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Instabile Schulterluxation

Unstable shoulder dislocation

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Zusammenfassung

Schulterluxationen sind ein häufiges Ereignis und werden in ihrer Verletzungsschwere leicht unterschätzt. Eine gründliche klinische Untersuchung sowie adaptierte bildgebende Diagnostik sind in der Lage, altersabhängige Verletzungen zu detektieren. Im Rahmen der konservativen Therapie bewährt sich bei jungen Patienten eine zweiphasige, insgesamt 3-wöchige Immobilisation unter Verwendung einer Abduktions-Außenrotations-Orthese, gefolgt von einer intensiven Physiotherapie. Trotzdem zeigen sich insbesondere bei jungen, sportlich aktiven Männern unter konservativer Therapie nicht akzeptable Rezidivraten, sodass eine operative Stabilisierung empfohlen wird. Diesbezüglich konkurrieren offene mit arthroskopischen Verfahren. Heute zeigt der arthroskopische Bankart-Repair unter Verwendung von Fadenankersystemen vergleichbare Rezidivraten zu den bisher als Goldstandard angesehenen offenen Techniken. Jedoch finden sich im Vergleich deutlich bessere funktionelle Ergebnisse unter Vermeidung von Insuffizienzen des M. subscapularis.

Abstract

Shoulder dislocations are a frequent event and the severity is often underestimated. A thorough clinical investigation and adapted imaging diagnostics are able to detect age-dependent injury patterns. A biphasic conservative treatment keeping the arm in a neutral to mild external rotation for 3 weeks has proven to be most effective and should be followed by an intensive physiotherapy. Nevertheless, conservative treatment protocols show unacceptable recurrence rates particularly in young men active in sport, therefore, surgical stabilisation is recommended. In the past open procedures were accepted as the gold standard, but today arthroscopic Bankart repair using suture anchors shows comparable recurrence rates. However, the clinical outcome with respect to the shoulder function is much better without compromising the subscapularis muscle.

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  1. Department Orthopädie und Traumatologie, Universitätsklinikum Freiburg, Hugstetter Straße 55, 79106, Freiburg, Deutschland

    M. Jaeger, K. Izadpanah, D. Maier & N.P. Südkamp

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  1. M. Jaeger
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  2. K. Izadpanah
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Jaeger, M., Izadpanah, K., Maier, D. et al. Instabile Schulterluxation. Chirurg 80, 657–674 (2009). https://doi.org/10.1007/s00104-009-1710-3

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