Der Orthopäde
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Delayed lesions of the femoral or sciatic nerve are a rare complication after total hip arthroplasty. Several cases in association with cement edges, scar tissue, broken cerclages, deep hematoma, or reinforcement rings have been published. We report about a 62-year-old female who developed a pure motor paresis of the quadriceps muscle 2 weeks after total hip arthroplasty. ⋯ Electrophysiological evaluation revealed several nerve conduction blocks in physiological entrapments and the diagnosis of hereditary neuropathy with liability to pressure palsies (HNPP) was established. Hereditary neuropathy with liability to pressure palsies (HNPP) is a rare disease with increased vulnerability of the peripheral nerve system with mostly reversible sensorimotor deficits. It should be taken into consideration in cases of atypical findings of compression syndromes of peripheral nerves or delayed neuropathy, e. g., after total hip arthroplasty.
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The distal radioulnar joint (DRUJ), the ulnocarpal joint and the ulnar carpus form an functional anatomical complex, as the head of the ulna is an articulated part of DRUJ as well as having a stabilising action and acting as an abutment due to its direct attachment to the triangular fibrocartilage complex. Pain in this area poses a diagnostic problem due to the close proximity of these structures. In addition to describing the standard clinical examination, the major pathologies of these ulnar hand components, their symptomatology and the basis of their therapy are discussed.
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The most common cause of an arthritically damaged distal radioulnar joint is a malunion of a distal radius fracture. Therapeutically, ulnar head resection, hemiresection-interposition-technique, Kapandji-Sauvé procedure and implantation of an ulnar head prosthesis have been described. None of these procedures is able to restore the complete function of the joint. ⋯ Biomechanically as well as clinically, replacement of the ulnar head using a prosthesis has been shown to either avoid or solve the problem of instability. We therefore consider ulnar head replacement the treatment of choice in secondary painful instability following resection procedures at the distal end of the ulna. Primary ulnar head replacement should be considered in special indications until long-term follow-up results are available.
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Injection of 17-20 ml of local anesthetic combined with corticosteroids via hiatus canalis sacralis or epidural between spinal processes in the lumbar region leads to distribution up to the level of the thoracolumbar junction. The indication for therapeutic peridual or epidural injections are radicular symptoms as a result of disc herniation, foraminal stenosis as well as neurogenic claudication. ⋯ Complications and side effects occur extremely seldom. There is only one RCT for radiculopathy and epidural steroids.
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Review Comparative Study
[Questionnaires for patients with back pain. Diagnosis and outcome assessment].
Self-assessment questionnaires are becoming increasingly important in the evaluation and outcome-assessment of low back pain patients, both in the research environment and in everyday clinical practice. Questionnaires allow a standardised, patient-orientated examination of the symptoms and effects of the disease as well as the assessment of change following treatment. The aim of the current review was to provide a summary of the questionnaires that are currently available in the German language for the assessment of patients with low back pain; the review focuses on those that have been shown to be reliable and valid and widely-used on an international basis. ⋯ For the analysis of treatment effects, prospective assessment of the relevant characteristics is recommended - that is, assessments should be made before the treatment and again with identical questionnaires at follow-up. Especially within the context of scientific studies, instruments should be chosen that enable an international comparison of the data generated. In everyday clinical routine, a short standardised documentation of the most important dimensions is recommended.