Primäre kapsuläre Steife der Schulter

Background

Primary capsular stiffness (PCS) is a common shoulder disease without identifiable etiology or associated pathology. The stage-adapted multimodal treatment of PCS is challenging and still requires optimization.

Objectives

The newest, evidence-based perceptions related to PCS with recommendation of clinically relevant diagnostic and therapeutic guidelines are summarized.

Materials and methods

Relevant, new findings regarding the etiology and diagnosis of PCS from the last 10 years were summarized. A 2012 treatment algorithm for PCS was updated and expanded with the most current knowledge.

Results

The subacromial space is involved in inflammatory processes in the initial phase of PCS. Identification of advanced glycation end products help with understanding the fibrotic changes. Elevated serum lipid levels are associated with PCS but their exact role remains unclear. Distension of the bursa in the superior subscapularis recess is a “new” suggestive MRI sign of the pathology. Combined intraarticular and subacromial corticosteroid injections seem favorable over intraarticular-only injections. Hospital-based exercise class is more effective regarding the functional outcomes of PCS than individual physiotherapy or home exercise. Additional passive stretching of the capsule in the pain-free frozen and thawing states is beneficial. After failure of nonoperative treatment of at least 6 months, arthroscopic arthrolysis is recommended.

Conclusions

Several publications in the literature over the past few years have contributed to an improved understanding and better treatment of PCS.

     

Stress, Stressverarbeitung und kraniomandibuläre Dysfunktionen

BACKGROUND: Stress is an etiologic factor of pain-relevant craniomandibular disorders (CMD). Interindividual differences in coping with stress and their relation to CMD have rarely been examined. PATIENTS AND METHODS: A total of 72 volunteers (20 men, 52 women) were examined according to the Research Diagnostic Criteria for Temporomandibular Disorders. Stress parameters and coping skills were assessed by questionnaires. RESULTS: Stress and one coping factor are correlated with CMD indices. Linear regression analysis found the Life Event Score and cognitive coping by changing appraisals to significantly predict CMD. CONCLUSION: Stress and coping skills are independent predictors of CMD.     

Radikuläre Schmerzen

Studies have been performed to elucidate the pathophysiologic mechanisms leading to sciatica. The studies comprise assessment of structural and functional changes as well as pain and have shown that the intervertebral disk (nucleus pulposus) may induce changes in a nerve root after local application in the absence of a mechanical component. Such changes may for the first time present a biologic or biochemical basis for the development of sciatica. Disk-related cytokines, in particular tumor necrosis factor (TNF), have been found to mediate such changes, and clinical trials have now been initiated to assess the possibility of treating sciatica with selective inhibition of TNF.     

Sekundäre mediale Patellainstabilität

Secondary medial patellar instability represents a severe complication following lateral retinacular release. Patients experience a new and different patellofemoral pain after surgery combined with medial patellar subluxation and subsequent weakness of the extensor mechanism. Incorrect indications and/or techniques with overrelease are the main reasons for these complaints. Medial patellar instability is documented using stress CT scans. Open revision with secondary reconstruction of the lateral structures using local tissue or, if insufficient, a tendon graft is necessary to eliminate medial patellar subluxation.     

Muskuläre und arthromuskuläre Dysbalancen – Pro und Kontra

The often one-sided daily load and also lack of movement in certain sectors of the population can lead to muscular and arthromuscular imbalance. Many athletes are also forced by internationally laid down rules to carry out training under conditions of arthromuscular imbalance. This article demonstrates the effects of arthromuscular imbalance on the occurrence and development of sports-related injuries or false loading in various competitive sport disciplines. These should be taken into consideration when planning training.     

Kraniomandibuläre DysfunktionEine Standortbestimmung

Evaluating the current understanding of craniomandibular disorders means attempting to discern structures among the dysfunctions of this functional disturbance rather than recording the multitude of different forms. Most dentists understand the functioning and dysfunctions of the craniomandibular system (CMS) while most orthopedists have knowledge in the functioning and dysfunctions of the craniocervical systems (CCS), and some are well trained in the disturbances of the craniosacral system (CSS). In clinical practice, however, the specific data and the structural and functional connections are not provided by associative connections. Therefore the figure at the end of the article will help those lacking substantial experience to keep in view the variety of disorders, recognize the inner structure of the dysfunction, consult with colleagues, and begin effective therapeutic procedures.     

Die kraniomandibuläre Dysfunktion

Although structural lesions in cervical vertebrae whiplash trauma stages 0 and I (introduction of the Coblenz Consensus report) are lacking or only minimally detectable, a chronification of symptoms occurs in 10–20% of those affected despite multimodal therapy. In these cases the question arises whether one or more pathogenetic factors were initially undiagnosed and not considered later in the therapy. It is nowadays practically undisputed that movements of the jaws and vertebral column are governed by a centrally controlled coordination and that craniocervical dysfunction (CCD) leads by a reflex action to craniomandibular dysfunction (CMD) and vice versa. In this study it was investigated whether trauma of the cervical vertebrae can lead to CMD which in turn maintains the functional CCD and the total complaints symptomatic. For this study 187 patients with chronic complaints following cervical vertebrae trauma were investigated with respect to CMD. CMD was initially diagnosed in a general medical manner using simple functional tests, with and without mandibular load and subsequently electrophysiologically confirmed by a dental examination. CMD was confirmed in all cases in addition to a CCD. The results of this study show that patients with persistent complaints following cervical vertebrae whiplash trauma regularly have a CMD. Treatment success underlines that a chronification of the complaints symptomatic can be clearly explained even with an unconsidered mandibular pathology and even in patients where the medical history goes back 5 years or more.     

Das Analekzem – eine interdisziplinäre, diagnostische Herausforderung

Ohne Zusammenfassung

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Interdisziplinäre Kooperation in der Prävention und Therapie des Rückenschmerzes

An expert committee of the German Chapter of the IASP has published five recommendations for the prevention and early treatment of low back pain. These refer to an early activation of the patient facilitated by scheduled pain medication and an interdisciplinary treatment including physiotherapy and psychotherapy if risk factors for chronicity are detected.