[Teleradiological report turnaround times: An internal efficiency and quality control analysis]. / Teleradiologische Prozess- und Untersuchungszeiten: Eine institutsinterne Effizienz- und Qualitätsanalyse.

AIMS: The teleradiological examinations performed at the Charité were analyzed for the purpose of internal quality and efficiency control. Data included the type and number of examinations performed, the time of day and week the examination was performed and the differences in teleradiologist report turnaround times. MATERIAL AND METHODS: A retrospective analysis of the radiology information system (RIS) database of all teleradiological computed tomography examinations performed at the Charité from 2011 through 2013 was carried out. The search retrieved 10,200 teleradiological examinations which were included in the analysis. The records were analyzed for the time of the day and week the examination was performed, the interval between examination and time of reporting, the type of teleradiological examination and the campus in which they were performed. RESULTS: The number of teleradiological examinations performed increased continuously during the observation period. Computed tomography of the head was the most frequently performed type of examination with 86%. Taking all forms of examination into consideration it took an average of 34 min until a report was written. Over the 3-year observation period the times remained virtually unaltered. CONCLUSION: During the 3-year observation period nearly constant report times could be observed in spite of the increased numbers of examinations. This indicates an efficiency enhancement and rational integration of teleradiology into the radiological workflow.

[Acute and overuse injuries of the shoulder in sports]. / Akutverletzungen und Überlastungsschäden der Schulter im Sport.

BACKGROUND: During sports the shoulder complex is exposed to considerable load especially where throwing is important and various pathological changes can occur. In the last two decades the shoulder in athletes has become a special term in clinical sports medicine METHODS: Selective literature review in PubMed and consideration of personal experience, research results as well as national and international recommendations RESULTS: In general acute lesions of the shoulder caused by sudden sport injuries, such as traumatic luxation, acromioclavicular (AC) joint disruption, traumatic tendon ruptures, labral lesions, cartilage defects and fractures have to be distinguished from chronic or long-standing pathologies due to recurrent microtrauma, such as overuse bursitis and tendinitis, as well as secondary forms of impingement along with rotator cuff tears and labral lesions. Besides common pathological changes that can be observed in almost all overhead-sports, there are also injuries that are more sport-specific due to the particular load profile in each sport. These injuries are especially common in racquet and throwing sports (e.g. golf, tennis, handball and volleyball) as well as in individual and artistic sports (e.g. swimming, gymnastics, dancing and rowing), contact and extreme sports (e.g. judo, mixed martial arts, bodybuilding, weightlifting, motocross and downhill mountain biking). CONCLUSION: Knowledge about sport-specific load profiles as well as about the variety of treatment options is crucial for successful treatment of these injuries.

[The gymnastics shoulder]. / Die Turnerschulter.

BACKGROUND: Adult gymnasts show a high prevalence of various shoulder pathologies. Due to the specific equipment used in gymnastics and the high training schedule with weekly training times up to 32 h, the shoulders of gymnasts are mostly subjected to symmetrical bilateral weight bearing. This is in contrast to overhead throwing, racket and martial arts sport forms in which the load is mainly located on the dominant side. CAUSES OF INJURY: Structural lesions of the shoulder and shoulder girdle in male gymnasts can arise due to high repetitive support and swing forces during exercises on the six specific types of apparatus and particularly the rings. INJURY PATTERNS: These lesions particularly affect the biceps tendon anchor, the long head of the biceps tendon and the tendon of the supraspinatus muscle. Because possible pathologies can increasingly occur even in younger gymnasts, awareness of the treating physician and also the trainer should be increased. THERAPY: Early initiation of intensive conservative treatment and arthroscopic interventions in cases of failure of non-operative management are relevant for satisfying results. Modern arthroscopic reconstructive techniques are available for treating structural lesions. CONCLUSION: Nevertheless, in almost 30 % of the patients the occurrence of shoulder pain or the necessity for surgical interventions will prevent them from achieving the national or international level of competition. This underlines the necessity for development of prevention programs.

Towards understanding knee joint laxity: errors in non-invasive assessment of joint rotation can be corrected.

The in vivo quantification of rotational laxity of the knee joint is of importance for monitoring changes in joint stability or the outcome of therapies. While invasive assessments have been used to study rotational laxity, non-invasive methods are attractive particularly for assessing young cohorts. This study aimed to determine the conditions under which tibio-femoral rotational laxity can be assessed reliably and accurately in a non-invasive manner. The reliability and error of non-invasive examinations of rotational joint laxity were determined by comparing the artefact associated with surface mounted markers against simultaneous measurements using fluoroscopy in five knees including healthy and ACL deficient joints. The knees were examined at 0°, 30°, 60° and 90° flexion using a device that allows manual axial rotation of the joint. With a mean RMS error of 9.6°, the largest inaccuracy using non-invasive assessment was present at 0° knee flexion, whereas at 90° knee flexion, a smaller RMS error of 5.7° was found. A Bland and Altman assessment indicated that a proportional bias exists between the non-invasive and fluoroscopic approaches, with limits of agreement that exceeded 20°. Correction using average linear regression functions resulted in a reduction of the RMS error to below 1° and limits of agreement to less than ±1° across all knees and flexion angles. Given the excellent reliability and the fact that a correction of the surface mounted marker based rotation values can be achieved, non-invasive evaluation of tibio-femoral rotation could offer opportunities for simplified devices for use in clinical settings in cases where invasive assessments are not justified. Although surface mounted marker based measurements tend to overestimate joint rotation, and therefore joint laxity, our results indicate that it is possible to correct for this error.