Die Schulterinstabilität

S. Weber-Spickschen; J. Agneskirchner

doi:10.1055/s-0037-1617751

Arthritis und Rheuma, Table of Contents

Arthritis und Rheuma 2016; 36(05): 293-304
DOI: 10.1055/s-0037-1617751

Schulterschmerz

Schattauer GmbH

Die Schulterinstabilität

Shoulder instability

S. Weber-Spickschen

¹Unfallchirurgische Klinik und Sportmedizinisches Institut, Medizinische Hochschule Hannover, Hannover

,

J. Agneskirchner

²go:h Gelenkchirurgie, Orthopädie Hannover, Hannover

› Author Affiliations

Abstract

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 gegebenenfalls auch knöchernen Begleitverletzungen. Entsprechend der großen Vielfalt an zu Grunde 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 Grund - lagen, fassen wesentliche Bausteine der suffizienten Diagnostik zusammen und stellen aktuelle Therapiemöglichkeiten vor. Im Fokus stehen sowohl nichtoperative Maßnahmen, wie die Reposition nach akuter Schulterluxation, als auch spezielle Operationsmethoden wie die arthroskopische Latarjet-Operation nach rezidivierenden Luxationsereignissen und relevantem Knochenverlust.

Summary

Shoulder instability is a common problem due to anatomic reasons. There are different forms from laxity without any pathology to acute or chronic types with soft tissue or bony injuries. Accordingly there is a variety of different therapy forms. A precise diagnostic is mandatory. This article should give you an overview about current diagnostics and therapy forms including conservative and operative treatment such as reposition of dislocated acute shoulder as well as the challenging arthroscopic Latarjet procedure after recurrent dislocations with relevant bone loss.

Schlüsselwörter

Schulterinstabilität - Schulterlaxizität

Keywords

Shoulder instability - shoulder laxity

Full Text

References

Vertiefende Literatur
1 Agneskirchner JD, Haag M, Lafosse L. Arthroscopic coracoid transfer: Indications, technique and initial results. Orthopade 2011; 40 (01) 41-51.
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.
3 Bankart ASB. The pathology and treatment of recurrent dislocation of the shoulder joint. Br J Med 1938; 23.
4 Boileau P. et al. Risk factors for recurrence of shoulder instability after arthroscopic Bankart repair. J Bone Joint Surg Am 2006; 88: 1755-1763.
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.
6 Burkhart SS. et al. Quantifying glenoid bone loss arthroscopically in shoulder instability. Arthroscopy 2002; 18: 488-491.
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.
8 Cheung EV. et al. Long-term outcome of anterior stabilization of the shoulder. J Shoulder Elbow Surg 2008; 17: 265-270.
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.
10 Gerber C, Nyffeler RW. Classification of glenohumeral joint instability. Clin Orthop Relat Res 2002; 400: 65-76.
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.
12 Helfet AJ. Coracoid transplantation for recurring dislocation of the shoulder. J Bone Joint Surg Br 1958; 40: 198-202.
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.
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.
15 Hovelius L. et al. Primary anterior dislocation of the shoulder in young patients. A ten-year prospective study. J Bone Joint Surg Am 1996; 78 (11) 1677-1684.
16 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.
17 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.
18 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.
19 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.
20 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.
21 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
22 Lafosse L. et al. The arthroscopic Latarjet procedure for the treatment of anterior shoulder instability. Arthroscopy 2007; 23: 1242e1-1242e5.
23 Latarjet M. Treatment of recurrent dislocation of the shoulder. Lyon Chir 1954; 49: 994-997.
24 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.
25 Magnusson L. et al. Revisiting the open Bankart experience: a four- to nine-year follow-up. Am J Sports Med 2002; 30: 778-782.
26 Mohtadi NG. et al. Arthroscopic versus open repair for traumatic anterior shoulder instability: a metaanalysis. Arthroscopy 2005; 21: 652-658.
27 Neviaser TJ. The anterior labroligamentous periosteal sleeve avulsion lesion: a cause of anterior instability of the shoulder. Arthroscopy 1993; 09: 17-21.
28 O’Connell PW. et al. The contribution of the glenohumeral ligaments to anterior stability of the shoulder joint. Am J Sports Med 1990; 18: 579-584.
29 Owens BD. 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.
30 Patte D, Rodineau J, Gardes JC. Epaules douloureuses et instables. Rev Chir Orthop 1980; 66: 157-165.
31 Provencher MT. 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.
32 Purchase RJ. et al. Hill-Sachs “remplissage”: an arthroscopic solution for the engaging Hill-Sachs lesion. Arthroscopy 2008; 24: 723-726.
33 Rowe CR, Patel D, Southmayd WW. The Bankart procedure: a long-term end-result study. J Bone Joint Surg Am 1978; 60: 1-16.
34 Sugaya H. et al. Glenoid rim morphology in recurrent anterior glenohumeral instability. J Bone Joint Surg Am 2003; 85: 878-884.
35 Tjoumakaris FP. et al. Arthroscopic and open Bankart repairs provide similar outcomes. Clin Orthop Relat Res 2006; 446: 227-232.
36 Walch G, Liotard JP, Boileau P, Noël E. [Posterosuperior glenoid impingement. Another impingement of the shoulder]. J Radiol 1993; 74 (01) 47-50 [French].
37 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.