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Biomedical subjects

S Lichtenberg

Publications and source records attributed to S Lichtenberg.

At least 19 recordsLinked to original sources
PubMed2006

Transfer of the tendon of latissimus dorsi for the treatment of massive tears of the rotator cuff: a new single-incision technique.

We describe 14 patients who underwent transfer of latissimus dorsi using a new technique through a single-incision. Their mean age was 61 years (47 to 76) and the mean follow-up was 32 months (19 to 42). The mean Constant score improved from 46.5 to 74.6 points. The mean active flexion increased from 119 degrees to 170 degrees , mean abduction from 118 degrees to 169 degrees and mean external rotation from 19 degrees to 33 degrees . The Hornblower sign remained positive in three patients (23%) as did the external rotation lag sign also in three patients (23%). No patient had a positive drop-arm sign at follow-up. No significant difference was noted between the mean pre- and postoperative acromiohumeral distance as seen on radiographs. An increased grade of osteoarthritis was found in three patients (23%). Electromyographic analysis showed activity of the transferred muscle in all patients.

Activities of Daily Living↗
PubMed2006

Three-dimensional glenoid deformity in patients with osteoarthritis: a radiographic analysis.

BACKGROUND: In osteoarthritis of the shoulder, the tilt of the glenoid surface undergoes an eccentric deformation not only in the anteroposterior but also in the superoinferior direction. The goals of this study were to analyze glenoid version in the coronal plane and to clarify the relationship between retroversion and inferior inclination of the glenoid. METHODS: Standardized radiographs of 100 consecutive patients with primary osteoarthritis of the shoulder and 100 otherwise healthy patients with shoulder pain (the control group) were included in this study and were analyzed by two independent observers. RESULTS: We defined four different types of inclination deformity of the glenoid. In a type-0 glenoid, a line at the base of the coracoid process and a line at the glenoid rim run parallel. Both lines intersect below the inferior glenoid rim in a type-1 glenoid. In a type-2 glenoid, the line at the base of the coracoid process and the glenoid line intersect between the inferior glenoid rim and the center of the glenoid. In a type-3 glenoid, the lines intersect above the base of the coracoid process. A significant difference (p < 0.0001) in the distribution of glenoid types between the two patient groups was observed. Forty-seven patients with osteoarthritis showed combined posterior and inferior glenoid wear. We found no correlation between the type of inclination and the type of glenoid morphology. The interobserver reliability of our observations was very high. CONCLUSIONS: In osteoarthritis, eccentric inferior glenoid wear is frequent and independent from retroversion deformity of the glenoid. Normalization of glenoid version in both transverse and coronal planes may reduce eccentric loading of the prosthetic glenoid, which has been associated with loosening.

Adult↗
PubMed2005

Intra-articular volume assessment in glenohumeral instability.

It is commonly claimed that instability of the shoulder is associated with an enlarged joint volume. The purpose of our study was to assess the intra-articular volume in acute and chronic glenohumeral dislocation. Sixty-seven patients were examined by intra-articular infusion of saline solution. Three groups could be formed. Group 1 (n = 51) consisted of patients with first time traumatic dislocation, group 2 (n = 8) of cases with recurrent post-traumatic dislocation. The patients of group 3 (n = 8) suffered from impingement syndrome and served as the control group. The joint volume was correlated to the body surface area (BSA). We found a strong correlation between height, sex and intra-articular joint volume. There was no statistically significant difference in joint volume correlated to BSA between the three groups. There is no statistically significant difference in joint volume correlated to BSA in patients with traumatic anterior instability, chronic instability and individuals without glenohumeral instability.

Adolescent↗
PubMed2005

[Traumatic anterior shoulder dislocation].

The purpose of this paper is to outline the present state of treatment for traumatic anterior shoulder dislocation. Pathoanatomic changes as well as intrinsic and extrinsic prognostic factors are discussed. Based on these, treatment options for first time traumatic dislocations and chronic posttraumatic instability are recommended.

Arthroplasty↗
PubMed2004

[Shoulder Arthroplasty. Surgical management].

Shoulder arthroplasty covers an extensive indication spectrum of degenerative, inflammatory to infectious, tumorous, instability-associated and neurogenic disease to acute trauma and posttraumatic joint destruction. Each of these indications requires its own regime and an appropriate implant. Osteoarthritis is the most frequent indication, and will be used as an example for surgical management, bringing the manufacturer-nonspecific general guidelines, joint mechanics and surgical technology into agreement. The fundamentals of the technique of implantation refer to the anatomical adaptability of the third generation of shoulder prostheses, which permits an accurate reconstruction of glenohumeralen joint centring. This article also describes far-reaching principles, which are generally applicable to all indications for shoulder arthroplasty.

Arthroplasty, Replacement↗
PubMed2004

[Shoulder instability. Classification and treatment].

Shoulder instability includes different degrees of instability from painful hyperlaxity to subluxation to dislocation. Different classifications of shoulder instability have been created in order to facilitate decision making for treatment. None of these, however, has gained acceptance. Subject to the indications, shoulder instability can be treated conservatively or surgically after repositioning the acute dislocation. A survey of arthroscopic and open stabilization procedures and their results are given in relation to the indications.

Arthroscopy↗
PubMed2004

[Outcome quality of psychosomatic rehabilitation: goal attainment scaling on the basis of a structured catalogue of therapy goals].

Within the scope of a multicenter study regarding the outcome quality of inpatient psychosomatic rehabilitation a structured catalogue of therapy goals (SZK, strukturierter Therapiezielkatalog) was developed. The catalogue contains 89 predetermined therapy goals as well as the option to formulate further goals in own words. The SZK is available both as a patient and as a therapist version. At the beginning of treatment up to five primary objectives are chosen from the list. At the end of treatment and at the 1-year follow-up the level of achievement of objectives is assessed. Moreover the SZK contains the option to mark goals as not relevant any more and to add goals which came up during the treatment and to evaluate them regarding the level of achievement. The study on hand asks for empirical identification of the target structure. Furthermore, reliability and validity of the calculated measures of goal attainment are analysed. As the most important finding the SZK turns out to be a practical and economical assessment instrument for goal-oriented evaluation.

Adult↗
PubMed2004

Osteochondral autologous transplantation for the treatment of full-thickness articular cartilage defects of the shoulder.

We performed eight osteochondral autologous transplantations from the knee joint to the shoulder. All patients (six men, two women; mean age 43.1 years) were documented prospectively. In each patient the stage of the osteochondral lesion was Outerbridge grade IV with a mean size of the affected area of 150 mm2. All patients were assessed by using the Constant score for the shoulder and the Lysholm score for the knee. Standard radiographs, magnetic resonance imaging and second-look arthroscopy were used to assess the presence of glenohumeral osteoarthritis and the integrity of the grafts. After a mean of 32.6 months (8 to 47), the mean Constant score increased significantly. Magnetic resonance imaging revealed good osseointegration of the osteochondral plugs and congruent articular cartilage at the transplantation site in all but one patient. Second-look arthroscopy performed in two cases revealed a macroscopically good integration of the autograft with an intact articular surface. Osteochondral autologous transplantation in the shoulder appears to offer good clinical results for treating full-thickness osteochondral lesions of the glenohumeral joint. However, our study suggests that the development of osteoarthritis and the progression of pre-existing osteoarthritic changes cannot be altered by this technique.

Adult↗
PubMed2003

Combination of microfracture and periostal-flap for the treatment of focal full thickness articular cartilage lesions of the shoulder: a prospective study.

Focal full-thickness articular cartilage lesions of the shoulder are less common than those of the lower extremity but are often symptomatic and may progress to degenerative osteoarthritis. This prospective study evaluated our clinical results for cartilage repair in five patients with chondral defects localized at the humeral head using a combination of microfracture and periostal flap, all by deltoidopectoral approach. Mean follow-up was 25.8 months (range 24-31) and consisted of a clinical examination, Constant score examination, radiography, and magnetic resonance imaging; three patients underwent a second-look arthroscopy an average of 8 months following cartilage repair. We found the Constant score significantly improved over the preoperative level, from 43.4% to 81.8%. Pain was reduced significantly to 18.6 points. Radiography and magnetic resonance imaging showed progression of the osteoarthritis in two patients. Second-look arthroscopy revealed a significantly reduced cartilage lesion. This is the first report of a combination of microfracture and a periostal flap for repair of focal full-thickness cartilage lesions at the shoulder. Short-term follow-up clinical results were satisfactory. It is essential to address the underlying pathology. Results must be reconfirmed in a long-term study.

Adolescent↗
PubMed2003

[Diagnosis and treatment of anterior and posterior shoulder dislocation. II. Treatment].

In Part I the anatomy, biomechanics, different pathologic changes, and diagnostic tools for anterior and posterior instability were discussed. In this second part, treatment of an acute dislocation is introduced. Furthermore different surgical procedures and their indications are discussed. Algorithms for treatment of first-time dislocation, chronic anterior instability, and posterior instability are presented.

Adolescent↗
PubMed2003

[Intraarticular pathology of atraumatic shoulder dislocations. An arthroscopic study].

AIM OF THE STUDY: According to the literature, atraumatic shoulder dislocations occur without or only minor trauma,self-reduction and no or little pain. Little is known about intraarticular pathology in this entity. It was the purpose of our study to evaluate such findings. METHODS: During a 2-year period,226 patients had surgery for shoulder dislocation.28 patients met the criteria for atraumatic dislocation as above (group A). Patients with bony pathology or recurrent microtrauma were excluded. All had been treated with a rehabilitation program without success.28 consecutive patients with surgery after posttraumatic dislocation served as a control group (group B). At the beginning of the surgery,arthroscopy was performed in all patients and the intraarticular findings were recorded. For the capsulo-labral pathology,we determined 3 types: type I had capsular elongation or scarring and included so called "non-Bankart-lesions"; type II had classic "Bankart"-lesions and type III more complex capsulo-labral lesions like e.g. "ALSPA"-lesions. RESULTS: The mean age in group A was 27.6 y and 26.2 y in group B.12 patients in group A and 5 in group B were female. The average no.of dislocations was 10 (1-30) or 9 (1-28), respectively. In group A we saw type I lesions in 11 patients (39.3%), type II lesions in 9 (32.1%) and type III lesions in 8 (28.6%) patients. In group B we found type I lesions in 8 (28.6%), type II lesions in 4 (14.3%) and type III lesions in 16 (57.1%) patients.Hill-Sachs lesions were found in 22 (78.6%) and 23 (82.1%) of the patients, respectively.Also, we saw chondral glenoid damage, cuff lesions and SLAP-lesions in both groups. CONCLUSION: The above mentioned criteria for atraumatic shoulder dislocation do not exclude intraarticular pathology comparable to posttraumatic cases, at least for patients, who do not respond to a conservative treatment. Besides the etiology, the given pathology must be considered for therapy.

Adult↗
PubMed2003

[Reconstruction of big rotator cuff ruptures. A new technique of tendon refixation with the corkscrew suture anchor system].

Tendon retraction and fatty degeneration is a major problem in repair of massive rotator cuff tears. Especially in the transosseous refixation technique, a tension-free refixation cannot be obtained in all cases. The purpose of this prospective study was to evaluate the postoperative results using a new tension-free reinsertion technique with a Corkscrew suture anchor system. Thirty patients (25 males, 5 females) with complete one and two tendon tears underwent open rotator cuff repair (rupture of one tendon: n=14, 47%). The torn tendons were mobilized and reinserted medially to reduce tension. Medialization was achieved by inserting tendon near the osteochondral border in a bony trough. The number of implanted suture anchors ranged from 2 to 6 (mean: 3.56). The mean age was 56 years (39-68 years) with a follow-up of 24 months (17-33 months). In one patient physical and sonographic examination showed a complete and in two patients a partial rerupture. A temporarily frozen shoulder occurred in two cases. No infection or rejection response was seen. In no case was revision surgery necessary. No displacement or loosening of the Corkscrew anchors was noticed. The constant score improved from 45 points preoperatively to 85 points at the time of follow-up (mean). The Corkscrew suture anchor system in combination with the new suture technique offers the possibility of a stable reinsertion even in reduced calcified bone structure. This facilitates good conditions for stable fibroblastic healing. Our midterm results show good osseous union combined with a low rerupture rate.

Adult↗
PubMed2003

[Superior labrum-biceps anchor complex].

The focus in overhead sport injuries of the shoulder has been directed on lesions of the superior labrum-biceps complex during the last few years. This is due to improved imaging modalities as well as a better understanding of the anatomy and biomechanics. Arthroscopy is capable of diagnosing and treating these lesions. The anatomy, biomechanics, and operative treatment strategies and techniques are described in detail. The superior labrum anterior-posterior (SLAP) lesion is found in young active overhead athletes. Based on their classification and concomitant lesions, the unstable SLAP lesions (types II and IV) have to be repaired in order to restore stability to the superior labrum-biceps complex for stabilizing the glenohumeral joint. According to our own results and after review of the current literature, SLAP repair yields good results in overhead athletes enabling them to return to pain-free participation in their sport.

Adult↗
PubMed2003

[Individualized outcome measurement -- a comparison between prospective and retrospective problem marking in psychosomatic rehabilitation].

This article reports on a questionnaire concerning individual problems in psychosomatic rehabilitation. A sample of 858 patients answered the questions at the beginning and on a one year catamnestic measurement. First, the frequency of occurrence of several symptoms was asked. Second, the rehabilitants were asked to indicate for each symptom if it was an important problem before treatment. This procedure of identifying problems was done at the beginning (prospective marking) and also at the one year follow up (retrospective marking). The questionnaire allows to compute eight subscales and one global scale regarding all items (classical approach). Frequency of occurrence decreased with an average effect size (ES) of 0.56 on the global scale. In the next step, measurement was individualized by regarding only items which were marked as relevant problem. By prospective marking, effect size was 1.32. By retrospective marking, no growth of effect size in comparison to the classical approach was found (ES = 0.56). The results indicate that the prospective approach of identifying problems is the better way of individualizing measurements. Moreover, the impact of individual problem definition on outcome was demonstrated.

Adjustment Disorders↗
PubMed2003

[Evaluating the rehabilitation process by means of peer review: examination of the methods used and findings of the 2000/2001 data collection in the somatic indications].

This paper reports the results of a peer review system that was implemented in the context of the quality assurance programme of the statutory German Pension Insurance scheme. The data reported refer to the 2000/2001 data collection period for medical rehabilitation in the somatic indications. Examination of inter-rater reliability for judgements of individual raters shows satisfactory results only in orthopaedics. In the quality assurance programme, rehabilitation centres are usually evaluated by the mean of 20 rater judgements. The reliability of this aggregated measure is satisfactory in all indications. The results of 561 rehabilitation centres show that those quality criteria are in particular need of improvement that refer to subjective concepts of patients (e. g., subjective theories of illness). Between peer review procedures in 1998 and 1999, the quality scores of rehabilitation centres had improved whereas between 1999 and 2000/2001, no further improvement can be shown. However, those rehabilitation centres with a low quality score in 1999 (lowest quartile of the distribution) underwent a positive development between 1999 and 2000/2001. Reasons for this trend and possibilities for improving interrater reliability of the peer review process as an element of the quality assurance programme of the German Pension Insurance scheme are discussed.

Chronic Disease↗
PubMed2002

[Isolated traumatic rupture of the subscapular muscle tendon as an adolescent injury].

INTRODUCTION: Until now no case of a traumatic tear of the subascapularis muscle in children was described in the German speaking literature. Using the example of 2 cases of a 12 and 14 year boys youth history, clinic, diagnostics and therapy will be presented. METHODS: The accident happened in extension and external rotation of the arm without dislocation. Beside the complete tear of the SCP-tendon in one case an accompanying expanded humeral flake fracture at the minor tuberosity was found. Under protection of the epiphysis line the refixation was performed using suture anchors. RESULTS: The post-operative control after 12 months showed a complete tendon healing, no arthritis or delayed bony ingrowth with return to full activity. CONCLUSION: Isolated traumatic SCP-tears can be occur also in young patients. As major consequence, it is necessary to perform a thorough clinical examination with additional apparative diagnostics (Sonography, MRI). This way, this rare but important lesion can be detected early and lead to adequate surgery without any delay.

Adolescent↗
PubMed2002

[Proximal humeral head fractures--Future development of shoulderimplants].

In 1951 a shoulder prosthesis was developed for the treatment of complex humeral head fractures by Neer. The Neer-II-Prosthesis, which was developed further in 1973 represents the basis of modern shoulder implants. The unsatisfactory postoperative functional results for primary humeral head replacement required the development of new adaptable implants for the treatment of complex humeral fractures, which allow the reconstruction of humeral length, the reconstruction of center of rotation and humeral offset, the anatomic positioning, the reconstruction of retrotorsion and the secure refixation of the tuberosities. The development of third and fourth generation of humeral head prosthesis achieves a three-dimensional adaptability for the conditions of posttraumatic arthritis. Primary and secondary humeral head replacement in humeral head fractures as well as revision of prosthetic replacement are complex and technical demanding operations with high and different requirements on implants having to be realised on further development.

Forecasting↗