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Diagnostik und Behandlungskonzept der anteroinferioren Schulterinstabilität

Aktuelle Trends

Diagnostics and treatment concepts for anteroinferior shoulder instability

Current trends

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Zusammenfassung

Zu einer Instabilität der Schulter kommt es, wenn statische oder dynamische Stabilisatoren aus dem natürlichen Gleichgewicht geraten. Die häufigste Form der Schulterinstabilität ist nach anteroinferior gerichtet, betrifft junge (Kontakt‑)Sportler und kann zu einer dauerhaften Beeinträchtigung der Schulterfunktion sowie zu einem frühzeitigen Verschleiß des Gelenks führen. Konservative sowie operative Therapieoptionen werden seit Jahren kontrovers diskutiert. Dieser Beitrag beschreibt die aktuellen Standards der Diagnostik, die aktuellen Trends bei der Therapiefindung und die relevanten Therapieoptionen bei vorderer Schulterinstabilität.

Abstract

Shoulder instability arises when static or dynamic stabilizers deviate from the natural equilibrium. The most common form of shoulder instability is in an anteroinferior direction, affects young athletes in contact sports and can lead to permanent impairment of shoulder function and early degeneration of the joint. Conservative as well as operative therapy options have been controversially discussed for years. This article describes the current state of diagnostics, current trends in therapy decisions and relevant therapy options for anterior shoulder instability.

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Authors and Affiliations

  1. Deutsches Schulterzentrum, ATOS Klinik, Effnerstr. 38, 81925, München, Deutschland

    F. Martetschläger, M. Tauber & P. Habermeyer

  2. Abteilung für Sportorthopädie, Klinikum rechts der Isar, München, Deutschland

    F. Martetschläger

  3. Universitätsklinik für Orthopädie und Unfallchirurgie, , Paracelsus Medizinische Universität Salzburg, Salzburg, Österreich

    M. Tauber

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Correspondence to F. Martetschläger.

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Interessenkonflikt

F. Martetschläger, M. Tauber und P. Habermeyer geben an, dass kein Interessenkonflikt besteht.

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Additional information

Redaktion

C. Chiari, Wien

R. von Eisenhart-Rothe, München

H. Gollwitzer, München

J. Grifka, Bad Abbach

M. Jäger, Essen

A. Meurer, Friedrichsheim

CME-Fragebogen

CME-Fragebogen

Welche Richtung der Schulterinstabilität ist die häufigste?

Anteroinferior

Posterior

Posteroinferior

Superior

Multidirektional

Bei welcher Armposition kommt es bevorzugt zur vorderen Schulterluxation?

Flexion-Innenrotation

Abduktion-Außenrotation

Retroversion-Innenrotation

Retroversion-Außenrotation

Flexion-Adduktion

Welcher Umstand weist im a.-p.-Röntgenbild auf einen knöchernen Pfannendefekt hin?

Doppelkontur

Keiner

Unterbrechung der Skleroselinie

„Double densitiy sign“

Hill-Sachs-Läsion

Welche Aufnahmen müssen bei der Diagnostik der akuten Schulterluxation mindestens gefordert werden?

True-a.-p.- und Y‑Aufnahme

Bernageau- und Stryker-Aufnahme

Bernageau- und axiale Aufnahme

True-a.-p.- und axiale Aufnahme

Y‑ und Velpeau-Aufnahme

Welcher der folgenden Tests kann als Zeichen einer vorliegenden Hyperlaxität dienen?

Gagey-Test

Apprehension-Test

Kim’s-Test

Hawkins-Test

Jobe-Test

Den Ausriss der glenohumeralen Bänder am Oberarmkopf nennt man …

GLAD-Läsion.

ALPSA-Läsion.

HAGL-Läsion.

SLAP-Läsion.

PASTA-Läsion.

Auf welche Begleitläsion ist gerade beim älteren Patienten mit Schulterluxation zu achten?

Labrumabriss

Klavikulafraktur

Rotatorenmanschettenruptur

Hämatom

HAGL-Läsion

Was kann zur Abschätzung der Wahrscheinlichkeit, ob ein Hill-Sachs-Defekt erneut einhaken wird, berechnet werden?

Pfannendefektgröße

Bewegungsumfang

Inklination des Glenoids

„Humeral track“

„Glenoid track“

Die posterosuperiore Impressionsfraktur am Humeruskopf nach vorderer Schulterluxation nennt man …

Bankart-Läsion.

Hill-Sachs-Läsion.

Double-Läsion.

Non-Bankart-Läsion.

Perthes-Läsion.

Welcher Punkt wird beim Instability Severity Index Score nach Balg als Risikofaktor berücksichtigt?

HAGL-Läsion

Perthes-Läsion

Hill-Sachs-Läsion im Röntgenbild

ALPSA-Läsion

Non-Bankart-Läsion

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Martetschläger, F., Tauber, M. & Habermeyer, P. Diagnostik und Behandlungskonzept der anteroinferioren Schulterinstabilität. Orthopäde 46, 877–892 (2017). https://doi.org/10.1007/s00132-017-3454-y

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