Omarthrose: Pathogenese, Diagnostik und konservative Therapieoptionen

Osteoarthritis of the shoulder: pathogenesis, diagnostics and conservative treatment options

Zusammenfassung

Pathogenese

Die Omarthrose ist durch einen fortschreitenden degenerativen Prozess des gesamten Schultergelenks gekennzeichnet, dem eine chronische Entzündung mit Ausschüttung verschiedener Zytokine und proteolytischer Enzyme zugrunde liegt. Als prädisponierende Faktoren gelten vor allem stattgehabte Unfälle und Operationen aber auch chronische Überbelastungen und Instabilitäten des Glenohumeralgelenks. Klinisch äußert sich die Omarthrose insbesondere durch eine verminderte Gelenkfunktion sowie durch Schmerzen, die nicht selten auch mit kognitiven und psychosozialen Einschränkungen assoziiert sind.

Diagnostik

Im Rahmen der klinischen und radiologischen Diagnostik müssen mögliche Begleitpathologien des Schultergelenks beurteilt und im Hinblick auf das therapeutische Vorgehen berücksichtigt werden. Ist eine endoprothetische Versorgung geplant, sollte zwingend eine präoperative CT-Diagnostik durchgeführt werden, um vor allem die glenoidalen Knochenverhältnisse zu beurteilen, da diese einen entscheidenden Einfluss auf die Wahl des Implantats haben.

Therapie

Im Rahmen der konservativen Therapieoptionen besteht neben oraler Schmerzmedikation und physikalischer Therapie auch die Möglichkeit zur lokalen intraartikulären Injektion, wobei hier die Hyaluronsäure den Kortikosteroiden vor allem hinsichtlich der Wirkungsdauer überlegen scheint.

Abstract

Pathogenesis

Osteoarthritis of the shoulder is characterized by a progressive degenerative process, which is based on chronic inflammation with intra-articular release of different cytokines and proteolytic enzymes. The main predisposing factors are a history of trauma or surgery, as well as chronic overuse or instability of the glenohumeral joint. Affected patients especially suffer from impaired joint function and pain, which are often associated with cognitive and psychosocial restrictions.

Diagnostics

Possible co-pathologies have to be evaluated carefully both clinically and radiologically as they must be taken into account in the therapeutic procedure. If arthroplasty of the shoulder is planned, a pre-operative CT scan is mandatory in order to evaluate the bone stock of the glenoid, which has a decisive influence on the choice of implant.

Treatment

Conservative treatment options are oral pain medication, physical therapy, and intra-articular injections, whereby, in comparison to corticosteroids, hyaluronic acid seems to be advantageous especially with respect to the duration of a positive clinical effect.

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Abbreviations

ACG:

Akromioklavikulargelenk

COX-2‐Hemmer:

Cyclooxygenase-2-Hemmer

MMP:

Matrix-Metalloproteasen

NSAR:

Nichtsteroidale Antirheumatika

PRP:

„Platelet-rich plasma“

RM:

Rotatorenmanschette

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Correspondence to Dr. J. Mehl.

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J. Mehl, A. B. Imhoff und K. Beitzel geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Mehl, J., Imhoff, A.B. & Beitzel, K. Omarthrose: Pathogenese, Diagnostik und konservative Therapieoptionen. Orthopäde 47, 368–376 (2018). https://doi.org/10.1007/s00132-018-3542-7

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Schlüsselwörter

  • Gelenkinstabilität
  • Hyaluronsäure
  • Intraartikuläre Injektion
  • Omarthrose
  • Schultergelenk

Keywords

  • Instability, joint
  • Hyaluronate sodium
  • Intraarticular injections
  • Osteoarthrosis
  • Glenohumeral joint