Aspekte einer liaisonpsychiatrischen Betreuung von Patienten einer universitären Schmerzambulanz

Background

Owing to a rise of psychosomatic comorbidities, the treatment of psychological disorders, which may negatively impact prognosis and therapy, is increasingly becoming a focus of attention for pain outpatient clinics.

Aim

This study investigates and discusses the advantages of liaison psychiatric care in a university pain clinic.

Methods

In this retrospective study, we investigated all patients who presented to an anaesthesiologically led pain clinic between January and June 2014. The psychiatric history was taken by the liaison psychiatrist of the pain clinic.

Results

In the period investigated, 485 patients were treated as outpatients. A psychiatric diagnosis was present 351 patients (72.4%). The distribution of the diagnoses was comparable with that of a consultation service. Adaptation and affective disorders dominated. The patients were preferentially treated with new generation antidepressants.

Conclusion

The constant presence of a liaison psychiatrist allows for timely, specialised care of pain patients in terms of a multimodal therapeutic approach.

     

Differenzialdiagnostik manualmedizinischer Syndrome der oberen Extremität

Pain in the upper extremities is as frequent as pain in the shoulder-region and these also often occur in combination. Patients are often severely affected. In this article manual medical syndromes are described which partially fit into existing concepts, such as epicondylopathy but also represent independent entities. Typical manual medical findings are presented on the basis of the main symptoms. The differential diagnostic delimitations, particularly of neurological and orthopedic syndromes are outlined in detail. The proposed manual medical osteopathic approach makes differential diagnostic considerations possible beyond compression of peripheral nerves, bone or joint-associated illnesses or circulatory disorders. It offers the possibility of an effective functional treatment planning and in particular cases could possibly replace invasive interventions.     

Therapiemöglichkeiten der chronischen ligamentären Ellenbogeninstabilität

Background

Chronic elbow instability is often the result of an acute trauma neglected by the patient or incorrect diagnostics by the treating doctor. Unspecific, epicondylitis-like symptoms and the absence of a feeling of instability make it difficult to diagnose; therefore, detailed knowledge of the pathology and a systematic search for clinical and radiological signs of instability in posttraumatic elbow pain and therapy-resistant epicondylitis are needed. Chronic instability can be concomitant with microtrauma, repetitive overload or hypermobility.

Diagnosis

The clinical tests are difficult and depend on the experience of the observer. Knowledge of the pathomechanisms of the elbow and targeted diagnostics allow the identification and successful treatment of a painful and unstable elbow.     

Thrombembolieprophylaxe bei kleineren unfallchirurgisch-orthopädischen Eingriffen an der unteren Extremität

Background

Data are lacking on the prophylaxis of deep vein thrombosis (DVT) after minor surgery of the low extremity.

Methods

Systematic literature searches were done to identify cohort studies and randomized controlled trials reporting DVT incidences after minor surgery of the lower extremities (i.e., excluding joint replacement surgery).

Results

After knee arthroscopy, DVT is detected clinically in about 4% of patients. Meta-analysis of three randomized trials on low molecular weight heparins yielded a relative risk reduction of 85% (p=0.002). Similar results can be expected for other minor operations of the calf and ankle, but the type of surgery and individual risk factors have to be considered.

Conclusion

Knee arthroscopy and other operations of the calf, ankle, and hindfoot all require medical DVT prophylaxis, especially when leading to immobilization or reduced weight bearing.     

Der kongenitale muskuläre Schiefhals

Congenital muscular torticollis (CMT) with unilateral shortening of the sternocleidomastoid muscle has a high rate of spontaneous remission so that the value of conservative treatment methods must be treated critically. Etiologically CMT is currently assumed to be a compartment syndrome and not a hematoma of the sternocleidomastoid muscle. In about 1 out of 7 cases the swelling of the muscle results in fibrosis of parts of the muscle. This tissue fibrosis differs dramatically in macroscopic aspects from shortened muscles in neuromuscular disorders. Physiotherapy does not influence the development of the fibrosis, nor does botulinum toxin A. Manual medical techniques also do not change the course of the tissue alteration but are indicated to treat coinciding segmental dysfunctions. Indications and limitations of manual medicine in the treatment of postural asymmetry of the head and neck are discussed in depth.     

Eine seltene Kombinationsverletzung im Rahmen einer Schulterinstabilität

Shoulder instability may veil various patho-anatomic findings. A case with a rare combination of patho-anatomic lesions is presented. In a patient with antero-inferior instability arthroscopy confirmed a superior labrum anterior-to-posterior (SLAP IV) lesion and a glenolabral articular disruption (GLAD) as well as a concomitant chondral injury to the apex of the humeral head. Stabilization of the labral complex was achieved arthroscopically. The osteochondral defect of the glenoid was addressed by interposition arthroplasty. Arthroscopic treatment of shoulder instability offers an individualized approach to a broad variety of patho-anatomic findings.     

Neue Untersuchungsmethoden der Tiefensensibilität am tastbaren Periost der Extremitäten bei Radikulärsyndromen

Background

In Part I, we reported on the current state of knowledge regarding the “Innervation of the periosteum”.

Methods

In Part II, we visually introduce our examination methods for deep sensibility (periosteal percussion pain, periosteal vibration perception and joint movement perception) and describe the individual examination methods.

Patients

A total of 443 patients with radicular syndrome of the upper and lower extremities was examined.

Results

The results of the percussion pain and vibration perception tests were the so-called indicating periostea, denoting the segmental innervations of the periosteum, and the so-called indicating joints, referring to extremity joints, such as the elbow and knee, which are predominantly supplied by certain nerves.

Conclusions

With our examination methods for deep sensibility at the palpable periosteum of the extremities, we were able to prove the segmental innervations of the periosteum (indicating periosteum). With the examination for kinaesthesia, we were able to prove the approximate segmental innervations of the joints of the extremities (indicating joint).     

Prothetischer Ersatz an der oberen Extremität bei Amputation oder Funktionsverlust

Manuelle Medizin - Die Indikation zum prothetischen Ersatz der oberen Extremität wurde in den letzten Jahren von der klassischen Amputation auch auf Patienten mit Verlust oder angeborenen...     

Lebensqualität und Schmerz bei Patienten einer medizinisch-geriatrischen Abteilung

BACKGROUND: To determine objective and subjective indications of quality of life in hospitalized geriatric patients. METHODS: Data were collected on 267 items using standardized interviews of 90 patients, including B-L and SF-36. RESULTS: In comparison to the control population, geriatric patients have worse SF-36 values; 91% have pain, and 63% depression and elevated B-L values. Pain therapy is usually with non-opiates and with warm/cold physical therapies. CONCLUSION: Pain therapy in the geriatric population surveyed does not reach the same standard as is usually offered to hospitalized medical and surgical patients.     

Die Glykogenose Typ IV als seltene Ursache einer Kardiomyopathie – Bericht einer erfolgreichen Herztransplantation

Zusammenfassung Wir berichten über einen 17j?hrigen Patienten, der an einer Glykogenose Typ IV (Morbus Andersen) und einem Immunglobulin-(Ig)-G-II-Subklassenmangel erkrankt war. Anamnestisch bedeutsam ist, da? bei gesunden Eltern des Patienten zwei jüngere Brüder im Alter von neun bzw. zehn Jahren an einer dilatativen Kardiomyopathie verstarben. Im Alter von zw?lf Jahren traten erstmals Symptome einer Herzinsuffizienz auf, wobei histologisch eine Kardiomyopathie auf der Basis der Glykogenose gesichert wurde. Das Krankheitsbild des Patienten war zus?tzlich durch rezidivierende pulmonale Infektionen mit Bildung von Bronchiektasen im Bereich des linken Unterlappens gekennzeichnet. In dieser Region entwickelte sich seit etwa dem elften Lebensjahr eine Atelektase. Bei rezidivierenden katecholaminpflichtigen kardialen Dekompensationen akzeptierten wir den Patienten trotz relativer Kontraindikationen (ausgepr?gte Kachexie, generalisierte Myopathie, Bronchiektasen bei Immundefekt) zur orthotopen Herztransplantation (HTX), welche erfolgreich durchgeführt wurde. Die ausgepr?gte Myopathie führte in der postoperativen Phase zu einer prolongierten Dauer der Mobilisation und einer verl?ngerten Beatmungszeit. Bei vorbestehenden Bronchiektasen kam es in der frühen Phase nach der Transplantation zur abszedierenden pulmonalen Infektion. Der Patient weist, über ein Jahr nach HTX, einen klinisch und funktionell stabilen Zustand auf. Die im Verlauf durchgeführten rechtsventrikul?ren Myokardbiopsien zeigten kein Anhalt für eine Rekurrenz der Glykogenose im Transplantat. Eingegangen: 12. April 1999, Akzeptiert: 22. Juni 1999