Piet Plumhoff

Gorham-Stout syndrome of the shoulder

Introduction: Gorham-Stout syndrome (GSS) is a rare but severe subtype of idiopathic osteolysis. There are no guidelines for the treatment of GSS. We analysed different diagnostic and therapeutic regimes and we describe the sucessful treatment of GSS considering individual patient factors. Methods: We diagnosed three patients with shoulder-specific GSS using clinical, radiological and histopathological examinations. Two out of three patients with similar clinical appearances were treated non-operatively. One patient was treated by reverse shoulder arthroplasty. All patients were analysed retrospectively using clinical and radiological evaluation with a mean follow-up of 42 (range 30–50) months. Results: Two patients had few symptoms of GSS and were treated conservatively. One patient underwent arthroplasty, with a good clinical result. No additional therapy, such as radiation or anti-resorptive medications, was needed for the stable fixation of the prosthesis and the termination of osteolysis. In all patients we found good clinical outcomes with high patient satisfaction. Discussion: GSS is diagnosed after exclusion of infectious, malignant, and systemic disorders. The diagnosis should be supported by clinical, radiological, and histopathological characteristics of patients. Different humoral and cellular changes have been reported in GSS, but lack sufficient supporting evidence. GSS is associated with angiomatous and lymphatic malformations. The changes in GSS and the theories of its pathophysiology may reveal.

Calcinosis Universalis of the Elbow: A Rare Case with Classical Presentation

Juvenile Dermatomyositis (JDM) is a rare autoimmune disease in children and adolescents. In these patients calcinosis might be the most characteristic symptom. However there are only few reported cases of intramuscular calcinosis in Dermatomyositis. We report a case of calcinosis universalis (CU) of the elbow in JDM successfully treated with broaching. The patient, a 24-year-old woman, suffered from a long history of JDM. On examination she presented with a fistula lateral to the olecranon and pain of the right elbow joint. Plain X-rays displayed a diffuse pattern of multiple periarticular, subcutaneous, and intramuscular calcifications. The patient underwent surgery for histological and microbiological sampling as well as broaching. Intraoperatively sinus formation and subfascial hard calcium deposition were found. Due to the risk of collateral tissue damage, incomplete broaching was performed. A local infection with Staphylococcus was diagnosed and treated with antibiotics. On six-week and 30-month follow-up the patient was free of pain and had very good function. Calcifications on standard radiographs had almost resolved entirely. This case report gives a summary on calcinosis in Dermatomyositis and adds a new case of recalcitrant CU to the literature. Broaching surgery proved to be a reliable treatment option in symptomatic calcinosis.

Neutral-0-Methode

In diesem Kapitel sind die Prinzipien der Dokumentation von Gelenkbewegungen dargestellt. Hierfur stehen die Messblatter fur obere und untere Gliedmasen, fur die Finger sowie fur die Wirbelsaule zur Verfugung.

Der strukturierte Weg zur orthopädischen Diagnose

Der strukturierte Weg zur orthopadischen Diagnose beschreibt den allgemeinen Ablauf, die Anamnese mit aktuellen und fruheren Beschwerden, ggf. Erfragen des Unfallmechanismus sowie die klinische Untersuchung.

Surgical technique and clinical outcome of arthroscopic shoulder stabilization via suture anchors using the lasso-loop stitch

During arthroscopic Bankart-repair the lasso-loop-stitch can be used. The clinical outcome of this technical modification to a broadly used procedure is not known. We followed-up 24 patients treated with this technique over 30 months. We found an excellent clinical outcome in 96% of all cases. The average Rowe-score was 96.3 points. The mean QuickDash was 2.8 points. Using the lasso-loop-stitch in arthroscopic Bankart-repair is safe and results in very good clinical outcomes. It might lead to an accentuated labral bump and enables secure knot-tying with knot-positioning away from the articular cartilage while avoiding the suture cutting through the tissue.

Arthroskopische Therapie bei spinoglenoidalem Ganglion

Aims and Indications A paralabral ganglion cyst of the shoulder can cause neuropathy of the inferior branches of the suprascapular nerve. This can lead to atrophy of the infraspinatus muscle. Arthroscopic decompression of the cyst in combination with repair of the associated labrum tear appears to be an effective treatment option. Methods Initially the connection of the cyst to the joint in the area of the posterior rim of the glenoid is identified arthroscopically. Following the decompression of the cyst the labrum tear is repaired to avoid recurrence. The goal is the complete decompression of the ganglion cyst carefully protecting the infraspinatus branch. Concomitant intraarticular pathologies are also addressed. Conclusions In the literature arthroscopic treatment is superior to open surgical treatments. The degree of muscle atrophy at the time of surgery determines the prognosis for functional recovery. There is a lack of long-term outcome studies and publications of larger case series.

Therapy-resistant septic olecranon bursitis due to Mycobacterium gordonae

Introduction: Septic olecranon bursitis due to atypical mycobacteria is rare. An insidious beginning can delay diagnosis and treatment. Antibacterial therapy recommendations are not well-defined for bursitis caused by atypical mycobacteria. We present a rare case of olecranon bursitis caused by Mycobacterium gordonae, reporting our experiences regarding pathogen identification and antibiotic therapy, which differs from regimes used in common septic bursitis mostly caused by staphylococcus aureus. Methods: A 35-year-old male with bursitis olecrani received open bursectomy. Microbiological culture did not reveal bacteria. Due to wound healing complications revision surgery was performed four weeks postoperatively. Finally, Mycobacterium gordonae was identified by PCR and an antibiogram could be developed. A triple antimicrobial combination therapy with Rifampicin, Clarithromycin, and Ethambutol was administered systemically for 12 months. The patient was followed-up for 24 months. Results: After the second operation with pathogen identification and antibiotic combination therapy the wound healed without any additional complications. At last follow-up 24 months after the first surgery with bursectomy and 23 months after revision surgery with debridement, the patient was still pain free with no significant clinical findings or tenderness to touch at the operation site. Elbow range of motion was full. Discussion: As septic bursitis can be caused by many different and sometimes rare and difficult to identify bacteria, intraoperative probes should be taken and histopathological and microbiological analysis should be conducted, including PCR. In a young man with olecranon bursitis due to Mycobacterium gordonae surgical treatment and an antibiotic combination therapy showed a good clinical outcome after one and two years.

Ultraschallbefunde bei Schulterschmerzen

Schulterbeschwerden sind ein häufiger Grund für eine Vorstellung beim Arzt. Die Schultersonografie ermöglicht eine nicht invasive und kostengünstige bildgebende Diagnostik. Lernen Sie hier die wichtigsten Befunde kennen.