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Operative Therapie der rheumatischen Schulter

Operative treatment of the rheumatic shoulder

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Zusammenfassung

Die Erkrankungsdauer und -schwere einer rheumatischen Schultererkrankung korreliert mit Symptomhäufigkeit, strukturellen Veränderungen und assoziierten Funktionseinschränkungen Der multifaktorielle Charakter der rheumatischen Grunderkrankung erfordert auch an der Schulter ein multimodales Therapiekonzept mit Interaktion nichtoperativer und operativer Disziplinen. Neben systemisch antiinflammatorischer Basismedikation sind injektorische Maßnahmen mit direkter Wirkung an der Synovialis als Zielorgan per Kortikoidinstillation wie auch Radiosynoviothesen (glenohumeral bei intakter Rotatorenmanschette) möglich. Operative Maßnahmen können an der Schulter stadienabhängig einen krankheitsmodifizierenden, strukturerhaltenden, rekonstruktiven oder palliativen symptomreduzierenden Charakter haben. Mit minimalinvasiven, arthroskopischen Operationstechniken ist in Verbindung mit einer modernen Basistherapie eine Verschiebung von Operationsindikationen hin zu frühen Erkrankungsstadien ohne bereits eingetretene Strukturveränderungen zu favorisieren/propagieren. Bei ausgeprägten Gelenkdestruktionen mit Rotatorenmanschettenverlust kann eine inverse Schulterendoprothese eine probate Therapieoption darstellen.

Abstract

The duration and severity of rheumatic diseases of the shoulder correlate with symptom frequency, structural changes and associated functional limitations. The multifactorial character of the underlying rheumatic disease requires a multimodal therapeutic concept including interaction of surgical and non-surgical disciplines. In addition to basic systemic anti-inflammatory medication, injections targeting the synovial tissue by corticoid instillation and glenohumeral radiosynoviorthesis (with an intact rotator cuff) are further options. Operative interventions on rheumatic shoulders can be characterized as disease-modifying, protective, reconstructive or palliative, depending on the stage. Combining minimally invasive arthroscopic surgical techniques with modern basic therapy has the potential to shift the indications for operative interventions towards an earlier stage of disease without favoring or propagating structural alterations which have already occurred. In cases of severe joint destruction with loss of the rotator cuff, reverse shoulder arthroplasty can be an appropriate option.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. G. Heers, J. Grifka, H.R. Springorum, B. Craiovan und S. Anders geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Orthopädische Klinik, Asklepios Klinikum Bad Abbach, Universität Regensburg, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Deutschland

    G. Heers, J. Grifka, H.R. Springorum, B. Craiovan & S. Anders

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  1. G. Heers
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  2. J. Grifka
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Correspondence to G. Heers.

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Heers, G., Grifka, J., Springorum, H. et al. Operative Therapie der rheumatischen Schulter. Z Rheumatol 74, 801–811 (2015). https://doi.org/10.1007/s00393-015-1614-1

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  • DOI: https://doi.org/10.1007/s00393-015-1614-1

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