Noch 2197 Tage!
Statistische Auswertung
ZURÜCK
Chondromatose (#R: 0; #F: 3)
Enchondrale Knochenneubildung als Metaplasie der Synovialis

- 30.-50. Lebensjahr
- Kniegelenk (ca. 70%)

Konventionelles Röntgen
- Röntgendichte Gelenkkörper meist gleicher Größe
Epicondylitis humeri radialis (#R: 0; #F: 3)
funktionelle Überbeanspruchung der Sehnen von Hand- und Fingerextensoren mit nachfolgender degenerativer Veränderungen der Sehnenursprünge (Insertionstendopathie)

- Tennisellenbogen
- Schmerzen außenseitig am Ellenbogen auf
- durch Supination, Faustschluss und kräftige Dorsalextension verstärkt.
Osteoklastom (#R: 0; #F: 2)
Vom Knochenmark ausgehender Tumor mit Riesenzellen

- Häufigkeitsgipfel im 20.-30. Lebensjahr
- Epiphyse langer Röhrenknochen (meist kniegelenksnah)

Klinik
- Lokale Belastungsschmerzen
- Spontanfrakturen

Histopathologie
- Mehrkernige Riesenzellen
Läuferknie (#R: 2; #F: 1)
Tractus-iliotibialis-Syndrom
- Entzündung der Bursa zwischen Tractus iliotibialis und Ansatz am lateralen Epicondylus der Tibia
Böhler-Zeichen (#R: 1; #F: 1)
Meniskus-Zeichen

- Liegender Patient, leicht gebeugtes Kniegelenk
- Adduktion und anschließende Abduktion des Unterschenkels
- Schmerzen bei Adduktion (Varusstress) → Hinweis auf mediale Meniskusläsion
- Schmerzen bei Abduktion (Valgusstress) → Hinweis auf laterale Meniskusläsion
Pes equinovarus adductus supinatus et excavatus (#R: 2; #F: 1)
Klumpfuß

- Equinus (Spitzfuß) = Fixierung in Plantarflexion durch Achillessehnenverkürzung
- Varus = Supinationsstellung des Kalkaneus
- Adductus (Sichelfuß) = Abweichen der Zehen nach medial (Vorfußadduktion)
- Supinatus: Supination/Inversion
- Excavatus (Hohlfuß) = Verstärkte Wölbung des Fußes

Beim Klumpfuß stehen Kalkaneus und Talus parallel
Hallux rigidus (#R: 1; #F: 1)
Arthrose des Grundzehgelenks
Pronation/Supination des Unterarms (#R: 2; #F: 1)
90/0/90
Untersuchungen des Meniskus (#R: 1; #F: 1)
- Steinmann-I-Zeichen
- Steinmann-II-Zeichen
- Böhler-Zeichen
- Payr-Zeichen
- Apley-Grinding-Zeichen
Untersuchungen des Hüftgelenks (#R: 1; #F: 1)
- Vierer-Zeichen
- Thomas-Handgriff
- Drehmann-Zeichen
- Trendelenburg-Zeichen
- Duchenne-Zeichen
- Hinge abduction
Hinweise auf Hyperlordose (#R: 1; #F: 1)
Baastrup-Phänomen
- Kontakt benachbarter Dornfortsätze der LWS
Arthrosezeichen (#R: 2; #F: 1)
- Verschmälerung des Gelenkspalts
- Subchondrale Sklerose
- Osteophyten
- Geröllzysten Subchondrale
- Keine Osteoporose!
angeborene Unterschenkelpseudarthrose (#R: 1; #F: 1)
- einseitige Verbiegung von Tibia und Fibula nach außen

Dabei ist eine Unterschenkelpseudarthrose (Falschgelenkbildung von Tibia und Fibula) bei Geburt vorhanden oder entsteht abhängig vom Grad der Verkrümmung im Verlauf.

Es besteht eine Assoziation zur Neurofibromatose I.
Osteochondrom (#R: 2; #F: 1)
Von Knorpelkappe bedeckter Tumor im Metaphysenbereich

- Häufigster primär benigner Tumor
- Häufigkeitsgipfel: 1.-2. Lebensdekade
- Lokalisation: Metaphyse langer Röhrenknochen
- Klinik: Meist keine Symptome
Osteom (#R: 2; #F: 1)
- Gutartiger rundlicher Knochentumor

- Jedes Lebensalter
- Schädel (Nasennebenhöhlen) + Lange Röhrenknochen

Klinik
- Keine Symptome

Therapie
- Keine
Nicht-ossifizierendes Knochenfibrom (#R: 1; #F: 1)
Tumorähnliche häufige Raumforderung

- Vorkommen im Rahmen von Wachstumsstörungen
- fast immer im 2. Lebensjahrzehnt
- Metaphysär, sehr häufig distaler Femur und distale Tibia

Klinik
- Keine Symptomatik

Konventionelles Röntgen
- Randständige Sklerose, lobulierte Binnenstruktur mit Aufhellung (Traubenkonfiguration)
Osteosarkom (#R: 2; #F: 1)
Bösartiger Tumor, der von polymorphen, knochenbildenden Zellen ausgeht

- 16.-25. Lebensjahr
- Häufigster primär maligner Knochentumor
- Assoziation mit Retinoblastom
- 60% kniegelenksnahe Metaphysen
- Metastasierung: Hämatogen! Erst Lunge, dann Skelett

- neoadjuvante Chemotherapie + radikale Resektion

- Der Tumor ist strahlenresistent!
- 5 Jahresüberlebensrate ca. 50-70%
Morbus Sinding-Larsen-Johansson (#R: 1; #F: 1)
aseptische Knochennekrose im Bereich des distalen Patellapols
Steppergang (#R: 1; #F: 1)
Ausfall des N. fibularis profundus
Scherengang (#R: 2; #F: 1)
spastische Tonuserhöhung der Adduktorenmuskulatur des Hüftgelenks bei Para- bzw. Tetraparese

Überkreuzen der Beine während des Gehens
Coxa antetorta (#R: 2; #F: 1)
Antetorsionswinkel >20°

- Innenrotiertes Gangbild, bei dem die Fußspitzen nach innen zeigen
- Bei etwa 15% Kinder physiologisch im Wachstumsalter
- Bildet sich meist spontan zurück
C7-Syndrom (#R: 1; #F: 1)
Parese
- M. triceps brachii
- M. pronator teres
- Thenarmuskulatur

Dermatom
- Palmare Finger II - IV (halber Finger II, III ganz und halb von IV)
- Dorsaler, mittlerer Unterarm bis halber Finger II, III und halb von IV

Reflexminderung
- Trizepssehnenreflex (TSR)
L5-Syndrom (#R: 2; #F: 1)
Parese
- Fußhebung (M. extensor hallucis longus und M. extensor digitorum brevis)
- Hackengang geschwächt
- Großzehenheberschwäche

Dermatom
- Dorsolateraler Oberschenkel, Außenseite des Knies, ventraler Unterschenkel
- Fußrücken, Großzehe

Reflexminderung
- Tibialis-Posterior-Reflex (TPR)
Bragard-Zeichen (#R: 1; #F: 1)
Bein wird im Kniegelenk gestreckt angehoben

Bei Dorsalextension des Fußes geäußerte Schmerzen sprechen ähnlich wie bei Lasègue-Zeichen für Nervendehnungsschmerz
Gowers-Zeichen (#R: 2; #F: 0)
Das Gowers-Zeichen bezeichnet ein Phänomen bei der progressiven Muskeldystrophie Typ Duchenne: Um sich aufzurichten, stützt sich der Patient auf seinen Oberschenkeln ab. Er klettert gewissermaßen an sich hoch.
Morbus Dupuytren (#R: 2; #F: 0)
Idiopathische Proliferation der Palmaraponeurose mit zunehmender Beugekontraktur insbesondere des kleinen Fingers
Induratio penis plastica (#R: 2; #F: 0)
- Vernarbung der Tunica albuginea mit Ausbildung von fibrotischen Plaques
- Schmerzhafte Penisverkrümmung (meist nach dorsal) bei Erektion
- Gefahr der progredienten erektilen Dysfunktion
- Nur bei ca. 15% spontane Rückbildung, keine etablierte kausale Therapie vorhanden
- Assoziation mit Fingerknöchelpolster („knuckle pads“) der PIPs
Tendovaginosis stenosans (#R: 2; #F: 0)
Knotige Verdickung einer Beugesehne (oder Einengung des Ringbandes) mit intermittierender Einklemmung

- Schnellender Finger
- Extension zunehmend schmerzhaft
Patellaspitzensyndrom (#R: 2; #F: 0)
- Schmerzen am proximalen Ende der Patellasehne am distalen Pol der Patella
- Häufigste Insertionstendinopathie des Jugendlichen
- ca. 30% beidseitig
- Schmerzen beim Treppensteigen und Bergabgehen sowie bei langer Kniebeugung im Sitzen
Osteogenesis imperfecta (#R: 2; #F: 0)
Es handelt sich am ehesten um die autosomal-rezessiv vererbte Osteogenesis imperfecta (Glasknochenkrankheit) vom Typ II (Vrolik). Durch die Kollagen-Typ-I-Synthesestörung kommt es zu einer vermehrten Knochenbrüchigkeit und -deformität mit konsekutivem Minderwuchs. Außerdem führt die unterentwickelte Lunge häufig zu einer erhöhten Letalität innerhalb des 1. Lebensjahres.
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Morbus Köhler II (#R: 3; #F: 0)
Der M. Köhler II bezeichnet eine aseptische Knochennekrose eines Mittelfußköpfchens und tritt hauptsächlich bei 10-18-jährigen Mädchen auf.
Mennell-Zeichen (#R: 2; #F: 0)
Das Mennell-Zeichen ist ein Druck- oder Kompressionsschmerz der Iliosakralgelenke und kann auf verschiedene Arten überprüft werden. Eine Möglichkeit ist, dass der Untersucher mit beiden Händen Druck auf beide Darmbeinschaufeln des auf dem Rücken liegenden Patienten ausübt. Treten hierbei Schmerzen im Iliosakralgelenk auf, ist dies ein Hinweis auf eine entzündliche und/oder degenerative Veränderung im Gelenk (Mennell-Zeichen positiv).
Cobb-Winkel (#R: 2; #F: 0)
Messung der seitlichen Krümmung der Wirbelsäule bei Skoliose in der a.p.-Aufnahme

Tangentiales Lot entlang der Deckplatten der Neutralwirbel → Schnittpunkt in Richtung der Konkavität der Krümmung
Bending-Aufnahme (#R: 2; #F: 0)
Aufnahmen der Wirbelsäule zur Beurteilung der Flexibilität der Krümmungen.

- unter maximal möglicher Seitwärtsneigung abgebildet
Morbus Calvé (#R: 2; #F: 0)
Aseptische Knochennekrose
- Wirbelkörper, meist Brustwirbelsäule
- Kindesalter
Morbus Scheuermann (#R: 2; #F: 0)
Aseptische Knochennekrose

- Deck-/Grundplatte der Wirbelkörper
- 11-13 Jahre
- Verstärkte Kyphosierung in der Brustwirbelsäule
- Hyperlordosierung in der Lendenwirbelsäule
- Radiologisch Schmorl-Knötchen
Morbus Perthes-Legg-Calvé (#R: 2; #F: 0)
Aseptische Knochennekrose

- Femurkopf
- 4-8 Jahre
Morbus Sever-Haglund (#R: 2; #F: 0)
Aseptische Knochennekrose

- Apophysis calcanei / Fersenbeinapophyse
- 5-12 Jahre
Morbus Köhler I (#R: 2; #F: 0)
Aseptische Knochennekrose

- Os naviculare pedis
- 2-12 Jahre
ARCO-Stadien (#R: 2; #F: 0)
Stadien der aseptischen Hüftkopfnekrose im Erwachsenenalter

Stadium 0 (Initialstadium)
→ Bildgebung unauffällig, histologisch nachweisbare Veränderungen

Stadium I (Reversibles Frühstadium)
→ Auffälliger MRT-Befund, Röntgen blande

Stadium II (Irreversibles Frühstadium) → Röntgen und MRT positiv, Kontur erhalten

Stadium III (Übergangsstadium)
→ Radiologisch subchondrale Fraktur

Stadium IV (Spätstadium)
→ Verkalkungen, Resorptionszysten und Knorpelneubildungen im Röntgenbild
Collum-Centrum-Diaphysen-Winkel (#R: 2; #F: 0)
Winkel, der von der Hauptachse des Oberschenkelhalses und der Längsachse des Oberschenkelschaftes gebildet wird

- Physiologisch ca. 126°
Antetorsionswinkel (#R: 2; #F: 0)
Winkel, der von der Hauptachse des Oberschenkelhalses und der Querachse der beiden Oberschenkelkondylen des distalen Oberschenkels gebildet wird

- Physiologisch ca 12°
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Coxa vara (#R: 2; #F: 0)
CCD-Winkel
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Coxa valga (#R: 2; #F: 0)
CCD-Winkel >140°

- Physiologisch bei Neugeborenen/Kleinkindern
- Durch zu geringe axiale Belastung
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Coxa retrotorta (#R: 2; #F: 0)
Antetorsionswinkel
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Sekundäre Koxarthrose - Ursachen (#R: 2; #F: 0)
- Morbus Perthes
- Epiphyseolysis capitis femoris
- Hüftgelenksdysplasie → kongenitale Hüftluxation
- Gicht
- Hämochromatose
- Versteifung des ipsilateralen Kniegelenkes
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Sekundäre Gonarthrose - Ursachen (#R: 2; #F: 0)
- Genu valga
- Genu vara
- Kreuzbandruptur
- Meniskusläsionen
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Meniskus-Zeichen

- Patient liegt auf dem Rücken
- Fixierung des gebeugten Kniegelenks mit einer Hand
- Rotation des Kniegelenks mit der anderen Hand (durch Umfassen des Knöchels)
- Schmerzen bei Außenrotation → Schädigung des medialen Meniskus
- Schmerzen bei Innenrotation → Schädigung des lateralen Meniskus
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Meniskus-Zeichen

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Payr-Zeichen (#R: 2; #F: 0)
Meniskus-Zeichen

- Im Schneidersitz sitzender Patient
- Druck von oben auf gebeugte Kniegelenke
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Apley-Grinding-Zeichen (#R: 2; #F: 0)
Meniskus-Zeichen

- Entspricht Steinmann I-Test in Bauchlage
- Bauchlage mit 90° Beugung des Kniegelenks
- Fixierung des Oberschenkels
- Rotation des Kniegelenks unter Druck und Zug
- Schmerzen bei Außenrotation → Hinweis auf Schädigung des medialen Meniskus
- Schmerzen bei Innenrotation → Hinweis auf Schädigung des lateralen Meniskus
Flake-Fracture (#R: 2; #F: 0)
Knorpelschädigung bzw. osteochondrale Abscherfraktur bei Patellaluxation
Unhappy Triad (#R: 2; #F: 0)
Ruptur von
- vorderem Kreuzband
- medialem Seitenband
- medialem Meniskus
Schubladen-Test (#R: 3; #F: 0)
Vorderes Kreuzband - Test

Test der anterolateralen Rotationsstabilität
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Test der anteromedialen Rotationsstabilität
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Prognostisch ungünstiges Zeichen des Morbus Perthes
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Flaschenzeichen
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Gaenslen-Zeichen
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Hinweis auf Tendovaginitis stenosans de Quervain (#R: 2; #F: 0)
Finkelstein-Zeichen

Entzündung der Sehnenscheiden des M. extensor pollicis brevis und M. abductor pollicis longus
Heberden-Arthrose (#R: 4; #F: 0)
Idiopathische Arthrose mit genetischer Komponente, die vor allem die distalen Interphalangealgelenke (DIP) betrifft
Bouchard-Arthrose (#R: 2; #F: 0)
Idiopathische Arthrose mit genetischer Komponente, die vor allem die proximalen Interphalangealgelenke (PIP) betrifft
Hallux rigidus (#R: 2; #F: 0)
Arthrose des Großzehengrundgelenks
Rachitis (#R: 2; #F: 0)
Skelettschmerzen
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Auftreibung der Knorpel-Knochen-Grenzen
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Kraniotabes
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Crus varum congenitum (#R: 2; #F: 0)
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-1 bis -2,5 Standardabweichung
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≤-2,5 Standardabweichung
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Osteopetrose (#R: 2; #F: 0)
Systemerkrankung, die zu einer generalisierten Sklerosierung des Skeletts führt
Morbus Jaffé-Lichtenstein (#R: 2; #F: 0)
Fibröse Dysplasie
Nicht vererbbarer Gendefekt mit Störung der Knochenneubildung
McCune-Albright-Syndrom (#R: 2; #F: 0)
Sonderform der Fibröse Dysplasie

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Labor
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Enchondrom (#R: 2; #F: 0)
Aus hyalinem Knorpel bestehender Tumor

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Klinik
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Osteoidosteom (#R: 2; #F: 0)
Vorwiegend kortikaler kleiner Tumor (etwa 1 cm) mit radiologisch zentraler Aufhellungszone (Nidus)

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Klinik
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Osteoblastom (#R: 2; #F: 0)
Vorwiegend kortikaler kleiner Tumor (> 1 cm) mit radiologisch zentraler Aufhellungszone (Nidus)

- 10.-20. Lebensjahr
- Wirbelsäule (hauptsächlich Wirbelbögen)

Klinik:
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Juvenile Knochenzyste (#R: 2; #F: 0)
Solitäre, meist einkammerige Knochenzyste

- 8.-15. Lebensjahr
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Chondroblastom (#R: 2; #F: 0)
Gutartiger Knorpeltumor, der sich üblicherweise in der Epiphyse befindet

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Ossifizierendes Knochenfibrom (#R: 2; #F: 0)
Fibröser Knochentumor

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Intraossäres Hämangiom (#R: 2; #F: 0)
Aus neu formierten Gefäßen bestehender Tumor

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Codman-Dreieck (#R: 2; #F: 0)
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Hochmaligner Knochentumor, der von undifferenzierten Mesenchymzellen des Knochenmarks ausgeht

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Knorpel-, aber nicht knochenbildender Tumor

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Konventionelles Röntgen/CT:
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MRT
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Karpaltunnelsyndrom (#R: 2; #F: 0)
chronische Kompression des Nervus medianus unter dem Retinaculum musculorum flexorum im Karpaltunnel

- Frühsymptom: Nächtliche Schmerzen und Parästhesien vor allem der volaren Hand und den Fingern I-III

- Spätsymptom: Thenarmuskelatrophie (Daumenballenatrophie)

Diagnostik
- Elektroneurographie
- Hoffmann-Tinel-Zeichen
- Phalen-Zeichen
- Flaschenzeichen
Signe de Lhermitte (#R: 2; #F: 0)
Das Lhermitte-Zeichen ist ein Hinweis auf eine Multiple Sklerose: Beim Vornüberbeugen des Kopfes kommt es zu elektrisierenden Missempfindungen entlang der Wirbelsäule.
Signe des cils (#R: 2; #F: 0)
Das Signe des cils (Wimpernzeichen) bezeichnet ein Phänomen bei Fazialisparese: Beim Augenzukneifen bleiben die Wimpern auf der betroffenen Seite mehr als üblich sichtbar.
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