[Myofascial meridional reflexotherapy of scapulohumeral periarthrosis in the course of the combined spa and health resort-based treatment].

The authors draw attention to the role of a whiplash injury in the pathogenesis of scapulohumeral periarthrosis (SHP). Peculiarities of the specific pathological biomechanical changes associated with this condition are described. The study included a group of 64 patients in whom the localization of the myofascial trigger points (MFTT) of the shortened muscles is described with reference to the differential techniques for soft-tissue manual therapy. Spatial emphasis is laid on the diagnostic dynamic ischemic compression of trigger points (TT) for their inactivation using the method proposed by J. Travel in the original modifications proposed by the authors of the present article. The results of the application of myofascial meridional reflexotherapy of scapulohumeral periarthrosis are presented and analysed in the context of the combined spa and health resort-based treatment.

[Interscalene plexus block for mobilizing chronic shoulder stiffness]. / Die interskalenäre Plexus-Blockade zur Mobilisation bei chronischer Schultersteife.

INTRODUCTION: After mobilisation of a frozen shoulder, patients should work with a physiotherapist one to two times a day. In the remaining time patients must exercise on their own: otherwise, the shoulder is likely to become less mobile. Exercise is only possible in the absence of pain. Therefore, adequate analgesic therapy for four to five days after the first mobilisation is of great importance. We used interscalene blockade of the brachial plexus to achieve mobilisation in patients suffering from a painful frozen shoulder. We investigated the efficacy of this technique by registering the use of additional analgesics and documenting the patient's assessment. The observation time was 18 months. METHODS: Thirty-seven patients were treated with a plexus block using a catheter inserted at the affected side. Catheter location was verified with electric nerve stimulation. In all patients a bolus of 20 ml bupivacaine 0.375% was given for initial mobilisation, followed by 10 ml bupivacaine 0.25% every 6 hours. RESULTS: In 34 of 37 (92%) patients, the shoulder could be mobilised without general anaesthesia. Thirty-three of 37 (89%) patients did not need any additional analgesics during the following mobilizations. The mean duration of catheter treatment was 4 days; no infections occurred. The following side effects were observed at the first mobilisation: Horner's syndrome in 20 patients (54%), paresis of the recurrent nerve in 9 patients (24%) and paresis of the phrenic nerve in 6 patients (16%). During subsequent treatment, Horner's syndrome was observed in 15 patients (41%) and a paresis of the recurrent nerve in 8 patients (22%). In an interview after the end of the treatment period all patients stated that they would use this method again if necessary. CONCLUSIONS: With the use of this regional anaesthesia technique it was possible to provide comfortable pain therapy during the mobilisation period. In order to achieve sufficient analgesia with only a mild motor blockade of the motoneurons, the exact location of the catheter tip is important. The latter can be verified by electrical stimulation.

["Primary" shoulder stiffness: illness duration and therapeutic comparison]. / Die "primäre" Schultersteife: Krankheitsdauer und Therapievergleich.

AIMS: Etiology, natural history and therapy of the frozen shoulder still remains obscure. Therefore observation of natural history is of interest. METHOD: In a retrospective study 140 patients with different therapies were followed-up. RESULTS: 28 (20%) patients were not considered as healed because of persisting complaints during the whole follow-up period with an average duration of 49 months. Mobilisation under anaesthesia (27 patients) showed an less improval in range of motion with a shortening of complaint period. CONCLUSION: The existence of a subgroup of patients with no response on regular therapy is assumed.

[Calcifying subacromial syndrome--clinical and ultrasound outcome of non-surgical therapy]. / Kalzifizierendes Subakromialsyndrom--Klinische und sonographische Ergebnisse unter nicht-operativer Therapie.

PURPOSE: The aim of this study is to analyse the mid-term clinical and sonographical results of non-operative therapy of calcifying tendinitis. METHODS: Retrospectively the anamnestical, clinical and sonographical results after various non-operative treatment of patients with calcifying tendinitis were reviewed. For this purpose 159 patients with 178 calcifying deposits in the rotator cuff were evaluated on an average of 60 months after their first examination in our clinic (mean age: 49.2 years; sex ratio: 58% women). RESULTS: During a mean symptomatic period of 49 months, an average of 4.2 different therapeutic modalities were applied. After this time 70% of all patients showed an excellent or good result. With regard to the age-correlated Constant-Score 85% of all patients had more than 81 points, i.e. a good result. The mid-term results on a visual analogous scale from 10 (pain) to 0 (no pain) showed a decrease from 7.7 to 2.2 and this correlated with the shoulder function scores (Constant-/Patte-Score, r -0.8). After an average of 104 months 82% of the hydroxyapatite deposits could not be diagnosed by sonography (7.5 MHz.) anymore. CONCLUSION: In the treatment of calcifying tendinitis the conservative methods achieve good and excellent results in 70%. Patients should be treated with analgetics, subacromial injections, physiotherapy and ice therapy up to a period of twelve months, above all with small deposits and radiologic resorptive stadiums. The results of this study should be compared with any invasive regimen.

[The role of physical balneological factors in the treatment of occupational diseases]. / Rol' fiziobal'neofaktorov v lechenii nekotorykh professional'nykh zabolevanii.

The authors review the results obtained in the treatment of some occupational diseases using physical factors. In osteoarthritis patients exposed to fluorine compounds good results were achieved at employment of decimeter-wave therapy combined with mud applications or sulfurated hydrogen baths. Patients with scapulohumeral periarthritis benefited from combination of EHF therapy with alternating magnetic field. Initial lead intoxication was effectively treated with magnetotherapy. Subjects with vascular pathology occupationally exposed to high temperature responded to magnetolaser impact on reflexogenic regions of the heart.

Frozen shoulder--treatment and results.

Even today the aetiology of the frozen shoulder is still under discussion. At the Orthopaedic Department of the Medizinische Hochschule Hannover, 118 persons with a frozen shoulder were treated as in- or outpatients between 1980 and 1988. We investigated the results of two different specific therapy concepts. Most of the patients received a mixture of drug therapy and physical rehabilitation under the guidance of a physiotherapist. In a smaller group of patients, the frozen shoulder was mobilized under anaesthesia (mobilisation force). After an average follow-up time of 3.8 years from the start of treatment, 93% of the patients was examined by means of an individual subjective rating (score). In addition, a clinical examination was performed in 69% of the cases. According to the subjective personal rating (score) as well as the improvement in range of motion, moderate mobilisation led to better results than the mobilisation under anaesthesia.

[The combined use of electromagnetic decimeter waves and deresinated naphthalan in patients with vertebrogenic humeroscapular periarthrosis (its experimental and clinical validation)]. / Sochetannoe primenenie élektromagnitnykh detsimetrovykh voln i obessmolennogo naftalana u bol'nykh vertebrogennym plechelopatochnym periartrozom (éksperimental'noe i klinicheskoe obosonovanie).

Physicochemical and experimental studies on pond snail neuron were made to validate combined or simultaneous usage of decimeter microwaves and deresinified naphthalane. Clinical and neurophysiological trials in 133 patients with vertebrogenic scapulohumeral periarthritis revealed that the above treatment is clinically beneficial and corrects functional activity of segmental-peripheral neuromotor system.

The use of arthroscopy in the treatment of resistant frozen shoulder.

Arthroscopy serves as a useful adjunct to manipulation under anesthesia in the treatment of resistant frozen shoulder. In this technique the shoulder is manipulated under interscalene brachial plexus block anesthesia, followed by arthroscopic examination and debridement of the glenohumeral joint and the subacromial space. The addition of arthroscopy allows the identification and treatment of associated pathology, such as impingement lesions and secondary subacromial space inflammation, calcific deposits, and acromioclavicular arthritis. Range of motion can also be increased by arthroscopically guided sectioning of the coracohumeral ligament. This treatment regimen has yielded overall satisfactory results in 25 (83%) of 30 shoulders in this series. The subgroup with diabetes mellitus fared less well than the other groups, with only 64% satisfactory results. While most patients with frozen shoulder will respond to nonoperative treatment, the technique of manipulation under anesthesia followed by arthroscopy offers a safe and reliable treatment for the resistant frozen shoulder.

[Predicting the outcome in patients with scapulo-humeral periarthritis]. / Prognozirovanie iskhodov u bol'nykh s plechelopatochnym periartrozom.

In the article is presented a prognostication table of scapulohumeral periarthrosis outcomes, developed in the process of investigation, which allows to predetermine the possibility of recidivation in these patients depending on the presence and expression degree of revealed inflammatory signs. The tactics of a doctor is determined in prescription of curative and prophylactic measures, concentration, sequence and specificity of which is stipulated by a probability of recurrence in different groups of patients with scapulohumeral periarthrosis. Elaborated scheme of patient control, based on preliminary prognostication of outcomes, has been tested at 150 patients.

Periarthrosis of the shoulder associated with diabetes mellitus.

Among the protean complications of diabetes mellitus are contractures of the joints and periarticular soft tissue. These complications have not been well described in the literature. This syndrome of "limited joint mobility," has been reported as occurring in young, insulin-dependent diabetics, with primary involvement of the small joints of the hands. In older diabetics, similar changes have been described with additional contractures developing in the large joints of the upper extremities. This report presents clinical findings occurring in five older diabetics with primary contractures of the shoulder. Theoretical considerations are also discussed regarding the neurophysiology of this entity as well as the current treatment options.

[Medical, physical and rehabilitative treatment in a case load of 250 patients affected by scapulo-humeral periarthritis]. / Il trattamento medico, fisico e riabilitativo in una casistica di 250 pazienti affetti da periartrite scapolo-omerale.

A series of 250 patients with scapulohumeral periarthritis, treated as outpatients in september 1982-september 1984 is presented. Medical, physical and rehabilitation treatment was targeted at the clinical phase of the condition and the results are evaluated.

Frozen shoulder: prospective clinical study with an evaluation of three treatment regimens.

Forty-two patients with frozen shoulder were followed up closely for eight months. They were all taught pendular exercises and randomly allocated to one of four treatment groups: (a) intraarticular steroids, (b) mobilisations , (c) ice therapy, (d) no treatment. This study has shown that there is little long-term advantage in any of the treatment regimens but that steroid injections may benefit pain and range of movement in the early stages of the condition.