Nero 7 Essential Plugin

Nerve compression syndromes

of http://gelenkzentrum-wiesbaden.de/hand/hand.php # lgs (see pictures there)

nerve compression syndromes need to be considered for differential diagnosis of other painful conditions of the upper extremity. In some of the compression syndromes the assignment is already a clear history with characteristic Beschwerdesymtomatik and typical failure pattern to provide clinically safe. For other forms of complex electrophysiological measurements of peripheral nerves and an idea to the neurologist is essential. The definition of parent interference from changes in the cervical spine and intervertebral discs may require further X-ray diagnostics. Hormonal influences have to be considered as well as inflammatory processes, differential diagnosis and excluded. An accident history is to raise more. indication for surgical treatment: If the history and clinical symptoms clearly should not be delayed with the recommendation for surgical decompression of the nerve. The decision for surgery also depends on the clinical symptoms, the suffering of patients and has already demonstrated neurophysiological changes in measured values. If a conservative treatment with rail storage and, if local infiltration is carried out, should a clinical Control after 2-3 weeks in. If the symptoms do not improve, the surgical decompression is recommended in detail. carpal tunnel syndrome, Guyon Lodge sulcus ulnaris syndrome anterior interosseous nerve syndrome supinator syndrome Wartenberg syndrome carpal tunnel syndrome anatomy: The median nerve runs on the wrist by an anatomical bottleneck, the carpal tunnel. The carpal tunnel is bounded by the flexor side carpal bones and flexor retinaculum by, a strong Bindegewebsband. If a compression syndrome of the nervous before at this level, the transverse carpal ligament divided surgically. This gives the median nerve to bend space and is easy to regenerate. From the median nerve, the sensory nerves arise for the thumb, index, middle, ring finger. The first is nerve branch of the wrist palmar branch off, an infringement of its branches leads to persistent complaints scars. The next departure is to thumb nerve motor branch of the motor. Its course is variable, an injury of this nerve leads to paralysis of the Thenarmuskels. Therefore, in all surgical procedures for decompression of the carpal tunnel syndrome, see the preservation of that Nevenstrukturen be paramount.

The course of the motor branch is not constant, but occurs with the variability shown here. The variability of the nerve paths is usually only a trained hand surgeon known. symptoms: Night pain in the thumb and Zeige-/Mittel-/Ringfinger, combined with numbness and "pins". shake out forced the hand of swelling and soreness in the hand. Often reinforced in the early morning hours, improvement in the day, increase by prolonged forced position (steering wheel in the car, newspaper, knitting) Ascending pain radiating to lower / upper arm and shoulder area possible but not obligatory. In the course of progressive damage to the nervous decrease in pain! This is not a sign of improvement when the numbness remains with loss of fine recognition of velvet and silk, or even a broadening of the 2-point discrimination performance. The further compression of the nerve leads to loss of motor fibers with loss of the thumb to make the little finger against (loss of the Opposition) and weakness of abduction (abduction). Fall of the Thenarmuskels. surgical procedures: Classic open surgery Endoscopic Minimally invasive surgery Classic open surgery The most important part of the decompression of the median nerve is the complete division of the transverse carpal ligament. The classical open method, all main structures and a revision of the flexor tendon sheath is quite possible. The ramus palmaris is well presented and, if necessary, free of coarse fascial tissue as the motor motor branch. In the subcutaneous tissue between the skin and flexor retinaculum run small nerve branches of the cutaneous radial nerve, which cross the traditional incision at the level of the wrist. These so-called Taleisnik nerve transection occasionally lead to persistent discomfort with Narbenneuromen scar area. Endoscopic surgery The endoscopic procedure for decompression of the median nerve is created, a small incision at approximately the level of the wrist crease and a further cut in the palm of the hand at the distal end of the carpal tunnel (method by Chow). About these incisions are various special trocars and slot knife inserted and placed the video look, which is connected to an arthroscopy tower. Special knives are then used for division of the retinaculum under video visual control. The disadvantage is considered by many hand surgeons methodically induced lack evaluability criticized the median nerve itself and its above-described outlets. Likewise, an assessment of the flexor sheaths not be seeing an inflammatory thickening remains untreated it. A variant, the method is to Agee, which is by the use of other instruments, only one incision is required. The restrictions mentioned in the evaluability of the structures are similar for both techniques. incision for endoscopic decompression of the median nerve after Chow . Minimally invasive surgery is In this operation, it is the classic open surgery in which access is limited to the palm. Here, the proximal portion of the carpal tunnel is tunneled subcutaneously and raised with retractors. With the use of magnifying glasses, the transverse carpal ligament divided under direct vision. This results in the benefits of classic open approach, including specific audit capability of the carpal tunnel. The problems of scar discomfort are avoided, however, since the transverse Taleisnik-sensitive nerves may be spared. The motor and the motor branch is represented flexor tendon bearing can be inspected. An external neurolysis of the median nerve is also possible. By the obligatory use of an upper arm tourniquet is improved visibility in the wound and reduces the risk of damaging important structures. Here is the minimal invasive approach for decompression of the median nerve shown. The classical incision is limited to the palm. Remaining discomfort in the scar area are thus observed only in exceptional cases. anesthesia procedures: The division of the transverse carpal ligament is under local anesthesia, intravenous regional anesthesia or plexus block possible. As always the need for partial or extended tenosynovectomy must be considered, we use the axillary brachial plexus block preferred. Here is a stimulation device in the armpit of the nerve plexus of the arm visited targeted and stunned. The surgery is an outpatient procedure. For more details, contact the individual consultation of your doctor in the joint center of Wiesbaden. treatment: bandaging the hand and forearm with immobilization in a plaster cast or orthosis to the completion of wound healing and suture removal after 10 days. Intermediate wound checks vary according to schedule local findings. After healing, an increasing functional use of the hand is possible. By the nerve compression related pain are usually immediately after the decompression or after a few days improved significantly. Nerve deficits with reduced sensitivity or even paralysis of the Thenarmuskels require significantly longer recovery times. The recovery time depends on the duration and intensity of the pre-lined nerve damage. Top Lodge Guyon syndrome Distal ulnar nerve compression syndrome anatomy: The nerve enters nerve at the wrist, accompanied by the ulnar artery into a tunnel-shaped box the palm. This Madame Guyon Loge is more superficial than the carpal tunnel and continue to create upward. The bottom of the box is formed by the proximal transverse carpal ligament and flexor side to the box of fiber tracts of the retinaculum is limited, which combine with fiber tracts from the Bindegewebsplatte the palm (palmar fascia). In the course of the lodge, the ulnar nerve divides into its superficial and deep nerve branch. The surface is purely sensory and supplies the ring and little fingers. The deep nerve branch is purely motor and supplies the majority of the hand intrinsic muscles. A failure of the motor branch leads to paralysis and the so-called claw-hand.

symptoms This compression syndrome is much less common than carpal tunnel syndrome. A cluster with bikers is observed and is interpreted to repeated damage by pressure from the bicycle handlebars. That symptoms are highly variable, depending on whether a preferred motor or sensory or combined injury to the nerve is present. Typical sensations of the drawn-side ring finger and little finger can completely absent in purely motor impairment. Here then is the atrophy (Verschmächtigung) side, stretching the muscles between the thumb and second metacarpal bone groundbreaking. An electrophysiological study by the neurologist is obligatory. Because of the possibility of combined occurrence of carpal tunnel syndrome Guyon and a box should always be the measurement of both nerves. surgical procedures The angle-shaped incision is drawn somewhat more versatile than the traditional open surgery for carpal tunnel syndrome. From proximal to distal ulnar artery is the dissection lead structure. The nerve is exposed to his division into the superficial and deep portion and the free entry of the motor branch to the muscles of constrictions. Endoscopic surgical procedures are not possible. The incision for decompression of the Lodge is more Guyon create another and is of lesser extent than the incision for the classical open division of the carpal tunnel. anesthesia procedures The anesthetic options are similar to those of carpal tunnel release, see there. treatment elastic bandage on until the wound has healed and stringing 10th postoperative day. Functional exercise treatment, depending on the severity of preoperative nerve injury and motor deficits. Also wearing a brace Ulnarisspange than is necessary. Sulcus ulnaris syndrome anatomy: The nerve passes ulnar at the elbow joint in a groove called the sulcus nervi ulnaris, which is covered by a tight connective tissue. Following the withdrawal of the sulcus of the ulnar nerve runs between the two heads of the drawn-side Handgelenksbeugers (FCU), which he innervated by motor. After the distal ulnar nerve runs along the deep Langfingerbeugers (FDP) to the wrist. From the deep Langfingerbeugern be the proportion of the little finger and ring finger completely, together with the median nerve by the ulnar nerve innervated by motor. symptoms are typical of sensory disturbances Pinky and ring finger, often in combination with a strain pain during rapid flexion of the elbow joint. A palpable snap phenomenon in the sulcus can be caused by a hypermobile nerve in the sulcus with dynamic Luxationsneigung or by snapping triceps tendon. Here the subtle examination by the experienced hand surgeon is required for differentiation, because both require different surgical treatment symptoms. In the sulcus ulnaris compression syndrome can often be provoked an electrical sensation on tapping the nerve (positive Tinel's sign). If the injury by motor units of the nervous and atrophy of the hand intrinsic muscles and reduces the visible sweat, the Diagnosis to make easy. Differentiation of distal motor injury in Lodge Guyon is possible by a powerful contraction of the deep Langfingerbeugers for the small finger and points at a weakness of the ulnar nerve injury above the box Guyon (eg in sulcus) out. An electrostatic € graphical measurement is recommended in any case before any surgery at this level. surgical procedures For initial surgery and initial recurrences after previous division of the sulcus ulnaris we lead the advancement of the subcutaneous nerves with his nutritional accompanying vessel. For this, on the inside of the elbow joint, a cut length of about 8-10 cm is required. The only way to mobilize the nerve supply and the medial Muskelseptum be resected up to the arcade of Struthers. Any kind of edge formation through Faszienzüge or acute-angled bends of the nerves are to be strictly avoided. The formed subcutaneous pocket is secured with absorbable suture material. The course is completely full nerves tested intraoperatively in all operating positions of the elbow joint. anesthesia procedures We recommend the axillary plexus anesthesia and surgery can offer as an outpatient surgery. In circumstances, however, general anesthesia may be indicated. You can do this by the operators of the Joint center Wiesbaden be discussed individually. treatment removal of the drain on the following days with the first dressing change. Elastic bandage with angebeugtem elbow joint to the completion of wound healing and suture removal. Depending on the severity of preoperative nerve deficits and paralysis, postoperative physiotherapy and occupational therapy in combination with rail supply is required. The convalescence of the nerve may be several months. anterior interosseous nerve syndrome anatomy: runs after the passage of the elbow the ulnar nerve, median of easily coming between the two heads of the pronator teres and here is the strong interosseous nerve from anterior. This is mainly motor and innervates the long Daumenbeuger (FPL) for the long Langfingerbeuger index and middle fingers (FDP II / III) and the square Einwärtsdreher forearm. Sensible supplies of N. anterior interosseous the bow-side wrist and the wrist. The passage of the median nerve with its distribution in the level of the anterior interosseous Pronatorköpfe is subject to many anatomic variations and to recognize the constricting structures only during surgery. Numerous clinical function tests help the experienced hand surgeon to limit the lesion in more detail. When motor failure of the anterior interosseous here is the inability of the thumb and index finger to form a single circle trend. Symptoms The symptoms are similar to those of carpal tunnel syndrome, the night pain is less and no Tinel's sign is found at the carpal tunnel. The differentiation is done by a number of different muscles and functional tests, all aimed to provoke the constricted nerve at the site of narrowing. the Einwärtsdrehtest against the resistance of the examiner, the isometric flexion test of the elbow against resistance and the "Fingerhakel" test against resistance (FDPII / III): the most important. An obligate electrophysiological measurement demonstrates the Amount of injury. surgical procedures Because of the multiple anatomical variations must complete the course of the median nerve to be revised in the elbow and proximal forearm. Coming from the proximal brachial artery is used as a lead. Upon reaching the pronator teres must depending on the course of the nerves or muscles are spread incised. Since the departure of the anterior interosseous muscle is in the stomach and must be revised, should this operation be performed by a surgeon with microsurgical experience using optical magnification aids (magnifying glasses). The joint center of Wiesbaden all nerve compression syndromes are operating with magnifying glasses. anesthesia procedures We recommend the axillary plexus anesthesia and surgery can offer as an outpatient surgery. In circumstances, however, general anesthesia may be indicated. To do this can be by the operators of the joint center of Wiesbaden individual advice. treatment elastic bandage until the wound has healed and stringing. Action taken in relation to the preoperative motor deficits to be personalized. Top Supinatorlogen-Syndrom/Interosseus posterior syndrome anatomy The radial nerve divides after its passage through the hiatus of the radial nerve in the lateral intermuscular septum in the elbow in the purely sensory Ranus superfizialis radial nerve and the predominantly motor branch of deep branch. The superficial branch runs with the radial artery distally and the deep branch passes through the supinator (Away Dreher of the forearm) and go to the extensor surface of the forearm where it innervates all the fingers and wrist extensor motor. The tendons at the entry level of the supinator (arcade Frohse) can lead to constriction. symptoms: errors usually sensory deficits. It is dominated by dull pain radiating the extensor-side forearm, similar to a Epicondylits radialis. For motor deficits, there is a corresponding weakness of the long finger extensor and / or the thumb. The entry into the Supinatorloge is often painful to pressure. The complaints are also that was felt when trying to external rotation against resistance and increases experienced in extension of the elbow joint. The middle finger extensor test is painful to the resistance. A certain degree of coincidence with the radial epicondylitis can complicate the diagnosis. We are therefore encouraged to be examined each patient with therapy-resistant tennis elbow in terms of a latent Supinatorlogen syndrome by a trained hand surgeon. An additional electrophysiological Measurement, which is often difficult to be carried out to support the indication for surgery. surgical procedures through a curved incision on the radial elbow radial is identified between the brachialis and the brachioradialis nerve. The muscular outlets are preserved and displayed the occurrence of the deep branch in the Supinatorloge, the present constricting tendon mirror and fiber tracts are severed and decompress the nerve. anesthesia procedures We recommend the axillary plexus anesthesia and surgery can offer as an outpatient surgery. In circumstances, however, a general anesthetic may be indicated. To do this can be by the operators of the joint center of Wiesbaden individual advice. treatment elastic bandage until the wound has healed and stringing. The further treatment is customized according to the preoperative motor deficits. Wartenberg syndrome anatomy the sensitive superficial radial nerve passes between the brachioradialis and extensor carpi radialis longus approximately 8 cm proximal to the wrist through the forearm. There you can find the nerve of bracelets, belts and jewelry chronic pressure damage. An irritation by rheumatic thickened paratenon is also possible. symptoms sense disturbances on the system side thumb and index finger area and the first Intermetacarpalraum. Minor electrical sensations and gain at Mißempfindungenmit provoked rotational movement of the wrist against resistance. surgical procedures cleavage of the forearm, revision of the nerve passage and, if resection of thickened paratenon. If necessary. Notch / Z-shaped extension of the tendon of the brachioradialis. anesthesia procedures surgery is an outpatient basis under local anesthesia or axillary brachial plexus block feasible. treatment dressing up for stringing, Narbenabhärtung, possibly silicon requirements for the prevention of keloids.

Johnson And Murphy Used

Craniosacral

of http://www.neuropaediatrie.com/aerzte/Stellungnahme/KRANIOSAKRAL.htm :

Craniosacral

Statement by the Society for Pediatric Neurology.

Commission treatments for developmental disorders and cerebral movement disorders: D. Karch, G. Gross-Selbeck, H.-G. Schlack, A. Ritz, D. Rating

Introduction

The Craniosacral is increasingly in recent years more frequently used in the treatment of developmental disorders in childhood and adolescence by physiotherapists, occupational therapists and speech therapists. The therapy is indicated for alleged motor and language development disorders, behavioral problems, learning disabilities, autism. However, in chronic pain, rheumatoid arthritis, scoliosis, vision and hearing disorders or mental disorders and is recommended. The Craniosacral is often framed in a longer-term treatment with conventional treatments, but are not that a special regulation.

The Craniosacral belongs to the realm of manual medicine and in the U.S. mainly promoted by doctors of osteopathy or osteopathic medicine at the Institute of the State University research in Michigan. Conceptually, it moves between traditional allopathic medicine and osteopathic medicine, which relies mainly on psycho-physiological self-regulation processes, such as Green in the preface of the textbook for Craniosacral (Upledger and Vredevoogd, 1996) performs. This opinion of the Society for Pediatric Neurology relates essentially to this textbook, and cited scientific publications.

Theoretical ideas

The "Kraniosakralsystem" is an independent physiological system considered, which is composed of: the Meningealmembranen, bone structures in which the Meningealmembranen are attached, the fibrous structures which are closely linked to the Meningealmembranen, the cerebrospinal fluid and for the production, absorption and storage of the liquor serving structures. The system would be in close liaison with all other body systems, especially the nervous and musculoskeletal system, the systems would interact.

The Kraniosakralsystem is characterized by continuous rhythmic movement ability, the frequency usually amounts to 6-12 cycles per minute. This rhythm is changing in diseases very and lie as much in comatose patients because of brain lesions at 2-4x per minute, or due to ingestion of drugs at 12x per minute. He was abnormally high in hyperkinetic children, or acute febrile conditions. Changes of the amplitudes would allow to draw conclusions about the vitality level of the patient. The other hand, remained stable at Kraniosakralrhythmus emotional arousal during physical exertion or at rest, in contrast to cardiac and respiratory rhythm. The Kraniosakralrhythmus leave at the entire body to detect especially in the area of the sacrum, palpation. Here there is a gentle rocking motion about a transverse axis, located about 25 mm before the second Sakrumsegment. A movement Sakrumspitze of the expansion phase corresponds to anterior and posterior movement of the extension phase. But also the entire body turn during the expansion phase and are wider to the outside or inside during the expansion phase and then narrower.

The origin of the Kraniosakralrhythmus had still not been known. Upledger and Vredevoogd (1996) posit a "pressure balance model": If one were to assume that the Liquorproduktion twice as fast as we successes the absorption, arises an upper pressure limit that care by an unknown mechanism to ensure that the Liquorproduktion be stopped, and a lower pressure limit at the start production again. The changing and dismantling of the pressure will indeed limited by the bony and connective tissue of the skull, but this limit is flexible, be deemed as the most anatomists. The collagen and elastic fibers of the sutures were crossed by vascular and nerve plexus, so that could be activated in certain hydraulic pressure in the skull inside a stretch reflex that is responsible for stop or start the Liquorproduktion. Researchers at the University of Michigan are trying to prove not only that neurophysiological control loop, but also about the fact that neuro-physiological regulation mechanisms in the cranial venous (Sine) admit that the flow of cerebrospinal fluid would control reflex.

non-physiological movements would occur as a result of restriction by connective tissue or fascia in the musculoskeletal system (eg, adhesions, inflammation or abnormal neuro-reflexes), but even with a constant overload of the sympathetic nervous system as a result of everyday stress when the body was no longer able to to reduce the stress stimuli. Against these restrictions or barriers to the work Kraniosakralsystem, which would change the quality and amplitude of craniosacral motion. Rigid barriers would arise by bony problems, elastic, by contrast, abnormal Membrane voltages. "The response of the whole body based on the Kraniosakralsystem on the concept of fascial continuity throughout the body. The movements of the body are probably related to the impact of fluctuations in the cerebrospinal fluid on the nervous system, which in turn affects the tone of the body tissue." (Upledger and Vredevoogd 1996, p.31)

techniques and objectives

The focus of the examination technique to evaluate the craniosacral rhythm is the palpation. It takes place with both hands, the proprioceptive perception had to be specially trained. Then one could feel, for example, that the head of 6-12x per minute will narrow and wide, with the occiput will broadly in the expansion phase and the base of the skull move anteriorly and to rotate about a transverse axis about 5 inches from the inion and in the expansion phase become smaller and curved turn back in the opposite direction. Also on palpation of the temporal bone or parietal you feel their movement, which runs symmetrically and in the same rhythm. Importance of the synchronous motion between the occiput and sacrum (above) to collect. The investigation techniques vary depending on the body part or organ system.

Treatment serves the aim of abnormal restrictions and barriers to the movement adopted to eliminate and has played an "autonomous flexibility" to restore. "Somatic dysfunction" or "osteopathic lesions" were palpable in the paravertebral areas as altered tissue structures, there are also pressure sensitivity and visceral dysfunction would.

barriers would be detected by moving samples, it is the movement initiated by the therapist of the tissue and evaluated in the further course. This could be abnormal restrictions of movement are detected, especially in the connective tissue and the fascia. The removal of restrictions is abnormal by indirect or by direct techniques. The indirect technique there is to promote the movement to free, unrestricted movement direction to the extent deemed possible. In this position, the structure is held by the therapist, it would be possible to the mobility of capital structure, stand-alone way back to a neutral position. This procedure is repeated for several craniosacral motion rhythms. This relaxed the tissue ("Release"). By the direct technique will attempt to resolve an abnormal barrier in that the limited structure or membrane was supported in its movement. All procedures are performed smoothly and without great effort in very different parts of the body, very often stood but occiput and sacrum at the center of the treatment. In the course of treatment will aim at the rhythm of the craniosacral motion can be modified or stopped. If the rest point (point still ") is reached, step on a total relaxation, somatic disorders were relieved and pain is alleviated. These phases are brought about several times.

As "CV-4 technique the treatment is called the occiput, where the adjustment to the intracranial pressure conditions is usually very good and vice versa as a result of external influence by the movement of the occipital bone of the intracranial pressure could be increased. A compression of the 4th Ventricle was adopted. Thus, the intracranial fluid movement and the exchange of cerebrospinal fluid is encouraged. The osteopathic treatment at occiput influences include the diaphragm activity and the autonomic breathing control. They also lower the tone of the sympathetic nervous system, which has a very positive effect on "stress patients" (Upledger and Vredevoogd 1996, p.54).

It is assumed that a continuity of fascial structures in the musculoskeletal system is so that abnormal changes and therapeutic measures along this system could be passed almost without hindrance. In this longitudinal system of fascial continuity links are involved ("Transverse diaphragms restrictive), the areas of significant pressures and therefore predilection for dysfunction of the craniosacral system are. Therefore, that the loosening of restrictions as to transverse the diaphragm, the diaphragm of the pelvis or upper thorax an important role.

Other goals of treatment are mentioned include: dysfunction in the craniosacral Durasystem, at the base of the skull, bone and bone joints of the skull, mouth and face and the temporomandibular joint. In these areas some special investigation techniques used for the detection of functional disorders in the textbook of Craniosacral (Upledger and Vredevoogd, 1996) described in detail together with the treatment techniques. Although this could be derived specific "lesions", but the clinical symptoms, which is caused by "lesions" or dysfunction, is addressed only very vague. In Torsionsstörungen (limited flexion or extension of Kraniosakralbewegung) should lead to headache and pain in the "nervous system, skeletal muscle, recurrent sinus infections or even malfunction of the endocrine system. For specific disorders sphenobasilar also existed personality changes (angry outbursts, antisocial behavior) in compression of the skull base, the most severe symptoms (depressive states, autism) were. In a "wedging" of the os sacrum (for example, fall injuries) between the ilia and disorders of the autonomic nervous system were observed. Breakdowns in the condyles of the Os would occiput lead to serious clinical symptoms were due to in part to faulty development of the bony nerve canals or impairment of the atlanto-occipital joints (eg, speech and swallowing difficulties, taste disturbances, heart rhythm disturbances). Find that the temporal bones symptoms existed in the area of hearing, Balance, motor control of eye (strabismus) and reading disorders. It could also be assumed that general disorders or disturbances outside of the nervous system, skeletal muscle "to the craniosacral rhythm take secondary influence, and thereby cause the above-mentioned disorders.

to the child's age, the following symptoms due to dysfunction of the craniosacral system can cause: severe anxiety and excessive crying in infants, hyperkinetic behavior, concentration problems and anxiety and learning problems (eg dyslexia) at school age, as well as spastic cerebral palsy and autism!

studies on the investigation techniques

Some publications deal with the frequency of measurable disturbances of Kraniosakralrhythmus for certain diseases or the reliability of applied research techniques. Thus Upledger et al. (1977) the reliability of the examination technique to determine the craniosacral rhythm at 25 preschool children tested. 4 doctors, all trained at the School of Osteopathy in Michigan studied independently with the same 19 techniques either every 25 or 11 children, 8 and 6 children. Evaluated, only the findings that were related to the restriction of each movement, and the degree of correspondence was sometimes very high, it was on average 71%. The authors therefore conclude that the existence of an imperceptible movement craniosacral system is proved substantially.

Upledger (1978) resulted in 203 primary school children by him for Kraniosakralbewegung by standardized tests and compared the results with the school success. Examined a total of 19 "Movement variables" are (on a scale of 1-3), were measured movement rash, bilaterality and restriction of movement caused by the doctor. The children were recruited from a regular school and a "Motor Coordination Clinic". The problems of the children were divided into 8 categories in advance, the report from the school or were taken from the history, according to the parents. 164 children were referred by the school as normal. Of these, 41 no other problems and 135 children have no problems from the categories 2-4 (behavioral disorders, motor disorders, learning disabilities) had, however, anamnestic abnormalities (category 5-8: seizures, head injury, pre-and perinatal risk factors or ear disorders). In the 39 non-normal children was usually more than one problem of the category 2-4. The comparison of these tests with the problems of the children showed a significant correlation between the mean values of all scales with the school assessment: normal / not-normal, and the existence of Behavioral problems, motor coordination disorder, learning difficulties and pre-and perinatal risk factors. It also showed that all tested investigative techniques or movement variables significantly correlated with the existing problems of the children had, had the highest correlation coefficient for "compression and decompression. The statistical calculations were carried out carefully and confirm that abnormal findings are significantly more common in school children with different problems in comparison with unproblematic children. The authors conclude that "the Kraniosakraluntersuchung as a reliable method for to see coverage of problem children in school is "without noticing that the statistical calculations on subjective rather than objectively verifiable findings are based.

outcomes

In the literature, no studies related to the evaluation of treatment results. In Textbook of Craniosacral (Upledger and Vredevoogd 1996) are reported experience and case reports or studies will be reported, but not in which journal they were published Here are some examples. On page 128 says that the correction "lateral strain" of the sphenobasilar " in a number of cases "to a staggering improvement of reading skills have done. On page 267 is of "immediate and dramatic relief of symptoms" in children's behavior and concentration problems in the treatment of the disorder reported the condyles of the occiput bone. The children were rarely more than 4 times must be treated to achieve a lasting success. A study for the treatment of hyperkinetic children was being prepared. On page 268, and 269 are "sensational" cases presented have which reached the Craniosacral an almost complete restoration of a 3-year-old boy and a 9-year-old girl with spastic hemiplegia, and an almost motionless tetraparetisches girls aged I learned 5 years after a few treatments and are crawling. It

and 108 children were treated with autism, which found themselves with little or no perceptible rhythmic movements of the Kraniosakralsystems and conducted various research findings at the conclusion were that would exist in autistic children heavy diaphragm restrictions (dural membrane). Even an etiological relationship is discussed. During the treatment, which must take place in several phases, would the behavior change in the typical way. First, improve the self-injurious behavior (possibly by reducing headaches), then many would Children's cooperative and showed a positive attitude toward therapy, and finally there is positive emotional and creative expression.

opinion

The Craniosacral is based on the assumption that a separate system of rhythmic movements in the CNS, whose existence was not proven and its possible origin is not even by the protagonists of this method explains uniform, but apparently due to changes in the cerebrospinal fluid pressure was. Another assumption is that bone synchondroses, coalitions, joints, fascia and muscles with the CNS a close-knit "nervous system, skeletal muscle" form and that mechanical changes particularly negative effect on the skull of this craniosacral system would (in the sense of abnormal barriers and restrictions). The third assumption is that, etc. are addressed by special, very gentle manual-medical interventions abnormal restrictions, blockades, jams could, especially by manual intervention on bone skull structures that are mechanically only minimally influenced. The treatment was necessary as would be caused by abnormal conditions somatic, psychosomatic and psychological symptoms. To date, although some case reports with clinical improvements described as blatantly informed but did no controlled studies on the treatment results.

There is no doubt that with careful palpation of the head, back, body and so on and tension, changes in Gewebskonsistenz be felt and so on. On this rests the diagnosis and treatment of manual medicine in general (Karch et al. 1998). The results of studies to monitor the investigation techniques of Craniosacral and the reliability of the findings are understandable in so far as the investigators are from the same school and have learned to interpret the palpatory findings in the same sense. Objective evidence of an alleged Kraniosakralrhythmus is not provided with it.

Passive and active mobilization with the aim of to alleviate abnormal limitation of motion of joints, and local and peripheral irritation of muscles, connective tissue and skin, are a means of manual therapy. Even and especially gentle massage techniques can lead to relaxation and mental relaxation techniques are helpful to many of the alleged subsequent symptoms of abnormal craniosacral rhythms (headache, restlessness and pain, impaired concentration, behavioral problems, changes in the autonomic nervous system, etc.) to alleviate.

are totally unacceptable the idea that by Kranialsakraltherapie "strangulation" of the os should be annulled or that the occiput "Kraniosakralrhythmus" immobilized may be, if its existence is based on the rhythm of Liquorproduktion and drain in the CNS should. In the preface of the book is highlighted with the Craniosacral the right analogy to an "energy therapy", that rationale no longer anatomical or neuro-psychological texts, and conducted their practices and assumptions to be compared with those of yoga. The detection of abnormal palpation findings in children with learning difficulties or autism, as well as in patients with different psychosomatic symptoms usually shows no causal relationship. There are many indications that can be detected in the non-specific tissue palpatory examination techniques, the caused secondary. Positive effects on the mental state of patients and the existing symptoms are the gentle manipulation and the entire treatment situation may be understandable, but certainly not specific. Therefore, the Craniosacral is ultimately to be regarded as a special type of body massage, which is in the broad sense of manual medicine associate. The use of the procedure for the treatment of specific developmental and learning disorders should be rejected.

Male Muscle Percentage

examination of the shoulder rotator cuff

of http://www.dgrh.de/paschulter.html : (see pictures there)

third Examination of the shoulder

Text in italics represent optional facts is to be developed!

General

• examination performed on the stationary (inspection), the sitting (palpation) and the patient is lying (eg stability testing)
• pain causes may lie outside of the shoulder joint (Head 'sche zones). Internal diseases (myocardial infarction, cholecystitis, Pancost tumors, etc.) and changes in the cervical spine should be deferred.

3.1. Inspection

Analysis of gait, the movement of the arms in walking, from early conversations

• is the movement of the shoulder joint for the bundle? Be avoided certain movements?

suspicious movement patterns:

• preventing movements above the horizontal line: frozen shoulder
• Pain-related fix the arm on one side: Bursitis calcarea
• Spontaneous internal rotation in relaxed, free-arm hanging => Note to Rotatorenmannschettenruptur Skin: bruises , swelling, redness, blisters, scars (eg accident zoster, herpes, surgery)
• contours: balanced, or canceled
• shoulder stand: Geradstand or depression
• changes in the clavicles, Sternoclavicular and Acromiaclaviculargelenk (step formation, swelling, high clavicle)
• muscular atrophy in the area of the rotator cuff, possibly with shoulder elevation of
• biceps tendon rupture: distal muscle belly of the biceps, limited Forearm
• protrusion of the shoulder blade has damage to the N. long thoracic

3.2. Palpation

Palpable bony landmarks:

• medial and lateral clavicle acromion
• Proc. coracoid
• tuberculum majus et minus with bicipital groove
• spina scapulae inferior angle of the scapula
• medial scapular border
• stability in the SC joint: review of the mobility of the clavicle
• examination of the AC joint: by adduction of the arm at the elbow flexed
• palpation of the joint space: in elevation and extension
• keys of the long biceps tendon: between tub. minus and majus
• keys of the infraspinatus approach: the tub. majus
• keys of the supraspinatus tendon: the case of extension of the arm below the acromion
• keys of the subscapularis tendon: is in external rotation on tubercle minor

3.3. Examination of the function

function of individual muscles: supraspinatus

• : starts infraspinatus abduction
• M.: external rotation, adduction
• subscapularis: internal rotation and adduction
• deltoid muscle: abduction
• teres minor: external rotation, adduction
• M. biceps: caput longum: abduction, short head: adduction

standard values for the active and passive motion (Neutral-0 method):

• adduction / abduction: 20 - 40 ° - 0 - 180 °
• anteversion / retroversion: 150-170 ° - 0 - 40 °
• horizontal extension / flexion: 135 ° - 0 - 40-50 °
internal / external rotation in adduction
• : 95 ° - 0 - 40-60 °
• internal / external rotation in 90 ° abduction, 70 ° - 0 - 70 °

3.3.1. Examination of the active mobility

Only on the healthy, sick then on the page. In the movements of the shoulder joint to the shoulder blade can be fixed.

• nerve pinch: shows function of the supraspinatus muscle (especially in abduction to 70 ° and the deltoid muscle)
• apron Handle: touching the lower end of the opposite scapula down behind his back as the ability of the internal rotators and adductors (and the m. subscapularis)
• touching the fingertips of the head with extended elbow: Trial of the deltoid muscle)

A disorder of the shoulder movement in all functional areas can have a Omarthritis (shoulder joint arthritis).

loss of active abduction and external rotation: so-called pseudoparalysis, an indication of fresh rupture of the rotator cuff .

3.3.2. Examination of passive Agility

The examiner stands behind the patient, a hand leads the movement of the arm, the other hand controls the movement of the scapula and the humeral head. To relieve the rotator cuff, the movement of the arm can be tested by forward inclination of the upper body and swing.

An orientation, whether the pain emanating from the shoulder, provides no analysis by Cyriax. Both arms are actively moved over the ear line next to the ear. Passively to one side then the arm will be conducted at a fixed thoracic spine and 10 ° behind the ear line. When pain arises beyond Shoulder joint, this is possible without problems (Fig. 1).

3.3.3. Function tests

impingement tests (to impinge: bounce, shock)

Certain movements cause compression of structures or crushing of soft tissues a localized pain.

In abduction between 40 ° and 120 ° occur with extended elbow compression subacromial structures between acromion and humeral head (subacromial arc Painful, painful Arc). Typical of changes in the supraspinatus and the bursa subdeltoid. A Painful arc is in the last 30 ° of abduction indicated irritation at the AC joint.

• impingement test according to Neer: forced flexion and internal rotation, ie => subacromial impingement
• impingement test after Hawkins: the slightly bent elbow is raised by the examiner and by simultaneously lowering his hand a subacromial impingement caused

;

Rotatorenmannschetten tests

• drop-arm sign: The patient's arms holds active in 90 ° abduction against resistance or against gravity (Fig. 2)
• zero-degree abduction test: active abduction at 0 ° abduction against resistance => Check the starter function of the external rotators M.supraspinatus
• test: The examiner stands behind the patient's arms patients hang side in neutral position, the elbow is 90 ° forward flexion. The forearms should move actively against the resistance of the examiner in the vertical (Fig. 3).
• The audit of the infraspinatus and teres minor is done by external rotation against resistance in 90 ° abduction + 90 ° - Elle diffraction (Fig. 3)
• Signe of Naboth: pressure in the arm from acromion Humeruslängsachse => Rotatorenmannschettenaffektion
• Jobe test: Hold the arm to pressure from cranial at 90 ° 30 ° horizontal flexion + abduction + inward rotation (thumbs down) => off of the deltoid muscle: function of the supraspinatus tendon
• A lesion in the subscapularis is seen when an active lift not the hand grip from the apron to posterior against the resistance of the examiner is possible. (Lift-off test according to Gerber). The examiner can fix the shoulder of the opposite side.

AC joint tests

• acromioclavicular Painful arc: complaints only about 120 ', which remain undiminished in the final position at 180 ° (cause of pain in the AC joint)
• horizontal Painful arc (cross-body-action): Pain with passive Horizontalflektion

tests of the long biceps tendon

• Yergason test: supination against resistance
• speed test: pressure upward against resistance with extended, supinated arm in 90 ° Anterversion (Fig. 5)

examination of Klavikulargelenkes

more resistance tests

adduction against resistance => Mm. latissimus dorsi, pectoralis major, teres major and minor

3.4. Neurological examination and testing of muscle strength

muscle tests: Evaluation of the force in comparison:

• level 5 (100%) possible movement against maximum resistance
• level 4 (75%) motion even against strong resistance possible
• Level 3 (50%) movement against gravity possible
• stage 2 (25%) movement with the elimination of gravity possible
• Level 1 (10%) No movement is possible, only muscle contraction
• Level 0 No contraction

investigation of the sensitivity of the test reflexes

:

• Addson maneuver to exclude a plexus irritation (eg, hypertrophy of the anterior M.scalenus)

3.5. Infiltration Test

differentiation of subacromial impingement versus affection of the AC joint: injection of local anesthetics in the subacromial space

• pain in subacromial impingement
• further pain and tenderness over the AC joint with AC Gelenksaffektion
• pain after 2 . injection into the AC joint

Skateboardramp England

of http://www.dr-gumpert.de/html/rotatorenmanschette.html

As rotator cuff defined as a functionally important group of muscles of the shoulder, on the shoulder blade (scapula) has its origins were held as a cuff around the humeral head sets and for the rotation and elevation of the arm is partly responsible.

A distinction in the rotator cuff

• subscapularis
• supraspinatus
• the infraspinatus
• musculus teres minor.

The subscapularis muscle arises from the front of the scapula (subscapular fossa of the scapula) and is on the front of the humeral head (lesser tuberosity) to. He clamped on, the upper arm rotated inward (strongest arm - inner Dreher) and used to the body (adduction).

The supraspinatus originates on the upper portion the rear surface of the scapula (supraspinatus fossa of the scapula) and draws under the acromion through (tuberculum majus) to the lateral humeral head . His role is that of lateral arm lift, especially in the initial phase of the movement in the body adjacent Poor. Less he appears regularly at the external rotation of the arm.

The infraspinatus muscle originates at lower part of the back surface of scapula (infraspinatus fossa of the scapula) and draws also on the greater tuberosity of the humeral head, a little behind the supraspinatus . He is the most powerful external rotator of the arm.

The teres minor has its origin in the margin of the scapula (Margo lateraris the scapula). He also draws on the tuberculum majus. Functionally, it is a weak external rotator of the Upper arm. He also is involved in pulling the upper arm to the body.

diseases

Unlike other large joints of the body is the shoulder joint is mainly carried out by its soft tissues (muscles, ligaments, joint capsule) and stabilized. The contact of the large humeral head (humerus) to the shoulder socket (glenoid) is small. Because of this intense pressure to find disease is more common in the area of the shoulder joint, the rotator cuff.

is often particularly affected the musculus supraspinatus under the roof of the shoulder through the humeral head moves. In the horizontal arm movements, there is a narrow shoulder cap for this muscle, because the humeral head during arm lift rises up under the acromion. Through the system must have acquired or due to wear shoulder roof frames can cause the symptoms of impingement syndrome . What it means is the repeated pinching of the supraspinatus tendon under the acromion, resulting in inflammation of the tendon and found there bursa (subacromial bursitis ) has resulted. If the carrying capacity of the supraspinatus tendon triggered, they can break without adequate injury ( Supraspinatussehnenruptur).

by a chronic injury may also lime deposit in the supraspinatus tendon, but also in other tendons of the rotator cuff. This is called the disease a tendinitis calcarea .

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magnetic therapy

v. Wikipedia:

history

Some proponents estimate that about 2000 years ago in a Chinese medical practitioners use of magnetic stones to aid healing was customary. Hippocrates described the use of magnetic stones. The ancient Romans are believed to have positive effects of magnetic fields and magnetic jewelry worn by the ancient Egyptians to the strengthening of health. In the 18th Century came the so-called animal magnetism of Franz Anton Mesmer in Europe to a brief flowering.

variants

Depending on the manufacturer static or pulsating magnetic fields - 217.249.8.31 18:23, 5 Feb 2007 (CET) is very different frequencies, intensities and programs through tubes, coil mat, small pillow and / or rods generated. produce permanent magnets , the static magnetic fields exist in the form of plasters, insoles, bracelets, etc. In spa is primarily carried out with static magnetic fields. Wellness products have not, however, a medical device the mechanism of action. Some therapists use a magnetic wand to acupuncture without needles or reflexology massage . are

for a universal application (according to textbook electrotherapy) are best appliances with a magnetic flux density in the 30μT and 10000μT and an adjustable frequency range between 0.1 Hz and 15000 Hz. The power setting should mehreren Stufen möglich sein. Wichtig ist ebenso die Verfügbarkeit der Signalform wie Sinus, Multisinus, Sägezahn/Dreieck und Rechteckimpulsform.

Die Geräte sind zwar meist als Medizinprodukte der Klasse II a zulassungspflichtig und unterliegen festgelegten Sicherheitsstandards, dennoch ist ihre physikalische Beschaffenheit nicht genormt. Wegen dieser großen Unterschiede dürfen Aussagen über die Wirksamkeit oder Nichtwirksamkeit einer bestimmten Magnetfeldanwendung nicht ohne Weiteres verallgemeinert oder auf andere Anwendungen übertragen werden. Daher ist die Übereinstimmung der Geräteparameter mit den Studienparametern Voraussetzung. Diese Daten gehen aus der "Klinischen Bewertung" des Magnetfeldtherapiegerätes forth.

application

The application can be made in the practice of a doctor or therapist, a hospital or rehabilitation facility, and in the home. Since often a long-term, or at least daily application is necessary and magnetic therapy is also recommended for health care receive home therapy at an extremely high priority. The generated magnetic field can

not even feel it. Some users, however, report a sensation of warmth or slight tingling through the application. The therapists attribute this to improved blood circulation.

Due to the fact that magnetic fields Penetrate clothing is to complete the application easily. Fractures can be treated through by the cast.

In Austria, the magnetic field therapy since 2003 only permitted a doctor's orders.

contraindications and warnings

The contraindications are in the manual of the magnetic field therapy device refer to. The use in healthy people for prevention or to improve the well-being without medical consultation appears harmless to current knowledge.

people with pacemakers or other electronic implants should generally not be subject to magnetic field therapy, as it could cause dangerous interactions with the control electronics.

use magnetic therapy devices, which field strengths below 35μT for whole-body therapy, can also be used with electronic implants (including pacemakers).

Since interactions with electronic implants can not be completely excluded are those laid down by the implant manufacturers critical limits, is generally referred to an individual assessment. In modern equipment is due to the influence of electromagnetic Fields no acute risk for heart pacemaker. All modern appliances switch in case of interference into a fixed-frequency mode. For patients, the only constant heart rate, independent of physical activity. Outside of the "interference field" around the pacemaker back on itself to normal function.

The self-treatment of a serious health problem with magnetic field therapy without medical assistance may not be carried out. In Austria the 343rd § MFTG regulation.

operation

There are scientific Hypotheses on the effects of magnetic therapy. The main mechanism seems to promote blood circulation and cell metabolism to be. From a scientific point of view, magnetic fields induce change by its action in the body voltages. This could affect the chemical and physical processes in cell membranes . Indeed cell cultures have shown experimentally reactions, and the conduction in isolated nerve was changed in the magnetic field. These effects are dependent on the strength of the magnetic field and frequency and waveform. An effect of static magnetic fields on living tissue has not been demonstrated until now.

results

the purposes of 'Evidence-based medicine' can be used following medical scientific evidence documenting the effectiveness of: - meta-analysis, individual randomized controlled trials; cross-over studies - The contexts are see the "clinical assessment" of each device (if any!). Please note: Wellness products have not a medical device the mechanism of action! see § 102 MPG

The health insurance cover the costs not usually. Even private health insurers often refuse to reimburse.

Physical criticisms

• contradicts the presumed positive effect of the magnetic field treatment of the presumed negative effect of electromagnetic , although both are based on electromagnetic fields. For electro There are more studies are conflicting but often.
• Everyone comes every day with a static / oscillating magnetic fields (speakers, car, rail, natural magnetic fields ...) with different Freuquenzen and field strengths in contact, so a magnetic field should have no measurable effect on the med. For staff who often comes with some very strong magnetic fields in contact such as physicists and physicians, no significant deviation is observed in the course of the disease.
• Static magnetic fields exert forces only on magnets, magnetized body and pallet made (see Lorentz force ) moved. Since the Lorentz force only the direction of the carrier is changed slightly, the effect is partially offset by stochastic movements in the body are averaged and the man is not magnetic (water for example diamagnetic ), no systematic manipulation of the human organism is to be expected. For oscillating magnetic fields can, for example in brain currents, however, be different. Most
• used magnetic fields (especially in permanent magnet) are too weak to change the nature of the cells or even cause the macroscopic structures. In some cases fall below the specified densities, the density of Earth's magnetic field (20-30 micro-Tesla).
• The blood is indeed part of iron, however, the iron loses its magnetic properties when it enters into a bond, thereby increasing blood flow can not be explained by the hemoglobin. must

method

[edit ] The appropriate drugs as a

Ion

:

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iontophoresis

of Wikipedia (Ionized) are present, that is its own electrical charge have. The only way they can be accelerated in an electric field to pass through the skin faster, then get to the blood or tissue in the . Usually the drug is present here in ointment form . Due to the different absorption in patients, the iontophoresis applied not very common, mostly in the dermatology .

The current can reach about 10-30 mA, and as with Stanger slow - highly regulated gradually from 0 to full scale and at the end of treatment turned down slowly. The maximum voltage for the Current flow is necessary, is at about 60 volts . A special form of DC but not used Iontopherese RF .

The drug is placed on moist paper pulp with an electrode. Positively charged drugs ( cations) are placed under the positive electrode, negatively charged drugs ( anions) under the negative electrode.

can be considered as cations: procaine as anions: salicylates.

application [edit ]

Typical applications for remedy for rheumatic diseases in which to enter the drug into a joint .

A common application is found at high welding tendency of the skin ( hyperhidrosis). Here, the affected area is traversed in a water bath of a direct current. The necessary procedures to Leitungswasseriontophorese (LWI) is.

Treatment atrophic scars , the active ingredient tretinoin be introduced by iontophoresis into the skin.

the treatment of cellulite androstanolone-containing gel may include using iontophoresis in the affected subcutaneous tissue be introduced.

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lumbago

Synonyms

pain in the lumbar region

Clinical features (symptoms)

definition
pain in the region of the lumbar spine, the entire region caudal of the dorsal ribs to lower border of the gluteal region on both sides can be included. (Low back pain). If the pain radiate from there in the leg, one speaks of the sciatica.

Clinical features (symptoms)
The clinical picture varies according to stage Pain cause (s) and pain intensity varied widely. With regard to the therapy particularly acute back pain should be distinguished from chronic low back pain. From chronic low back pain is when the pain (recurrent or persistent short-term) last for three months.

The many associated symptoms and findings in addition to the pain and the situations that lead to the pain in the lumbar region and to increase or decrease resulting, then the immediate diagnosis and differential diagnosis (see below) to distinguish

are:
a) specific low back pain: 15%; here are clear causes and correlations with imaging techniques, such as Fractures, tumors, inflammation, disc events, olistheses, spinal stenosis, etc.
b) nonspecific low back pain: about 85%, functional status, and myofascial pain, etc. legamentäre

history

It provides an essential and indispensable part of the diagnostic dar. A systematic approach is recommended. First the question:

• WO the pain is localized and whether a broadcast is in the leg, one or both sides. -> sciatica

• HOW LONG the pain already exist to meet the essential differential diagnosis between acute and chronic back pain can (> 3 months: chronic). have

• HOW started the complaints, so suddenly or slowly increasing, after an accident or a wrong movement, etc.

• BEING worsen the pain or facilitate
eg standing, lying, walking, sitting, and, in Gehleistung terms of spinal stenosis, etc.

- Daily temporal existence, night pain as an indication of inflammation or systemic process, morning stiffness less than half an hour as a reference for disco own pain or spondylarthrosis activated, over an hour as rheumatic Done
- increase in pain when sneezing and crunches when reproducible may be taken as a sign of a disco
own pain - pain of the stress dependence
- response to previous treatments: Success? Side effects?
- General history with evidence of tumor or infection, two so-called specific low back pain forms, cardio - vascular and / or gastrointestinal disorders with regard to the tolerance of physical therapy and NSAIDs
- Social history - occupational history
- mental history and in particular with regard to depression and anxiety.

diagnosis

comprises addition to the history of the diagnosis

clinical examination, after the hearing (history), and seeing the keys, and various tests.
observation of the attitude - asymmetry? Increased or decreased kyphosis?, Lumbar lordosis?, Pelvic tilt?, Scoliosis?
observation of the Ganges - limp?
examination of mobility - regional and segmental, in the sagittal plane - flexion and extension and in the frontal plane, the side slope region on both sides (each side comparison!)

Tests
- straight leg raising test (leg lift test) if positive, then the shortening of the posterior leg muscles (Pseudolasegue) or the nervous strain pain is to differentiate (true Lasegue);
- modified Schober'Test: provides information on the mobility of the lumbar spine in the sagittal plane
- Test the trunk muscles: abdominals and back extensors
- Segmental function tests for disorders: Hypo Mobility - Hypermobility - instability of the lumbar segments and / or the sacroiliac joints
(manual medicine see) - mobility tests of the hip joints with regard to the rotation, Flexion, Extension, Ab- und Adduktion
– Prüfung auf Schwächen und Hypertonus der hüftgelenksbewegenden Muskulatur, einschließlich Musculus Piriformis Tests (Priformissyndrom)

Weitere Muskeltests bei Lumboischialgie, insbesondere bei der radikuläre Läsion siehe Lumboischialgie

Untersuchung der kinetischen Kette (Muskelfunktion und Muskelmuster von craniocaudalen Muskelketten)

Bildgebende Verfahren
– Röntgen sofern kein Hinweis auf spezifischen Kreuzschmerz, erst bei Therapieresistenz innerhalb drei Wochen und zwar
Röntgen der LWS im Stehen, ap und seitlich und Beckenübersicht ap
– CT and MRI and Knochenszintigrafie on specific issues, in particular the specific back pain (tumor, fracture, inflammation, scarring, status post disc surgery) in spondylolisthesis functional images, sacroiliac joint inspection images or CT in suspected Sacroileitis - ankylosing spondylitis

Laboratory:
- especially with questions regarding specific low back pain such as inflammation, infection, tumor, rheumatic events, etc. hyperuricemia

differential diagnosis

The differential diagnosis is not only targeting the big Number of different causes of back pain and their combinations, but also diseases of other organ systems, which go hand in hand with low back pain, such as the rare back pain on the basis of an aortic aneurysm or the rare purely psychogenic back pain.

therapy

specific low back pain (only about 15%), injury - fracture, tumor, inflammation, in addition to the symptomatic and specific therapy

The treatment of nonspecific low back pain whose symptoms at 45 % of patients within one week and 85 - 90% within 6 improve to 12 weeks, findings and stage dependent.

Acute low back pain: are secured

Evidence based medicine
- resume normal activities as possible, so no lasting bed rest
- analgesics according to WHO - Scheme ( analgesics, NSAIDs , rarely weak or strong opioids) and muscle relaxants administer
- No therapeutic exercise, including stretching and aerobics
- limited effect according to EBM have targeted infiltration, Back School, Transcutaneous electrical nerve stimulation (TENS ) Traction, manual therapy, physical therapy, such as cold or heat

Chronic low back pain:

- When the pure analgesic medication lose importance, however, gain pain-medications such as antidepressants .
- The treatment plan includes acupuncture, manual therapy, infiltration, behavior therapy, occasional panty supply for pressure situations and occupational therapy.
- EBM status physiotherapy as part of multidisciplinary treatment programs, manual therapy, psychosocial treatment approaches with behavioral therapy, Cooping strategies, biofeedback, etc.
- The physiotherapy is mainly aimed at the diagnosis-oriented individual deficits of the patient: endurance, fitness, flexibility and coordination.
- The successful treatment of chronic low back pain requires intensive and prolonged interdisciplinary care led by a physician, including compliance http://www.schmerznetz.at/view.php?name=IndikationenLumbalgie promotions

of

When Schober test a point 10 cm cranial marked by S1, then measuring the length differences are at max. Flexion and extension. Normal values betragen hierbei ca. 7/10/14-17.

  Bild: http://www.gvle.de/kompendium/allgemein/03/03.html

The modified Schober method : a technique for assessing spinal motion. Although the technique is reliable (Moll & Wright, 1971), its primary usefulness may be in screening for the very limited mobility that patients exhibit who have diseases like ankylosing spondylitis.

Use a pen to mark the midpoint between the posterior superior iliac spines (PSIS). Then use your tape measure to identify and mark two points: (1) one that is 10 cm superior to the PSIS, and (2) one that is 5 cm inferior to the PSIS.

As your partner flexes the spine as far as possible, measure and record the distance between the superior and inferior marks.

Similarly, measure and record the distance between the superior and inferior marks as your partner extends the spine as far as possible.

Bei Lumboischialgie an M. piriformis denken! http://www.forumgesundheit.at/esvapps/Document/PrintView.jsp?p_pageid=226&p_menuid=63348&pub_id=120871&p_id=4

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dystrophy

Sudeck-Syndrom
Synonym: reflex sympathetic dystrophy

definition
dystrophy of all tissues of a limb segment during vegetative derailment due to various exogenous (usually traumatic), endogenous, peripheral or central causes of constitutional readiness.

first Stadium
symptoms
- redness and swelling of soft tissue
- Major Pain sensitivity
- hair and nails grow faster

diagnosis
X-ray: patchy bone atrophy as an expression of reactive reconstruction after weeks

differential diagnosis
all early stages of chronic bone and joint inflammation

second Stadium
symptoms
- cyanosis, glossy skin, reducing the temperature
- movement pain
- Trophic disorders of skin appendages, skin and muscles
- Spongiosaatrophie, secondary joint changes due to proliferation of connective tissue

diagnosis
X
Diffuse bone atrophy, especially near the joints, transverse whitening strips in the area of the former epiphyses

differential diagnosis
Chronic bone and arthritis

3. (Final) stage: defect healing
symptoms
- Verschmächtigung of the limbs (atrophy, muscle loss)
- Major movement disability of the joints
- touch, stress and temperature sensitivity

General and medical therapy
first Stadium
- General therapy
• Absolute immobilization of the whole limb in a relaxed physiological Joint position
- Drug therapy and oral anti-inflammatory drugs •
local analgesics

• • • sympatholytic
sedatives
second Stadium
- General therapy
• Temporary immobilization only in pain and increasing swelling
- Drug therapy
• Anti-inflammatory
• to improve the circulation Central
• sedatives
• Experiment with calcitonin
third Stadium
- Drug therapy
• sedatives, experiment with calcitonin

Physical Therapy

M = masseur MB = Med Bathhouse KG = physiotherapy ÆP = Medical Practice

( http://www.akh-consilium.at/daten/gelenkverletzungen.htm )

http:// science.orf.at/science/news/113918

dystrophy: pain after fracture
		a hand injury or a trivial forearm fracture in the area can, although injury and fracture healing well to chronic pain to the Paralysis of the whole arm out. For over 100 years, researchers around the world searched unsuccessfully for the causes of this insidious disease - the dystrophy, for which there was previously no cure. Vienna Scientists have solved the mystery of the disease Sudecksche now: the cell metabolism in the connective tissue is disrupted, according to them through the injuries and released oxygen radicals play a key role.

		open This finding now real opportunities to get the disease under control.

	Small cause, big effect
		Not infrequently is a minor injury triggered dystrophy, frequent bone fractures as well as operations in the arm and leg joints. Was already described these complications from the Hamburg doctor Paul Sudeck in 1900. Sudeck called the disease a "derailed healing inflammation" and described the similarity between the symptoms of an inflammatory response and the Sudeck syndrome. From dystrophy is always a joint, usually hand or foot, knee or shoulder less hip and less frequently affected.

	Individual disease The dystrophy is a very individual disease, in each patient again appears to be somewhat different, and expires. The best chance for cure, patients are treated properly in the first few weeks, but the disease usually lasts for months, unfortunately in some cases for years. You may leave permanent damage such as severe pain, stiffness and loss of tissue. Women are affected slightly more often than men, and children can suffer from this disease.
	more about the disease (morbus-sudeck.ch)

	part contradictory warning signs
		The disease usually begins one to seven weeks after the causative event of severe pain in the affected limb. The body part is often swollen and red and looks like an infection. Still no inflammation in the blood can be detected, the patients have no fever. The joint starts to stiffen painfully. The limited mobility and pain are not the only signs of Sudeck's disease. In some patients, the affected limbs are numb, this is a noticeable temperature change: The affected hand may feel colder or warmer than the healthy. This large number of, often contradictory, symptoms does not make it easy to identify the disease. Especially because all the symptoms occur only rarely in the same intensity and there may be quite different combinations.

	New Diagnostic model
		In is the first phase of the disease the best chance of recovery. Provided the disease is detected. In this case, many doctors find it difficult because they are rarely confronted with it. The researchers at the Ludwig Boltzmann Institute for Clinical and Experimental Traumatology " have therefore developed for their colleagues in practice, a diagnostic model, which lists all possible side effects of the dystrophy. With simple device, the mobility of the joints, thickening, swelling, measured and evaluated on a point system. With the score increases the probability of Sudeckschen disease. For the physician, this means that a specialist must be turned on.

	Difficult treatment
		The treatment was previously limited to pain relief, to stop the inflammation and stop the paralysis with physiotherapy. Experiment was also conducted with acupuncture and other alternative healing methods - is the resounding success of this has failed. There are also no panacea, because the disease in nearly every case with a different, individual symptoms occur.

	Mysterious causes
		Because no other explanation was, have not doctors the cause of the disease rarely located in the psychological field. From patient reports is herauszulesen: They were taken in their suffering is not always serious and were often confronted with the fact that the doctor spoke of imaginary pain. In fact, the cause is not really clarified. The injury is the trigger, what happens then lay in the dark. The researchers at the Ludwig Boltzmann Institute for Clinical and Experimental Traumatology "have now taken a promising track. With elaborate analysis and in animal models could be demonstrated that the play dystrophy released oxygen radicals play a key role.

	Dangerous radicals comes When metabolic processes, it the formation of molecular fragments, the "free radicals". While the formation of these molecules or atoms for certain reactions absolutely necessary, the release of these radicals in the cell or body fluid can be dangerous. They react and combine with everything they encounter, for example, tissue and muscle cells, the genetic material, with the blood cells including problem for the body is not only the immediate high reactivity of free radicals, but the fact that they can trigger chain reactions: this takes a radical to another molecule, destroying it and thereby releases more free radicals. Under unfavorable circumstances, such a single free radical destroying thousands of molecules. Since the body constantly radicals are released, will be continuously significant damage caused by these molecules.
	Free radicals cause cell damage but not? (26/02/2004)

	radical scavenger against dystrophy
		The detection of increased, oxygen free radicals in a Sudeckschen disease seems almost solved the puzzle. By the previous violation, it could lead to membrane damage of cells in the affected area have come. Radicals are released, a fatal chain reaction takes its beginning. now is for the scientists is to develop suitable radical scavengers, which can be used in dystrophy. Until then, the earlier the diagnosis, the greater the chances of recovery. Gerhard Roth, Modern Times Health