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DOI: 10.1055/s-0037-1620117
Frozen Shoulder und Schulter-Hand-Syndrom bei Diabetes mellitus
Frozen shoulder and stiff-hand syndrome in patients with diabetes mellitusPublication History
Publication Date:
24 December 2017 (online)
Zusammenfassung
„Frozen Shoulder” wird ausgelöst durch Degenerationen des Sehnen- und Bandapparates oder Kapselschrumpfung des Schultergelenks. Es resultiert eingeschränkte Beweglichkeit mit intraartikulären Kontrakturen und Kontrakturen der Muskel-Sehnen-Einheiten oder extraartikulären Adhäsionen. Gelegentlich ist der Verlauf assoziiert mit entzünd-lichen Veränderungen, Schmerzen und einem Schulter-Hand-Syndrom. Bei Patienten mit Langzeit-Diabetes treten „Frozen Shoulder” oder Schulter-Hand-Syndrom gehäuft und früher auf. Ursache sind Alterationen der kollagenen Bindegewebsstrukturen. Bei akuter Schmerzsymptomatik werden antiinflammatorische Medikamente, z.T. auch in-traartikuläre Applikationen von Kortikosteroiden, empfohlen. Es soll Schmerzlinderung erfolgen, Bewegungsfähigkeit hergestellt und Physiotherapie angewendet werden. Weiterhin werden intraartikuläre Glukokortikoidinjektionen, Gelenkkapseldistensionen und bei refraktären Be-schwerden Injektionen in subakromiale Schleimbeutel an-gewandt. Eine relativ neue Therapieoption, zu der erste Da-ten publiziert wurden, stellt die Gabe von Triamcinolonace-tat dar.
Summary
Frozen shoulder is a result of degeneration of the muscletendon units or degeneration of the joint capsule. The result is reduced motion with intraarticular and contractures of the muscle-tendon units and extraarticular adhesions. Often the pathophysiological findings are associated with inflammatory alterations, pain, and stiff-hand syndrome. In patients with long-term diabetes, frozen shoulder and stiffhand syndrome occur not only earlier but also more frequently. The causes are alterations of the collagenous tissue. Antiinflammatory drugs, and sometimes the intraarticular application of corticosteroids, are recommended for pain relief. Restoring of motion will result, and physiotherapy can be used. Moreover, intraarticular glucocorticoid injections, and joint capsule distensions are used, and, in the case of refractory complaints, injections are made in subacromiale bursae. A relatively new therapeutic option is the application of triamcinolonacetate.
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