Orthopaedics and Neuro-orthopaedics
Orthopaedics – specialists working together
At the Swiss Paraplegic Centre, the Orthopaedics and Neurology department is part of an interdisciplinary and interprofessional treatment team specialising in the treatment of disabilities of the locomotor system caused by paralysis. It is an essential factor in the treatment of problems of the locomotor system and in the care required to avoid recurrent events. The unique specialist combination of non-surgical and surgical skills enables us to play a key role in the interdisciplinary treatment of patients of all ages with a spinal cord injury.
Pain, spasticity, and their consequences
Pain caused by tendon problems in the shoulder – Spasticity caused by osteoporotic fractures of the leg – Foot misalignment with skin problems – Restrictions to movement of the hip caused by the formation of bone spurs – Muscle weakness with a reduction in everyday mobility
Symptoms and problems of the locomotor system are often a consequence of congenital or acquired paralysis. In addition to incorrect or excessive strain due to the paralysis, triggers tend to be the reshaping or breakdown of the tissue structure of bones and soft tissue, vegetative dysregulation, and inadequate protective reactions. Patients are often unable to carry out the required corrections to posture or movement, which means that numerous small episodes of strain accumulate and, over time, result in serious and limiting problems.
The consequences can be severe: skin problems all the way to exposed inflamed bone, increase in spasticity or autonomic dysfunction (sweating, circulatory problems), deterioration of the seating position in the wheelchair, decreased independence, and increased requirements for assistance in everyday life.
Wide range of treatment options from splints to surgery
In addition to the comprehensive non-surgical and orthotic treatment, points of focus within the team include shoulder surgery, foot surgery, and treatment of osteoporotic bone fractures of the lower extremities. In close cooperation with external partners, we also offer elective joint replacement surgery of the large joints and complex orthopaedic procedures. This cooperation offers unique potential in terms of orthopaedic/traumatology options, especially for patients with a spinal cord injury.
Overview of treatment options
Shoulder pain is common among people with a spinal cord injury. As wheelchair users rely on their arms to perform activities of daily living independently, the shoulder joint is subject to very heavy, and in some cases unphysiological, strain. A look at the everyday life of a wheelchair user suggests that the shoulder muscles become fatigued due to the excess strain, primarily during transfers and when propelling the wheelchair forwards, which means that the dynamic centring of the humeral head during movement is no longer guaranteed. This results in rapidly advancing joint damage.
By the time a consultation takes place, the pain is unfortunately often already permanent and can no longer be managed with non-surgical forms of therapy, or a considerable loss of function has already occurred. In most cases this means deterioration in the ability to perform a physical transfer, which is the process that determines independence in a person with a spinal cord injury.
Many years of experience
The Orthopaedics department at the Swiss Paraplegic Centre (SPC) Nottwil has been offering standalone consultations for shoulders since 2005. The full range of non-surgical and surgical measures can be performed. Surgical procedures include arthroscopic (“keyhole technique”) reconstruction of ligaments and tendons, treatment of broken bones, implantation of endoprostheses, and the treatment of other injuries and diseases of the upper and lower extremities. Consultations, non-surgical therapy, and surgical therapy in the SPC are also available to patients without paralysis, who can benefit from the department’s particular experience in treating “challenging” shoulder joints and other joints.
- Rotator cuff
- Impingement syndrome
- Calcific tendonitis of the shoulder
- Shoulder instability
- Pathologies of the long biceps tendon (SLAP-Lesion)
- Osteoarthritis of the shoulder joint
Elbow and hand
In recent years, elbow arthroscopy has seen a particularly high level of further development due to technical advances. This has resulted in improved treatment options and a broader area of application. Elbow arthroscopy is now able to represent all sections of the joint, which years ago only used to be possible by making multiple skin incisions. Constriction caused by floating cartilage and stress-induced pain due to osteoarthritis make arthroscopic treatment of the elbow necessary in most cases. Further treatment options exist for cartilage and bone defects (including the assessment of fractures), in particular of the radial head, but also in the other joint sections of the elbow joint. Detachment of adhesions that cause severe restrictions to movement and removal of an inflamed synovial membrane (synovialitis), in particular in the case of a rheumatic disease, are often a good indication for elbow joint arthroscopy.
Hand and tetra hand surgery at the Swiss Paraplegic Centre Nottwil. Please click on the link below.
The knee is the largest joint in the human body. It is made up of three bones: the femur, tibia, and patella. It is stabilised by the surrounding muscles and ligaments (cruciate and lateral ligaments). The menisci also span the joint, stabilising it, serving as shock absorbers, and distributing pressure. As is the case with all other joints, the knee is covered by a layer of cartilage.
- Cartilage damage
- Meniscal injury
Ankle and foot
- Hallux valgus
- Hallux rigidus
- Hammer toe / Claw toe
- Tailor's bunions / Bunionette (bunion on the little toe)
Within the field orthopaedics and paediatric orthopaedics, the specialist area of neuro-orthopaedics assumes a key role in the treatment of the orthopaedic consequences of congenital neurological diseases. Spina bifida and MMC patients require targeted, age- and case-appropriate treatment that combines non-surgical and surgical components. The transition for adolescent patients to treatment in adult medicine and to lifelong further treatment is often problematic and, in addition to advanced specialist knowledge, requires the seamless interplay of various professional and specialist groups in order to guarantee high-quality treatment.