Wolfram Lipka

Außenrotationsosteotomie des Humerus zur Behandlung des lähmungsbedingten Außenrotationsdefizits der Schulter

ZusammenfassungOperationszielVerlagerung des Rotationssektors der Schulter zugunsten der Außendrehung. Erreichen einer ungestörten und physiologischeren Beugung des Ellbogens ohne Anschlagen des Unterarms am Thorax oder kompensatorische Abduktions- Anteversions-Bewegung in der Schulter. Steigerung der Aktivitäten des täglichen Lebens, da die Hand wieder ungestört zum Gesicht geführt werden kann.IndikationenNicht besserungsfähige Lähmung des Musculus infraspinatus und Musculus teres minor mit ausgefallener oder unzureichender Außenrotation, spontaner Innenrotationsstellung des Arms, Behinderung der Ellbogenbeugung durch Anschlagen des Unterarms am Thorax und konsekutiv erforderlicher Abduktions-Anteversions-Bewegung in der Schulter beim Versuch, die Hand zum Gesicht zu führen.KontraindikationenUnvollständige Rehabilitation nach einem neurochirurgischen Eingriff.Einsteifung des glenohumeralen Gelenks mit unzureichendem passivem Gesamtrotationssektor durch zusätzlich eingeschränkte Innenrotation.OperationstechnikZur Verschiebung des Rotationssektors der Schulter zugunsten der Außendrehung wird der Humerus im mittleren Drittel osteotomiert. Der distale Humerusanteil wird um 30–60° außenrotiert. Die Stabilisierung erfolgt mit einer Plattenosteosynthese.WeiterbehandlungGilchrist-Verband bis zur 6. postoperativen Woche (insbesondere nachts), Abnahme tagsüber und zur Physiotherapie ab dem 1. postoperativen Tag mit assistiver und passiver Beübung von Ellbogen, Hand und Fingern sowie aktiver Außenrotation der Schulter. Freigabe aller Bewegungen nach Abschluss der 6. postoperativen Woche.Ergebnisse15 Patienten wurden operiert und nach 3 Jahren (0,5–8,7 Jahre) nachuntersucht. In sämtlichen Fällen wurde der Rotationssektor (präoperatives Außenrotationsdefizit 37°, postoperative Zunahme 46°) so verschoben, dass die vorhandene Ellbogenbeugung wieder besser einsetzbar war und die Hand ohne gleichzeitige Ausweichbewegungen in der Schulter zum Gesicht geführt werden konnte.AbstractObjectiveAim of the procedure is shifting the arc of shoulder rotation for an improved external rotation, reaching a physiological elbow flexion without striking of the lower arm against the thorax; improvement of the activities of daily living because guidance of the hand to the face is possible without any simultaneous evasive movements of the shoulder.IndicationsPalsy of infraspinatus and teres minor muscles after complete neurosurgical therapy (neurolysis, reconstruction of the brachial plexus), which leads to loss of external rotation and an internally rotating posture of the arm. Elbow flexion is hindered because of striking of the lower arm against the thorax, simultaneous abduction and foreward flexion is necessary to guide the hand to the face.ContraindicationsNot completed rehabilitation after a neurosurgical procedure.Stiffness of the glenohumeral joint with insufficient passive overall rotational sector due to additional reduced internal rotation.Surgical TechniqueTo improve external rotation by shifting of the arc of rotation, a transverse osteotomy is done in the mid third of the humerus and the distal part of the humerus is rotated outward (30–60°). A dynamic compression plate is used for osteosynthesis.Postoperative ManagementImmobilization of the arm in a Gilchrist bandage is necessary for 6 weeks (especially at night). The physiotherapy program starts on the 1st postoperative day with assisted and active training of elbow, hand, and fingers, as well as active external rotation of the shoulder. After 6 weeks, all movements and daily activities are allowed.ResultsThe procedure was performed in 15 cases, followed up on average after 3 years (0.5–8.7 years). In all cases, the shifted arc of rotation (preoperative 37° deficit of external rotation, postoperative 46° increase) eliminated striking of the lower arm against the thorax on flexion of the elbow. All patients were able to guide their hands to their faces without any simultaneous evasive movements of the shoulder.OBJECTIVE Aim of the procedure is shifting the arc of shoulder rotation for an improved external rotation, reaching a physiological elbow flexion without striking of the lower arm against the thorax; improvement of the activities of daily living because guidance of the hand to the face is possible without any simultaneous evasive movements of the shoulder. INDICATIONS Palsy of infraspinatus and teres minor muscles after complete neurosurgical therapy (neurolysis, reconstruction of the brachial plexus), which leads to loss of external rotation and an internally rotating posture of the arm. Elbow flexion is hindered because of striking of the lower arm against the thorax, simultaneous abduction and foreward flexion is necessary to guide the hand to the face. CONTRAINDICATIONS Not completed rehabilitation after a neurosurgical procedure. Stiffness of the glenohumeral joint with insufficient passive overall rotational sector due to additional reduced internal rotation. SURGICAL TECHNIQUE To improve external rotation by shifting of the arc of rotation, a transverse osteotomy is done in the mid third of the humerus and the distal part of the humerus is rotated outward (30-60 degrees ). A dynamic compression plate is used for osteosynthesis. POSTOPERATIVE MANAGEMENT Immobilization of the arm in a Gilchrist bandage is necessary for 6 weeks (especially at night). The physiotherapy program starts on the 1st postoperative day with assisted and active training of elbow, hand, and fingers, as well as active external rotation of the shoulder. After 6 weeks, all movements and daily activities are allowed. RESULTS The procedure was performed in 15 cases, followed up on average after 3 years (0.5-8.7 years). In all cases, the shifted arc of rotation (preoperative 37 degrees deficit of external rotation, postoperative 46 degrees increase) eliminated striking of the lower arm against the thorax on flexion of the elbow. All patients were able to guide their hands to their faces without any simultaneous evasive movements of the shoulder.

External rotation osteotomy of the humerus for treatment of external rotation deficit in palsies

ZusammenfassungOperationszielVerlagerung des Rotationssektors der Schulter zugunsten der Außendrehung. Erreichen einer ungestörten und physiologischeren Beugung des Ellbogens ohne Anschlagen des Unterarms am Thorax oder kompensatorische Abduktions- Anteversions-Bewegung in der Schulter. Steigerung der Aktivitäten des täglichen Lebens, da die Hand wieder ungestört zum Gesicht geführt werden kann.IndikationenNicht besserungsfähige Lähmung des Musculus infraspinatus und Musculus teres minor mit ausgefallener oder unzureichender Außenrotation, spontaner Innenrotationsstellung des Arms, Behinderung der Ellbogenbeugung durch Anschlagen des Unterarms am Thorax und konsekutiv erforderlicher Abduktions-Anteversions-Bewegung in der Schulter beim Versuch, die Hand zum Gesicht zu führen.KontraindikationenUnvollständige Rehabilitation nach einem neurochirurgischen Eingriff.Einsteifung des glenohumeralen Gelenks mit unzureichendem passivem Gesamtrotationssektor durch zusätzlich eingeschränkte Innenrotation.OperationstechnikZur Verschiebung des Rotationssektors der Schulter zugunsten der Außendrehung wird der Humerus im mittleren Drittel osteotomiert. Der distale Humerusanteil wird um 30–60° außenrotiert. Die Stabilisierung erfolgt mit einer Plattenosteosynthese.WeiterbehandlungGilchrist-Verband bis zur 6. postoperativen Woche (insbesondere nachts), Abnahme tagsüber und zur Physiotherapie ab dem 1. postoperativen Tag mit assistiver und passiver Beübung von Ellbogen, Hand und Fingern sowie aktiver Außenrotation der Schulter. Freigabe aller Bewegungen nach Abschluss der 6. postoperativen Woche.Ergebnisse15 Patienten wurden operiert und nach 3 Jahren (0,5–8,7 Jahre) nachuntersucht. In sämtlichen Fällen wurde der Rotationssektor (präoperatives Außenrotationsdefizit 37°, postoperative Zunahme 46°) so verschoben, dass die vorhandene Ellbogenbeugung wieder besser einsetzbar war und die Hand ohne gleichzeitige Ausweichbewegungen in der Schulter zum Gesicht geführt werden konnte.AbstractObjectiveAim of the procedure is shifting the arc of shoulder rotation for an improved external rotation, reaching a physiological elbow flexion without striking of the lower arm against the thorax; improvement of the activities of daily living because guidance of the hand to the face is possible without any simultaneous evasive movements of the shoulder.IndicationsPalsy of infraspinatus and teres minor muscles after complete neurosurgical therapy (neurolysis, reconstruction of the brachial plexus), which leads to loss of external rotation and an internally rotating posture of the arm. Elbow flexion is hindered because of striking of the lower arm against the thorax, simultaneous abduction and foreward flexion is necessary to guide the hand to the face.ContraindicationsNot completed rehabilitation after a neurosurgical procedure.Stiffness of the glenohumeral joint with insufficient passive overall rotational sector due to additional reduced internal rotation.Surgical TechniqueTo improve external rotation by shifting of the arc of rotation, a transverse osteotomy is done in the mid third of the humerus and the distal part of the humerus is rotated outward (30–60°). A dynamic compression plate is used for osteosynthesis.Postoperative ManagementImmobilization of the arm in a Gilchrist bandage is necessary for 6 weeks (especially at night). The physiotherapy program starts on the 1st postoperative day with assisted and active training of elbow, hand, and fingers, as well as active external rotation of the shoulder. After 6 weeks, all movements and daily activities are allowed.ResultsThe procedure was performed in 15 cases, followed up on average after 3 years (0.5–8.7 years). In all cases, the shifted arc of rotation (preoperative 37° deficit of external rotation, postoperative 46° increase) eliminated striking of the lower arm against the thorax on flexion of the elbow. All patients were able to guide their hands to their faces without any simultaneous evasive movements of the shoulder.OBJECTIVE Aim of the procedure is shifting the arc of shoulder rotation for an improved external rotation, reaching a physiological elbow flexion without striking of the lower arm against the thorax; improvement of the activities of daily living because guidance of the hand to the face is possible without any simultaneous evasive movements of the shoulder. INDICATIONS Palsy of infraspinatus and teres minor muscles after complete neurosurgical therapy (neurolysis, reconstruction of the brachial plexus), which leads to loss of external rotation and an internally rotating posture of the arm. Elbow flexion is hindered because of striking of the lower arm against the thorax, simultaneous abduction and foreward flexion is necessary to guide the hand to the face. CONTRAINDICATIONS Not completed rehabilitation after a neurosurgical procedure. Stiffness of the glenohumeral joint with insufficient passive overall rotational sector due to additional reduced internal rotation. SURGICAL TECHNIQUE To improve external rotation by shifting of the arc of rotation, a transverse osteotomy is done in the mid third of the humerus and the distal part of the humerus is rotated outward (30-60 degrees ). A dynamic compression plate is used for osteosynthesis. POSTOPERATIVE MANAGEMENT Immobilization of the arm in a Gilchrist bandage is necessary for 6 weeks (especially at night). The physiotherapy program starts on the 1st postoperative day with assisted and active training of elbow, hand, and fingers, as well as active external rotation of the shoulder. After 6 weeks, all movements and daily activities are allowed. RESULTS The procedure was performed in 15 cases, followed up on average after 3 years (0.5-8.7 years). In all cases, the shifted arc of rotation (preoperative 37 degrees deficit of external rotation, postoperative 46 degrees increase) eliminated striking of the lower arm against the thorax on flexion of the elbow. All patients were able to guide their hands to their faces without any simultaneous evasive movements of the shoulder.

Arthroskopische Synovektomie des Hüftgelenks

OBJECTIVE The aim of the treatment is reduction of hip pain through arthroscopic synovectomy of the hip joint, reduction in activity of the synovial disease and removal of loose bodies in chondromatosis. INDICATIONS Synovialitis of the hip due to synovial disease, such as pigmented villonodular synovitis (PVNS) and chondromatosis, synovialitis of the hip due to a further diseases of the hip. The disease must be treatable by arthroscopy (e.g. femoroacetabular impingement and lesion of the acetabular labrum). CONTRAINDICATIONS Suspicion of malignant synovial disease, extensive synovitis, especially in those areas of the hip which are difficult to reach or inaccessible to arthroscopy, primary disease not sufficiently treatable by arthroscopy, e.g. coxarthrosis. SURGICAL TECHNIQUE Arthroscopy of the central compartment of the hip is carried out by lateral, anterolateral (alternatively inferior anterolateral) and posterolateral portals, using all portals both for the camera and for instruments. In the central compartment synovectomy of the acetabular fossa is performed. A shaver and/or a high frequency diathermy applicator (HF applicator) are employed for removal of the synovial membrane. For arthroscopy of the peripheral compartment lateral, anterolateral (alternatively inferior anterolateral) and superior anterolateral portals are established and all portals are used both for the camera and instruments. In the peripheral compartment, the synovial membrane of the anterior, anteromedial, anterolateral and as far as possible posterolateral areas of the hip is removed. The dorsolateral synovial plica needs to be spared. POSTOPERATIVE MANAGEMENT Non-steroidal anti-inflammatory drugs (NSAIDs) are administered as prophylaxis of heterotopic ossification for 10 days. Contraindications for NSAIDs need to be considered. Thrombosis prophylaxis with low molecular weight heparin over 5 days. Mobilization with full weight bearing. Intensive physiotherapeutic exercises for at least 6 and possibly up to 12 postoperative weeks. Radiosynoviorthesis 6-8 weeks after surgery depending of the histopathological results. RESULTS From June 2007 to December 2013 a total of 20 patients with specific synovial diseases were treated with hip arthroscopy of which 18 had chondromatosis and 2 had PVNS. A telephone interview was carried out after an average of 40.2 months (range 8-92 months) and revealed a recurrence rate of the synovial disease of 20 %. In two cases (10 %) a second arthroscopy was necessary due to recurrent symptoms but without return of the synovial disease.

Arthroscopic synovectomy of the hip joint

OBJECTIVE The aim of the treatment is reduction of hip pain through arthroscopic synovectomy of the hip joint, reduction in activity of the synovial disease and removal of loose bodies in chondromatosis. INDICATIONS Synovialitis of the hip due to synovial disease, such as pigmented villonodular synovitis (PVNS) and chondromatosis, synovialitis of the hip due to a further diseases of the hip. The disease must be treatable by arthroscopy (e.g. femoroacetabular impingement and lesion of the acetabular labrum). CONTRAINDICATIONS Suspicion of malignant synovial disease, extensive synovitis, especially in those areas of the hip which are difficult to reach or inaccessible to arthroscopy, primary disease not sufficiently treatable by arthroscopy, e.g. coxarthrosis. SURGICAL TECHNIQUE Arthroscopy of the central compartment of the hip is carried out by lateral, anterolateral (alternatively inferior anterolateral) and posterolateral portals, using all portals both for the camera and for instruments. In the central compartment synovectomy of the acetabular fossa is performed. A shaver and/or a high frequency diathermy applicator (HF applicator) are employed for removal of the synovial membrane. For arthroscopy of the peripheral compartment lateral, anterolateral (alternatively inferior anterolateral) and superior anterolateral portals are established and all portals are used both for the camera and instruments. In the peripheral compartment, the synovial membrane of the anterior, anteromedial, anterolateral and as far as possible posterolateral areas of the hip is removed. The dorsolateral synovial plica needs to be spared. POSTOPERATIVE MANAGEMENT Non-steroidal anti-inflammatory drugs (NSAIDs) are administered as prophylaxis of heterotopic ossification for 10 days. Contraindications for NSAIDs need to be considered. Thrombosis prophylaxis with low molecular weight heparin over 5 days. Mobilization with full weight bearing. Intensive physiotherapeutic exercises for at least 6 and possibly up to 12 postoperative weeks. Radiosynoviorthesis 6-8 weeks after surgery depending of the histopathological results. RESULTS From June 2007 to December 2013 a total of 20 patients with specific synovial diseases were treated with hip arthroscopy of which 18 had chondromatosis and 2 had PVNS. A telephone interview was carried out after an average of 40.2 months (range 8-92 months) and revealed a recurrence rate of the synovial disease of 20 %. In two cases (10 %) a second arthroscopy was necessary due to recurrent symptoms but without return of the synovial disease.

Arthroskopische Synovektomie des Hüftgelenks@@@Arthroscopic synovectomy of the hip joint

OBJECTIVE The aim of the treatment is reduction of hip pain through arthroscopic synovectomy of the hip joint, reduction in activity of the synovial disease and removal of loose bodies in chondromatosis. INDICATIONS Synovialitis of the hip due to synovial disease, such as pigmented villonodular synovitis (PVNS) and chondromatosis, synovialitis of the hip due to a further diseases of the hip. The disease must be treatable by arthroscopy (e.g. femoroacetabular impingement and lesion of the acetabular labrum). CONTRAINDICATIONS Suspicion of malignant synovial disease, extensive synovitis, especially in those areas of the hip which are difficult to reach or inaccessible to arthroscopy, primary disease not sufficiently treatable by arthroscopy, e.g. coxarthrosis. SURGICAL TECHNIQUE Arthroscopy of the central compartment of the hip is carried out by lateral, anterolateral (alternatively inferior anterolateral) and posterolateral portals, using all portals both for the camera and for instruments. In the central compartment synovectomy of the acetabular fossa is performed. A shaver and/or a high frequency diathermy applicator (HF applicator) are employed for removal of the synovial membrane. For arthroscopy of the peripheral compartment lateral, anterolateral (alternatively inferior anterolateral) and superior anterolateral portals are established and all portals are used both for the camera and instruments. In the peripheral compartment, the synovial membrane of the anterior, anteromedial, anterolateral and as far as possible posterolateral areas of the hip is removed. The dorsolateral synovial plica needs to be spared. POSTOPERATIVE MANAGEMENT Non-steroidal anti-inflammatory drugs (NSAIDs) are administered as prophylaxis of heterotopic ossification for 10 days. Contraindications for NSAIDs need to be considered. Thrombosis prophylaxis with low molecular weight heparin over 5 days. Mobilization with full weight bearing. Intensive physiotherapeutic exercises for at least 6 and possibly up to 12 postoperative weeks. Radiosynoviorthesis 6-8 weeks after surgery depending of the histopathological results. RESULTS From June 2007 to December 2013 a total of 20 patients with specific synovial diseases were treated with hip arthroscopy of which 18 had chondromatosis and 2 had PVNS. A telephone interview was carried out after an average of 40.2 months (range 8-92 months) and revealed a recurrence rate of the synovial disease of 20 %. In two cases (10 %) a second arthroscopy was necessary due to recurrent symptoms but without return of the synovial disease.

Außenrotationsosteotomie des Humerus zur Behandlung des lähmungsbedingten Außenrotationsdefizits der Schulter@@@External Rotation Osteotomy of the Humerus for Treatment of External Rotation Deficit in Palsies

ZusammenfassungOperationszielVerlagerung des Rotationssektors der Schulter zugunsten der Außendrehung. Erreichen einer ungestörten und physiologischeren Beugung des Ellbogens ohne Anschlagen des Unterarms am Thorax oder kompensatorische Abduktions- Anteversions-Bewegung in der Schulter. Steigerung der Aktivitäten des täglichen Lebens, da die Hand wieder ungestört zum Gesicht geführt werden kann.IndikationenNicht besserungsfähige Lähmung des Musculus infraspinatus und Musculus teres minor mit ausgefallener oder unzureichender Außenrotation, spontaner Innenrotationsstellung des Arms, Behinderung der Ellbogenbeugung durch Anschlagen des Unterarms am Thorax und konsekutiv erforderlicher Abduktions-Anteversions-Bewegung in der Schulter beim Versuch, die Hand zum Gesicht zu führen.KontraindikationenUnvollständige Rehabilitation nach einem neurochirurgischen Eingriff.Einsteifung des glenohumeralen Gelenks mit unzureichendem passivem Gesamtrotationssektor durch zusätzlich eingeschränkte Innenrotation.OperationstechnikZur Verschiebung des Rotationssektors der Schulter zugunsten der Außendrehung wird der Humerus im mittleren Drittel osteotomiert. Der distale Humerusanteil wird um 30–60° außenrotiert. Die Stabilisierung erfolgt mit einer Plattenosteosynthese.WeiterbehandlungGilchrist-Verband bis zur 6. postoperativen Woche (insbesondere nachts), Abnahme tagsüber und zur Physiotherapie ab dem 1. postoperativen Tag mit assistiver und passiver Beübung von Ellbogen, Hand und Fingern sowie aktiver Außenrotation der Schulter. Freigabe aller Bewegungen nach Abschluss der 6. postoperativen Woche.Ergebnisse15 Patienten wurden operiert und nach 3 Jahren (0,5–8,7 Jahre) nachuntersucht. In sämtlichen Fällen wurde der Rotationssektor (präoperatives Außenrotationsdefizit 37°, postoperative Zunahme 46°) so verschoben, dass die vorhandene Ellbogenbeugung wieder besser einsetzbar war und die Hand ohne gleichzeitige Ausweichbewegungen in der Schulter zum Gesicht geführt werden konnte.AbstractObjectiveAim of the procedure is shifting the arc of shoulder rotation for an improved external rotation, reaching a physiological elbow flexion without striking of the lower arm against the thorax; improvement of the activities of daily living because guidance of the hand to the face is possible without any simultaneous evasive movements of the shoulder.IndicationsPalsy of infraspinatus and teres minor muscles after complete neurosurgical therapy (neurolysis, reconstruction of the brachial plexus), which leads to loss of external rotation and an internally rotating posture of the arm. Elbow flexion is hindered because of striking of the lower arm against the thorax, simultaneous abduction and foreward flexion is necessary to guide the hand to the face.ContraindicationsNot completed rehabilitation after a neurosurgical procedure.Stiffness of the glenohumeral joint with insufficient passive overall rotational sector due to additional reduced internal rotation.Surgical TechniqueTo improve external rotation by shifting of the arc of rotation, a transverse osteotomy is done in the mid third of the humerus and the distal part of the humerus is rotated outward (30–60°). A dynamic compression plate is used for osteosynthesis.Postoperative ManagementImmobilization of the arm in a Gilchrist bandage is necessary for 6 weeks (especially at night). The physiotherapy program starts on the 1st postoperative day with assisted and active training of elbow, hand, and fingers, as well as active external rotation of the shoulder. After 6 weeks, all movements and daily activities are allowed.ResultsThe procedure was performed in 15 cases, followed up on average after 3 years (0.5–8.7 years). In all cases, the shifted arc of rotation (preoperative 37° deficit of external rotation, postoperative 46° increase) eliminated striking of the lower arm against the thorax on flexion of the elbow. All patients were able to guide their hands to their faces without any simultaneous evasive movements of the shoulder.OBJECTIVE Aim of the procedure is shifting the arc of shoulder rotation for an improved external rotation, reaching a physiological elbow flexion without striking of the lower arm against the thorax; improvement of the activities of daily living because guidance of the hand to the face is possible without any simultaneous evasive movements of the shoulder. INDICATIONS Palsy of infraspinatus and teres minor muscles after complete neurosurgical therapy (neurolysis, reconstruction of the brachial plexus), which leads to loss of external rotation and an internally rotating posture of the arm. Elbow flexion is hindered because of striking of the lower arm against the thorax, simultaneous abduction and foreward flexion is necessary to guide the hand to the face. CONTRAINDICATIONS Not completed rehabilitation after a neurosurgical procedure. Stiffness of the glenohumeral joint with insufficient passive overall rotational sector due to additional reduced internal rotation. SURGICAL TECHNIQUE To improve external rotation by shifting of the arc of rotation, a transverse osteotomy is done in the mid third of the humerus and the distal part of the humerus is rotated outward (30-60 degrees ). A dynamic compression plate is used for osteosynthesis. POSTOPERATIVE MANAGEMENT Immobilization of the arm in a Gilchrist bandage is necessary for 6 weeks (especially at night). The physiotherapy program starts on the 1st postoperative day with assisted and active training of elbow, hand, and fingers, as well as active external rotation of the shoulder. After 6 weeks, all movements and daily activities are allowed. RESULTS The procedure was performed in 15 cases, followed up on average after 3 years (0.5-8.7 years). In all cases, the shifted arc of rotation (preoperative 37 degrees deficit of external rotation, postoperative 46 degrees increase) eliminated striking of the lower arm against the thorax on flexion of the elbow. All patients were able to guide their hands to their faces without any simultaneous evasive movements of the shoulder.