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Schulterluxationen des älteren Patienten

Shoulder dislocations in elderly patients

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Zusammenfassung

Die anteriore Schulterluxation des älteren Patienten geht im Gegensatz zu der des jüngeren häufiger mit Verletzungen an der Rotatorenmanschette und mit Frakturen einher. Des Weiteren findet sich gehäuft eine Beteiligung des Plexus brachialis oder peripherer Nerven. Nach der Reposition und kurzer Ruhigstellung sollte früh eine physiotherapeutische Beübung zur Wiederherstellung von Mobilität und Kraft erfolgen. Essenziell für das weitere Therapieregime ist die Beurteilung der Rotatorenmanschette. Die Mehrzahl der Patienten wird klassischerweise konservativ behandelt. Ältere Patienten mit einer begleitenden Rotatorenmanschettenläsion und fehlgeschlagener konservativer Therapie können von einer operativen Intervention profitieren. Prinzipiell sollten rekonstruierende Eingriffe erwogen werden, häufig wird aber auch die Implantation einer inversen Prothese zu erwägen sein. Herausforderungen für den behandelnden Arzt bestehen in der exakten Definition des (ggf. vorbestehenden) strukturellen Schadens an der Schulter und der Wahl des optimalen Therapieverfahrens.

Abstract

In contrast to shoulder dislocations in younger patients, anterior shoulder dislocation in the elderly is often associated with concomitant injuries to the rotator cuff and fractures. There is also frequent involvement of the brachial plexus or peripheral nerves. After closed reduction and a short period of immobilization, physiotherapy should be performed to restore mobility and strength. The evaluation of the rotator cuff is essential for further treatment decisions. The majority of patients are classically treated conservatively. Elderly patients with accompanying rotator cuff lesions and failed conservative therapy can benefit from a surgical intervention. Reconstructive interventions of the rotator cuff should be principally considered; however, some individuals may benefit from a reverse prosthesis in this elderly subgroup of patients. The challenge for the treating surgeon is to exactly define the structural injury of the shoulder (which may include pre-existing lesions) and to select the optimal treatment option.

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Authors and Affiliations

  1. Klinik für Unfallchirurgie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland

    N. Hawi, D. Ratuszny, E. Liodakis, M. Omar, C. Krettek & R. Meller

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  1. N. Hawi
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  2. D. Ratuszny
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  3. E. Liodakis
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  4. M. Omar
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  5. C. Krettek
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  6. R. Meller
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Correspondence to N. Hawi.

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Interessenkonflikt

N. Hawi, D. Ratuszny, E. Liodakis, M. Omar, C. Krettek und R. Meller geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren. Alle Patienten, die über Bildmaterial oder anderweitige Angaben innerhalb des Manuskripts zu identifizieren sind, haben hierzu ihre schriftliche Einwilligung gegeben. Im Fall von nichtmündigen Patienten liegt die Einwilligung eines Erziehungsberechtigten oder des gesetzlich bestellten Betreuers vor.

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Hawi, N., Ratuszny, D., Liodakis, E. et al. Schulterluxationen des älteren Patienten. Unfallchirurg 121, 126–133 (2018). https://doi.org/10.1007/s00113-017-0421-3

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  • DOI: https://doi.org/10.1007/s00113-017-0421-3

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