As long as geriatric patients are able to communicate verbally, they are most likely to profit from the structured pain interview in spite of existing cognitive impairment. A MMSE score <10 indicates that the interpretation of the data obtained may be difficult, especially due to a high frequency of missing values.
The aim of this examination was to recognize and, if possible, avoid the origin of artifact images in sonograms caused anatomically and by the physics of ultrasound. Experimental investigations were carried out in a waterbath on models of knee joints using Schlierenoptics and on specimens from corpse knees. When a sector transducer was used, the artifact images that originated in the joint cavity appeared outside the cavity on the sonogram so that there were no danger of mistaking them for reflected images of tears in lesions of the meniscus. In sonography, the surfaces of tears reflect a strong signal, but diagnosis depends on the position of the edges of the tears to the direction of the ultrasonic waves, which means to get a reliable record of tears of the meniscus is only possible by means of a dynamic examination technique.
A 45-year-old woman who suffered from juvenile tuberculous coxitis at the age of 4 is presented. Her hip joint replacement lasted for 18 years and then needed replacing. Intraoperatively removed caseous soft tissue and an opalescent secretion histologically resembled a tuberculous focus, and bacteriological culture grew a Mycobacterium tuberculosis strain. Four months after the replacement, the patient suffered from a tuberculosis-induced septic loosening of the newly replaced hip joint endoprosthesis. The tuberculosis relapse was probably due to aseptic loosening of the first hip joint endoprosthesis.
As a supplement to clinical findings, sonographic examination of the meniscus is an easily available, noninvasive imaging technique that can be used to optimize preoperative diagnosis and check the indication for arthroscopy. Careful consideration of the technical requirements and systematic performance of the dynamic examination should lead to further improvement of the examination results and to growing clinical significance in the future.
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