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Biomedical subjects

P Schlapbach

Publications and source records attributed to P Schlapbach.

At least 19 recordsLinked to original sources
PubMed1995

Diffuse idiopathic skeletal hyperostosis (DISH) of the shoulder. A controlled radiological study.

The prevalence of hyperostotic spurs (HS) in different areas of the shoulder was studied in 36 probands with and 58 probands without thoracospinal hyperostosis on lateral chest radiographs. Bilateral shoulder radiographs in three projections were analysed blindly, recording the presence of HS at six separate sites (glenoid, greater tuberculum, acromion, acromioclavicular joint, coracoid and humeral shaft) and applying defined grading criteria. The prevalence of HS ranged from 11.7% of the shoulders at the coracoid to 50.0% at the glenoid. The prevalence of HS was similar on both sides [right, 30.1% of the sites versus left, 27.0%, relative risk (RR) 1.12 (95% confidence interval [Cl] 0.93-1.35)] and was not related to sex and history of work. Classification for the presence of shoulder hyperostosis was identical on both sides with the exception of one individual. In probands with thoracospinal and shoulder hyperostosis all areas analysed contributed to the classification. However, this was particularly prominent at the humeral shaft [RR 5.3 (95% Cl 2.1-13.0)] and the coracoid [RR 8.4 (95% Cl 1.9-36.4)]. These results indicated that the prevalence of HS and the specificity for the presence of diffuse idiopathic skeletal hyperostosis (DISH) vary between different sites. We suggest that future grading criteria for shoulder hyperostosis take into account the localization of HS, in addition to their number and size.

Aged↗
PubMed1994

[Back school as a preventive measure against backache: method of intervention or neurotigenic method?].

The therapeutic objectives of conventional back schools are a) instruction of people with and without back pain to use their backs according to currently accepted ergonomic principles, b) improvement of the cardiovascular performance of back school participants and c) acquisition of knowledge of simple methods of pain and stress management. Due to the diversity of back pain causes and the biopsychosocial complexity of back pain as the therapeutic target, back schools can never be the sole solution of a multifaceted problem. The prime objectives of this review are to describe the recent back school curriculums and to define possible therapeutic components of future back schools.

Activities of Daily Living↗
PubMed1992

[Identification of crystals in synovial fluid: joint-specific identification rate and correlation with clinical preliminary diagnosis].

The diagnostic clarification of joint effusions of unknown origin is a challenge to every primary-care physician. Important diagnostic procedures are arthrocentesis and analysis of the aspirated synovial fluid. Synovial fluid analysis frequently allows differentiation between harmless effusions due to osteoarthritis and crystal induced inflammation, or the more devastating septic arthritis. 4475 synovial fluids were evaluated retrospectively to calculate the identification rate of crystals compatible with calcium pyrophosphate dihydrate (CPPD) and monosodium urate monohydrate (MSUM). 40.8% (1827) of synovial fluids were taken from females and 59.2% (2648) from males. The frequency of crystal identification varied considerably: 13.2% CPPD crystal identification in females, 10.9% in males; MSUM was identified in 1.5% of females, and in 10.9% of males. The spectrum of joint involvement was nearly identical in CPPD and MSUM positive synovial fluids. Exceptions were the higher frequency of CPPD identification in shoulder joints (CCPD:MSUM = 15.6:1), the higher frequency of MSUM identification in the ankle (MSUM:CPPD = 15.6:1) and the first metatarsophalangeal joints (MSUM:CPPD = 8:1). Clinical suspicion correlated well with crystal identification in MSUM positive samples (60%), but was poor in CPPD positive samples (36%). The poor correlation between clinical suspicion and crystal identification in CPPD positive synovial fluids is explicable by the less characteristic clinical presentation of pyrophosphate arthropathy in contrast to classical gout. A high percentage of crystal identification was found in joints or periarticular swellings in which aspiration is difficult and therefore rare (e.g. tendon sheaths, first metatarsophalangeal and first metacarpophalangeal joints), underlining the importance of synovial fluid aspiration despite the difficulty of arthrocentesis.

Adolescent↗
PubMed1992

Diffuse idiopathic skeletal hyperostosis (DISH) of the elbow: a cause of elbow pain? A controlled study.

Elbow pain is a common complaint and elbow hyperostosis a frequent radiological condition. However, little is known about the association between the clinical and radiological findings. To evaluate the relationship between spinal and extraspinal hyperostotic features and the clinical relevance of elbow hyperostosis we have performed the first controlled, double-blinded study of 85 hospitalized probands, 33 with and 52 without thoracospinal hyperostosis on lateral chest X-ray. Elbow and shoulder hyperostosis were graded on bilateral standard radiographs. Elbow pain was assessed by an interviewer using a standardized questionnaire and extraskeletal causes of elbow pain were recorded. The prevalence of elbow hyperostosis was increased in cases with thoracospinal hyperostosis compared to controls (82% versus 58%, chi 2 = 5.32, P less than 0.025, n = 85, olds ratio (OR) 3.30 (95% CI 1.16-9.35)). Similarly, the prevalence of elbow hyperostosis was increased in cases with shoulder hyperostosis compared to controls (83% versus 60%, chi 2 = 4.51, P less than 0.05, n = 84, OR = 3.20 (95% CI 1.06-9.66)), emphasizing the multifocal nature of hyperostotic features. Elbow pain was only slightly more prevalent in cases with elbow hyperostosis compared to controls (21% versus 13%, chi 2 = 0.75, NS, OR = 1.84 (95% CI 0.46-7.44)). We conclude that elbow hyperostosis is a radiological finding of doubtful clinical relevance.

Aged↗
PubMed1992

The prevalence of palpable finger joint nodules in diffuse idiopathic skeletal hyperostosis (DISH). A controlled study.

The presence of clinically palpable finger joint nodules (Heberden's and Bouchard's nodes) was documented in 123 consecutive cases with diffuse idiopathic skeletal hyperostosis (DISH) of the thoracic spine and 191 matched DISH negative controls. The prevalence of palpable finger joint nodules was almost twice as frequent in cases with spinal DISH compared to controls (46% versus 31%, chi 2 = 7.67, P less than 0.01; multivariate adjusted odds ratio OR = 1.84; 95% CI: 1.14-2.98). This increase was most marked at the proximal interphalangeal joint, in males and in patients up to the age of 65 years. In addition and independent of other variables such as hyperostotic features, age and sex, the prevalence of palpable finger joint nodules was about twice as high in probands with a history of physically heavy work compared to those without (43% versus 26%, chi = 9.18, P less than 0.005; multivariate adjusted odds ratio OR = 2.10; 95% CI: 1.26-3.52). From these results we conclude that DISH should be considered as an independent risk factor in the development of finger joint nodules.

Aged↗
PubMed1991

Detection of flexor tenosynovitis by magnetic resonance imaging: its relationship to diurnal variation of symptoms.

Fifteen patients with noninfectious arthritis and morning stiffness were examined clinically, and with magnetic resonance imaging (MRI) at the metacarpophalangeal level of one hand in the evening and early the following morning. Our purpose was to determine the prevalence of hand flexor tenosynovitis, and to look for diurnal changes in the swelling state of the flexor tendon sheaths as a possible cause for morning stiffness. MRI showed a higher prevalence of flexor tenosynovitis than clinically suspected by using the pinch test. We could not observe an increase in soft tissue swelling in the morning compared to the evening.

Adult↗
PubMed1990

[Diagnosis of lumbar spine pain: are simple anatomic concepts sufficient for common practice?].

Low back pain is a very frequent complaint. Unfortunately, a specific diagnosis can be made only in a minority of cases. Many pain provocation and alleviation tests have been done, and their results help the clinician in some cases to locate the origin of pain in the lumbar spine. It has been postulated that these tests should be reserved for the realization of controlled clinical trials evaluating different treatment modalities.

Back Pain↗
PubMed1990

Bacterial arthritis: are fever, rigors, leucocytosis and blood cultures of diagnostic value?

Clinical suspicion, positive gram stains and cultures of the synovial fluid are the fundamental criteria for the diagnosis of bacterial arthritis. Bacterial arthritis may, however, show an oligosymptomatic clinical course and thus lead to a delay in diagnosis. The case records of 43 patients with bacterial arthritis were reviewed retrospectively. Rigors (20.9%), fever (40.5%), blood leucocytosis (41.8%) and a shift to the left of blood leucocytes (35%) were found in less than half of all examined patients. Positive cultures of the synovial fluid (71.4%) were far more frequent than positive blood cultures (23.5%). We conclude, that the absence of fever, rigors, blood leucocytosis and positive blood cultures does not rule out the possibility of bacterial arthritis.

Arthritis, Infectious↗
PubMed1990

Diffuse idiopathic skeletal hyperostosis (DISH) of the shoulder: a cause of shoulder pain?

Shoulder pain is a common complaint and shoulder hyperostosis a frequent radiological condition. However, little is known about the association between the clinical and radiological findings. To evaluate the clinical relevance of shoulder hyperostosis we performed a controlled, blind study of 99 hospitalized probands with and without thoracospinal hyperostosis on lateral chest X-rays. The study included grading of the shoulder hyperostosis on the basis of three bilateral standard radiographs, assessing shoulder pain in a standardized way by an interviewer and recording extraskeletal causes of shoulder pain. The prevalence of shoulder hyperostosis was doubled in probands with thoracospinal hyperostosis compared to controls (chi 2 = 5.90, P less than 0.025, n = 99). Shoulder hyperostosis, irrespective of thoracospinal hyperostosis, predisposed to shoulder pain (40% versus 18%, chi 2 = 4.06, P less than 0.05, n = 74). Shoulder hyperostosis in combination with thoracospinal hyperostosis (shoulder DISH) predisposed to shoulder pain to an even greater extent (46% versus 12%, chi 2 = 6.64, P less than 0.01, n = 47). We conclude that shoulder hyperostosis is a radiological finding of potential clinical relevance.

Arthrography↗
PubMed1989

[Bacterial arthritis--a retrospective analysis].

Bacterial arthritis is an emergency situation in which rapid diagnosis and immediate therapy are the main factors conditioning a satisfactory functional outcome. Not infrequently, bacterial arthritis may involve only mild clinical features, thus leading to a delay in diagnosis. The case histories of 43 patients with bacterial arthritis are reviewed retrospectively. Only 20.9% mentioned a history of rigor and less than half (40.5%) of the patients had a body temperature elevation above 38 degrees C. Other signs of bacterial infection (i.e. leukocytosis, positive blood cultures, synovial fluid pleocytosis) were less frequent than expected. Functional outcome was better for patients with a short latent period between the onset of clinical symptoms and initiation of treatment.

Adolescent↗
PubMed1989

Diffuse idiopathic skeletal hyperostosis (DISH) of the spine: a cause of back pain? A controlled study.

This is the first controlled study of the frequency of back pain in a European caucasian population with diffuse idiopathic skeletal hyperostosis (DISH). Elderly patients admitted to hospital for reasons other than back pain were assessed for the presence of spinal DISH using the routine lateral chest radiograph films. A total of 106 probands (82 males, 24 females) with a mean age of 70 years fulfilled the criteria for DISH as defined previously. One hundred and seventy-eight patients (117 males, 61 females) not meeting these criteria were used as controls. The prevalence of back pain was assessed by a blinded interviewer using a structured questionnaire. Our primary hypothesis was that spinal DISH positive probands had not had back pain more often than controls. This controlled study showed no statistically significant difference in pain frequency between spinal DISH positive probands and controls at any spinal level. We conclude that back pain does not occur more often in radiographically defined DISH positive probands than in controls. The radiological finding of spinal DISH, as far as it does not lead to stenosis of the spinal canal or dysphagia, thus seems to be a finding without clinical relevance.

Aged↗
PubMed1989

[Physical therapy treatment of pain].

Pain control is one of the primary goals of physiotherapeutical methods. Unfortunately, the true mode of pain relief by most of the applied physical methods remains hypothetical. Based on a problem orientated proceeding, decisive factors for the prescription of physical methods shall be presented. Emphasis has been placed on the practicability, safety and economical aspects of prescribed methods.

Combined Modality Therapy↗
PubMed1988

[Relapsing polychondritis: a diversified disease picture].

Relapsing polychondritis is a rare, at times fatal systemic disease involving inflammatory destruction mainly of cartilaginous structures. The sensory organs, respiratory tract, cardiovascular system and kidneys are most frequently involved. Based on the current state of knowledge it seems probable that relapsing polychondritis is an autoimmune disease. Early involvement of the respiratory tract and kidneys, anemia, arthritis and saddle-nose deformity are associated with poor prognosis. 2 cases of relapsing polychondritis (one with erosive symmetrical polyarthritis and the second with massive involvement of the respiratory tract) are presented.

Adult↗
PubMed1988

Relapsing polychondritis mimicking rheumatoid arthritis.

A woman with relapsing polychondritis presented with progressive and deforming polyarthritis (but always negative for rheumatoid factor) 14 years before the appearance of typical clinical and histological changes of nasal and auricular cartilage destruction.

Aged↗
PubMed1987

[Pleuropulmonary manifestations in chronic polyarthritis].

Nine cases of rheumatoid arthritis with pleuropulmonary involvement illustrate the most common pulmonary symptoms of this disease: rheumatoid pleurisy, interstitial pneumopathy, pulmonary rheumatoid nodules and bacterial pleuropulmonary infections. Each of these pleuropulmonary manifestations may precede the joint disease and cause considerable diagnostic difficulties. Rheumatoid pleural effusion displays an interesting pathognomic constellation: low glucose- and elevated lactate-dehydrogenase concentration, acid pH, often pathologic C1q-binding assay, and characteristic cytomorphology of the pleural fluid. Interstitial pneumopathy is usually mild and slowly progressive. Additional spirometric tests to determine ventilation disturbances sometimes demonstrate airway obstruction. Lower-airway obstruction is probably not caused by the disease itself but may be due to other risk factors (eg cigarette smoking). Depending on their localization, intrapulmonary nodules may lead to severe complications (hemoptysis, bronchopleural fistula, pneumothorax, abscess formation). The possibility of pleuropulmonary infection must always be kept in mind as patients with rheumatoid arthritis have a higher susceptibility to infection.

Adult↗