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Skapulothorakaler Rhythmus, Skapulasporn und Incisura-scapulae-Syndrom

Scapulothoracic rhythm, spur of the scapula and suprascapular notch syndrome

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Arthroskopie Aims and scope

Zusammenfassung

Die veränderte Position bzw. Bewegung der Skapula wird als Skapuladyskinesie bezeichnet. Klinisch ist diese v. a. durch ein Abheben des medialen Skapularands sowie eine fehlende Außenrotation und posteriore Kippung beim Anheben des Arms gekennzeichnet. Das primäre Winging wird dabei aus ätiopathogenetischer Sicht in einen neurologischen, einen knöchernen und einen Weichteiltyp unterteilt. Die Kompressionsneuropathien stellen insgesamt eine seltene Ursache für Schultergürtelbeschwerden dar. Bei Hochleistungsathleten in Überkopfdisziplinen müssen sie jedoch als wichtige Differenzialdiagnose bei anhaltendem Schulterschmerz in Betracht gezogen werden. Nervenläsionen skapulothorakaler und skapulohumeraler Nerven ereignen sich zumeist im Rahmen eines Traumas. Sowohl Nervenrekonstruktionen und Dekompressionen als auch Muskeltransferoperationen bei irreparablen Muskelläsionen stehen zur effektiven Behandlung zur Verfügung, bedürfen jedoch einer besonderen operativen Expertise. Pathologische Formveränderungen betreffen sowohl die knöcherne Formgebung der Skapula als auch die periskapuläre Muskulatur, Rippen und Wirbelkörper. Klinisch äußern sich diese Ätiopathologien sehr unspezifisch mit Impingement-artigen Beschwerden der betroffenen Schulter. Beim Incisura-scapulae-Syndrom handelt es sich um ein neuronales Kompressionssyndrom des N. suprascapularis im Bereich der Incisura scapulae sowie der Basis der Spina scapulae. Pathophysiologische Folgen sind v. a. die fettige Infiltration und die muskuläre Atrophie von M. supraspinatus und/oder M. infraspinatus.

Abstract

The altered position or movement of the scapula is referred to as scapular dyskinesia. Clinically, this pathology is characterized by raising of the medial margin of the scapula and by a lack of external rotation and posterior tilting when the arm is lifted. From an etiopathogenetic perspective primary winging is divided into neurological, osseous and soft tissue types. Compression neuropathies are a rare cause of shoulder girdle disorders; however, especially in the case of high-performance athletes in overhead disciplines with ongoing shoulder pain, they must be considered as an important differential diagnosis. Nerve lesions of scapulothoracic and scapulohumeral nerves are mostly caused by traumatic events. Both nerve reconstruction and decompression as well as muscle transfer operations are available as effective treatment options in the case of irreparable muscular lesions but require special surgical expertise. Pathological deformation affects quasi the bony structure of the scapula as well as the periscapular muscles, the ribs and the vertebrae. Clinically, these etiopathologies present with quasi very unspecific, impingement-like symptoms of the affected shoulder. The so-called suprascapular notch syndrome is a neuronal compression syndrome of the suprascapular nerve in the area of the suprascapular notch and the base of the spine of the scapula. Pathophysiological consequences are primarily fatty infiltration and muscular atrophy of the supraspinatus muscle and/or infraspinatus muscle.

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  1. Klinik für Unfall und Handchirurgie, Sporttraumatologie, ViDia-Kliniken Karlsruhe, Südendstraße 32, 76137, Karlsruhe, Deutschland

    L.‑J. Lehmann, J. Schmalzl, M. Moursy & D. Rzepka

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L.J. Lehmann, J. Schmalzl, M. Moursy und D. Rzepka geben an, dass kein Interessenkonflikt besteht.

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Lehmann, L., Schmalzl, J., Moursy, M. et al. Skapulothorakaler Rhythmus, Skapulasporn und Incisura-scapulae-Syndrom. Arthroskopie 30, 179–188 (2017). https://doi.org/10.1007/s00142-017-0132-3

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