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Diagnostik
Diagnosis
Clinical Examination
The thorough taking of the anamnesis (medical history) and the physical examination are the foundation not only for a trusting relationship between patient and doctor, but also for the specific diagnosis and implementation of other necessary diagnostic measures.
A useful addition is the collection of so-called scores. These are validated questions and test results which, according to an algorithm, provide point values that try to objectify the subjective complaints and limitations of the patient and make them comparable. This enables not only an objective follow-up for the patient, but also a comparison with other patients in scientific studies. Such patient-related outcome scores (PROMS) are a valuable tool for improving the treatment of diseases. Typical examples are the Constant Murley Score, Disability of the Shoulder and Arm Score (DASH) and the American Shoulder and Elbow Society Score (ASES).
Supination elbow extension test SEET, positive for hyperlaxis
There are a number of special examination techniques and tests that focus on certain anatomical structures of the body and, in combination, provide valuable information on the presence of diseases and syndromes (combination of disease symptoms). These test procedures are usually carried out in combination with one another (test battery).
Untersuchung
Ultrasound
The Sonography (ultrasound examination) is an ideal aid in the hands of the experienced examiner. It allows the high-resolution representation of the superficial structures, e.g. the rotator cuff. The dynamic examination (the object, in this case the upper arm, is moved) gives the unique opportunity to observe the behavior of the structures under load in real time. A major advantage compared to the MRI, which is always relatively static and relatively poor in terms of spatial resolution.
The procedure is quick and inexpensive without any risk for health, and it is no longer possible to imagine everyday clinical practice without it.
Serious disadvantage: the sound has a limited penetration depth, bony structures block it from penetrating. The interior of the joint can practically not be fully visualized.
Ultraschall
Radiography
The radiographic examination is part of the orthopedic's standard in imaging and has developed enormously since it was invented in Würzburg over 100 years ago. Modern digital radiography systems have an extremely low radiation exposure when scanning the bone and can be stored digitally in high resolution.
The domain of the method lies in the summation recording of bones and joints and their pathological changes.
Suspected diagnoses are sensibly supplemented by additional examinations, but not replaced.
Important classifications and standard biometric measures are based on the analysis of radiographs.
Röntgen
MRI
The imaging examination of the human body using an external magnetic field goes back to research by Swiss and Americans in the 1940s and 1950s. It then took a long time to develop powerful MR tomographs and computer workstations with the appropriate software.
The images are created by the harmless stimulation of the tissue by magnetic fields, which are switched on and off at lightning speed, and the measurement of the reaction of the fluid-containing tissue. Countless pieces of information are then put together to form an image and output.
The 1.5-Tesla and 3-Tesla devices commonly used today require around 20-30 minutes for a shoulder examination for the various protocols (sequences with different settings and resulting displays). For technical reasons, it is quite loud, which is tolerable with sound-absorbing headphones.
Intra-articular administration of a contrast agent (arthro-MRT) is rarely necessary, e.g. for the differential diagnosis of an injury to the upper biceps-labrum complex (SLAP lesion).
The spatial resolution in the MRI is relatively low, the patient must not move during the examination.
MRT
CT
A computed tomogram (CT) is created by taking layers of radiographs, whereby the image is calculated by algorithms on the computer and then displayed. This happens very quickly; a full-body scan, as in the ER for accident victims, can be carried out with modern devices within a few minutes . The basics go back to Sir GN Hounsfield and Prof. W Kalender from Erlangen.
The amount of radiation has decreased over time and with the development of modern devices, but it cannot be neglected.
Regarding the shoulder, CT is particularly important for complex fractures (3D reconstruction) and for planning arthroplasty treatment of severe deformities and glenoid bone defects.
The image resolution is very good, but the soft tissue display works better in the MRI.
CT
Laboratory
In the case of certain diseases, the examination of blood findings is an essential part of the basic diagnosis, e.g. gout, rheumatism, inflammation.
Before planned operations, it is part of the standard that the basic parameters are collected and evaluated (blood count, electrolytes, liver and kidney values, clotting).
Even after the operation, it is checked at time intervals whether the body has adequately recovered from the stress of the operation.
The analysis takes place promptly in large laboratories, which make the results available very quickly and with high precision.
For extended diagnostics, e.g. of tissue samples and punctures, special tests can be carried out in other laboratories (e.g. microbiological cultivation of pathogens and resistance tests, fluid analysis including light microscopy, antibody tests, etc.).
Labor
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