvelles-recommandations-relatives-aux-lesions-musculo-squelettiques\/"},"modified":"2025-10-02T13:51:40","modified_gmt":"2025-10-02T13:51:40","slug":"la-car-collabore-avec-choisir-avec-soin-et-des-specialistes-en-vue-de-nouvelles-recommandations-relatives-aux-lesions-musculo-squelettiques","status":"publish","type":"post","link":"https:\/\/car.ca\/fr\/nouvelles\/la-car-collabore-avec-choisir-avec-soin-et-des-specialistes-en-vue-de-nouvelles-recommandations-relatives-aux-lesions-musculo-squelettiques\/","title":{"rendered":"La CAR collabore avec Choisir avec soin et des sp\u00e9cialistes en vue de nouvelles recommandations relatives aux l\u00e9sions musculo-squelettiques"},"content":{"rendered":"\n

Un nouveau projet multidisciplinaire a donn\u00e9 naissance \u00e0 une s\u00e9rie de recommandations pour le traitement des l\u00e9sions musculo-squelettiques dans le but d’harmoniser les proc\u00e9dures d’imagerie m\u00e9dicale.<\/p>\n\n\n\n

La CAR a collabor\u00e9 avec le groupe Choisir avec soin et des experts de diverses sp\u00e9cialit\u00e9s m\u00e9dicales pour \u00e9laborer ses recommandations en mati\u00e8re d’imagerie du syst\u00e8me musculo-squelettique.<\/p>\n\n\n\n

La Dre Natalia Gorelik<\/strong> a dirig\u00e9 le projet de pair avec le Dr Kawan Rakhra<\/strong> et affirme qu’il s’agissait d’un travail essentiel. En effet, les patients qui se soumettent \u00e0 des examens d’imagerie doivent \u00eatre s\u00fbrs qu’ils passent le bon test en temps voulu.<\/p>\n\n\n\n

\u00ab L’imagerie m\u00e9dicale est essentielle au diagnostic et \u00e0 la prise en charge de nombreux probl\u00e8mes de sant\u00e9. Toutefois, un nombre important d’examens d’imagerie ne r\u00e9pondent pas aux crit\u00e8res de pertinence. Ces examens de faible valeur nuisent aux patients, surchargent le syst\u00e8me de soins de sant\u00e9, allongent les listes d’attente, font grimper les co\u00fbts et engendrent des r\u00e9percussions n\u00e9gatives sur l’environnement. Le syst\u00e8me de sant\u00e9 canadien est aux prises avec des ressources limit\u00e9es et des p\u00e9nuries de personnel. De ce fait, l’optimisation du recours \u00e0 l’imagerie m\u00e9dicale est cruciale \u00bb, a-t-elle soulign\u00e9. \u00ab Dans le but d’augmenter la pertinence des examens, la CAR a mis \u00e0 jour treize lignes directrices relatives aux demandes d’examen d’imagerie diagnostique. Les derni\u00e8res donn\u00e9es issues de ces lignes directrices peuvent servir de base \u00e0 la mise \u00e0 jour des recommandations en mati\u00e8re d’imagerie m\u00e9dicale de Choisir avec soin. \u00bb<\/p>\n\n\n\n

L’un des aspects uniques de ce projet est la collaboration multidisciplinaire entre ses diff\u00e9rents acteurs.<\/p>\n\n\n\n

\u00ab Ces recommandations ont \u00e9t\u00e9 \u00e9labor\u00e9es gr\u00e2ce \u00e0 la collaboration d’experts cliniques de diverses sp\u00e9cialit\u00e9s, notamment la radiologie, l’orthop\u00e9die, la rhumatologie et la m\u00e9decine familiale \u00bb, explique le Dr Gorelik. \u00ab Les experts ont recours \u00e0 une m\u00e9thodologie de recherche structur\u00e9e en plusieurs \u00e9tapes et fond\u00e9e sur l’atteinte d’un consensus pour \u00e9valuer tous les sc\u00e9narios des lignes directrices de la CAR en mati\u00e8re d’imagerie musculo-squelettique. Ils cherchaient \u00e0 d\u00e9finir les domaines o\u00f9 le recours excessif \u00e0 l’imagerie \u00e9tait courant et avait des cons\u00e9quences substantielles sur les patients et le syst\u00e8me de soins de sant\u00e9. \u00bb<\/p>\n\n\n\n

\u00ab Les l\u00e9sions et maladies du syst\u00e8me musculo-squelettique peuvent \u00eatre diagnostiqu\u00e9es et prises en charge dans diff\u00e9rents services et environnements cliniques. Ainsi, le processus a command\u00e9 la participation de m\u00e9decins issus des sp\u00e9cialit\u00e9s de la m\u00e9decine familiale, de la m\u00e9decine d’urgence, de la m\u00e9decine sportive, de la rhumatologie, de la chirurgie orthop\u00e9dique et de la radiologie musculo-squelettique \u00bb, explique le Dr Rakhra. \u00ab Les affections complexes de l’appareil locomoteur peuvent n\u00e9cessiter une approche multidisciplinaire, de sorte que diff\u00e9rents m\u00e9decins sp\u00e9cialis\u00e9s devront avoir recours \u00e0 l’imagerie en vue d’am\u00e9liorer les soins prodigu\u00e9s \u00e0 leurs patients. Il est donc n\u00e9cessaire d’\u00e9laborer des recommandations g\u00e9n\u00e9rales, accept\u00e9es par tous, qui puissent \u00eatre mises en \u0153uvre dans tous les cas de figure, par les m\u00e9decins de toutes les sp\u00e9cialit\u00e9s. \u00bb<\/p>\n\n\n\n

Dans l’ensemble, le Dr Rakhra esp\u00e8re que les recommandations conduiront \u00e0 des choix optimaux de la part des m\u00e9decins lorsqu’ils demandent des examens d’imagerie dans le cadre de la prise en charge des affections de leurs patients.<\/p>\n\n\n\n

\u00ab Les recommandations ont \u00e9t\u00e9 r\u00e9dig\u00e9es par des experts et, par cons\u00e9quent, les m\u00e9decins peuvent les suivre en toute confiance lors de leurs activit\u00e9s cliniques. Leur adoption r\u00e9duira les demandes d’examens de faible valeur, ce qui permettra un diagnostic et une prise en charge plus rapides tout en r\u00e9duisant les co\u00fbts des soins de sant\u00e9 \u00bb.<\/p>\n\n\n\n

Ce travail a \u00e9t\u00e9 g\u00e9n\u00e9reusement soutenu par la bourse de recherche de la Fondation canadienne de radiologie (CRF)\/Canadian Heads of Academic Radiology (CHAR).<\/p>\n\n\n\n

\"MSK<\/figure>\n\n\n\n

Recommendations<\/h2>\n\n\n\n

1. Ne demandez pas d’IRM sans envisager d’abord une \u00e9chographie pour l’\u00e9valuation d’une affection de la coiffe des rotateurs ou d’une bursite.<\/em><\/p>\n\n\n\n

Chez les adultes souffrant de douleurs \u00e0 l’\u00e9paule, si des examens compl\u00e9mentaires sont n\u00e9cessaires apr\u00e8s l’\u00e9valuation par radiographie initiale, l’\u00e9chographie est recommand\u00e9e comme modalit\u00e9 d’imagerie suivante en vue de l’\u00e9valuation des affections des tissus mous (telles qu’une rupture de la coiffe des rotateurs, une tendinopathie, un \u00e9panchement, une bursite, une calcification des tissus mous ou un conflit extra-articulaire).<\/p>\n\n\n\n

R\u00e9f\u00e9rences<\/strong><\/p>\n\n\n\n

    \n
  • Hamel C, Avard B, Gorelik N, et al. Canadian Association of Radiologists Musculoskeletal System Diagnostic Imaging Referral Guideline. Can Assoc Radiol J. 2024; 75(2):269-278. doi: 10.1177\/08465371231190807.<\/li>\n\n\n\n
  • Weber S, Chahal J. Management of rotator cuff injuries. J Am Acad Orthop Surg. 2020;28(5):e193-e201. doi:10.5435\/JAAOS-D-19-00463<\/li>\n\n\n\n
  • Small KM, Adler RS, Shah SH, et al. ACR appropriateness criteria\u00ae shoulder pain-atraumatic. J Am Coll Radiol. 2018; 15(11S):S388-S402. doi:10.1016\/j.jacr.2018.09.032<\/li>\n\n\n\n
  • Scon\ufb01enza LM, Albano D, Allen G, et al. Clinical indications for musculoskeletal ultrasound updated in 2017 by european society of musculoskeletal radiology (ESSR) consensus. Eu Radiol. 2018;28(12):5338-5351. doi:10.1007\/s00330-018-5474-3<\/li>\n\n\n\n
  • The Royal College of Radiologists. RCR IRefer Guidelines: Making the Best Use of Clinical Radiology. London: The Royal College of Radiologists, 2017.<\/li>\n<\/ul>\n\n\n\n

    2. <\/em>Ne demandez pas d’IRM de la hanche uniquement sur la base des caract\u00e9ristiques du conflit f\u00e9moro-ac\u00e9tabulaire \u00e0 la radiographie, \u00e0 moins qu’il n’y ait des signes cliniques et des sympt\u00f4mes de conflit articulaire.<\/em><\/p>\n\n\n\n

    Si la radiographie montre des r\u00e9sultats d’imagerie qui peuvent pr\u00e9disposer au conflit f\u00e9moro-ac\u00e9tabulaire, il est conseill\u00e9 de consulter un sp\u00e9cialiste du syst\u00e8me musculo-squelettique, car l’IRM pourrait ne pas \u00eatre n\u00e9cessaire et ne pas faire progresser le diagnostic ou la prise en charge.<\/p>\n\n\n\n

    R\u00e9f\u00e9rences<\/strong><\/p>\n\n\n\n

      \n
    • Hamel C, Avard B, Gorelik N, et al. Canadian Association of Radiologists Musculoskeletal System Diagnostic Imaging Referral Guideline. Can Assoc Radiol J. 2024; 75(2):269-278. doi: 10.1177\/08465371231190807.<\/li>\n\n\n\n
    • Jawetz ST, Fox MG, Blankenbaker DG, et al. ACR Appropriateness Criteria\u00ae Chronic Hip Pain: 2022 Update. J Am Coll Radiol. 2023; 20(5): S33-S48. doi: 10.1016\/j.jacr.2023.02.019<\/li>\n\n\n\n
    • Reiman MP, Agricola R, Kemp JL, et al. Consensus recommendations on the classi\ufb01cation, de\ufb01nition and diagnostic criteria of hip-related pain in young and middle-aged active adults from the International Hip-related Pain Research Network, Zurich 2018. BJSM online. 2018;54(11):631-641. doi:10.1136\/bjsports-2019-101453<\/li>\n\n\n\n
    • Mascarenhas VV, Castro MO, Rego PA, et al. The lisbon agreement on femoroacetabular impingement imaging-part 1: overview. Eur Radiol. 2020;30(10):5281-5297. doi:10.1007\/s00330-020-06822-9<\/li>\n\n\n\n
    • Mascarenhas VV, Castro MO, Afonso PD, et al. The Lisbon Agreement on femoroacetabular impingement imaging-part 2: general issues, parameters, and reporting. Eur Radiol. 2021;31: 4634-4651. Published online. doi:10.1007\/s00330-020-07432-1<\/li>\n\n\n\n
    • The Royal College of Radiologists. RCR IRefer Guidelines: Making the Best Use of Clinical Radiology. London: The Royal College of Radiologists, 2017.<\/li>\n<\/ul>\n\n\n\n

      3. <\/em>Ne demandez pas d’IRM de la hanche ou du genou si une arthrose plus que l\u00e9g\u00e8re est observ\u00e9e \u00e0 la radiographie, sauf sur recommandation d’un sp\u00e9cialiste du syst\u00e8me musculo-squelettique.<\/em><\/p>\n\n\n\n

      Chez les patients souffrant de douleurs \u00e0 la hanche ou au genou probablement li\u00e9es \u00e0 une affection articulaire d\u00e9g\u00e9n\u00e9rative, quand les radiographies montrent une ost\u00e9o-arthrite de s\u00e9v\u00e9rit\u00e9 moyenne ou \u00e9lev\u00e9e, une IRM pourrait ne pas \u00eatre indiqu\u00e9e, car elle ne fera souvent pas progresser le diagnostic ou la gestion du trouble. L’avis d’un sp\u00e9cialiste du syst\u00e8me musculo-squelettique devrait \u00eatre sollicit\u00e9 afin de d\u00e9terminer si une IRM est n\u00e9cessaire.<\/p>\n\n\n\n

      R\u00e9f\u00e9rences<\/strong><\/p>\n\n\n\n

        \n
      • Hamel C, Avard B, Gorelik N, et al. Canadian Association of Radiologists Musculoskeletal System Diagnostic Imaging Referral Guideline. Can Assoc Radiol J. 2024; 75(2):269-278. doi: 10.1177\/08465371231190807.<\/li>\n\n\n\n
      • Fox MG, Chang EY, Amini B, et al. ACR appropriateness criteria\u00ae chronic knee pain. J Am Coll Radiol. 2018;15(11S): S302-S312. doi:10.1016\/j.jacr.2018.09.016<\/li>\n\n\n\n
      • The Royal College of Radiologists. RCR IRefer Guidelines: Making the Best Use of Clinical Radiology. London: The Royal College of Radiologists, 2017.<\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"

        Un nouveau projet multidisciplinaire a donn\u00e9 naissance \u00e0 une s\u00e9rie de recommandations pour le traitement des l\u00e9sions musculo-squelettiques dans le but d’harmoniser les proc\u00e9dures d’imagerie m\u00e9dicale. La CAR a collabor\u00e9 avec le groupe Choisir avec soin et des experts de diverses sp\u00e9cialit\u00e9s m\u00e9dicales pour \u00e9laborer ses recommandations en mati\u00e8re d’imagerie du syst\u00e8me musculo-squelettique. La Dre 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