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.


    Available treatments:

    • 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

    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

    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.

    Available treatments:

    • Ligaments
    • Cartilage damage
    • Meniscal injury
  • Available treatments:

    • 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.

Our specialists

  • meunzel-johannes-orthopaedie-0129

    Dr. med. Johann Meunzel

    Specialty Registrar in Neuro-Orthopaedics
    johann.meunzel@paraplegie.ch

    Specialist medical qualification

    Specialist in General Medicine

    Professional background

    since 2020
    Specialty Registrar in Neuro-Orthopaedics, Swiss Paraplegic Centre, Nottwil

    2009 - 2019
    Specialist / MSc in Neuro-Orthopaedics, Swiss Paraplegic Centre, Nottwil 

    1996 - 2008
    Independent, joint partner in Gemeinschaftspraxis für Kinder und Jugendliche (community practice for children and adolescents), Laupheim (D)

    1995
    Reintegration phase after service as a development aid worker

    1991 - 1994
    Director of a development aid project, operational and medical management, Jeevan Prakash Child Center (NGO), Murinjapalam Medical College, Trivandarum (India)

    1990 - 1991
    Intern, Kinderzentrum München (children's centre Munich), Munich (D)

    Training and further education

    2014
    Master of Science (MSc), Neuro-Orthopaedics postgraduate programme, Danube University Krems (A)

    2008
    Specialist in General Medicine, State Chamber of Physicians of Baden-Württemberg (D)

    2003
    Conferment of title of Doctor of Human Medicine

    1982 - 1990
    Degree in Human Medicine, Friedrich-Alexander University Erlangen-Nürnberg (D)

    Membership in professional associations

    APO
    Swiss Working Group for Prostheses and Orthoses

    GAMMA
    Society for the Analysis of Human Motor Function and its Clinical Application

    Society for Transition Medicine

    Transition 1525 association

    Vojta
    Swiss Working Group for Vojta Therapy

  • bohnert_laurent

    Dr. med. Laurent Bohnert

    Consulting Physician in Shoulder Surgery
    laurent.bohnert@paraplegie.ch

    Specialist medical qualification

    Federal Diploma (FA) in Orthopaedic Surgery and Traumatology of the Locomotor System

    Professional background

    since 2020
    Consulting Physician in Shoulder Surgery, Swiss Paraplegic Centre, Nottwil

    since 2015
    Senior Consultant in Orthopaedics, Lucerne Cantonal Hospital LUKS, Sursee

    2013 - 2014
    Specialty Registrar in Orthopaedics, Bürgerspital Solothurn

    2011 - 2013
    Specialty Registrar in Orthopaedics, Bürgerspital Solothurn

    2009 - 2011
    Specialty Registrar in Orthopaedics, Bürgerspital Solothurn

    2007 - 2009
    Junior Doctor in Orthopaedics, Balgrist University Hospital, Zurich

    2006 - 2007
    Junior Doctor in Orthopaedics, Hôpital de la Providence, Neuchâtel

    2005 - 2006
    Junior Doctor in Surgery, Biel Hospital 

    2004 - 2005
    Junior Doctor in Orthopaedics, Braine l’Alleud-Waterloo Hospital (Belgium)

    Training and further education

    2012
    Specialist in Orthopaedic Surgery and Traumatology of the Locomotor System (FMH)

    2003
    Conferment of title of Doctor of Human Medicine

    1996 - 2003
    Degree in Human Medicine, Free University of Brussels (ULB, Belgium)

    Membership in professional associations

    AO Trauma

    FMH
    Swiss Medical Association

Contact/Referrals

  • Secretary's Office for Orthopaedics

    orthopaedie.spz@paraplegie.ch
    Telephone +41 41 939 57 88
    Fax +41 41 939 58 80

    Opening times 

    Monday to Thursday
    8 am to 5 pm

    Friday
    8 am to 4 pm

     

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