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Begutachtung des Rotatorenmanschettenschadens der Schulter nach Arbeitsunfällen

Assessment of rotator cuff tears of the shoulder after occupational accidents

  • Begutachtung
  • Published:
Trauma und Berufskrankheit

Zusammenfassung

Bei der Begutachtung des Rotatorenmanschettenschadens der Schulter lag bisher der Fokus auf der Analyse des Unfallgeschehens mit der Kernaussage, dass bestimmte Unfallabläufe „geeignet“ sind, eine Verletzung an der Rotatorenmanschette zu verursachen, andere wiederum nicht. Trotz vielfältiger wissenschaftlicher Erkenntnisse über die Entstehung der Erkrankung der Sehnenplatte der Rotatorenmanschette gibt es keine neuen Ergebnisse darüber, unter welchen Bedingungen es zur isolierten oder kombinierten Verletzung einer gesunden Sehne an der Schulter kommt. Im Blick auf grundsätzliche Urteile des Bundessozialgerichtes aus 2005, 2006 und 2012 ist im Bereich der gesetzlichen Unfallversicherung die ärztliche Begutachtung des Rotatorenmanschettenschadens vorrangig an den tatsächlichen und individuellen medizinischen Befunden zu orientieren. Dies setzt voraus, dass der Gutachter den aktuellen wissenschaftlichen Kenntnisstand der Analyse der medizinischen Befundtatsachen zugrunde legt. Nur dann kann er dem Befund einen Wert beimessen, den dieser für die Beantwortung der Fragestellung hat. Diese Arbeit übermittelt die Rechtsgrundlagen für die Begutachtung und das derzeitige medizinische Wissen um die Schädigung der Rotatorenmanschette der Schulter.

Abstract

When assessing the causality of rotator cuff tears, the focus was previously on analysis of the accident with the core message that certain accident sequences are “suitable” to cause an injury to rotator cuffs, while others are not. Despite a great deal of scientific knowledge about the development of diseases of rotator cuff tendons, there are no new results about the conditions which can lead to isolated or combined injury of a healthy tendon of the shoulder. In view of fundamental verdicts of the Federal Social Court from 2005, 2006 and 2012 the medical assessment in the field of statutory accident insurance is primarily based on the actual and individual medical findings. This presupposes that the expert opinion is based on current scientific knowledge on the analysis of facts regarding medical findings. Only then can findings be given a value for answering medical and legal questions. This article provides the legal basis for the assessment and the current medical knowledge on damage to rotator cuffs of the shoulder.

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Abbreviations

AC:

Akromioclavikulargelenk

AHD:

Akromiohumerale Distanz

AI:

Akromionindex

AO:

Arbeitsgemeinschaft Osteosynthese

ARO:

Außenrotation

AT:

Akromieller Tilt

AUB:

Allgemeine Unfallversicherungsbedingungen

AWMF:

Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften

BSG:

Bundessozialgericht

CID:

„Concealed interstitial delamination“

CSA:

„Critical shoulder angle“ (kritischer Schulterwinkel)

DGOU:

Deutsche Gesellschaft für Orthopädie und Unfallchirurgie

DGU:

Deutsche Gesellschaft für Unfallchirurgie

DVSE:

Deutsche Vereinigung für Schulter- und Ellenbogenchirurgie

ECM:

Extrazellulärmatrix

GUV:

Gesetzliche Unfallversicherung

IRO:

Innenrotation

ISP:

Infraspinatus

LAA:

Lateraler Akromionwinkel

LBS:

Lange Bizepssehne

LSG:

Landessozialgericht

MRT:

Magnetresonanztomographie

PUV:

Private Unfallversicherung

RM:

Rotatorenmanschette

RMR:

Rotatorenmanschettenruptur

SOV:

„Supraspinatus outlet view“

SSP:

Supraspinatus

SSC:

Subscapularis

UZH:

Unfallzusammenhang

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  1. Berufsgenossenschaftliche Unfallklinik Murnau, Prof.-Küntscher-Str. 8, 82418, Murnau, Deutschland

    R. Beickert, S. Panzer & S. Wurm

  2. Chirurgische Klinik und Poliklinik Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil Bochum, Bochum, Deutschland

    J. Geßmann & D. Seybold

  3. Centrum für Muskuloskeletale Chirurgie, Klinik für Orthopädie, Klinik für Unfall- und Wiederherstellungschirurgie, Charité Universitätsmedizin Berlin, Berlin, Deutschland

    S. Pauly

  4. Klinik für Unfall- und Handchirurgie, St. Vincentiuskliniken Karlsruhe, Karlsruhe, Deutschland

    L. Lehmann

  5. Referat Soziale Reha/Begutachtung/Pflege/Psyche, Deutsche Gesetzliche Unfallversicherung (DGUV) Berlin, Berlin, Deutschland

    D. Scholtysik

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Beickert, R., Panzer, S., Geßmann, J. et al. Begutachtung des Rotatorenmanschettenschadens der Schulter nach Arbeitsunfällen. Trauma Berufskrankh 18, 222–247 (2016). https://doi.org/10.1007/s10039-016-0167-0

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