Schultersteife – wann und wie behandeln?

Zusammenfassung

Die Schultersteife ist charakterisiert durch einen eingeschränkten glenohumeralen Bewegungsumfang mit schmerzhaftem Funktionsverlust in der aktiven und passiven Beweglichkeit. Entsprechend der Ätiologie lassen sich primäre und sekundäre Formen unterscheiden. Verschiedene Therapien der Schultersteife wurden vorgeschlagen, die bei Vorhandensein umfassender Evidenz in ihren Ergebnissen kritisch analysiert und diskutiert werden müssen. Ziel dieser Übersichtsarbeit ist es, die aktuellen Konzepte in der konservativen und operativen Behandlung der Schultersteife zusammenzufassen, die Ergebnisse der verfügbaren Studien mit hohem Evidenzgrad zu diskutieren und dadurch einen Therapiealgorithmus für die klinische Praxis abzuleiten. Die Behandlung der Schultersteife sollte auf die Situation des Patienten und das Stadium seiner Schulterpathologie zugeschnitten sein und auf eine Schmerzreduktion, Wiederherstellung des Bewegungsumfanges sowie eine funktionelle Wiederherstellung und Verkürzung der Symptomdauer abzielen. Wenn möglich, sollten bekannte Risikofaktoren für die primäre Schultersteife und Ursachen der sekundären Schultersteife berücksichtigt werden, um Rückfälle zu vermeiden. Die konservative Therapie ist der wesentliche Pfeiler in der Behandlung der Schultersteife und sollte einen stadiengerechten, multimodalen und aktivitätsorientierten Ansatz beinhalten. Die intraartikuläre Injektion niedrig dosierter Kortikosteroide ist sicher und wirksam, bietet unmittelbare Vorteile und wird in Kombination mit einem geeigneten Rehabilitationsprotokoll in der „Freezing“-Phase empfohlen. In therapierefraktären Fällen kann eine, trotz adäquater konservativer Therapie, an die Bewegungseinschränkung angepasste, arthroskopische Arthrolyse mit Kapselrelease durchgeführt werden.

Schlüsselwörter

Schultersteife - adhäsive Kapsulitis - Frozen Shoulder - Ergebnisse - Therapiealgorithmus

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