Zusammenfassung
Überkopfsportler haben ein erhöhtes Risiko für Läsionen an der Rotatorenmanschette (RM). Durch die hohen Belastungen der Schulterstrukturen kommt es zu frühen anatomischen und biomechanischen Veränderungen des Schultergelenks (Sportlerschulter). Die repetitiven Belastungen führen zur Kontraktur der posterioren Strukturen bei gleichzeitiger Aufdehnung der anterioren Kapsel. In der Folge entsteht ein glenohumerales Innenrotationsdefizit (GIRD), und es kommt zu einem internen Impingement des Supraspinatus am posterosuperioren Glenoid und einer Ablösung des Bizepssehnenankers. Partialläsionen der Supraspinatussehne treten etwa bei 40–50 % aller Überkopfsportler schon im frühen Alter auf. Diese können asymptomatisch bleiben oder zu schmerzhaften Einschränkungen im Alltag und der Sportausübung führen. Die konservative Therapie spielt eine Schlüsselrolle in der Behandlung der Sportlerschulter. Die Wiederherstellung der Rotationsfähigkeit sowie des skapulothorakalen Rhythmus steht hier im Vordergrund. Bei frustranen Verläufen kann eine arthroskopische Therapie erforderlich werden. Hierbei stehen je nach Ausdehnung, Ätiologie und Risskonfiguration 3 Techniken zur Wahl: Débridement, Sehne-zu-Sehnen-Naht und Refixation an die knöcherne Insertion. Die Ergebnisse für einen operativen Eingriff sind widersprüchlich. Insgesamt zeigt sich ein Return to sports (RTS) von etwa 80 %, von denen 60–65 % der Patienten postoperativ Sport auf präoperativem Leistungsniveau ausüben können. Profisportler weisen eine deutlich geringere RTS auf (ca. 50 %). Es besteht nur ein geringer Unterschied zwischen den Patienten nach Débridement und arthroskopischem Repair (53,7 % vs. 47,5 %). Eine aktive Sportteilnahme ist nach operativer RM-Versorgung im Mittel erst nach 8,3 Monaten postoperativ möglich.
Abstract
Overhead athletes are at high risk for early development of rotator cuff pathologies. Anatomical and biomechanical alterations of the shoulder occur due to the immense stress on the shoulder girdle. This symptom complex is generally described as athletes shoulder. Repetitive straining leads to contracture of the posterior capsule and simultaneously to widening of the anterior structures. Subsequently, glenohumeral internal rotation deficits (GIRD) arise. This results in impingement of the supraspinatus tendon at the posterosuperior glenoid and detachment of the anchorage of the biceps tendon. Radiographically, 40–50% of young asymptomatic overhead athletes show signs of partial articular-sided lesions of the supraspinatus tendon through posterosuperior impingement (PSI). Conservative treatment plays a key role in the management of athletes shoulder and reduces the necessity of surgery. Reestablishment of rotational movement and regular scapula coordination are important in physical therapy. After failed conservative treatment arthroscopic surgery is required. According to tear size, etiology and location three different methods are described: debridement, tendon to tendon suture and footprint refixation. Results after arthroscopic management are under debate. Overall, a return to sports (RTS) rate of 80% is reported, of whom 60–65% of athletes achieve the preoperative level. Professional athletes show low RTS rates of approximately 50%. The difference in outcome between debridement and arthroscopic repair is minor (53.7% vs. 47.5%, respectively). Convalescence after operative treatment is reported to take on average 8.3 months.
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L. Willinger und K. Beitzel geben an, dass kein Interessenkonflikt besteht.
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Willinger, L., Beitzel, K. Überlastung der Supraspinatussehne beim Überkopfsportler. Arthroskopie 30, 173–178 (2017). https://doi.org/10.1007/s00142-017-0147-9
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DOI: https://doi.org/10.1007/s00142-017-0147-9
Schlüsselwörter
- Sportlerschulter
- Wurfbewegung
- Rotatorenmanschettenläsion
- Glenohumerales Innenrotationsdefizit
- Impingement