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Biomedical subjects

P Habermeyer

Publications and source records attributed to P Habermeyer.

At least 55 records · Page 3Linked to original sources
PubMed1993

[Treatment strategies in infections of the shoulder joint].

Shoulder joint infections are severe pathological conditions. Since the success of therapy is decisively dependent on early treatment, if joint infection is suspected, the patient should be hospitalized immediately. Characteristic suspicious features are extremely severe shoulder pain, adoption of a pain-relieving posture, and severe malaise. The diagnosis and differential diagnosis are discussed. In addition to selective parenteral administration of antibiotics, treatment comprises various methods of draining the shoulder joint in combination with temporary immobilization.

Anti-Bacterial Agents↗
PubMed1993

[Endogenous bilateral compression syndrome of the suprascapular nerve. Overview and case report].

Entrapment of the suprascapular nerve with shoulder pain and atrophic paresis of both the supraspinatus and infraspinatus muscles has been known since the fifties. So far a bilateral entrapment of the suprascapular nerve has rarely been described. We present a report of an endogenous bilateral entrapment neuropathy of the suprascapular nerve and discuss the differential diagnoses in relation to therapeutic and prognostic consequences.

Adult↗
PubMed1992

The intra-articular pressure of the shoulder: an experimental study on the role of the glenoid labrum in stabilizing the joint.

It was shown on human corpses that the glenohumeral joint may be compared to a piston surrounded by a valve. The glenoid labrum, then, should work like the valve block, sealing the joint from atmospheric pressure. In order to test this hypothesis, 18 human shoulder preparations were studied. The mean stabilizing force obtained by atmospheric pressure was 146 N. Additionally, 15 patients without any sign of instability and 17 patients with an anterior instability of the shoulder were tested under general anesthesia. In stable shoulder joints, traction at the arm caused negative intra-articular pressure that could be correlated to the amount of force exerted. In contrast, unstable shoulder joints with a tear of the glenoid labrum (Bankart lesion) did not exhibit this phenomenon. For unstable shoulder joints, the piston-and-valve model is no longer valid. This enlarges the current concept of shoulder joint stability in two ways: (a) the absence of negative intra-articular pressure disturbs joint mechanics and (b) altered pressure receptors might disturb motor coordination that dynamically protects the shoulder from dislocating forces.

Adult↗
PubMed1992

[Ultrasound assessment of reconstructed rotator cuffs].

The evaluation of recurrent shoulder symptoms in patients who have had rotator cuff repair is a diagnostic challenge. Pain and limitation of motion may be caused by a recurrence of the rotator cuff tear. Arthrography is not considered to be helpful in postoperative cases, since it is false-positive in most of them. Pre-operative ultrasonography of the shoulder is regarded as a highly accurate diagnostic tool for rotator cuff tears. The diagnostic criteria used are: the continuity of the rotator cuff, its contour, its thickness and its echogenicity. Our study was aimed at determining which ultrasonographic criteria were significant for a retear. In addition, the "normal" postoperative sonographic appearance of the rotator cuff was established. Of 133 patients with a full thickness rotator cuff tear, 110 were evaluated 4-48 months (mean in 21 months) after surgery. A total of 85 cuffs were reconstructed, in 46 cases by direct suture, in 33 cases by suture to the major tubercle and in 6 cases by tendon transfer (Cofield technique). In 25 cases cuffs the could not be reconstructed. Subacromial decompression was performed routinely. The patients were evaluated clinically by range of movement, force and isometric and impingement tests. The subjective outcome was assessed by the algo-functional index of Patte. Ultrasonography was performed using a 7.5-MHz linear scanner. Each sonographic criterion was referred to the clinical and subjective findings. Ultrasonographic evaluation of the rotator cuffs that could not be reconstructed revealed non-visualization of the tendons. In 13 of the 85 patients in whom reconstruction of the cuff was possible a normal sonographic pattern was seen.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

[Osteoid osteoma of the elbow].

The osteoid osteoma is a rare, benign neoplasm of bone, most frequently located in the lower extremity (head of the tibia). Because of its rarity and its mostly rather unspecific clinical symptoms, diagnosis of the tumor is frequently problematic. Ideally, osteosclerosis surrounding a central focus (nidus) is revealed by radiology. Radiological imaging seems to be the most effective tool in reaching the correct diagnosis. Operative resection of the nidus is the only known curative therapy for osteoid osteoma.

Adult↗
PubMed1992

[Corrective interventions subsequent to humeral head fractures].

The complications of old fractures of the proximal humeral head and fracture dislocations are nonunion, malunion, osteonecrosis, early traumatic arthritis, chronic dislocation and instability with subluxation. We reviewed a consecutive series of 34 shoulders that were treated between 1986 and 1990. We performed 7 hemiarthroplasties and 11 total shoulder arthroplasties (Neer type) in 17 patients (group I). Group II consisted of 12 osteotomies, 3 internal fixations for nonunion (AO technique), and 1 shoulder arthrodesis. The average follow-up was 27 months (group I) and 26 months (group II), respectively. The results were: good in 32%, fair in 50%, and poor in 18% in group I; excellent in 6%, good in 62%, and fair in 32% in group II. The results indicate that varus/valgus-osteotomies and derotation osteotomies should be considered as an alternative procedure prior to arthroplasties before traumatic arthritis has developed. Internal fixation for nonunion (AO technique) is a replacement for hemiarthroplasty.

Adult↗
PubMed1992

[Scapula fractures--classification and differential therapy].

The classification of fractures of the scapula (type A: body and process fractures; type B: neck fractures; type C: glenoid fractures) is shown, and the indications for conservative and operative treatment are described, as are the surgical approaches and operative techniques. In our hospital, 93 patients with 153 fractures of the scapula type A, B or C (ratio 1.6:1) were treated. This ratio was 1.7:1 in patients treated by operation. The indication for operation was usually glenoid fractures with accessory process fractures.

Adolescent↗
PubMed1992

[Special status of lateral clavicular fracture].

Fractures of the lateral clavicle have different biomechanical conditions compared with fractures of the medial and central third; they therefore demand different therapy. Some 237 patients with fractures of the clavicle were followed, of which 75 (33%) were located in the lateral third of the clavicle. At the 5-year follow-up after exclusively conservative treatment, good results were found for Neer types I and III and 3 Jäger/Breitner type IIb fractures, while 4 out of 13 Jäger/Breitner type II a fractures ended in pseudarthroses (31%). Conservative treatment is recommended for Neer types I and III, as well as for the more stable Jäger/Breitner type II b and old II a fractures. Therefore, a new bandage is presented. It prevents the posterior and upward dislocation of the proximal fragment by vertical compression and rotation of the distal fragment by fixation of the arm. Open reduction and internal fixation by preferably extraarticular implants is recommended for unstable and dislocated Jäger/Breitner type II a fractures. For fractures of the lateral clavicle, good results can be achieved when the instability is recognized and adequately treated.

Acromioclavicular Joint↗
PubMed1991

[Fractures of the humeral head. Conservative and surgical differential therapy].

The Neer classification for fractures of the proximal humerus is a system based on accurate identification of the four major fragments and their relationship to each other. There is a specific type of displaced 4-fragment fracture of the proximal humerus which consists in valgus impaction of the head fragment. This type of fracture is combined with a lower rate of avascular necrosis than that of other displaced 4-fragment fractures. In addition, the outcome is different according to whether a displaced 4-fragment fracture affects the surgical or the anatomical neck. Those through the surgical neck have a much lower rate of avascular necrosis than those through the anatomical neck. Therefore, 4-fragment valgus impacted fractures through the surgical neck should be treated by open reduction and internal fixation rather than by primary hemiarthroplasty in younger patients.

Adult↗
PubMed1990

[Incisura scapulae syndrome].

The suprascapular nerve may rarely be entrapped in the suprascapular notch. This causes weakness of the supra- and infraspinatus muscles and pain in the glenohumeral and acromioclavicular joints, which are innervated by this nerve. The entrapment syndrome may result from direct or indirect trauma, fracture of the neck of the scapula, kinking or traction on a sling affecting the nerve, from the shape of the notch, compression by a ganglion, or its cause may be idiopathic. Diagnosis of the syndrome is based upon deep unceasing pain reported at the postero-lateral shoulder, atrophy of the supra- and infraspinatus muscles, and impaired shoulder external rotation and a lidocaine test. The final proof is taken from polyphasic EMG potentials which are decreased in amplitude and increased in distal latency. Initially the entrapment neuropathy may be treated by immobilization, analgesics, and physiotherapy. A tear of the rotator cuff as well as a frozen shoulder have to be excluded by arthrography. In persistent cases of pain and pathologic EMG findings surgical decompression of the nerve should be done. The trapezius muscle is approached by a postero-superior incision. Via the suprascapular fossa the notch may be reached. Then the nerve is decompressed by removing the transverse scapular ligament. Reports of the cases operated so far are promising, though their number is small.

Humans↗
PubMed1990

[Significance of the glenoid labrum for stability of the glenohumeral joint. An experimental study].

In human cadavers we were able to show that the glenohumeral joint is comparable to the model of a physical piston. The labrum glenoidale functions like a valve against atmospheric pressure. It is possible to characterize the behavior of intraarticular negative pressure by the equation (formula; see text). The calculations of the force F of atmospheric pressure tending to resist distraction of the joint surfaces leads to a 95% confidence interval from 6.9 to 22.9 kp. Under a general anesthetic, distraction of the healthy glenohumeral joint also produces negative intraarticular pressure in the area of the fossa glenoidalis in vivo. Joints with a labral tear (Bankart defect) and a chronic instability are not characterized by this phenomenon. A change in intraarticular pressure might stimulate intraarticular pressure receptors. This could be important in functioning as a neuromuscular protection reflex for the joint.

Adult↗
PubMed1989

[Fractures of the proximal humerus].

The Neer four-part classification for displaced proximal humeral fractures is the most useful classification so far devised for consistent diagnosis and treatment. Nevertheless, there are several points in the Neer classification that need changing. Group II fractures, i.e., displaced fractures of the anatomical neck have a severe prognosis, excluding a mild graduation as in group II. Displaced four-segment fractures can be classified in group IV as well as in group V, which means the classification less than sharp. Without disregarding Neer's criteria, we use our own simplified classification: group A: extra-articular non-displaced two- to four-segment fractures; group B: extra-articular displaced two- to four-segment fractures; group C: intra-articular impacted or dislocated two- to four-segment fractures. The prognosis following fracture treatment is heavily influenced by the outcome of avascular necrosis of the head. Additionally, surgical treatment offers the change of further devascularization. Rigid plate fixation leads to a high incidence of avascular necrosis. In the case of displaced fractures, we prefer open reduction and internal fixation by means of tension-band wiring. Screws have a limited use in the presence of decreased pullout strength in osteoporotic bone. A Neer II prosthesis is indicated as a primary procedure for impacted fractures of the humeral head, displaced or dislocated four-part fractures and dislocated three-part fractures in elderly patients. In other patients primary open reduction with internal fixation is preferred. Relief of impaction of the humeral head should be avoided. In case of a late osteonecrosis in younger patients hemiarthroplasty is indicated as a secondary procedure.

Fracture Fixation, Internal↗
PubMed1989

[Fractures of the distal end of the radius].

Attitudes to the treatment of distal radial fracture are now more critical than previously, especially where intraarticular fracture is concerned. Inadequate primary reduction and such complications as redislocation or dystrophic problems lead to poor results. Quantification of fracture instability is becoming increasingly important in fracture classification, determination of the indications for the different treatment modalities and management. Accurate anatomical reduction also improves later function. The quality of alignment attained during the treatment depends on the quality of reduction. Closed reduction by means of traction should be achieved by pulling on fingers I, II and IV. The radial dislocation should be corrected first and then the dorsal dislocation; a cast applied to the lower arm is sufficient for immobilization. Primary surgery is indicated more urgently and the type of surgery in more detail, for example, when there are steps in the articular surface or when there is more than one factor in instability. Pin fixation should be applied sooner and more frequently with either primary or early secondary indications. Plate fixation is mostly achieved from the volar surface; it is indicated in flexion fractures and sometimes in extension fractures, but only in combination with rigid screw fixation with or without bone grafting. We are finding increasingly more indications for external fixation, not only in the case of open fractures with soft tissue damage but also with multiple fragments or comminuted fractures, sometimes in combination with bone grafting.

Bone Nails↗
PubMed1989

[Tendon ruptures of the shoulder].

Common sports, involving raising the arms above the head, i.e., throwing, racquet games and swimming, often result in rotator cuff tendinitis. During the throwing motion, the humeral head and its overlying biceps tendon and rotator cuff must pass rapidly under the coraco-acromial arch. Damage to these structures can occur by several mechanism. First, an increase in the size of the structures passing underneath the arch may lead to impingement. This can occur either by way of hypertrophy of the musculotendinous cuff or by way of inflammation of the cuff. Second, a decreased space available underneath the arch secondary to osteophyte formation of the acromion and fibrosis of the subacromial space may lead to impingement. Third, weakness or incompetence of the rotator cuff allows the humerus to ride up and impinge on the coracoacromial arch with motion of the shoulder. Tendinitis can be combined with increased laxity of the glenohumeral joint and/or acquired instability due to a labral tear. Prevention of overuse injuries is a cornerstone of our treatment concept. The muscle tendon unit requires passive and neuromuscular facilitated streching after warming-up exercises. Muscular imbalance and weakness are prevented by balanced eccentric strenthening with particular attention to the external rotators and scapular muscles. Knowledge of the mechanics of the pitching motion, tennis serve, swimming stroke, etc. is of paramount importance in the prevention of injuries. As the onset of shoulder problems contributes to a particularly fatiguing situation, extreme fatique performance severity should be avoided. Every effort must be made to apply conservative treatment when overuse problems arise in the athlete's shoulder.(ABSTRACT TRUNCATED AT 250 WORDS)

Athletic Injuries↗
PubMed1988

[Value of conventional x-ray diagnosis and computerized tomography in the detection of Hill-Sachs defects and bony Bankart lesions in recurrent shoulder dislocations].

Forty patients with anterior dislocation of the shoulder were examined in order to demonstrate Hill-Sachs defects and bony Bankart lesions. All patients had conventional radiographs of the shoulder in two planes, special views according to Hermodsson and Bernageau and CT. The examinations were evaluated by three observers. CT was regarded as the gold standard. Sensitivity for demonstrating Hill-Sachs defects for the standard views was 45% and for the Hermodsson views was 76%. For demonstrating Bankart lesions, standard views had a sensitivity of 37% and the Bernageau view 64%. Computed tomography was markedly superior to the standard and the special views, both for demonstrating the lesions and the agreement between various observers.

Female↗
PubMed1988

[Conservative treatment of elbow dislocations].

Ligamentous injuries following dislocations of the elbow joint are a primary indication for nonsurgical treatment. The principles of closed reduction are longitudinal traction of the forearm, followed by flexion. The period of immobilization in a plaster cast should be decided on an individual basis. For elbows that show no tendency to redislocate, immobilization for no more than 1 week should suffice. For elbows with a tendency to redislocate 2-3 weeks' immobilization is recommended. Radiological follow-up shows a high percentage of degenerative changes, i.e. subchondral sclerosis, osteophytosis, periarticular calcification, irregularities in the epicondyles. In addition to slight degenerative changes, there are few subjective complaints and functional impairments. Now evidence has been found to recommend primary surgical treatment of ligamentous injuries associated with dislocation of the elbow.

Casts, Surgical↗