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M.I.A., a British -Sri Lankan singer, came to prominence in early 2004 via file-sharing of her singles "Galang" and "Sunshowers" on the Web. M.I.A. When you adored this post as well as you desire to acquire more details regarding mariachis bogota generously visit our own web site. has explained her new music design as becoming "other". In 2009, Time journal placed M.I.A. in the Time 100 record of "World's Most Influential folks" for having "world influence throughout several genres".






M.I.A. was in the Time one hundred listing of "World's Most Influential people" for having "international impact throughout numerous genres".




Lady Gaga has mentioned that fashion is a supply of inspiration for her songwriting and performances. Billboard rated Gaga the 73rd Artist of the 2000-10 decade. She was in Time
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Recently, improved technology in car Elevator Company means that multiple parking spaces can be created in one spot, creating space and increased parking availability. At it's most simple, two cars can be stacked in one parking spot, but at the more complex end more elaborate, units are able to house and move many cars at once using robotics. This is done using lift platforms and turntables which lift and stack cars or move them underground.

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HDTV Frequencies Explained: The Difference Between HDTV Frequencies and Refresh Rates

Understand the jargon, decode the technicalities. Learn quite aspects of HDTV terminology which will allow you to make informed decisions when planning your following HDTV purchase.
People frequently get the term frequency combined with the refresh rate when talking about TV's, especially HDTV.




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The frequency will be the broadcast information that the cable or satellite box needs to be able to tune in to a particular channel. Much like if you used to manually tune an analog TV or video into each signal individually, a decoder does exactly the same on the digital spectrum in order to pick up the broadcasts.
Analog and digital signals are broadcast on a similar frequencies, 55-88Mhz VHF low, 174-216Mhz VHF high and 470Mhz-806Mhz UHF television. Some channels it is broadcast in analog, though the other channels, especially HD ones will likely be broadcast in digital.
Each individual channel is allocated 6Mhz of the spectrum in order to carry the signal. Analog can send the standard 480i picture in this particular limit, and digital can carry a 1080i or p inside.



The 480i signifies that the signal carries 480 horizontal lines of data, the i is perfect for interlaced, meaning each line is refreshed alternately. The 1080 is perfect for the lines, i is good for interlaced, nevertheless the p is good for progressive, meaning the lines refresh in the top down. HDTV are available in two varieties, 1080i and 1080p. Currently the 1080p sets provide an advantage in display quality over the 1080i ones.
The frequency doesn't make excessive difference to display quality as it is cleaned up with the set-top box or TV. The refresh rate in the TV is why the most difference to the quality of a picture.




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When studying the specifications of an TV, you will frequently see '60Hz" or '120Hz" in the description. This is entirely different to frequency, this will be the refresh rate.
A refresh rate of 100Hz is how many times a second an image frame is drawn around the screen. For example, a movie is broadcast at 24Hz, that's 24 frames per second. A 60Hz LCD TV will convert the frames into 30Hz frames automatically, and refresh them twice every second. A 120Hz TV will repeat the first 24Hz frame more within every 24th of your second.
In the real world what this means is which a 120Hz TV will make a much clearer, crisper picture than that of the 60Hz one for the reason that image will be refresh doubly quickly. Moving images will be sharper along with less flickering when compared to a 60Hz picture and definately will have much less motion blur.

Motion blur is made when an image moves rapidly from position to an alternative and the eye picks it down. On a 60Hz signal, the picture is held for 1/60th of your second the quickly moves to another position within the next frame. The eye is sensitive enough to detect this and manifests itself as motion blur. As a 120Hz TV refreshes two times as quickly, the in-between frames are less noticeable and also the action appears smoother.
The frequency and refresh information will be the same for normal TV in addition to HDTV television. High Definition denotes how much lines in images, very little else. So a TV that has 1080i or 1080p is HD since it has a little over twice the information on screen that normal television does.
So hopefully we have decoded the technology enough for you to be able to decide for yourself which is the best option when looking for a new TV. No more depending for the "expertise" in the guy inside the store to help you!
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Many have heard about the kid known as the autistic savant that can tell someone your day of the week which they were delivered within minutes when given only the particular date of birth. There are lots of individuals who are blessed with a higher degree of cleverness and ability in an exceedingly slim area, such as computations of calendar schedules, but who lack broader skills in more accepted areas conventionally.

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Want to DOUBLE your vertical jump? Here are Ten Tips to do so in 2 Weeks! How would you like to be able to have as much spring as MJ, and as much power and finesse as Lebron James when jumping?

A plyometric volleyball workout should focus on jumping from both feet. There is no use in training to jump off of one foot if you are not ever going to jump from 1 foot in a game. Yet so many coaches train their players with all sorts of 1 leg jumping because they aren't experts in jump training. Don't fall into this trap, stay away from jumping off of one leg.



The first method is the most effective, most difficult, allows you to improve in a short period of time bouncing. The specific approach: Wage Keng, probably about one meter deep. Your legs tied five pounds of sandbags, jump into the pit. Try weight-bearing jumped from the pit. Two weeks later, the pit deepened to 20 cm, while weight gain 2-3 pounds, continued to practice. Such a cycle, and finally to no longer load, not from the pit leaping exercises on the end here. Lifting heavy loads, and try again able to Vertical Jump Training Program tall.

Increasing your stamina for enhanced sprinting is another one of the important tips to help you jump higher. Sprinting will help you jump higher because it is stretching your muscles in different ways. While you are increasing your muscle strength in your legs, the sprinting will give you enhanced flexibility. Eventually, you'll notice that you're jumping higher because of the the sprinting. This is one of those benefits that people gain from sprinting.

If you really want to increase your vertical jump, then make sure you are training correctly and with the right exercises. If you want to improve your performance then start training to increase vertical jump height now and watch your play on the court increase in no time at all.

Well, for starters it's not filled with fluff or hype. Jacob doesn't come across as a sales guy. Which is probably why he is so successful at selling the guide. And this could probably be why he's had to raise the price more than twice.

Once you determine the type of Vertical Jump Training Program you are, you have to get ready. First and most important is to dedicate time. Nothing will work if you do it rarely. Make an effort and practice a lot. It might seem difficult at the beginning, but you will see at the end how easy it actually is! And the results will really amaze you!

But one thing to remember is to never over-strain your muscles. You should always discontinue if you feel tired. If you push yourself too much then there are high chances that you might tamper your muscles and ligaments. Take breaks between sessions and soon you will be jumping like a pro.

Mike Robertson chipped in on another over looked component of vertical training or any training for that matter. And that my friend is mobility training. As Mike pointed out: If you Google vertical jump advice you'll get thousands of hits focusing on strength and plyometric training. But mobility is a critical factor many don't touch on and that is a big mistake. And don't make the mistake of thinking mobility is the same of flexibility. Mobility is the ability to use your flexibility while you move. If you can't reach certain positions in makes it a lot harder to maximize your performance. Mobility training will help you to achieve this and even better yet is that you can do it as a warm-up and with minimal time.

There are many ways that you can learn how to get a higher vertical jump. You can ask some of the other members of your team what they are doing. You can also rely on your trainer or coach to give you some information and helpful tips. The best thing that you can do is research it. One of the major things that you should be looking for that is related to getting a higher vertical jumping height is strength training for your lower body.

Simple enough right. 5 sets of 5 reps on big bang exercises and you are good to go! Don't forget to practice your jumping. I mean would you ask someone wanting to improve their speed not to sprint?
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I was one of several very scarce persons receiving their diplomas on my small graduation day that failed to whatever they desired inside a career. I simply imagined eh I?ll make a decision in the summer seasonn that?s sufficient time. Now I?m not speaking about my High school graduation here instead I mean my college graduation ceremony. After graduation possibly at the first stages of my under graduate education I was guaranteed persistently that I wouldn't need to select a major until mid-way through my four years. As many other 18 year-olds would, I asked myself "well okay that?s cool I?ll basically be concerned with that the moment the time comes". Two years of partying and cruising through courses afterwards I out of the blue needed to make up your mind about what I wanted to check and (within my younger, na?ve thoughts during the time) base gaming in addition to the all my professional career away from. So instead than going off from my personal personality and in actual fact thinking to the long haul by what I might like to undertake I merely picked this issue that have piqued my fascination one of the most all over my educational career: History. History no-brainer right? A lot of money as racket.

Mostly finance coursework topics are decided because of the professor so that you can appraise the student's capabilities which are necessary to complete it. The reason behind it is to ascertain the student's knowledge inside critical parts of a certain topic. As Finance is often a major topic students really should make a proper coursework that reflects their effort inside eyes with the marker. Therefore, students are forced to look at the guideline furnished with the subject to cook a paper that is certainly depending on needing instructor. But in case students are free of charge to pick their paper, then this helpful advice should be to opt for a topic by which they can be interested and competent to write confidently.

The first requirement quite simply should have a bachelor's degree, or perhaps an equivalent work experience. The United States Citizens and Immigration Services have determined that 3 years of training experience is the same as 12 months of formal education. Depending on the field, it's possible to be entitled to an H-1B visa using a valid blend of education and work experience.

Other findings on the study were: over 30 % of the with BMIs inside 'normal' range (approximately 20.7 million people) are unhealthy according to their other health data; and a lot more than 2 million people who find themselves considered 'very obese' according to a BMI of 35 or more are in fact healthy (that may be approximately 15% of Americans that are classified as very obese). Dr. Tomiyama, who directs UCLA's Dieting, Stress and Health laboratory, within previous research that there was no clear link between fat reduction and benefits in connection with hypertension, diabetes, and cholesterol and blood sugar levels.

If you organize yourself, you will notice that you won't need to stress yourself out about documents and deadlines. You should be warned, however, that this process is lengthy and ideally, a prospective grad student is likely to begin the appliance process within his junior year attending college and spend better section of annually completing the grad school admission requirements.

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The tasty treat eliminates the trouble of dosing your dog with tablets. In fact, it is normally ideal to talk to your veterinarian concerning any alterations to your dog's diet. She might give you advice concerning what supplements ought to be added to your dog's diet regime and in what quantity. Glucosamine is also not prescribed to individuals who have bleeding problems and are taking anti-clotting or anti-platelet medicines. Its intake is supposed to improve the danger of bleeding in case of these men and women. Apart from, it is also presumed to have adverse effects on the insulin, blood sugar and hemoglobin levels, especially on insulin-resistant or diabetic patients.



shopping complex in londonHow does this drug perform? Glucosamine - An Alternative Medicine Glucosamine is a precursor of glycosaminoglycan, one particular of the key components of the cartilage. It is therefore believed that administration of glucosamine can retard, if not avoid, joint degeneration. To avoid the side effects, supplements manufactured by a trustworthy business should only be consumed. Adverse effects of glucosamine have not shown any case of fatality and the rewards of glucosamine tremendously outweigh the minor side effects. Pet owners across the world use glucosamine chondroitin if their dogs are suffering from arthritis or hip dysplasia.

However, body's organic capability to generate glucosamine reduces with increasing age due to shortage of the enzyme glucosamine syntheses. Glucosamine, typically glucosamine sulfate, is primarily used in the treatment of osteoarthritis, a group of ailments normally caused by the damage or loss of cartilage. In osteoarthritis, the cartilage of joints loses elasticity and becomes stiff, which in turn causes discomfort, inflammation, tenderness, creaking and locking of joints. It assists lessen the symptoms of arthritis and hip dysplasia. Glucosamine chondroitin for dogs is accessible in numerous flavors. It could be a bacon flavored treat for the pet.

It will take, typically, 4 or maybe 6 weeks ahead of receiving benefits. Glucosamine is not just a pain killer, it in fact fixes damaged cartilage for your dogs to have healthier joints. Glucosamine For Dogs With Chondroitin has been confirmed to be protected simply because it is an all-natural supplement and therapy.

Glucosamine is 1 of the dietary supplements most typically prescribed for elderly people who suffer from arthritis and joint pain. This is a compound created kind glucose and glutamine, an amino acid. This compound, naturally located in the human body, helps in the production of glycosaminogen, which is utilized to regenerate tissues and sustain cartilage strength. Comparable is the case with medicines. To give you an idea - the typical pain-killer paracetamol is marketed beneath more than 50 brand names! In this clutter or 'me-too' drugs, how does a single decide on the right drug for him/her?

As stated earlier, the body produces it from glucose and the amino acid glutamine. Glucose is freely accessible in the normal human diet, and typically a deficiency is unlikely. Nevertheless, where it is believed that a supplement is required, then it is most likely ideal taken as element of a balanced combined glyconutrient supplement in which the eight essential sugars are accessible in the proportion that would normally be necessary.

Glucosamine For Dogs With Chondroitin has utilized for stomach ailments, joint troubles and skin wounds. Glucosamine's greatest use, particularly these days, is for joint problems or joint complications. It s a extremely powerful supplement as properly as a medication for arthritis. There are also internal variables for example immune situations, the physique's the body's the physique's hormones and inherited strains. Folks are continuously putting their in danger with meals that consists of higher body body body fat content material, alcohol and smoking. All of men and women elements turn out to be entrepreneurs.

Dermalogica Gentle Soothing Booster Dermalogica Boosters are concentrated skin care formulas that can support you deal with skin irritations caused by hormonal, climate connected, or other irritants. The Dermalogica skin care line consists of numerous boosters. A single great booster is the Dermalogica Gentle Soothing Booster. Glucosamine will also support lessen the advancement of osteoarthritis. A recent study utilized glucosamine combined with hydrochloride identified the final results to be less then successful. The exact same investigation also established that glucosamine mixed with chondroitin, did small to ease discomfort in the knees.

This indicates it is sold with limited or no study. It is a solution that can not be patented. This leaves little incentive for the huge pharmaceutical organizations to want to research, promote and sell this product. Hence, taking glucosamine supplements can definitely contribute to alleviate symptoms of osteoarthritis. On the other hand, chondroitin (a polysaccharide) is also an critical constituent of the tissues of the cartilage. It prevents cartilage from becoming dry as it displays water retaining properties.

The dosage depends upon the weight of every single person. An overdose can lead to serious side effects. Side Effects of Glucosamine Sulfate The main side effect is observed on the gastrointestinal tract of the individual consuming glucosamine sulfate. This led to a dilemma with the research completed on the supplements effects. It takes amongst three to six months to see any final results. Early research have been not extended adequate and the outcomes have been inconclusive.

upromocodes.co.uk of What Is The Role Of Glucosamine In A Dog Diet here try it.

It is available in numerous forms, for example, chewable tablets, powder, liquid, tablets of various strength, and so forth. It assists repair and renew the worn and broken cartilage by offering the matrix that is beneficial in the process of regeneration. Glucosamine supplement combined with chondroitin sulfate can be the ideal supplement for dogs diagnosed with arthritis. If left undetected, the cells will multiply and still create in the areas of the body. Cancer resulting in cancer major to cancer causing carcinogens are the main agent that is the cause of cancer, provided that they boost the developing process of cancerous cells. A lot of the existing research is flawed and it is difficult to draw definitive conclusions from analysis evaluations because of inadequate sample size, lacking study methodology, various dose sizes, and, in some case, direct conflict of interest with the manufacturers.

Glucosamine is present in animal bones, bone marrow and is also found in some fungi. But chitin, a substance found in several sea dwelling creatures such as shrimps, lobsters or crabs, is the richest supply of glucosamine. Most glucosamine supplements in the market are produced from this organic product. Vitamins, minerals, amino acids and antioxidants is often included in every single royal jelly and some of the examples of vitamins that can be identified in royal jelly are: niacin riboflavin and pantothenic acid; for minerals it involves calcium, copper, iron, magnesium, manganese, phosphorus, potassium and zinc. A mixture of flavonoids and phenolic acids which is known for antioxidants, scavenging and abolishing totally free radicals is present in every single royal jelly. Royal jelly when sensibly taken will not cause weight acquire even if it is sweeter than sugar.



img src="https://storage.googleapis.com/imgfave/image_cache/1475893906300362.jpg" alt="online shopping sites for men" title="Our pick on Mansfield - Notts County October 08, 2016
(C) imgfave.com" style="max-width:410px;float:left;padding:10px 10px 10px 0px;border:0px;">Other Uses for Glucosamine Glucosamine is utilized for rheumatoid arthritis, chronic venous insufficiency, skin issues and bowel disease or Crohn's illness. An estimated 27 million adults in the United States live with Joint pain-the most widespread type of arthritis. It also named degenerative joint disease, is brought on by the breakdown of cartilage, which is the connective tissue that cushions the ends of bones within the joint.
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Free Video Call Recorder for Skype is among those does what it says on the tin" tools - it is free, records video and sound Skype dialogs and there aren't any strings attached. Complete version of Skype Camera supports to record Skype calls with unlimited recording length, including free upgrade support for life. If I actually needed to report a video-chat on Skype, I wouldn't normally use any one of the add-on I found (view my personal suggestions at the top of this article). The program puts without any problems and you'll only must authorize it within Skype As Soon As this has been completed, whenever you begin a fresh phone, iFree Skype Camera may automatically record it and save yourself it as an MP3 supply to the file you select. MP3 Skype Camera is a free skype call recording application which allows you to record P2P (c all from computer to the pc) together with calls to or from fixed-lines and cellular telephones. For recording Skype conversations on Windows, we advocate the Free Video Call Recorder from DVDVideoSoft. You'll be getting both your microphone and Skype individually, uniting them in the mixer, and delivering to the digital camera.
Changeable recording movie codec, video resolution (helps 240p, 360p, 480p, 720p, 1080p), aspect ratio (4:3, 16:9) and framerate. The free version of the application only allows you to record conversations up to 10 minutes- it is possible to document for longer that that, but it'll have added noise. You can record FaceTime movie calls or FaceTime sound calls. But if you have $30 - and I am sure you do - get Call Recorder for Skype.


Recording audio interviews: everybody h AS a telephone, and if you might have a Skype out consideration then you certainly can c-all a phone and record an interview. MP3 Skype Camera demands a version of Skype using the Accessories Manager installed. Iwill be working my first documented live video-call & streamed event and I'm not sure whether to utilize Skype or Google Haunt. The closing, and most effective way to record Skype calls for a Podcast necessitates the intro of yet another piece of gear. Reloading Skype and attempting to record a contact it says no calls discovered (as I am in a contact).
Some choices: TapeaCall ($10), which functions only on I-phone; Report my Contact , available exclusively on Android; and Call Recorder , for iPhone and Android. Additionally, it makes it so easy to manage and to save all your movie messages together with Skype voicemails.


All the info assembled by the Skype Call Recorder should only be used for the purpose for which it was intended when utilizing a Skype Call Recorder. When you obtain Skype voicemail and Skype video concept, you are able to save yourself it directly to your own pc by a few straightforward clicks. Or a screen camera that can document loudspeaker and microphone at the same time. I 've just used the sound recorder that produces amazing music files that plays on my windows media without problem since 6/9#14/14. I thought to myself there should be a totally free version away there someplace and then I discovered Music Skype Recorder.
First, down load the program in the state site and install it. While installing, make sure that you click on Custom setup" and assess both ad ware choices should iFree Skype Recorder younot desire them (most likely, you do not need them). In the event you cherished this short article and you want to be given more details concerning IFree Skype Recorder for PC generously stop by the web site. IFree Skype recorder has the capacity to obtain both movie and audio.

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Wenn Patienten mit einer Kalkschulter ihren Hausorthopäden auf die microinvasive Therapie der Kalkschulter in Form der Nadel Lavage ansprechen wird oft die Nase gerümpft und nicht selten fällt auch der Begriff Scharlatan.
Als Scharlatan bezeichnet der Duden jemanden, der bestimmte Fähigkeiten vortäuscht und andere damit hinters Licht führt.
Dies ist in unserer Praxis mit Sicherheit nicht der Fall. Zur Diagnostik und Therapie werden von mir ausschließlich wissenschaftlich erprobte und durch Studien belegte Verfahren eingesetzt. Um hier immer auf dem neuesten Stand zu sein, besuche jährlich mehrere nationale und internationale Schultertagungen und Schulungen. Im Rahmen dieser Veranstaltungen werden die neuesten Erkenntnisse vorgestellt und mit anderen Spezialisten diskutiert.
Zusätzlich durchforste ich regelmäßig die Medizinisch wissenschaftlichen Datenbanken (Medline), die alle neuen Publikationen enthalten die irgendwo auf der Welt veröffentlicht werden. Durch diesen hohen zeitlichen Aufwand, neben der täglichen Patientenversorgung, kann ich sicherstellen, immer über die neuesten Erkenntnisse auf dem Gebiet der Schultererkrankungen informiert zu sein. Gleichzeitig muss ich aber eingestehen, dass dieser zeitliche Aufwand nicht auf die gesamte Orthopädie anzuwenden ist. Dann müsste ein Tag 36 oder 48 Stunden haben um sich alles anzulesen oder anzueignen. Erst der hohe Grad an Spezialisierung erlaubt mir, in einem noch vertretbaren zeitlichen Aufwand, wirklich tief in das Themengebiet der verschiedenen Schultererkrankungen einzusteigen und dabei auch noch über den Tellerrand hinauszublicken.
Dieser Blick über den Tellerrand war es auch, der zur Einführung der Nadel Lavage in meiner Praxis führte.

Bei einer meiner regelmäßigen Datenbankrecherchen bin ich 2007 auf eine Publikation in der renommierten medizinisch wissenschaftlichen Zeitschrift „Radiology“ gestoßen. Dieses weltweit publizierte Fachmagazin für Radiologie beschrieb eine neue Therapieform zur Behandlung der Kalkschulter -die ultraschallgestützte Nadel Lavage. An ca. 260 Patienten hatten Ärzte in Mailand mit großem Erfolg diese neue Behandlungsform getestet.
Von den guten Ergebnissen und dem schonenden Verfahren begeistert, habe ich bereits 2007 angefangen Patienten mit dieser neuen Therapieform zu behandeln. Ein neues hochauflösendes 3-D Ultraschallgerät, viele Versuche mit unterschiedlichen Nadeln sowie Spritzen und vor allem viel Übung waren erforderlich bis auch ich gute reproduzierbare Ergebnisse nachweisen konnte.
Nach mehr als 1500 Behandlungen ist die Nadel Lavage für mich heute zur Routine geworden in der Behandlung der Kalkschulter.

Im Gegensatz zur Situation in Deutschland stehe ich International nicht alleine auf weiter Flur da. Im Ausland gilt die Nadel Lavage bereits als etabliertes, sicheres und vor allem schonendes Verfahren zur Behandlung der Kalkschulter. Immer mehr Studien werden veröffentlich, die über die guten Ergebnisse und geringe Komplikationsraten des Verfahrens berichten. Im Gegensatz zur Stoßwellentherapie, bei der es eine Vielzahl von Studien gibt, die hohe Misserfolgsraten aufzeigen, sind die Ergebnisse zur microinvasiven Nadel Lavage alle extrem gut. Sie liegen nur geringfügig unter den Erfolgsraten der operativen arthroskopischen Therapie, bei weitaus geringerem Risiko.
Ein Grund für mich regelmäßig bei einer Kalkschulter die Nadel Lavage zu empfehlen und z.B. nicht eine Stoßwellentherapie. Erst wenn eine Nadel Lavage nicht zum gewünschten Erfolg führte ist die Gelenkspiegelung für mich als nächster Therapieschritt angezeigt.

Warum die microinvasive Therapieform der Nadel Lavage nicht von viel mehr Kollegen durchgeführt wird ist für mich nur schwer nachzuvollziehen. Ein Hauptproblem scheint bereits die Aufteilung und strikte Trennung von ambulanter und stationärer Medizin zu sein, wie dies eigentlich nur in Deutschland der Fall ist.
Orthopäden sind entweder in ihrer eigenen Praxis vor allem konservativ tätig oder im Krankenhaus, dann fast ausschließlich operativ, tätig. Praktisch bedeutet das: „Kommt ein Patient mit einer Kalkschulter in eine Orthopädiepraxis wird in aller Regel zunächst versucht mit allen Mitteln die Schulter konservativ zu behandeln, geht der Patient jedoch zu einem im Krankenhaus tätigem Orthopäden wird er meist eine Operation empfohlen bekommen.“
Die Begründung ist einfach. Der Arzt in der Praxis lebt vor allem von der konservativen Therapie wie z.B. der Stoßwellentherapie, Akupunktur usw.. Das Krankenhaus lebt von den Operationen und den belegten Betten. Hinzu kommt, dass fast alle ausgewiesenen Schulterspezialisten in Krankenhäusern tätig sind.

Als Schulterspezialist in eigener Praxis gehöre ich zur winzigen Gruppe von Ärzten, die zwischen den Stühlen sitzt - Konservative Behandlung in der Praxis, operative Behandlung im OP-Zentrum eines Krankenhauses. Patienten profitieren so von den Vorteilen „beider Welten“. Von der konservativen Therapie mit einer Stoßwelle bis zur komplexen arthroskopischen Sehnenrekonstruktion wird alles geboten. Die Entscheidung welche Therapie zum Einsatz kommt erfolgt dabei nach den Regeln der Schulmedizin und den aktuellsten wissenschaftlichen Erkenntnissen. Und nicht wie leider viel zu oft, ob der Arzt eben nur „die Eine“ oder eben nur „die Andere“ Therapie anbieten kann.

Dr. Holger Groß
Saarlouis

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Nicht selten kommen Patienten in unsere Praxis zur Behandlung einer Kalkschulter und haben bereits einen weite Anreise auf sich genommen. Die Erwartungshaltung an die Therapie und den Erfolg der Nadel-Lavage ist dementsprechend hoch.
Wir sind glücklich darüber, dass in der weitaus überwiegenden Zahl der Patienten diese hohe Erwartung, die in uns und die Therapie gesetzt wird, nicht entäuscht wird. Bedauerlicherweise ist dies aber nicht bei allen Patienten der Fall.

Bei der Nadel-Lavage handelt es sich nicht um Voodoo Medizin und Wunderheilung. Auch wenn diese Therapie in Deutschland nicht weit verbreitet ist, handelt es sich um ein klassisches schulmedizinsiches Verfahren. Zum Einsatz kommen Spritzen, Kanülen, Ultraschalltechnik u.s.w..

Die Therpie von Kalkherden mit der Nadel-Lavage ist verglichen mit anderen Verfahren z.B. der Stoßwellentherapie höchst erfolgreich. Dies haben wissenschaftliche Studien aus verschiedenen Ländern bewiesen. Insbesondere die Studien in der sehr renommierten Zeitschrift Radiology, die an mehr als 200 Patienten durchgeführt wurden, seien hier angeführt.
Typisch für die Schulmedizin ist aber, dass mit keinem Verfahren jedem Patienten geholfen werden kann. Der Mensch als Individuum und seine Erkrankungen sind zu verschieden, dass ein und dieselbe Therapie bei jedem Menschen zu 100% wirken kann. So ist es auch bei der Nadel-Lavage an der Schulter. Die wissenschaftlichen Studien berichten über Erfolgsraten von ca. 75%. Einfach ausgedrückt, sind 3 von 4 Patienten zufrieden und sehr zufrieden mit der Behandlung und dem Ergebnis.

Die Kehrseite der Medaille besagt aber, dass einem von vier Patienten nicht geholfen werden konnte. Dieser ist verständlicherweise meist unzufrieden. Verglichen mit anderen Therapien aus den verschiedenen Fachbereichen der Medizin muss aber festgehalten werden, dass Erfolgsraten von 75% bereits für eine sehr gute Therapie stehen. Für den einen Patienten von Vieren, dem mit diesem Verfahren nicht geholfen werden konnte, bleibt meist nur der Ausweg - operativer Eingriff.

Aufgrund der großen Anzahl an Kalkschultertherapien mit der Nadel-LAvage, können wir die Ergebnisse der Studien nur bestätigen. Aus meiner Sicht können wir in etwa 75 - 80% unserer Patienten mit einer Nadel-Lavage helfen. Durch das Wiederholen der Procedur, ist bei den Therapieversagern unter Umständen das Ergebnis noch etwas zu verbessern. 100% erreichen wir aber nie. Eine Aussage mit einer Erfolgsgarantie und 100% Heilungschance wäre auch zu schön und bleibt ein Wunschdenken.

Für die Patienten denen eine Erfolgsrate von 75% zu niedrig erscheint und aus diesem Grund gleich zur operativen Therapie tendieren, sei jedoch erwähnt, dass auch die operativen Verfahren lediglich Erfolgsraten von 75% bis ca. 80% aufweisen. Das heißt, auch nach einem operativen Eingriff zur Behandlung einer Kalkschulter gibt es Patienten, die mit dem Ergebnis unzufrieden sind. Die Zahl dieser unzufrieden Patient ist statistisch gesehen leider nicht viel kleiner als bei einer Nadel-Lavage. Der Aufwand der operativen Therapie, die damit verbundenen Risiken und die meist lange Nachbehandlung sind jedoch deutlich größer als bei einer Nadel-Lavage.

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Plötzlich auftretende starke Schulterschmerzen sind oftmals ausgelöst von einem Kalkherd in der Schulter. Insbesondere wenn die Beschwerden sehr stark oder als fast nicht auszuhalten charakterisiert werden ist eine spontane Kalkauflösung die Ursache.
Diese Situation ist typisch für die Phase 3 der Kalkschultererkrankung und endet meist mit einem vollständigen Abbau des Kalkherdes. In der nachfolgenden Phase 4 kommt es zur deutlichen Besserung der Beschwerden, wenn nicht sogar zur vollständigen Beschwerdefreiheit.
Problematisch an der akuten Kalkauflösung sind die starken Schmerzen die oft einen Gebrauch des Arms nahezu unmöglich machen. Leider ist die Dauer dieser sehr schmerzhaften Phase nicht abschätzbar. Sie kann mehrere Wochen andauern.
Wichtig ist es diese Phase möglichst erträglich zu machen und die Abheilung zu beschleunigen. Idealerweise sollten neben Schmerzmitteln Verfahren eingesetzt werden die direkt auf eine Reduktion des Kalkherdes hinwirken.
Denn je weniger Kalk der Körper selbst resorbieren muss, desto schneller verläuft die Heilung.
Als klassische Verfahren können die offene Operation und die Arthroskopie zur Anwendung kommen. Hier wird der Kalk in Vollnarkose operativ entfernt.

Auch unser Verfahren - Die ultraschallgestützten Nadel Lavage (microinvasiven Therapie) hat sich als sehr erfolgreich erwiesen.
Bei einer von uns durchgeführte Nachtuntersuchung bei Patienten mit akuter Kalkschulter (Phase 3) konnten wir feststellen, dass durch die schonende Entfernung des Kalkherdes mit der ultraschallgestützten Nadel Lavage die Beschwerden schnell und erheblich reduziert werden. Der spontane Verlauf der Erkrankung wird deutlich abgekürzt.

Unsere Empfehlung in der akuten Phase 3 der Erkrankung ist die möglichst schnelle Behandlung und mit Entfernung des Kalkes.
Um Patienten hier besser helfen zu können planen wir eine verbesserte Kontaktmöglichkeit zu unserer Praxis mit Notfallnummer und Rückrufservice, sowie Anreiseplanung und bei Wunsch auch Unterstützung bei der Planung von Übernachtungsmöglichkeiten.

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