Arthroskopische Therapie der Rotatorenmanschettenmassenruptur

Today, large rotator cuff tears can be treated arthroscopically. Most decisive is analysis of the shape of the tear. After performing the essential mobilisation of the cuff and knowing the tear configuration, the surgeon can reconstruct the tendons with regard to individual pathoanatomy. Herein we explain the different steps during the operation and elucidate them with examples. A partial reconstruction, especially of the anterior and posterior parts of the cuff, makes sense and can be done in many cases. The clinical results are similar to those of open surgery, whereas the advantages of arthroscopic surgery are the clear mobilisation and visualisation of the cuff and the tear, respectively, in addition to the lower morbidity and co-treatment of other lesions.     

Arthroskopische Therapie der hinteren Schulterinstabilität

Posterior shoulder instability is less frequent than anterior instability and is also considered more difficult to diagnose and manage. Beside posttraumatic unidirectional cases without signs of hyperlaxity, posterior shoulder instability occurs as either atraumatic or microtraumatic unidirectional instability with hyperlaxity or as the leading component of multidirectional instability with hyperlaxity. The surgical treatment of choice after excluding bony abnormalities includes capsular shift procedures with or without reattachment of the labrum. The goal of arthroscopic treatment is to combine the good results of open techniques with the potential advantages of minimal-invasive surgery. With more modern techniques of suture management and anchor placement, there has been an improvement in the success rate of posterior arthroscopic stabilization. At present, it appears, that the results of arthroscopic treatment of posterior shoulder instability are approaching the results of those achieved through open surgical techniques.     

Arthroskopische Therapie der hinteren Instabilität des Schultergelenkes

Posterior instability of the shoulder is a rare entity. Arthroscopic stabilization of posterior instability is a well established technique whose indications and contraindications have to be taken into consideration for a successful surgical outcome. In this article the pathological mechanisms, diagnostics, therapy and results are described.     

Arthroskopische Diagnostik und Therapie synovialer Erkrankungen

Synovial disorders are amongst the most common indications for hip arthroscopy. Arthroscopic intervention has been reported for symptomatic synovial plicae, synovial chondromatosis, pigmented villonodular synovitis (PVNS) and rheumatoid arthritis. In comparison to radiologic imaging one major advantage is the ability to inspect, biopsy and treat during one procedure. In contrast to an arthrotomy hip arthroscopy avoids the potential risks of an extensive surgical exposure and prolonged rehabilitation. Nevertheless hip arthroscopy cannot be promoted as curative in all synovial disorders. In patients with localized synovitis, impinging synovial folds and, to a certain extent, PVNS a curative therapy and “restitutio ad integrum” can be achieved. The goal of hip arthroscopy in patients with synovial chondromatosis and rheumatoid arthritis is to enable the correct diagnosis and to provide symptomatic relief and improve joint function. Success or failure of arthroscopic treatment depends on proper patient selection and a correct arthroscopic technique.     

Arthroskopische Knotentechnik bei der Rotatorenmanschettenrekonstruktion

Due to the rapid evolution and wide availability of the special technology of arthroscopic rotator cuff repair more and more surgeons switch from the open to the arthroscopic approach in the management of even complex cuff tears. However the operative technique is still demanding and requires special skills, such as a precise analysis of the type of the lesion and the handling of specialized instruments and refixation systems. It is absolutely mandatory for every surgeon, to be able to tie arthroscopic knots even in difficult situations of the procedure. This paper gives an overview on the current state of the technology of arthroscopic knot tying in arthroscopic rotator cuff repair.     

Arthroskopische vs. offene Stabilisierung der Schulter

The shoulder joint provides a large range of motion which is an essential reason for injuries, dislocations and instability, especially in the younger population. The open surgical procedure has been widely accepted and it is known as the golden standard. Using the advanced arthroscopic techniques the surgeon should be also able to restore the stability at least in a recurrent, posttraumatic instability. In order to decide whether to perform an open Bankart repair or an arthroscopic stabilization procedure one must know the existing pathologies as large bony Bankart or Hill-Sachs lesions or HAGL lesions as well as poor glenohumeral ligament quality. The surgeon must know that refixation of the labrum alone is not the appropriate operative treatment for glenohumeral instability.     

Arthroskopische Stabilisierung der lateralen Sprunggelenkinstabilität

The anatomic reconstruction of the anterior talofibular ligament (LFTA) by a modified Broström-Gould procedure is an established method for treatment of chronic lateral ankle instability providing good long-term results and a low complication rate. This paper describes the arthroscopic technique of this procedure. The arthroscopic approach offers the advantage that intra-articular lesions can be more easily recognized and simultaneously treated.     

Therapie der Autoimmunhepatitis

Ohne Zusammenfassung     

Arthroskopische Befunde bei der chronischen Sprunggelenkinstabilität

Zusammenfassung Die Beurteilung des Ausmaßes von Bandinstabilitäten des oberen Sprunggelenks (OSG) mittels klinischer und radiologischer Diagnostik fällt oft schwer. Umfang und Häufigkeit insbesondere der medialen Instabilität werden dabei häufig unterschätzt. Werden bei einer operativen Rekonstruktion nicht alle betroffenen Bänder eingeschlossen, können Instabilität und Beschwerden persistieren.In einer konsekutiven Serie von 281 chronisch instabilen Sprunggelenken (188 Frauen, 93 Männer, Alter 35,8 [15–61] Jahre) fand sich in 140 Fällen (50%) eine Verletzung des Lig. deltoideum, und diese war in 103 Fällen (37%) mit einer Verletzung der lateralen Bänder kombiniert. Eine isolierte laterale Instabilität lag in 121 Fällen (43%) und eine isolierte mediale Instabilität in 38 Fällen (14%) vor.Die präoperative arthroskopische Untersuchung des Sprunggelenks hat sich als hilfreich erwiesen, den Umfang der ligamentären Insuffizienz sowie begleitende Schäden zu erkennen. Diese Informationen hätten meist auch mit aufwändigen bilddiagnostischen Maßnahmen nicht in diesem Ausmaß gewonnen werden können. Die Erkenntnisse aus der funktionellen Prüfung der medialen und lateralen Bandstrukturen erlauben dem Chirurgen, die notwendige operative Rekonstruktion optimal dem Verletzungsmuster anzupassen. Dies ist deshalb so wichtig, weil gezeigt werden konnte, dass die Sprunggelenkinstabilität nicht einer einzigen Entität entspricht, sondern eine hohe Variabilität aufweist. Obschon nicht in einer randomisierten Studie nachgewiesen, sind wir doch der Meinung, dass die präoperative Arthroskopie die Effizienz der operativen Behandlung der symptomatischen, konservativ erfolglos behandelten Instabilität des Sprunggelenks verbessert. Die arthroskopische Untersuchung wird deshalb dem Patienten Nutzen bringen, aber auch volkswirtschaftlich sinnvoll sein.     

Therapie der Hand in der Ergotherapie

Manuelle Medizin - Menschen mit Erkrankungen und Problemen der Hand sind in ihrer Handlungsfähigkeit bei Alltagstätigkeiten beeinträchtigt. Die Erhaltung oder Wiederherstellung der...