Zusammenfassung
Subakromiale Beschwerden mit den typischen Leitsymptomen von Schmerzen bei abspreizenden Bewegungen und nachts beim Liegen auf der Schulter sind ein häufiges Krankheitsbild. Die häufigsten Ursachen für subakromiale Beschwerden sind entzündliche, verschleißbedingte Veränderungen der Supraspinatussehne und des subakromialen Bursagewebes. Die Behandlung des Subakromialsyndroms ist nur nachhaltig, wenn sie mehrere Inhalte umfasst und den Patienten aktiv einbindet. Wesentliche Parameter der nichtoperativen ganzheitlichen Behandlung sind: Belastungsreduktion durch Modifikation des Bewegungsmusters, sportliche Aktivität, Modifikation der Haltung im Alltag und am Arbeitsplatz, tägliche entlastende Eigenübungen, lokale physikalische Anwendungen in Eigenregie, subakromiale Injektionstherapie, Reduktion psychosozialer Stressfaktoren, Behandlung der Funktionskette und überlagernder Pathologien der Halswirbelsäule (HWS). Bewährte zusätzliche Behandlungsoptionen sind Stoßwellentherapie und Akupunktur. Die nichtoperative Behandlung ist nur dann Erfolg versprechend, wenn sie konsequent über mindestens 6 Wochen erfolgt und die Belastungsreduktion dauerhaft fortgeführt wird. Eine komplette Wiederherstellung dauerhafter Vollbelastung ist in der Regel bei den zugrunde liegenden Verschleißerscheinungen nicht möglich. Mit geringen Restbeschwerden und bleibenden Einschränkungen muss in der Regel gerechnet werden. Im Verlauf der nichtoperativen Therapie verbleiben bei 10–20 % der Patienten inakzeptable Beschwerden, welche dann eine Operationsindikation darstellen, wenn der Patient in seiner individuellen Lebenssituation nicht zurechtkommt.
Abstract
Subacromial shoulder disorder with typical clinical signs of painful abduction and pain at night are common. Subacromial shoulder pain is commonly caused by degenerative, inflammatory lesions of the supraspinatus tendon and subacromial bursa. Treatment of subacromial syndrome may only lead to consistent results when the patient is actively involved in the therapy management and when treatment includes multiple methods. Important parameters of comprehensive nonsurgical treatment include reduction of mechanical stress on the shoulder by modification of typical daily living movements, sport activities and general body posture during the day and work, daily self-treatment with relaxing exercises, local physical therapy, subacromial injections, reduction of psychosocial stress, treatment of the functional chain (spine, scapula, shoulder, elbow, hand) and underlying cervical spine pathologies. Proven additional therapeutic options are extracorporeal shock wave therapy and acupuncture. Nonsurgical treatment will only be successful if therapy is consistently applied for at least 6 weeks and if load reduction is strictly followed. Complete restoration of full weight bearing shoulder function is impossible in most cases due to the underlying degenerative changes of the soft tissue. Moderate chronic complaints and limitations must be generally accepted. In the course of nonsurgical therapy, unacceptable complaints remain in 10–20% of patients, which then constitute an indication for surgery if the patient is unable to cope with his or her individual life situation.
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Ambacher, T., Lanzerath, F. Ganzheitliche konservative Therapie des Subakromialsyndroms bei Tendopathien der Rotatorenmanschette. Obere Extremität 17, 127–134 (2022). https://doi.org/10.1007/s11678-022-00698-5
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DOI: https://doi.org/10.1007/s11678-022-00698-5