Kalkschulter – konservative und operative Therapie

Erkrankungen der Rotatorenmanschette beinhalten ein breites Spektrum, unter denen die Kalkschulter oder Tendinosis calcarea (TC) eine häufige Pathologie der Schulter darstellt und eine herausragende Rolle einnimmt. Das Erscheinungsbild kann dabei enorm variieren. Die Kalkschulter kann als Zufallsbefund bei der radiologischen Diagnostik auffallen, jedoch auch bis hin zu einem der stärksten Schulterschmerzen avancieren. Nachfolgend wird ein Überblick für das diagnostische und therapeutische Vorgehen gegeben.

Kernaussagen

• Die Kalkschulter ist eine meist selbstlimitierende Erkrankung, wobei Krankheitsverläufe zwischen 0,5 – 3 Jahren zu erwarten sind.

• Pathophysiologisch handelt es sich um eine zellvermittelte Erkrankung, bei der es zu Ablagerungen von Kalziumhydroxylapatit kommt.

• Die Symptome können unspezifisch und multiform sein.

• Die maximale Schmerzmanifestation tritt häufig im Rahmen der Resorptionsphase auf.

• In den meisten Fällen ist eine symptomatische bzw. konservative Behandlung ausreichend, wenngleich bei progredienten und chronischen Verläufen eine invasive/arthroskopische Therapie in Betracht gezogen werden kann.

• Die konservative Therapie umfasst systemische und lokale Analgesie, die subakromiale Kortikosteroidinjektion im akuten Schmerzstadium, die extrakorporale Stoßwellentherapie und mit geringerem Effekt physikalische und physiotherapeutische Anwendungen.

• Bei Versagen und ausgeschöpfter konservativer Therapie werden invasive bzw. operative Verfahren wie das Needling (mit oder ohne Lavage) bzw. die Gelenkspiegelung und operative Entfernung des Kalkdepots angewendet.

• Eine subakromiale Dekompression sollte nur bei Nachweis eines zusätzlichen knöchernen oder ligamentären (Lig. coracoacromiale) Impingements erfolgen.

Schlüsselwörter

Kalkschulter - extrakorporale Stoßwellentherapie - Needling - Kalzifikation - Rotatorenmanschette - Schultergelenk - Tendinosis calcarea

Publication History

Article published online:
04 August 2022

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