Skip to main content
SpringerLink
Log in

Multidirektionale Schulterinstabilität

Klassifikation, Klinik, Differentialdiagnose, Behandlungsmethoden

  • Chapter
Schulterinstabilität — Rotatorenmanschette

  • 83 Accesses

Zusammenfassung

Die operative Therapie der Schulterinstabilität erlebte in den letzten Jahren einen enormen Wandel. Zusätzlich zur Wiederherstellung der Stabilität und Minimierung der Reluxationsrate wird vor allem bei sportlich aktiven Patienten zunehmend auf die Bedeutung der Kraft und der vollen postoperativen Beweglichkeit Wert gelegt. Neben den etablierten offenen Operationsmethoden (z. B. Kapselshift nach Neer) gelingt dies vor allem durch die exakte Rekonstruktion der anatomischen Verhältnisse mittels der arthroskopischen OP-Technik [4]. Als sehr komplexes Problem im Hinblick auf Diagnostik und Therapie, stellen sich Schulterinstabilitäten dar, die in verschiedene Richtungen ausgeprägt sind. Diese multidirektionalen Instabilitäten (MDI) sind mit 2% der Gesamtzahl aller Instabilitäten relativ stelten und wurden früher in der Regel konservativ therapiert. Aber nicht zuletzt aufgrund der Kenntnis von Übergangsformen zwischen diesen multidirektionalen und den häufigen unidirektionalen Instabilitäten tritt die operative Therapie immer mehr in den Vordergrund [7, 9, 13, 17, 24, 46, 57–59, 64, 71, 75]. Um die optimale Therapieform einzusetzen, ist die Kenntnis der Begriffe Laxität und Instabilität sowie die Kenntnis einer differenzierten Klassifikation der Schulterinstabilität Voraussetzung [24, 78].

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 69.99
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 89.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

Literatur

  1. Altchek DW, Warren RF, Skyhar MJ, Ortiz G (1991) T-plasty modification of the Bankart procedure for multidirectional instability of the anterior and inferior types. J Bone and Joint Surg 73-A:105–112

    Google Scholar 

  2. Barthel T, König U, Gohlke F (1998) Anatomie des anterosuperioren Labrum-KapselKomplexes. Z Orthop 136:A141

    Google Scholar 

  3. Barthel T, König U, Gohlke F, Löhr J (1999) Anatomie und Histologie des Labrum glenoidale unter besonderer Berücksichtigung des sublabralen Foramen und der SLAP-Läsionen. Orthopäde (in Druck)

    Google Scholar 

  4. Bateman JE (1978) The Shoulder and Neck (ed 2) WB Saunders, Philadelphia, p 515

    Google Scholar 

  5. Belle RM (1989) Collagen typing in multidirectional instability of the shoulder. Orthop Trans 13:680–681

    Google Scholar 

  6. Berg EE, Ciullo JV (1998) A clinical test for superior glenoid labral or SLAP-lesions. Clin J Sports Med, Apr 8(2):121–123

    CAS  Google Scholar 

  7. Bigliani LU (1989) Anterior and posterior capsular shift for multidirectional instability of the shoulder. Orthop Trans 13:680–681

    Google Scholar 

  8. Bigliani LU, Kurzweil PR, Schwartzbach CC, Wolfe IN, Flatow EL (1994) The inferior capsular shift procedure for anterior-inferior shoulder instability in athletes. Am J Sports Med 22:578–584

    Article  PubMed  CAS  Google Scholar 

  9. Bigliani LU, Pollock RG, Owens JM, Mcllveen SJ, Flatow EL (1993–1994) The inferior capsular shift procedure for multidirectional instability of the shoulder. Orthop Trans 17:576

    Google Scholar 

  10. Burkart A, Imhoff AB (1999) Adverse reactions to bioabsorbable suretac device in arthroscopic shoulder stabilisation. Arthroscopy (accepted)

    Google Scholar 

  11. Burkhead WZ Jr, Rockwood CA Jr (1992) Treatment of instability of the shoulder with an exercise program. J Bone and Joint Surg 74-A:890–896

    Google Scholar 

  12. Carter C, Sweetnam R (1960) Recurrent dislocation of the patella and of the shoulder. Their association with familial joint laxity. J Bone and Joint Surg 42-B(4):721–727

    Google Scholar 

  13. Cooper RA, Brems JJ (1992) The inferior capsular-shift procedure for multidirectional instability of the shoulder. J Bone and Joint Surg 74-A:1516–1521

    Google Scholar 

  14. Cordasco FA, Pollock RG, Flatow EL, Bigliani LU (1993) Managemnt of multidirectional instability. Op Tech Sports Med 1:293–300

    Google Scholar 

  15. De Palma AF (1973) Surgery of the Shoulder (ed 2) JB Lippincott, Philadelphia, p 425

    Google Scholar 

  16. Dowdy PA, O’Driscoll SW (1993) Shoulder Instability. An analysis of family history. J Bone and Joint Surg Br 75:782–784

    CAS  Google Scholar 

  17. Duncan R, Savoie FH III (1993) Arthroscopic inferior capsular shift for multidirectional instability of the shoulder: a preliminary report. Arthroscopy 9:24–27

    Article  PubMed  CAS  Google Scholar 

  18. Emety RJH, Mulli AB (1991) Glenohumeral joint instability in normal adolescents. Incidence and significance. J Bone and Joint Surg 73-B(3):406–408

    Google Scholar 

  19. Fanton GS, Wall MS, Markel MD (1999) Electrothermally assisted capsule shift (ETACS) procedure for shoulder instability. Oratec Company (in press)

    Google Scholar 

  20. Field LD, Warren RF, O’Brien SJ, Altchek DW, Wickiewicz TL (1995) Isolated closure of rotator interval defects for shoulder instability. Am J Sports Med 23:557–563

    Article  PubMed  CAS  Google Scholar 

  21. Finnsterbush A, Pogrund H (1982) The hypermobility syndrome. Musculoskeletal complaints in 100 consecutive cases of generalized joint hypermobility. Clin Orthop 168:124–127

    Google Scholar 

  22. Flatow EL (1992) Multidirectional instability. In: Kohn D, Wirth CJ (eds) Die Schulter: Aktuelle operative Therapie. Thieme, Stuttgart, pp 180–187

    Google Scholar 

  23. Flatow EL (1996) Multidirectional instability. In: Bigliani LU (ed) The Unstable Shoulder. The American Academy of Orthopaedic Surgeons, Rosemont, Illinois, pp 79–90

    Google Scholar 

  24. Flatow EL, Warner JP (1998) Instability of the Shoulder: Complex Problems and Failed Repairs. J Bone and Joint Surg Am 80-A:122–140

    Google Scholar 

  25. Foster CR (1983) Multidirectional instability of the shoulder in the athlete. Clin Sports Med 2:355–368

    PubMed  CAS  Google Scholar 

  26. Fredrich H, Imhoff AB, Höfler H (1998) Biomechanische and histomorphologische Untersuchungen zur Laserwirkung an der Schultergelenkskapsel. Z Orthop 136/5:A 119–120

    Google Scholar 

  27. Friedman RJ, Bonutti PM, Genez B, Norfray JF (1993–1994) Cine magnetic resonance imaging of the glenohumeral joint. Orthop Trans 17:1018–1019

    Google Scholar 

  28. Fu F, Ticker JB, Imhoff AB (1997) An atlas of shoulder surgery. Dunitz, London

    Google Scholar 

  29. Hardy P, Thabit G III, Fanton GS, Blin JL, Lortat-Jacob A, Benoit J (1996) Arthroscopic management of recurrent anterior shoulder dislocation by combining a labrum suture with antero-inferior holmium: YAG laser capsular shrinkage. Orthopäde 25:91–93

    PubMed  CAS  Google Scholar 

  30. Hawkins RJ, Bokor DJ (1990) Clinical evaluation of shoulder problems. In: Rockwood CA Jr, Matsen FA III (eds) The Shoulder. Vol 1, WB Saunders, Philadelphia, pp 149–177

    Google Scholar 

  31. Hawkins RJ, Kunkel SS, Nayak NK (1991) Inferior capsular shift for multidirectional instability of the shoulder: 2–5 year follow-up. Orthop Trans 15:765

    Google Scholar 

  32. Huber H, Gerber C (1994) Voluntary subluxation of the shoulder in children. A longterm follow-up study of 36 shoulders. J Bone and Joint Surg Br 76:118–122

    CAS  Google Scholar 

  33. Imhoff A (1995) The use of lasers in orthopaedic surgery. Controversial topics in sports medicine. Operat Tech Orthop 5:192–203

    Article  Google Scholar 

  34. Imhoff A, De Simoni C (1996) Die arthroskopische Schulterstabilisierung mit Suretacs - eine Kompliktionsanalyse. 2. Zentraleuropäischer Unfallkongreß 29. 5.-1. 6. 1996, Davos, Swiss Surgery 2:30

    Google Scholar 

  35. Imhoff A, Ledermann T (1995) Arthroscopic subacromial decompression with and without Holmium: YAG-Laser - a prospective comparative study. Arthroscopy 11:549–556

    Article  PubMed  CAS  Google Scholar 

  36. Imhoff A, Perrenoud A, Neidl K (1992) MRI bei Schulterinstabilität - Korrelation zum Arthro-CT and zur Arthroskopie der Schulter. Arthroskopie 5:122–129

    Google Scholar 

  37. Imhoff AB (1997) Arthroscopic shoulder stabilisation and capsular shift with Fastak and laser assisted capsular shift - procedure (LACS). 5th Symposium of the Korean Arthroscopy Association June 20, 1997, Seoul, Korea

    Google Scholar 

  38. Imhoff AB (1997) The role of capsuloligamentous structure in the unstable shoulder - a biomechanical and arthroscopical approach. 24th Annual Meeting of the Japan Shoulder Society. October 31-November 1, Kyoto, Japan

    Google Scholar 

  39. Imhoff AB, Burkart A, Roscher E (1998) Adverse reaction to bioabsorbable suretac device in arthroscopic shoulder stabilisation and SLAP-refixation. 8th Congress of the Europan Society of Sports Traumatology. Knee Surgery and Arthroscopy (ESSKA) April 29-May 2, 1998, Nizza/France, p 163

    Google Scholar 

  40. Imhoff AB, Debski RE, Warner JJP, Patel PR, Demirhan M, Fu FH, Woo SL-Y (1995) Biomechanical function of the glenohumeral ligaments - A quantitative assessment. AOSSM, July 16–19, 1995, Toronto, Canada, pp 87–88

    Google Scholar 

  41. Imhoff AB, Roscher E, König U (1998) Arthroskopische Schulterstabilisierung: Differenzierte Behandlungsstrategie mit Suretac, Fastak, Holmium: YAG-Laser and Elektrochirurgie. Orthopäde, 27:518–531

    PubMed  CAS  Google Scholar 

  42. Jalovaara P, Myllylä V, Päivännsalo M (1992) Autotraction stress roentgenography for demonsration anterior and inferior instability of the shoulder joint. Clin Orthop 284:136–143

    PubMed  Google Scholar 

  43. Jerosch J, Castro WH (1990) Shoulder instability in Ehlers-Danlos syndrome. An indication for surgical treatment? Acta Orthop Belgica 56:451–453

    CAS  Google Scholar 

  44. Jobe C (1990) Symposium on anterior instability. Read at the Fourth Congress of the European Society for Surgery of the Shoulder and the Elbow, Milan, Italy, Oct 4

    Google Scholar 

  45. Jobe CM (1996) Anatomy and surgical approaches. In: Jobe FW, Mosby CV (eds) Operative Techniques in Upper Extremity Sports Injuries, St. Louis, pp 124–153

    Google Scholar 

  46. Jobe FW, Giangarra CE, Kvitne RS, Glousman RE (1991) Anterior capsulolabral reconstruction of the shoulder in athletes in overhand sports. Am J Sports Med 19:428–434

    Article  PubMed  CAS  Google Scholar 

  47. Jobe FW, Kvitne RS, Giangarra CE (1989) Shoulder pain in the overhand or throwing athlete: The relationship of anterior instability and rotator cuff impingment. Orthop Rev 18:963–975

    PubMed  CAS  Google Scholar 

  48. König U, Barthel T, Imhoff AB (1999) Anatomie and Histologie des Labrum-KapselKomplexes. In: Imhoff AB, König U (Hrsg) Schulterinstabilität, Rotatorenmanschette, Steinkopff Darmstadt

    Google Scholar 

  49. König U, Imhoff AB (1999) Die multidirektionale Schulterinstabilität. In: Meyer/Gächter (Hrsg) Schulterchirurgie in der Praxis. Springer, Heidelberg (in Druck)

    Google Scholar 

  50. Kronberg M, Broström L-A, Nemeth G (1991) Differences in shoulder muscle activity between patients with generalized joint laxity and normal controls. Clin Orthop 269:181–192

    PubMed  Google Scholar 

  51. Lebar RD, Alexander AH (1992) Multidirectional shoulder instability. Clinical results of inferior capsular shift in an active-duty population. Am J Sports Med 20:193–198

    Article  PubMed  CAS  Google Scholar 

  52. Lephart SM, Warner JJP, Borsa PA, Fu FH (1994) Proprioception of the shoulder joint in healthy, unstable, and surgically repaired shoulders. J Shoulder and Elbow Surg 3:371–380

    Article  CAS  Google Scholar 

  53. Lusardi DA, Wirth MA, Wurtz D et al (1993) Loss of external rotation following anterior capsulorrhaphy of the shoulder. J Bone and Joint Surg Am 75:1185–1192

    CAS  Google Scholar 

  54. Mallon WJ, Speer KP (1995) Multidirectional instability: current concepts. J Shoulder and Elbow Surg 4:54–64

    Article  CAS  Google Scholar 

  55. McIntyre LF, Caspari RB, Savoie FH III (1997) The arthroscopic treatment of multidirectional shoulder instability: two-year results of a multiple suture technique. Arthroscopy 13(4):418–425

    Article  PubMed  CAS  Google Scholar 

  56. Mizuno K, Itakura Y, Muratsu H (1992) Inferior capsular shift for inferior and multidirectional instability of the shoulder in young children: report to two cases. J Shoulder and Elbow Surg 1:200–206

    Article  CAS  Google Scholar 

  57. Neer CS II, Foster CR (1980) Inferior capsular shift for involuntary inferior and multidirectional instability of the shoulder. A preliminary report. J Bone and Joint Surg 62A:897–908

    Google Scholar 

  58. Neer CS II (1985) Involuntary inferior and multidirectional instability of the shoulder etiology, recognition, and treatment. In: Instructioal Course Lectures. The American Academy of Orthopaedic Surgeons. Park Ridge, Illinois Vol. 34, pp 232–238

    Google Scholar 

  59. Neer CS II (1990) Shoulder Reconstruction, WB Saunders, Philadelphia, pp 273–341

    Google Scholar 

  60. Oettl G, Imhoff AB, Merl T, Keydel M (1998) Physical examination. MRI, MRA and Arthroscopy of SLAP-Lesions - a prospective comparison. 8th Congress of the European Society of Sports Traumatology. Knee Surgey and Arthroscopy (ESSKA) April 29-May 2, 1998, Nizza/France, p 422

    Google Scholar 

  61. Resch H, Povacz P, Wambacher M, Sperner G, Golser K (1997) Arthroscopic extraarticular Bankart repair for the treatment of recurrent anterior shoulder dislocation. Arthroscopy 13:188–200

    Article  PubMed  CAS  Google Scholar 

  62. Richardson AB, Jobe FW, Collins HR (1980) The shoulder in competitive swimming. Am J Sports Med 8:159–163

    Article  PubMed  CAS  Google Scholar 

  63. Rockwood CA Jr (1994) Management of patients with multi-directioal instability of the shoulder. Orthop Trans 18:328

    Google Scholar 

  64. Rowe CR, Patel D, Southmayd WW (1978) The Bankart procedure. A long-term end-result study. J Bone and Joint Surg 60-A: 1–16 Jan

    Google Scholar 

  65. Rowe CR, Pierce DS, Clark JG (1973) Voluntary dislocation of the shoulder. A preliminary report on a clinical, electromyographic, and psychiatric study of twenty-six patients. J Bone and Joint Surg 55-A:445–460

    Google Scholar 

  66. Rowe CR, Zarins B (1981) Recurrent transient subluxation of the shoulder. J Bone and Joint Surg Am 63:863–872

    CAS  Google Scholar 

  67. Silliman JF, Hawkins RJ (1993) Classification and physical diagnosis of instability of the shoulder. Clin Orthop 291:7–19

    PubMed  Google Scholar 

  68. Snyder SJ, Karzel RP, Del Pizzo W, Ferkel RD, Friedman MJ (1990) SLAP lesions of the shoulder. Arthroscopy 6:274–279

    Article  PubMed  CAS  Google Scholar 

  69. Speer KP, Deng X, Borrero S, Torzilli PA, Altchek DA, Warren RF (1994) Biomechanical evaluation of a simulated Bankart lesion. J Bone and Joint Surg 76-A:1819–1826

    Google Scholar 

  70. Thabit G III (1994) Laser-assisted capsular shift for treatment of glenohumeral instability. Orthop Spec Ed 3:10–12

    Google Scholar 

  71. Thomas SC, Matsen FA III (1989) An approach to the repair of avulsion of the glenohumeral ligaments in the management of traumatic anterior glenohumeral instability. J Bone and Joint Surg 71-A:506–513

    Google Scholar 

  72. Walch G, Agostini JY, Levigne C, Nové-Josserand L (1995) Recurrent anterior and multidirectional instability of the shoulder. Rev Chir Orthop Reparatrice Appar Mot 81(8):682–690

    PubMed  CAS  Google Scholar 

  73. Walch G, Liotard JP, Boileau P, Noel E (1993) Postero-superior glenoid impingement. Another impingement of the shoulder. J Radiol 74:47–50

    PubMed  CAS  Google Scholar 

  74. Warner JJ, Deng XH, Warren RF, Torzilli PA (1992) Static capsuloligamentous restraints to superior-inferior translation of the glenohumeral joint. A J Sports Med 20:675–685

    Article  CAS  Google Scholar 

  75. Warner JJ, Kann S, Marks P (1994) Arthroscopic repair of combined Bankart and superior labral detachment anterior and posterior lesions: technique and preliminary results. Arthroscopy 10:383–391

    Article  PubMed  CAS  Google Scholar 

  76. Warner JJ, Miller MD, Marks P, Fu FH (1995) Arthroscopic Bankart repair with Suretac device. Part I: clinical observations. Arthroscopy 11:2–13

    Article  PubMed  CAS  Google Scholar 

  77. Warner JJP, Johnson DL, Miller MD, Caborn DNM (1994–1995) The concept of a “selective capsular shift” for anterior-inferior instability of the shoulder. Orthop Trans 18:1183

    Google Scholar 

  78. Warner JJP, Schulte RK, Imhoff AB (1995) Current Concepts in Shoulder Instability. Adv in Operative Orthopaedics, 3:217–248

    Google Scholar 

  79. Welsh RP, Trimmings N (1987) Multidirectional instability of the shoulder. Orthop Trans 11:231

    Google Scholar 

  80. Yamaguchi K, Flatow EL (1995) Management of multidirectional instability. Clin Sports Med 14:885–902

    PubMed  CAS  Google Scholar 

  81. Zuckerman JD, Matsen FA III (1984) Complications about the glenohumeral joint related to the use of screws and staples. J Bone and Joint Surg Am 66:175–180

    CAS  Google Scholar 

Download references

Authors
  1. U. König
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. B. Imhoff
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Abteilung und Poliklinik für Sportorthopädie, TU München, Connollystraße 32, 80809, München, Germany

    Andreas B. Imhoff  & Uwe König  & 

Rights and permissions

Reprints and permissions

Copyright information

© 1999 Springer-Verlag Berlin Heidelberg

About this chapter

Cite this chapter

König, U., Imhoff, A.B. (1999). Multidirektionale Schulterinstabilität. In: Imhoff, A.B., König, U. (eds) Schulterinstabilität — Rotatorenmanschette. Steinkopff, Heidelberg. https://doi.org/10.1007/978-3-642-58711-5_9

Download citation

  • DOI: https://doi.org/10.1007/978-3-642-58711-5_9

  • Publisher Name: Steinkopff, Heidelberg

  • Print ISBN: 978-3-642-63694-3

  • Online ISBN: 978-3-642-58711-5

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics

Search

Navigation