Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Die rein traumatische Ruptur der Rotato renmanschette (RMR) vor dem 40sten Lebensjahr ist ein seltenes Ereignis und in der Regel auf eine erhebliche Gewalt einwirkung zurückzuführen. Sehr viel häufiger sind Situationen in denen bei über 50jährigen nach einem Trauma eine RMR diagnostiziert wird und sich die Fra ge stellt, ob der strukturelle Schaden dabei entstanden ist oder ob er möglicherwei se schon vorher bestand, ohne dass es bis dahin zu Symptomen gekommen ist. Die Antwort hat erhebliche Konsequenzen für das therapeutische Vorgehen. Wäh rend bei einer sicher akuten, traumati schen RMR in den meisten Fällen eine operative Rekonstruktion in Erwägung gezogen wird, ist bei wahrscheinlich vor bestehenden, degenerativen Rotatoren manschettenläsionen (RML) in vielen Fällen ein abwartendes, zunächst konser vatives Verhalten indiziert.Darüber hinaus gibt es bei der Begut achtung für gesetzliche und private Un fallversicherungen in der Kausalitätsfra ge in vielen Einzelfällen sehr kontroverse Ansichten darüber, ob eine anlässlich ei nes versicherten Traumas diagnostizierte RML als Unfallfolge zu werten oder even tuell bereits asymptomatisch vorbeste hend sei. In diesem Zusammenhang ist umstritten welcher Mechanismus für eine strukturelle Sehnenläsion geeignet, wel cher Befund verletzungstypisch ist und welche radiologischen Kriterien für oder gegen eine traumatische Läsion sprechen.Ziel der Untersuchung ist es daher die objektiven Befunde von Patienten mit ein deutig degenerativer Läsion mit denen bei einer mutmaßlich traumatischen RMR zu vergleichen um eine Entscheidungs hilfe für das medizinische Vorgehen aber auch um eine Hilfestellung für die Begut achtung zu erarbeiten. Die Arbeitshypo these lautete, dass es klinische und radio logische Kriterien gibt, anhand derer sich traumatische und degenerative Läsionen statistisch signifikant voneinander unter scheiden lassen. Material und MethodeIn einer prospektiv angelegten Unter suchung wurden 25 aufeinanderfolgen de Patienten mit einer Läsion der Rota torenmanschette (RM) in die Studie auf genommen, bei denen nach einem Sturz oder einer Gewalteinwirkung erstma lig Beschwerden in der verletzten Schul ter aufgetreten waren (Gruppe A) und bei denen innerhalb von 6 Wochen ein MRT durchgeführt und anschließend die ope rative Versorgung vollzogen wurde. Eben falls in der Reihenfolge ihrer Vorstellung wurden 25 Patienten mit degenerativer RMR in die Studie aufgenommen (Grup pe B), bei denen es innerhalb der letzten 12 Monate zum Auftreten von Schulterbe schwerden gekommen war, ohne dass ei ne Gewalteinwirkung stattgefunden hat te. Da sich aus der Zuteilung für die Pa tienten keine diagnostischen oder thera peutischen Konsequenzen ergaben war die Einholung eines Ethikvotums nicht erforderlich.Einziges Einschlusskriterien über die aufgeführten Vorgaben hinaus war das Patientenalter zwischen 40 und 75 Jah re; Ausschlusskriterien waren Voropera tionen an der betroffenen Schulter, gene ralisierte und regionale neurologische Er krankungen und eine relevante Glenohu meralarthrose (>...
Background: The aim of the study was to analyze the functional and radiological outcome of Monteggia-like lesions in adults with unreconstructible fracture of the radial head and treatment with radial head arthroplasty. Methods: Twenty-seven patients (mean age 56 years; range 36 to 79 years) with a Monteggia-like lesion and treatment with radial head replacement were included in this retrospective study. Minimum follow-up was 2 years. Clinical assessment included the pain level with the visual analog scale in rest (VAS R) and under pressure (VAS P), range of motion, Mayo Elbow Performance Score (MEPS), and Disability of the Arm, Shoulder, and Hand score (DASH). A detailed radiological evaluation was performed. Complications and revisions were also analyzed. Results: After a mean follow-up period of 69 months (range, 24 to 170) the mean DASH score was 30 ± 24, the MEPS averaged 77 ± 20 points, the mean VAS R was 2.1 ± 2.4, and VAS P was 4.5 ± 3.5. Mean loss of extension was 24°± 18 and flexion was 124°± 20. Heterotopic ossifications were noted in 12 patients (44%). A total of 17 complications were noted in 11 patients (41%), leading to 15 revision surgeries in 9 patients (33%). Patients with a complicated postoperative course showed a worse clinical outcome compared with patients without complications measured by MEPS (68 ± 22 vs. 84 ± 16), DASH (49 ± 16 vs. 20 ± 22) and ulnohumeral motion (77°± 31 vs. 117°± 23). Conclusions: Monteggia-like lesions with unreconstructible radial head fracture and treatment with radial head replacement are prone to complications and revisions.
BackgroundThe primary objective of this study was to assess the interobserver and intraobserver agreement on ligamentous injuries on conventional magnetic resonance imaging (MRI) in acute simple elbow dislocation. The secondary objectives were to determine the interobserver agreement on the assessment of joint congruity, joint effusion, loose bodies and chondral lesions on conventional MRI.MethodsConventional MRIs (1.5 Tesla, elbow specific surface coil) of 30 patients (40.7 years; range 14–72) with simple elbow dislocations were evaluated by four blinded examiners. An analysis of the interobserver agreement of all raters and for several subgroups (radiologists, orthopaedics, experienced, non-experienced) was performed. The examiners assessed the integrity (intact, partial tear, complete tear) of the lateral collateral ligament (LCL), medial collateral ligament (MCL), extensor and flexor tendons, as well as the presence of joint congruity, joint effusion, loose bodies and chondral lesions. Agreement strength, correlation and proportion of exact agreement were determined for interobserver agreement, and intraobserver agreement analyses.ResultsInterobserver agreement of all examiners was fair to moderate for collateral ligaments (LCL: 0.441, MCL: 0.275). Exact agreement of all raters was found in 33.3% for the LCL and in 26.7% for the MCL. The both experienced examiners showed highest agreement strength for the LCL (0.619) and the radiologists showed highest agreement strength for the MCL (0.627), the proportion of exact agreement was 60.0% in both categories. A high proportion of exact agreement regarding joint congruity (90%), joint effusion (100%), loose bodies (96.7%) and chondral lesion (80%) was found among the radiologists. The evaluation of the intraobserver agreement revealed slight to substantial agreement (0.227 to 0.718) for the collateral ligaments.ConclusionsThis study shows difficulties in the evaluation of ligaments by conventional MRI technique as demonstrated by a weak inter- and intraobserver agreement. This should be the basis to develop new MRI quality standards with special focus on coronal oblique reconstructions to improve the evaluation of ligament injuries after simple elbow dislocations.
BackgroundUse of the arm above shoulder level has been described as a risk factor for developing rotator cuff tears (RCT). There is a lack of information regarding the frequency and distribution of RCT in a population using their arms above shoulder level during daily work. The aim of this study was to analyze clinical and radiographic findings in a population of painters working more than 10 years and to compare the results with a control group (CG)Materials and methods100 individuals working more than 10 years as a painter were compared to 100 matched controls without using their arms above shoulder level. MRI scans were performed in all participants. Clinically, the Constant score, DASH score and range of motion (ROM) of the shoulders were analyzed.ResultsIn the painter group (PG) a tear of the supraspinatus tendon was detected in 45% (10%full-thickness; 35% partial) compared to 8% in the (CG) (3% full-thickness; 5%partial; p<0.001). Impingement test was painful in 52% of PG and 7% of CG (p<0.001). The Constant score in the PG was significantly lower compared to the CG (62 vs. 93 points; p<0.001). PG had significantly worse DASH scores and inferior active and passive ROM of the dominant shoulders. In the multivariable logistic regression analysis, three risk factors (smoking, sports activity, and handedness) showed no effect. However, group membership (PG/CG) and age revealed a significant effect.ConclusionLong-term occupational load on the shoulders in painters seems to be associated with an increased risk for developing RCT. Our findings may provide support for developing preventive strategies for this unique cohort.Level of evidence: III
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