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Glenohumerale Instabilität im Kindes- und Jugendalter

Glenohumeral instability in childhood and adolescence

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Zusammenfassung

Instabilitätssymptome sind ein häufiges Problem bei Kindern und Jugendlichen im Wachstumsalter. Echte Dislokationen und operationspflichtige Befunde unterhalb des 12. Lebensjahres sind selten.

Eine eingehende Anamnese und gezielte körperliche Untersuchung wird durch eine erweiterte Schnittbilddiagnostik (MRT) ergänzt. In die Therapieplanung sollte unbedingt das Vorliegen einer Hyperlaxität der Schultern und oder des gesamten Bewegungsapparates einbezogen und ggf. weiter abgeklärt werden. In besonderen Fällen von atraumatischen und willkürlichen Instabilitäten sollte die fachneurologische Beurteilung in speziellen pädiatrischen Zentren erfolgen. Echte traumatische Luxationen mit Strukturschäden profitieren von einer frühen operativen Intervention mit guten Aussichten auf eine restitutio ad integrum. Die Reluxationsraten bei Adoleszenten und jungen Erwachsenen sind sehr hoch, insbesondere beim Vorliegen von weiteren Risikofaktoren (knöcherne Bankart-Läsion, engaging Hill-Sachs-Läsion; Hyperlaxität), konnten jedoch bei adäquater Therapie in den letzten Jahren erheblich gesenkt werden.

Abstract

Shoulder instability is a common problem among children and adolescents in the growth period. True dislocations and indications for surgery before the age of 12 years are rare. A thorough medical history and clinical examination are supplemented by diagnostic magnetic resonance imaging (MRI). All therapeutic concepts should take hyperlaxity of the shoulders or a general hyperlaxity of the complete musculoskeletal system into account. In special cases of atraumatic or volitional dislocation referral to a pediatric neurological centre is recommended. Traumatic dislocations with structural lesions benefit from early surgical intervention with good chances of restitutio ad integrum. The recurrence rate in adolescents and young adults is very high, especially with accompanying risk factors (e.g. bony Bankart lesion, engaging Hill-Sachs lesion and hyperlaxity) but could be considerably reduced in recent years by improved interventional strategies.

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    Jörn Kircher

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Kircher, J. Glenohumerale Instabilität im Kindes- und Jugendalter. Obere Extremität 9, 84–89 (2014). https://doi.org/10.1007/s11678-014-0254-4

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