Download PDF
OP-Journal 2013; 29(1): 72-80
DOI: 10.1055/s-0032-1328458
Georg Thieme Verlag KG Stuttgart · New York

Instabilitätsformen des Schultergelenks

Diagnostik und Therapie
Sanjay Weber-Spickschen
,
Hamid Hosseini
,
Jens Agneskirchner
Further Information

Publication History

Publication Date:
08 May 2013 (online)

   Permissions and Reprints

Zusammenfassung

Anatomisch bedingt sind Instabilitätsprobleme am Schultergelenk sehr häufig. Die Bandbreite reicht von der Laxizität ohne Krankheitswert bis hin zu akuten oder chronischen Luxationen mit weichteiligen und ggf. auch knöchernen Begleitverletzungen. Entsprechend der großen Vielfalt an zugrunde liegenden Entitäten unterscheiden sich die resultierenden Therapieoptionen. Um eine optimale Behandlungsstrategie abzuleiten, ist die präzise Diagnostik unerlässlich. Im folgenden Artikel geben wir einen Überblick über die relevanten anatomischen Grundlagen, fassen wesentliche Bausteine der suffizienten Diagnostik zusammen und stellen aktuelle Therapiemöglichkeiten vor. Im Fokus stehen sowohl nicht operative Maßnahmen wie die Reposition nach akuter Schulterluxation als auch spezielle Operationsmethoden wie die arthroskopische Latarjet-Operation nach rezidivierenden Luxationsereignissen und relevantem Knochenverlust.

Types of Instability of the Shoulder Joint: Diagnostics and Therapy

For anatomic reasons instability problems at the shoulder joint are very common. The spectrum ranges from laxity without clinical significance through to acute or chronic dislocations with accompanying soft-tissue and possibly also bone injuries. As a consequence of the wide range of underlying entities there are also numerous therapeutic options. In order to determine the optimal treatment strategies an exact diagnostic work-up is mandatory. In the present contribution we give an overview of the relevant anatomic principles, summarise the essential components for an adequate diagnostic procedure and describe the current therapeutic options. The emphasis is placed not only on non-surgical interventions such as repositioning after acute shoulder dislocations but also on special surgical methods such as the arthroscopic Latarjet operation after dislocation recurrences and relevant bone deficits.

 

  • Literatur

  • 1 Agneskirchner JD, Haag M, Lafosse L. Arthroscopic coracoid transfer: indications, technique and initial results. Orthopade 2011; 40: 41-51
    CrossrefPubMedGoogle Scholar
  • 2 Balg F, Boileau P. The instability severity index score. A simple pre-operative score to select patients for arthroscopic or open shoulder stabilisation. J Bone Joint Surg [Br] 2007; 89: 1470-1477
    CrossrefPubMedGoogle Scholar
  • 3 Bankart ASB. The pathology and treatment of recurrent dislocation of the shoulder joint. Brit J Surg 1938; 26: 23-29
    CrossrefPubMedGoogle Scholar
  • 4 Boileau P, Villalba M, Héry JY et al. Risk factors for recurrence of shoulder instability after arthroscopic Bankart repair. J Bone Joint Surg [Am] 2006; 88: 1755-1763
    CrossrefPubMedGoogle Scholar
  • 5 Burkhart SS, De Beer JF. Traumatic glenohumeral bone defects and their relationship to failure of arthroscopic Bankart repairs: significance of the inverted-pear glenoid and the humeral engaging Hill-Sachs lesion. Arthroscopy 2000; 16: 677-694
    CrossrefPubMedGoogle Scholar
  • 6 Burkhart SS et al. Quantifying glenoid bone loss arthroscopically in shoulder instability. Arthroscopy 2002; 18: 488-491
    PubMedGoogle Scholar
  • 7 Carreira DS et al. A prospective outcome evaluation of arthroscopic Bankart repairs: minimum 2-year follow-up. Am J Sports Med 2006; 34: 771-777
    CrossrefPubMedGoogle Scholar
  • 8 Cheung EV et al. Long-term outcome of anterior stabilization of the shoulder. J Shoulder Elbow Surg 2008; 17: 265-270
    CrossrefPubMedGoogle Scholar
  • 9 Elmlund AO et al. A 7-year prospective, randomized, clinical, and radiographic study after arthroscopic Bankart reconstruction using 2 different types of absorbable Tack. Am J Sports Med 2009; 37: 1930-1937
    CrossrefPubMedGoogle Scholar
  • 10 Gerber C, Nyffeler RW. Classification of glenohumeral joint instability. Clin Orthop Relat Res 2002; 400: 65-76
    CrossrefPubMedGoogle Scholar
  • 11 Halder AM et al. Effects of the glenoid labrum and glenohumeral abduction on stability of the shoulder joint through concavity-compression: an in vitro study. J Bone Joint Surg [Am] 2001; 83: 1062-1069
    PubMedGoogle Scholar
  • 12 Helfet AJ. Coracoid transplantation for recurring dislocation of the shoulder. J Bone Joint Surg [Br] 1958; 40: 198-202
    PubMedGoogle Scholar
  • 13 Hovelius L, Sandstrom B, Saebö M. One hundred eighteen Bristow-Latarjet repairs for recurrent anterior dislocation of the shoulder prospectively followed for fifteen years: study II – the evolution of dislocation arthropathy. J Shoulder Elbow Surg 2006; 15: 279-289
    CrossrefPubMedGoogle Scholar
  • 14 Hovelius L et al. One hundred eighteen Bristow-Latarjet repairs for recurrent anterior dislocation of the shoulder prospectively followed for fifteen years: study I – clinical results. J Shoulder Elbow Surg 2004; 13: 509-516
    CrossrefPubMedGoogle Scholar
  • 15 Huijsmans PE et al. Quantification of a glenoid defect with three-dimensional computed tomography and magnetic resonance imaging: a cadaveric study. J Shoulder Elbow Surg 2007; 16: 803-809
    CrossrefPubMedGoogle Scholar
  • 16 Ide J, Maeda S, Takagi K. Arthroscopic Bankart repair using suture anchors in athletes: patient selection and postoperative sports activity. Am J Sports Med 2004; 32: 1899-1905
    CrossrefPubMedGoogle Scholar
  • 17 Itoi E et al. Quantitative assessment of classic anteroinferior bony Bankart lesions by radiography and computed tomography. Am J Sports Med 2003; 31: 112-118
    PubMedGoogle Scholar
  • 18 Itoi E et al. The effect of a glenoid defect on anteroinferior stability of the shoulder after Bankart repair: a cadaveric study. J Bone Joint Surg [Am] 2000; 82: 35-46
    PubMedGoogle Scholar
  • 19 Kim SH et al. Arthroscopic anterior stabilization of the shoulder: two to six-year follow-up. J Bone Joint Surg [Am] 2003; 85: 1511-1518
    CrossrefPubMedGoogle Scholar
  • 20 Lafosse L, Baier GP, Jost B. Footprint fixation for arthroscopic reconstruction in anterior shoulder instability: the Cassiopeia double-row technique. Arthroscopy 2006; 22: 231.e1-231.e6
    PubMedGoogle Scholar
  • 21 Lafosse L, Lejeune E, Bouchard A et al. The arthroscopic Latarjet procedure for the treatment of anterior shoulder instability. Arthroscopy 2007; 23: 1242.e1-1242.e5
    PubMedGoogle Scholar
  • 22 Latarjet M. Treatment of recurrent dislocation of the shoulder. Lyon Chir 1954; 49: 994-997
    PubMedGoogle Scholar
  • 23 Lazarus MD et al. Effect of a chondral-labral defect on glenoid concavity and glenohumeral stability. A cadaveric model. J Bone Joint Surg [Am] 1996; 78: 94-102
    PubMedGoogle Scholar
  • 24 Magnusson L, Kartus J, Ejerhed L et al. Revisiting the open Bankart experience: a four- to nine-year follow-up. Am J Sports Med 2002; 30: 778-782
    PubMedGoogle Scholar
  • 25 Mohtadi NG, Bitar IJ, Sasyniuk TM et al. Arthroscopic versus open repair for traumatic anterior shoulder instability: a meta-analysis. Arthroscopy 2005; 21: 652-658
    PubMedGoogle Scholar
  • 26 Neviaser TJ. The anterior labroligamentous periosteal sleeve avulsion lesion: a cause of anterior instability of the shoulder. Arthroscopy 1993; 9: 17-21
    CrossrefPubMedGoogle Scholar
  • 27 OʼConnell PW, Nuber GW, Mileski RA et al. The contribution of the glenohumeral ligaments to anterior stability of the shoulder joint. Am J Sports Med 1990; 18: 579-584
    CrossrefPubMedGoogle Scholar
  • 28 Owens BD, DeBerardino TM, Nelson BJ et al. Long-term follow-up of acute arthroscopic Bankart repair for initial anterior shoulder dislocations in young athletes. Am J Sports Med 2009; 37: 669-673
    CrossrefPubMedGoogle Scholar
  • 29 Patte D, Rodineau J, Gardes JC. Epaules douloureuses et instables. Rev Chir Orthop 1980; 66: 157-165
    PubMedGoogle Scholar
  • 30 Provencher MT, Detterline AJ, Ghodadra N et al. Measurement of glenoid bone loss: a comparison of measurement error between 45 degrees and 0 degrees bone loss models and with different posterior arthroscopy portal locations. Am J Sports Med 2008; 36: 1132-1138
    CrossrefPubMedGoogle Scholar
  • 31 Purchase RJ et al. Hill-Sachs “remplissage”: an arthroscopic solution for the engaging Hill-Sachs lesion. Arthroscopy 2008; 24: 723-726
    CrossrefPubMedGoogle Scholar
  • 32 Rowe CR, Patel D, Southmayd WW. The Bankart procedure: a long-term end-result study. J Bone Joint Surg [Am] 1978; 60: 1-16
    PubMedGoogle Scholar
  • 33 Sugaya H, Moriishi J, Dohi M et al. Glenoid rim morphology in recurrent anterior glenohumeral instability. J Bone Joint Surg [Am] 2003; 85: 878-884
    CrossrefPubMedGoogle Scholar
  • 34 Tjoumakaris FP, Abboud JA, Hasan SA et al. Arthroscopic and open Bankart repairs provide similar outcomes. Clin Orthop Relat Res 2006; 446: 227-232
    CrossrefPubMedGoogle Scholar
  • 35 Wellmann M, Petersen W, Zantop T et al. Open shoulder repair of osseous glenoid defects: biomechanical effectiveness of the Latarjet procedure versus a contoured structural bone graft. Am J Sports Med 2009; 37: 87-94
    PubMedGoogle Scholar