Reinhard Weinstabl

Ultrasound Therapy for Calcific Tendinitis of the Shoulder

BACKGROUND AND METHODS Although ultrasound therapy is used to treat calcific tendinitis of the shoulder, its efficacy has not been rigorously evaluated. We conducted a randomized, double-blind comparison of ultrasonography and sham insonation in patients with symptomatic calcific tendinitis verified by radiography. Patients were assigned to receive 24 15-minute sessions of either pulsed ultrasound (frequency, 0.89 MHz; intensity, 2.5 W per square centimeter; pulsed mode, 1:4) or an indistinguishable sham treatment to the area over the calcification. The first 15 treatments were given daily (five times per week), and the remainder were given three times a week for three weeks. Randomization was conducted according to shoulders rather than patients, so a patient with bilateral tendinitis might receive either or both therapies. RESULTS We enrolled 63 consecutive patients (70 shoulders). Fifty-four patients (61 shoulders) completed the study. There were 32 shoulders in the ultrasound-treatment group and 29 in the sham-treatment group. After six weeks of treatment, calcium deposits had resolved in six shoulders (19 percent) in the ultrasound-treatment group and decreased by at least 50 percent in nine shoulders (28 percent), as compared with respective values of zero and three (10 percent) in the sham-treatment group (P=0.003). At the nine-month follow-up visit, calcium deposits had resolved in 13 shoulders (42 percent) in the ultrasound-treatment group and improved in 7 shoulders (23 percent), as compared with respective values of 2 (8 percent) and 3 (12 percent) in the sham-treatment group (P=0.002). At the end of treatment, patients who had received ultrasound treatment had greater decreases in pain and greater improvements in the quality of life than those who had received sham treatment; at nine months, the differences between the groups were no longer significant. CONCLUSIONS In patients with symptomatic calcific tendinitis of the shoulder, ultrasound treatment helps resolve calcifications and is associated with short-term clinical improvement.

Economic Considerations for the Diagnosis and Therapy of Meniscal Lesions: Can Magnetic Resonance Imaging Help Reduce the Expense?

Abstract. With magnetic resonance imaging (MRI) the surgeon has such an effective diagnostic tool in the diagnosis of a meniscal lesion that the times of diagnostic arthroscopy should be in the past. A total of 823 patients with clinically diagnosed meniscal lesions were divided into two groups: group A, 143 patients underwent MRI and 75 of those arthroscopy; group B, 680 patients, 201 (30%) of whom were operated after being only clinically examined. MRI was done on a Siemens Medical System Magnetom 1.5 Tesla with a 256 × 256 matrix. Spinal echo and gradient echo images were performed with slices of 2 to 4 mm thickness. All meniscal tears were graded according to Reicher and Crues, respectively. Grades III and IV were judged to be positive for a meniscal lesion. Arthroscopy was carried out under general anesthesia and the usual technique. The MRI revealed the following results: Medial meniscus: accuracy 95%, positive predictive value (PPV) 92%, negative predictive value (NPV) 95%, sensitivity 98%, and specificity 82%; lateral meniscus: accuracy 97%, PPV 92%, NPV 98%, sensitivity 94%, and specificity 98%. The overall values for MRI of the medial and lateral menisci combined were: accuracy 96%, PPV 93%, NPV 98%, sensitivity 96%, and specificity 90%. The clinical examination often failed to diagnose a meniscal lesion: accuracy 64%, PPV 59%, NPV 89%, sensitivity 96%, and specificity 33% for the medial meniscus. For the lateral meniscus the accuracy was 91%, PPV 61%, NPV 98%, sensitivity 89%, and specificity 91%. The overall values for the clinical investigation of the medial and lateral menisci combined were: accuracy 78%, PPV 60%, NPV 94%, sensitivity 93%, and specificity 62%. Investigation of all 201 patients operated from group B with MRI would have cost

The diagnosis of meniscal tears in athletes : A comparison of clinical and magnetic resonance imaging investigations

160,800. The cost of 30% fewer arthroscopies would have been

Spiral bundle nailing for subcapital humeral fractures: preliminary report of the method of Henning.

562,800—in total

Zur versorgung subkapitaler humerusfrakturen mit spiralbündelnägeln nach henning

723,600. The operation of all 201 patients cost

A new approach to the subacromial space: Technique and 2-year results in 28 rotator-cuff repair cases

804,000. Hence about

Anatomische Studien zur perkutanen Bohrdrahtosteosynthese an der distalen Speiche

80,000 could have been saved by scanning all 201 patients and therefore reduce the rate of diagnostic arthroscopies.

Imaging of tendons—adaptation, degeneration, rupture

This study evaluated the predictability of clinical examination alone in comparison with magnetic resonance imaging in the diagnosis of meniscal tears in competitive athletes. Ninety-three competitive athletes were prospectively investigated between 1992 and 1995. A total of 57 athletes were operated on based on clinical examination alone, and the 36 remaining athletes had magnetic resonance imaging before surgery. The correct diagnosis of a meniscal lesion was made on clinical examination alone in 83 athletes (89%) and on magnetic resonance imaging the correct diagnosis was also made in 89% of 36 athletes. The overall values for the clinical investigation of the medial and lateral menisci combined were 94.5%, 91.5%, 99%, 96.5%, 87% for accuracy, positive predictive value, negative predictive value, sensitivity, and specificity, respectively. The overall values for magnetic resonance imaging of the medial and lateral menisci combined were 95.5%, 96.5%, 91.5%, 98%, 85.5% for accuracy, positive predictive value, negative predictive value, sensitivity, and specificity, respectively.This study evaluated the predictability of clinical exam ination alone in comparison with magnetic resonance imaging in the diagnosis of meniscal tears in compet itive athletes. Ninety-three competitive athletes were prospectively investigated between 1992 and 1995. A total of 57 athletes were operated on based on clinical examination alone, and the 36 remaining athletes had magnetic resonance imaging before surgery. The cor rect diagnosis of a meniscal lesion was made on clin ical examination alone in 83 athletes (89%) and on magnetic resonance imaging the correct diagnosis was also made in 89% of 36 athletes. The overall values for the clinical investigation of the medial and lateral me nisci combined were 94.5%, 91.5%, 99%, 96.5%, 87% for accuracy, positive predictive value, negative predic tive value, sensitivity, and specificity, respectively. The overall values for magnetic resonance imaging of the medial and lateral menisci combined were 95.5%, 96.5%, 91.5%, 98%, 85.5% for accuracy, positive pre dictive value, negative predictive value, sensitivity, and specificity, respectively.

The extensor apparatus of the knee joint and its peripheral vasti: anatomic investigation and clinical relevance.

This is a preliminary report of 31 patients treated with Hennings spiral bundle nails for subcapital humeral fractures. Complications included motion restriction at the elbow joint (n = 4), elbow pain caused by pin migration (n = 2), misalignment attributable to incorrect reduction (n = 4), and redislocation attributable to improper technique (n = 1), humeral head perforation (n = 3), caudal subluxation of the humeral head (n = 3), and local infections at the insertion site (n = 1). Immobilization was 3 weeks on average. By using the scoring scheme of Constant and Murley, 11 patients showed a moderate result, whereas 19 patients had an excellent outcome.

Unstable distal radius fractures treated by modified Kirschner wire pinning: anatomic considerations, technique, and results.

ZusammenfassungIn den Jahren 1994 bis 1996 wurden 31 Patienten wegen eines subkapitalen Oberarmbruchs mit Spiralbündelnägeln nach Henning versorgt. An Komplikationen traten vier primäre Achsenfehlstellungen und eine sekundäre Redislokation sowie ein Infekt an der Einschlagstelle auf. Bei zwei Patienten perforierten die Nägel den Oberarmkopf ohne funktionelle Beeinträchtigung. Die Patienten wurden durchschnittlich drei Wochen in einem Gilchrist-Verband immobilisiert. Bei ausreichender Nagelzahl (sieben bis zehn) kann die Mobilisierung jedoch bereits nach einer Woche angestrebt werden. Elf Patienten zeigten bei der Nachuntersuchung ein mäßiges, 19 ein sehr gutes Zwei-Jahres-Resultat, wobei die mäßigen Resultate durch Einschränkungen der Abduktion, Außenrotation und Innenrotation in Graden, weniger durch Funktionsbeeinträchtigung verursacht wurden (Constant-Score).AbstractThis is a preliminary report on 31 patients treated with Hennings spiral bundle nails for subcapital humeral fractures. Complications included misalignment due to incorrect reduction (4), and re-dislocation due to improper technique (1), humeral head perforation (2), and local infections at the insertion site (1). Immobilization was 3 weeks on average but can be reduced to 1 week only provided a sufficient number of nails implied elastic jamming in the medullary channel. Using Constants score 11 patients showed a moderate result, while 19 had an excellent outcome