Sportassoziierte Schulterverletzungen

Im Vordergrund des Beitrags stehen die häufigsten Pathologien sportassoziierter Schulterverletzungen wie die glenohumerale Instabilität, AC-Gelenk-Sprengungen, Rupturen der Rotatorenmanschette, Klavikulafrakturen sowie Pathologien der langen Bizepssehne. Diese Entitäten unterscheiden sich hinsichtlich Ätiologie, Pathomechanismus und klinischer Präsentation. Eine adäquate Erstdiagnostik zur Einleitung einer konservativen oder operativen Therapie sowie eine angemessene Beurteilung der Prognose und des funktionellen Outcomes sind von zentraler Bedeutung.

Kernaussagen

• Rotatorenmanschettenrupturen treten altersabhängig häufig auf, zeigen je nach betroffener Sehne unterschiedliche Pathomechanismen und erfordern eine individuelle Therapie: Kleine, degenerative Läsionen werden konservativ behandelt, traumatische oder große Rupturen bei jungen, aktiven Patienten operativ rekonstruiert.

• SLAP- und Pulley-Läsionen der langen Bizepssehne verursachen vor allem bei Überkopfsportlern Schmerzen und Instabilität. Jüngere Patienten profitieren von einer Bizepstenodese, um funktionelle Ergebnisse und die Rückkehr zum Sport zu sichern.

• Klavikulafrakturen des mittleren Drittels sind die häufigste Form und meist konservativ behandelbar. Stark dislozierte, mehrfragmentäre Frakturen oder funktionell anspruchsvolle Patienten profitieren von einer operativen Versorgung mit Plattenosteosynthese.

• Die anteriore traumatische glenohumerale Instabilität ist die häufigste Schulterinstabilität, besonders bei Überkopfsportlern. Unterschieden wird zwischen traumatischer unidirektionaler (TUBS) und atraumatischer multidirektionaler Instabilität (AMBRII), was die Therapie maßgeblich beeinflusst. Diese richtet sich nach Begleitverletzungen, Rezidivrisiko und sportlicher Belastung; eine präzise Diagnostik inkl. Glenoid-Track-Konzept ist entscheidend.

• AC-Gelenk-Sprengungen machen 9–10% aller Schulterverletzungen aus, besonders bei Kontaktsport und Radsport, durch direkte (Sturz auf die Schulter) oder indirekte Traumata (Sturz auf die protrahierte Schulter). Die Diagnostik erfolgt klinisch und radiologisch. Anhand der Rockwood-Klassifikation wird ein Therapieregime erstellt.

Schlüsselwörter

Sportverletzung - Rotatorenmanschettendefekt - Schulterfraktur - Schulterluxation

Publication History

Article published online:
20 November 2025

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