Author/Editor		Vrabl, Miran
Title		Izvedensvto poškodb rotatorne manšete rame
Translated title		Expert appraisal in injuries of the shoulder rotator cuff
Type		članek
Source		Zdrav Vestn
Vol. and No.		Letnik 76, št. 5
Publication year		2007
Volume		str. 309-15
Language		slo
Abstract		Background Most of detected changes in the shoulder rotator cuff are the consequence of chronic changes. Fresh injuries of individual parts of the rotator cuff have to be proved without a doubt as soon as possible after the injury. The basic question with regard to any expert appraisal of changes in the shoulder rotator cuff is undoubtedly the determination of post-injury changes as well as the distinction between degenerative changes, charges discovered by chance and fresh inuries of the rotator cuff. A detailed analysis of the clinical picture, the biomechanics of the event and early application of specific imaging diagnostic methods enable certain determination of causal connections between the actual event and the established changes in rotator cuff. Conclusions A systematic approach to analysis of all data about the condition of the shoulder prior to the injury, certain establishment of connection between the injury event, the first medical surgical, histological and ultrasound results, CT and magnetic resonance, along with the analyses of accompanying changes, enable an expert to give a decisive medical expert appraisal. The latest findings about the biomechanics of rotator cuff injuries which contain an analysis of load on individual parts of the rotator cuff in certain arm positions as well as the knowledge about the progress and causes of the circulation changes in parts of rotator cuff and the role of microtrauma provide for the distinction between the manifestation of silent changes which have been undergoing for a longer time and undoubtedly established fresh injuries of the healthy parts of the rotator cuff. The article presents the phase analysis of established changes in the rotator cuff, including the findings and instructions for providing an expert appraisal of the shoulder rotator cuff following an injury.
Summary		Izhodišča Večina najdenih sprememb v rotatorni manšeti rame je posledica kroničnih sprememb. Sveže poškodbe posameznih delov rotatorne manšete je potrebno nedvomno dokazati čimprej po sami poškodbi. Osnovno vprašanje za vsako izvedensko ocenjevanje sprememb v rotatorni manšeti rame je nedvomno ugotavljanje popoškodbenih sprememb ter ramejevanje med degenerativnimi spremembami, slučajno odkritimi spremembami in svežimi poškodbami rotatorne manšete. Natančna analiza klinične slike, biomehanike dogajanja in zgodnja uporaba specifičnih slikovnih diagnostičnih metod omogoča nedvomno ugotavljanje vzročnih povezav med aktualnim dogodkom in ugotovljenimi spremembami v rotatorni manšeti. Zaključki Sistematski pristop k analizi vseh podatkov o stanju ramenskega sklepa pred poškodbo, nedvomno ugotavljanje povezanosti med škodnim dogodkom, prvim medicinskim izvidom, operacijskim izvidom, histološkim izvidom in izvidi ultrazvoka, računalniške tomografije in magnetno resonančnega slikanja in analiza spremljajočih sprememb omogočajo izvedencu verodostojno medicinsko izvedensko oceno. Najnovejša dognanja o biomehaniki poškodb rotatorne manšete, ki vsebujejo analizo obremenitev posameznega dela rotatorne manšete v določenih položajih roke, a tudi poznavanje poteka in vzrokov za prekrvitvene spremembe delov rotatorne manšete in vloge mikrotravm, omogočajo razmejevanje med pojavom nemih sprememb, ki so potekale že dalj časa, od nedvomno ugotovljenih svežih poškodb zdravih delov rotatorne manšete. Članek prikazuje stopenjsko analizo ugotovljenih sprememb rotatorne manšete ter vsebuje ugotovitve in navodila za izvedenstvo po poškodbi rotatorne manšete.
Descriptors		ROTATOR CUFF EXPERT TESTIMONY INSURANCE, ACCIDENT