We present the clinical case of a sixty-four-year-old man with bilateral spontaneous rupture of the Achilles tendon having a multiple disseminated oesophagus carcinoma. After immobilisation due to metastases of the 2nd lumbar vertebra, there was a spontaneous, painless rupture of the Achilles tendon while the patient was mobilised wearing a Hohmann spine brace. Afterwards we carried out a thorough case history with the help of clinical examination, sonographic and magnetic resonance imaging. The bilateral rupture has been treated conservatively with the Adipromed Shoe. With regard to the 2nd lumbar vertebra fracture and metastases, a Hohmann spine brace was given to the patient. Because of the described circumstances, no surgery had been carried out. Furthermore, the patient experienced much more independence and an improved quality of life in his last couple of months. Surgery would have not been recommended and could have caused the complete immobilisation and loss of patient's quality of life. With this case report we would like to point out the consequences of an unwise therapeutic decision to a patient who only has a few more months to live. This case report is discussed with regard to the possible aetiopathology and the current literature.

Achilles Tendon↗

PubMedDate not supplied

[Tendinosis calcarea--results of treatment with needling].

In a prospective study, 33 patients with calcifying tendinitis had a needling in local anaesthesia performed under control of an image converter. There was at least a one year follow-up period. Resorption of the hydroxyapatite deposits was seen in 23 instances; 75% of all patients were free of symptoms or had considerably improved (Table 3). For better assessment of these results we embarked on an additional retrospective study observing the spontaneous evolution of 235 hydroxyapatite deposits for 3 years on average. On the x-ray, these deposits had a characteristic appearance and could be classified into one of three types: either sharply outlined and densely structured (type I), or with cloudy limitations and transparent in structure (type III). In addition we saw deposits combining the features of both of the above named types (type II) (Table 5, Fig. 6). Based on this classification, a clear correlation was revealed to exist between initial x-ray findings and the frequency of resorption after needling: with type I, complete resorption was seen in 33% of the cases, with type II in 71%, and with type III in 85% of the cases (Table 6). With type II, however, only half of the patients were free of symptoms. Surgical removal of the hydroxyapatite deposits became necessary in 3 patients because of persisting heavy pains. As complication we observed intraoperatively an incomplete tear of the rotator cuff, the relation of which to the needling remained unsure. In this context, the question is discussed whether calcifying tendinitis and rupture of the rotator cuff may represent two disease entities of identical origin.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMedDate not supplied

[The value of the anamnesis for the probability diagnosis of shoulder pain].

The response to pain of the shoulder in different diseases and injuries in this joint is uniform and this is of very little help in recognizing the cause. A detailed case history is useful in delineating the differential diagnosis. We have therefore developed a questionnaire consisting of 55 specifically aimed questions to these case histories. The acquired information was specifically rated for the 24 most frequent shoulderillnesses/injuries, and integrated in a computer program. In 55.4% of the cases the computer predicted the correct diagnosis and in 80% of the cases the right diagnosis was suggested amongst the first 3 preferences of the differential diagnosis.

Diagnosis, Computer-Assisted↗

PubMedDate not supplied

[Results of rotation osteotomy using the Weber method in the treatment of habitual shoulder dislocation].

Weber's rotational osteotomy is a surgical treatment of recurrent shoulder dislocation. While eliminating recurrence of the complaint, it attempts to regain full range of movement in the joint. Of the 39 operated patients it was possible to follow up 34 cases. The percentage of recurrent dislocation was 5.7%. The range of movement was reduced in some patients; in one by 10 degrees - 20 degrees. Otherwise there were no significant complications or post-operative complaints. The operative technique, the X-ray procedure and the pathogenesis of the original dislocation are described. Typical accompanying injuries require a particular operative method. The most common accompanying damage was normally the typical defect of the humeral head (incidence 91%). The regular overstretching of the subscapular muscle and the defect of the humeral head are considered by the operational technique introduced by Weber.

Adolescent↗

PubMedDate not supplied

[Is tendinosis calcarea associated with HLA-A1?].

Increased frequency of HLA-A1 in calcifying tendinitis? In a study with 46 patients Sengar et al. observed an association of calcifying tendinitis and HLA-A1 in 50% (normal regional frequency: 26.7%). In our study with 55 patients we found a presence of HLA-A1 in only 32.7% (normal regional frequency: 30.5%), there was no increased frequency.

Calcinosis↗