Osteochondritis dissecans is most frequently seen at the knee, the elbow and the ankle joint. The localisation at the humeral head is very rare. There were 7 cases like this reported up to now. We present two more patients with osteochondritis dissecans of the humeral head; a 26-year-old man and a 36-year-old woman. For diagnosis and follow-up roentgenograms and MRI are used. MRI even helps to decide which operative strategy should be followed. Drilling of the sclerotic margin resulted in a satisfactory bony reintegration of the fragment in our male patient. The female patient refused an arthroscopy of her shoulder joint.

Adult↗

PubMedDate not supplied

[Diagnosis and conservative therapy of cervical spondylitis].

We report diagnostic procedures and conservative therapy of eight patients suffering from unspecific bacterial cervical spondylitis. In three cases an infection of the craniocervical junction occurred. In addition to the clinical examination the diagnosis was made by the help of a serological examination, conventional radiographs, radioisotopes scannings and tomograms (CT and MRI). In all cases therapy was conservative because of absence of neurological symptoms. For immobilization a halo-west was used. Intravenous and oral antibiotics were applied according to antibiogram. In five cases an osseous fusion was achieved, six out of eight patients had no more complaints. The malposition of the concerned segment increased in one case, in a further case a post-arthritic arthrosis evolved.

Adult↗

PubMedDate not supplied

[Bone and joint infections due to unusual pathogens].

Between 1989 and 1993, 7 patients--2 men and 5 women from 19 to 70 years of age--with osteomyelitis due to an unusual organism were observed. 3 cases with Salmonella typhimurium and one at a time with Escherichia coli, Peptostreptococcus, Propionibacterium acnes and Pasteurella multocida. 5 patients were treated operative accompanied with antibiotics and 1 without operation. 1 patient declined the indicated surgical therapy. The outcome were total healing in 3 cases, healing with ankylosis of the concerning joints in 2 cases and healing with defect in 1 case.

Adult↗

PubMedDate not supplied

[Diagnosis and therapy of psoas abscess].

PROBLEM: Psoas abscesses are really rare so that the diagnostic onset is commonly very late. The differential diagnosis to other retroperitoneal processes is therefore important. METHOD: In a period of observation of 6 years 21 patient were treated with psoas abscesses. The evaluation of 16 records was done retrospectively under consideration of etiology, history, clinical examination, lab results and x-ray/CT/MRI etc. RESULTS: With the knowledge of the anatomy of the ilio-psoas muscle the clinical examination gives us important information about the diagnosis of psoas abscess. The history and the clinical examination precede the further diagnostics and are condition for high rates of sensitivity and specificity. Lab results indicate an absedation without being specific. The exclusive position of radiological diagnostics is undisputed. Ultrasound, x-ray and leucocyte marked bonescan are proven to be helpful in cases of unknown location of the abscesses. Method of choice seems to be the contrast enhanced CT-scan. The differential diagnosis includes gastrointestinal or renal disorders as well as pathology of bone or joints. In our cases differential diagnosis was complicated since the diagnostic onset was delayed and the initial therapy was not adequate. The diagnosis "abscess of the psoas" does not imply a general regime for therapy therefore an individual treatment in consideration of percutaneous and operative drainage has to be recommended. In selected cases a combination therapy is advised. CONCLUSION: In every case of retroperitoneal symptoms the differential diagnosis of an abscess of the psoas has to be regarded. The diagnosis is subtil and requires clinical and laboratory examinations as well as contrast enhanced computerscan. The therapy follows operative measures. The technique has to be individually decided.

Adult↗

PubMedDate not supplied

["Lumbar intervertebral disk-induced sciatica" diagnostic error in extensive extra- and intrapelvic lipoma].

PURPOSE: The aim of this study is to demonstrate the importance of the differential diagnosis of sciatica. Radiculopathy in the lower extremity of an adult usually originates from a herniated nucleus pulposus. In this paper an extraspinal cause of sciatica due to a pelvic tumor is reported, which is initially often not recognized. METHODS AND RESULTS: A 67-year old woman suffered from sciatica. After one year of unsuccessful conservative treatment and beginning weakness of hip flexion a computed tomography of the pelvis revealed a giant lipoma with compression of the lumbosacral plexus. CONCLUSIONS: The results of this case illustrate the problem of over-rating CT-findings of the lumbar intervertebral disks in patients with sciatica. Extraspinal tumorous causes of radiculopathy are rare, but should be considered if the therapeutical measures are resistant to treatment. Computed tomography and magnetic resonance imaging are most useful in confirming a retroperitoneal tumor causing lumbosacral radiculopathy.

Adult↗

PubMedDate not supplied

[Structural findings of the coraco-acromial ligament in rotator cuff rupture, tendinosis calcarea and supraspinatus syndrome].

Coracoacromial ligaments from 133 operation specimens were examined histomorphologically near their acromial attachments. 85% showed signs of moderate to severe degeneration, 67% to 85% chondroid metaplasia near the origin. No significant differences were found between specimens brought to operation for the three diseases mentioned. It is therefore concluded that an intermittent local pressure on the origin of the ligament is present in these diseases, and this can lead to chondroid changes near its acromial attachment.

Acromion↗

PubMedDate not supplied

[Results with Garth's modified roentgen exposures].

With the apical oblique view of Garth, a modified ap-projection of the shoulder, the postero-lateral aspect of the humeral head (Hill-Sachs defect) and the antero-inferior glenoidal rim (Bankart lesion) are well demonstrated. Additionally a posterior dislocation of the shoulder can be detected and an orthograde view of the glenohumeral joint can be obtained at the same time. The affected arm is kept close to the body which is advantageous in case of a fresh trauma. The apical oblique view has worked well at the radiological follow-up of 56 patients 10-23 years after the Eden-Hybbinette-Lange operation for chronic shoulder instability for an assessment of a Hill-Sachs lesion and of the fate of the bone block antero-inferiorly. The results are described. Disadvantages of the apical oblique view are a geometrical distortion and an exposure to radiation which is three times that of a standard ap x-ray picture.

Adolescent↗