Der Unfallchirurg
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Irreparable rotator cuff tears represent a significant everyday clinical challenge. A high degree of tendon retraction and muscle degeneration means that a direct reconstruction is impossible. Patients often suffer from pain and pseudoparalysis. ⋯ Minimally invasive arthroscopic treatment approaches can lead to pain relief and slight functional improvements in selected patients; however, to restore the active movement of the joint a partial cuff repair, augmentation with a graft or replacement with muscle transfer is necessary. This article presents the various treatment options and the results reported in the literature. Through this a treatment algorithm is suggested in order to facilitate management decisions.
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Tendon pathologies are a frequent cause of shoulder pain and can lead to significant decline in the quality of life. Conservative treatment is suitable for most tendon pathologies. In addition to classical conservative treatment options, such as physiotherapy, oral analgesia and infiltrations, there are a number of additive treatment options to promote structural tendon healing and clinical outcome. ⋯ The objective of this article is to give an overview of biological and regenerative therapeutic options in the treatment of tendon injuries of the shoulder. Therefore, the anatomical and molecular biological principles of the tendon structure and their importance for tendon healing are explained in order to highlight the various therapeutic options for daily practice. Biological augmentation procedures and regenerative medicine represent a promising therapeutic option for tendon injuries of the shoulder, however, the benefits are so far supported by little or no evidence at all.
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An evidence-based psychotraumatological expert assessment should include a thorough clarification of the diagnoses on different levels of findings and an inclusion of modern methods to clarify the authenticity. The surgical examiner is of great importance in the cooperation since he mostly undertakes the initial documentation, including psychological damage, and ultimately evaluates the overall damage after an assessment. A good interdisciplinary understanding and appreciation are therefore the prerequisite for a comprehensible expert assessment.
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Review
[Posttraumatic stress disorder : Risk factors, phenomenology, early recognition and management].
Posttraumatic stress disorder is characterized by the symptom levels intrusion, avoidance and hyperarousal as a reaction to an exceptionally threatening event. It is a well-investigated and well-treatable mental condition; however, the frequently accompanying disturbances in sleep, cognition, affect and especially avoidance behavior represent substantial hurdles in the trauma surgery treatment as well in occupational reintegration. Basic knowledge about risk factors and the clinical phenomenology also enable early identification by the primary trauma surgeon or the accident insurance consultant (D-physician) and if necessary to initiate a qualified psychotraumatologically founded treatment.
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Cognitive and psychoemotional impairment after traumatic brain injury is often underrated, especially after mild injury. Even subtle problems can considerably interfere with routine functioning. They require precise psychotherapeutic diagnostics and adequate neuropsychological treatment. Early detection and documentation of the initial symptoms and initiation of further steps are mandatory, also and particularly during first-line surgical management.