Biomedical subjects
Publications and source records attributed to M Loew.
Many studies and publications have been devoted to Sudeck's syndrome. A much more rare occurrence is described here, namely, after a lesion affecting the lower extremity and knee joint. The case report concerns the typical course of a reflex dystrophy of the knee joint after a mild interior lesion of the knee followed by arthroscopy.
Explore the source record for details and available documents.
This study examined the effects of high-energy shock wave treatment on the course of calcifying tendinitis of the shoulder. Twenty patients were included in the protocol. Shock waves were applied to the calcifications with a lithotripter in two sessions of 2000 pulses each. The energy that produced the shock wave was 18 to 22 kV. Six and 12 weeks after treatment the subjective and functional state was assessed with the Constant score. All patients underwent radiographs and magnetic resonance imaging. At the 12-week follow-up evaluation 15 patients had a marked reduction of symptoms with an average of 30% improvement in the Constant score. Radiographs showed a complete elimination of the calcifications in seven patients, and in five cases a partial disintegration was seen. The overall morbidity was low; 14 patients had a transient subcutaneous hematoma. Magnetic resonance imaging did not show any lasting damage to bone or soft tissue.
In a prospective study radiographs and magnetic resonance images of 75 patients with calcifying tendinitis of the rotator cuff were analyzed. The aim was to evaluate any relation between calcifying tendinitis and subacromial impingement. A total of 83% of the calcifications were located in the supraspinatus or the adjoining part of the subscapularis tendon. On T1-weighted images they could be demonstrated with high accuracy as areas of decreased signal intensity. A magnetic resonance imaging categorization of the calcium deposits was carried out by means of a differentiation of form, outline, and density. A partial rotator cuff tear was found in one shoulder; in 11% variable aspects of degenerative alteration of the affected tendon were seen. By analysis of the radiographic outlet view 16% of the cases had a type III acromion. In conclusion, little correlation exists between calcifying tendinitis and additional findings associated with subacromial impingement.
AIM: Osteo-destructive effects as well as stimulation of bone growth are often described after extracorporeal shock-wave application (ESWA). A correlation between the applicated energy and outcome is assumed. The purpose of this study was to analyze, whether ESWA has an influence on growth and proliferation of bone cells in vitro. METHODS: Human cancellous bone was cultivated until a confluent cell layer had grown. 5 x 10(5) bone cells were transferred into U-formed tubes, centrifuged and covered with cultivation medium. Thereafter ESWA was applicated in a standardized manner. Number and intensity of ESWA were systematically combined (500, 1000, 2000 and 0.15, 0.26, 0.51 mJ/mm2 energy flux density--EFD, respectively). Ten samples per combination were analyzed. In addition, we examined an untreated control group. Survival, metabolism (alkaline phosphatase activity), type I collagene-synthesis as well as proliferation were determined. RESULTS: There is a decrease of survival after ESWA depending on the number of impulses and intensity (dose-dependent survival). Cell survival was significantly reduced to 40% after 2000 impulses with high energy rates. Metabolism of surviving cells is not altered by ESWA in comparison with controls. Depending on the number but not on the energy of impulses the type I collagene-synthesis of surviving cells decreased. Between the 3rd and the 8th day after ESWA proliferation increased significantly in cell cultures treated with 2000 impulses of medium or high energy rates. CONCLUSIONS: There is a direct relation between dose and effect for ESWA: A minimum number of impulses and EFD is needed to cause effects on bone-cells. This mainly depends on the numbers of impulses. Destruction of cells is a short-time effect of high shock-wave-doses, a medium-term effect is a cell-stimulation.
A traumatic rotator cuff tear is a very rare condition, especially in the adolescent. We report about a 14-year-old boy who fell onto the right arm while riding his bicycle. Immediately after the accident he described some kind of click in his right shoulder. he was referred to our institution 3 days after the trauma. The MRI showed a huge defect of the labrumligament complex including the rotator interval. Intraoperatively, we found a complete disruption of the subscapularis and supraspinatus tendons as well as of the anterior stabilizers. We performed a modified Bankart repair and a reconstruction of the ruptured rotator cuff. The patient returned to his former sports as cyclist 3 months after surgery. This case is of clinical relevance because of the traumatic disruption of an intact rotator cuff in a young patient. Not the bone but rather the tendons and ligaments were the weakest link in this situation. In cases of primary traumatic shoulder dislocation, we have to look for bony and soft-tissue damage including the rotator cuff. With the present high standards in ultrasound and MR imaging we have to keep these techniques in mind in order not to overlook this type of accompanying injury.
During the past decade application of extracorporal shock waves became an established procedure for the treatment of various musculoskeletal diseases in Germany. Up to now the positive results of prospective randomised controlled trials have been published for the treatment of plantar fasciitis, lateral elbow epicondylitis (tennis elbow), and of calcifying tendinitis of the rotator cuff. Most recently, contradicting results of prospective randomised placebo-controlled trials with adequate sample size calculation have been reported. The goal of this review is to present information about the current clinical database on extracorporeal shock wave treatment (ESWT).
AIM: It was the aim of this study to investigate the success of biceps tenoplasty in massive interval rotator cuff tears. METHOD: Fifteen patients, who had a massive rotator cuff tear in the area of the interval and a pathology of the long head of the biceps tendon, were examined clinically and by MRI. A primary reconstruction of the rotator cuff tear was possible in none of the patients. All patients had a secondary reconstruction with a biceps tenoplasty. The Constant Score was determined postoperatively and the satisfaction of the patients was explored. RESULTS: The mean age at the time of the operation was 55 years. The examination was 23 months postoperatively. A simultaneous rupture of the supraspinatus- and subscapularis tendon was seen in 12 patients, an additional rupture of the infraspinatus tendon in 3 patients intraoperatively. The long head of the biceps was dislocated in 10 patients and subluxated in 5 patients. The postoperative determined Constant Score was 82.7 points. The personal satisfaction was investigated by asking for the German schoolmarks, which extend from 1 (excellent) to 6 (not satisfactory). The preoperative schoolmark was 5.2 and the postoperative schoolmark 1.4. In the MRI examination one rerupture could be seen, an atrophy of the supraspinatus tendon was evaluated in four patients. Knowing the postoperative result, all patients would have repeated the operation. CONCLUSION: The biceps tenoplasty is a suitable operative method to achieve a better function and relief of pain in massive interval rotator cuff tears with simultaneous pathology of the long head of the biceps tendon. A high degree of personal satisfaction for the patient can be achieved.
AIM: The purpose of this study was to evaluate the isokinetic muscle strength, range of motion and radiological signs of arthopathy of recurrent dislocation of the shoulder after an open Bankart procedure. METHODS: This retrospective study is based on the analysis of isokinetic muscle strength, range of motion, function and arthropathy of the shoulders of 81 patients at an average of 2.3 years (range 1-4 years) after a Bankart procedure. Isokinetic muscle strength testing was performed using the Cybex 6000 dynamometer. RESULTS: Clinical testing at follow-up revealed no significant loss of range of motion of the operated shoulder compared to the healthy contralateral shoulder. The deficit of muscle strength (average peak torque, total work, total power) of the involved side averaged 10 % of the not-involved side and was not statistically different. Follow-up radiographs demonstrated an increase of arthropathy in 35 % of the shoulders after the Bankart procedure. CONCLUSION: At an average follow-up of 2.3 years after an open Bankart repair for treatment of recurrent dislocation of the shoulder we found no significant difference between the operated shoulder and the healthy contralateral side concerning range of motion and isokinetic muscle strength. From that we conclude that the Bankart procedure offers an excellent clinical outcome combined with a low degree of morbidity.
BACKGROUND: Migration after shoulder arthroplasty can induce muscular dysbalance and instability of the shoulder joint. The aim of this study was to analyse the frequency, causes and consequences of secondary migration after shoulder arthroplasty. METHODS: 107 shoulder arthroplasties in patients with primary osteoarthritis (OA, n = 83) or avascular necrosis of the humeral head (AVN, n = 24), were followed clinically and radiographically over a period of 1 to 10 years. RESULTS: 17 Patients (16 %) developed secondary migration of the prosthesis. These were determined after a mean period of 33 months after shoulder arthroplasty. Patients with secondary migration of the prosthesis showed a worse function with a mean Constant score (CS) of 52.3 points in comparison to the patient group without migrated shoulder arthroplasties (62 points) (p = 0.038). In patients with total shoulder arthroplasty (TSA, n = 75), migration was observed in 13 % of cases during follow-up. Lucent lines at the glenoid were found in radiographs in 55 % of migrated shoulders and in 52 % of non-migrated shoulders (p = 0.633). The Constant score showed no significant difference between the groups (non-migrated shoulders 63 points, migrated shoulders 61 points, p > 0.5). Migration was seen in 22 % (7/32 patients) after hemiarthroplasty, however, no significant difference could be found between the respective Constant scores for migrated (47.7 points) or non-migrated (55.1 points) shoulders (p = 0.447). In patients with OA there was no significant difference in Constant score between migrated and non-migrated shoulders (p = 0.331), whereas patients with AVN showed significantly worse function after migrated shoulder arthroplasty (p = 0.007). CONCLUSION: Migration after total shoulder arthroplasty leads in the medium term neither to an increased frequency of lucent lines at the glenoid nor to a worsening of the functional score in comparison to non-migrated prosthesis. In patients with AVN, migration is accompanied by a worsening of the functional score and can consequently be regarded as a negative prognostic factor.
AIM: The main objective of this study was to prove that a postoperative combined continuous passive motion (CPM) and physiotherapy treatment protocol (CPM group) can achieve 90 degrees active abduction in the shoulder joint earlier than physiotherapy alone (PT group). The indication was a complete tear of the rotator cuff. METHOD: The study was conducted under in-patient and out-patient conditions. 55 patients were included in this study. The prospective, randomized multicenter study design complies with DIN EN 540. The primary endpoint was the time span until 90 degrees active abduction was achieved by the patients. RESULTS: Patients in the CPM group reached the primary endpoint on average 12 days earlier than the control group. This difference was statistically significant (p = 0.0292). Analyzing the secondary endpoints, e. g., pain and disablement, the results in the CPM group showed again advantages of the combined treatment protocol (CPM + physiotherapy). CONCLUSION: The postoperative treatment of a total tear of the rotator cuff with a combined continuous passive motion and physiotherapy protocol provided a significantly earlier range of motion in the shoulder joint than physiotherapy alone. There was no report of CPM-related adverse effects.
The Göttingen mini swine is a good experimental animal. The electrolytes and the bone healing rate is comparable to human. The weight of the animals should be 30-45 kg. All surgery is performed under endotracheal general anaesthesia without any complication. There is minimal blood loss because blood pressure is only 40/80 mmHg. We used the anterolateral approach. The feature peculiarity of this animal model are: 1. Skin incision should start 10 cm cranial to the tail and should be curved. 2. The osteotomy of the head is V-shaped in maximal external rotation. 3. The acetabulum is prepared with a 23.5 mm reamer. 4. The stem should be implanted first. After completion of the preliminary test operations, 10 animals were operated in the described standard manner. During one year follow-up there was only one radiological cup-loosening.
The indication for functional or operative treatment of fractures of a vertebral body depend on the additional injury, on the stability of the fracture and on the amount of deformity. In a retrospective radiological study on 74 patients we analysed the behavior of secondary deformation in stabile fractures of thoraco-lumbal vertebral bodies under treatment with a 3-Points-Corset. The average initial sagittal deformity was 12.5 degrees. After three months an average increase of 1.5 degrees was measured resulting in an average increase of total kyphosis of 2.5 degrees during fracture consolidation. No further secondary changes were seen after a period of three months following the injury.
An analysis of the MR-images of 75 patients with calcifying tendinitis of the shoulder was performed. The aim of the study was to recognize characteristic findings of the calcific deposits and their relation to the involved tendons as well as the coincidence with additional degenerative alterations of the rotator cuff. The calcifications can be demonstrated with high accuracy (> 95%) in T1-weighted images as areas of decreased signal intensity. It is possible to characterize the calcifications similar to Gärtner's radiologic classification differentiating form and density of the calcific deposits as well as their delimitation to the tendon structure. In T2-images there frequently is a perifocal band of increased signal intensity which can be identified as an oedema around the calcification. Analysing two perpendicular planes the calcifications can be assigned to the corresponding anatomical structure. 83 percent were located in the supraspinatus tendon above the humeral head or in the superior part of the subscapularis tendon. Degenerative areas of the rotator cuff are demonstrated as small zones of increased signal intensity, abnormal morphology or discontinuity of the tendon. Only in one patient a partial tear could be found; 11 percent showed variable signs of degenerative alteration of the involved tendon.
We report on a 59 year old patient with repetitive shoulder trauma due to numerous grand mal convulsions and consequent severe osteoarthritis of the shoulder joint with formation of multiple loose bodies. We discuss the aetiology of the loose bodies as being different to those found in synovial chondromatosis, as well as the radiological, histological, clinical and therapeutical features of this entity.
Posterior dislocation of the shoulder is rare. Only 2-3% of dislocated shoulders are displaced posteriorly. It is a diagnostic trap for young doctors. Over 60% of the cases are not diagnosed initially. This is a case report of a patient treated with physical therapy and even mobilisation in anesthesia for 2 years and then needed a total shoulder replacement.
This study investigates retrospectively the preoperative findings and postoperative courses of 580 children with altogether 1001 intertrochanteric osteotomies. The evaluation of on average 5 postoperative years determines criteria assisting the revalgisation of the femoral neck. Of main importance is the age at the date of operation; the younger the child is the higher is the degree of revalgisation. An also important factor is the preoperative CCD-angle, high values correlate with a high revalgisation rate. Exceptional features and alterations of femoral head, form and depth of the hip-socket also assist the revalgisation of femoral neck. Mechanical mistakes, little varization, low medialization of distal femoral fragment e.g., lead to an increase of postoperative CCD-angle; meanwhile damage of the apophyseal or epiphysial line does not affect the revalgisation.
The value of sonography for diagnosis of injuries of the acromioclavicular joint was examined in a prospective investigation. In 22 successive patients sonography was used in two defined positions, the results were compared with standard X-rays under weight loading. Only in 9 cases the findings could be controlled during operative exploration. In 16 cases, sonographic and radiologic findings were corresponding, in 6 cases both methods lead to different results. In all corresponding cases sonography was able to demonstrate direct or indirect signs of the damage of acromioclavicular and coracoclavicular ligaments. In the operatively controlled group in all cases the sonographic diagnosis was confirmed.