Skip to main content

Advertisement

SpringerLink
Log in

Arthroskopische Neurolyse und Therapie periglenoidaler Ganglien am Schultergelenk

Arthroscopic nerve release and decompression of ganglion cysts around the shoulder joint

  • Operative Techniken
  • Published:
Operative Orthopädie und Traumatologie Aims and scope Submit manuscript

Zusammenfassung

Operationsziel

Arthroskopische Visualisierung und Dekompression von Nervenstrukturen im Bereich des Schultergelenks, Dekompression periglenoidaler Ganglien.

Indikationen

Arthroskopische Therapie klinisch und neurologisch gesicherter Nervenkompressionssyndrome rund um das Schultergelenk (N. suprascapularis, N. axillaris). Arthroskopische Visualisierung und Release von knöchernen und ligamentären Strukturen, welche die Nervenbahnen einengen. Arthroskopische Dekompression und Resektion von periglenoidalen Ganglien. Arthroskopische Rekonstruktion von Begleitläsionen an Labrum, Rotatorenmanschette und Bizepssehne.

Kontraindikationen

Fehlender klinischer und neurologischer Nachweis für ein Nervenkompressionssyndrom, fehlende Voraussetzungen für einen komplexen arthroskopischen Eingriff (Visualisierungstechnik, Instrumentarium, Kenntnisse der speziellen Neuroanatomie).

Operationstechnik

Diagnostische Arthroskopie, Dekompression, ggf. Resektion eines Ganglions. Visualisierung und ggf. spezifische Dekompression des komprimierten Nervenasts und Adressieren von Begleitpathologien.

Weiterbehandlung

Ruhigstellung am Operationstag in Orthese. Beschwerdeadaptierte aktiv-assistierte und aktive Mobilisierung beginnend am 1. postoperativen Tag. Manuelle Lymphdrainage ab dem 1. postoperativen Tag. Je nach Therapie von Begleitpathologien ggf. Orthese für ca. 4 Wochen. Spezifisch an die Rekonstruktion der Begleitläsion angepasste Rehabilitation.

Abstract

Objective

Arthroscopic visualisation and release of nerves around the shoulder, decompression of ganglion cysts.

Indications

Arthroscopic treatment of nerve entrapment syndromes around the shoulder (suprascapular nerve, axillary nerve). Arthroscopic visualisation and release of osseous or ligamentous structures causing nerve entrapment. Arthroscopic decompression and resection of periglenoid ganglion cysts. Arthroscopic release of concomitant lesions (labrum, rotator cuff, biceps).

Contraindications

No clinical or neurological evidence for nerve entrapment syndrome. Lack of conditions for a complex arthroscopic procedure (technique of visualisation, instrumentation, knowledge of specific neuroanatomy).

Surgical technique

Diagnostic arthroscopy, decompression/resection of ganglion cyst. Visualisation and decompression of nerve. Detection and fixation of concomitant pathologies.

Postoperative treatment

Immobilisation in sling during the day after the operation. Actively assisted and active mobilisation of shoulder controlled by discomfort level. Manual lymph drainage starting on postoperative day 1. Sling and further rehabilitation according to treatment of concomitant lesions.

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

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5
Abb. 6
Abb. 7
Abb. 8
Abb. 9
Abb. 10
Abb. 11

Literatur

  1. Asami A, Sonohata M, Morisawa K (2000) Bilateral suprascapular nerve entrapment syndrome associated with rotator cuff tear. J Shoulder Elbow Surg 9:70–72

    Article  CAS  PubMed  Google Scholar 

  2. Ball CM, Steger T, Galatz LM, Yamaguchi K (2003) The posterior branch of the axillary nerve: an anatomic study. J Bone Joint Surg Am 85-A:1497–1501

  3. Bigliani LU, Dalsey RM, McCann PD, April EW (1990) An anatomical study of the suprascapular nerve. Arthroscopy 6:301–305

    Article  CAS  PubMed  Google Scholar 

  4. Costouros JG, Porramatikul M, Lie DT, Warner JJ (2007) Reversal of suprascapular neuropathy following arthroscopic repair of massive supraspinatus and infraspinatus rotator cuff tears. Arthroscopy 23:1152–1161

    Article  PubMed  Google Scholar 

  5. Francel TJ, Dellon AL, Campbell JN (1991) Quadrilateral space syndrom: diagnosis and operative decompression technique. Plast Reconstr Surg 87:911–916

    Article  CAS  PubMed  Google Scholar 

  6. Ghodarra N, Nho SJ, Verma NN et al (2009) Arthroscopic decompression of the suprascapular nerve at the spinoglenoid notch and suprascapular notch through the subacromial space. Arthroscopy 25:439–445

    Article  Google Scholar 

  7. Gerber C, Yian EH, Pfirrmann CA et al (2005) Subscapularis muscle function and structure after total shoulder replacement with lesser tuberosity osteotomy and repair. J Bone Joint Surg Am 87A:1739–1745

    Article  Google Scholar 

  8. Hosseini H, Agneskirchner JD, Tröger M, Lobenhoffer P (2007) Arthroscopic release of the superior transverse ligament and SLAP refixation in case of suprascapular nerve entrapment: a case report. Arthroscopy 23:1134

    Article  PubMed  Google Scholar 

  9. Lafosse L, Tomasi A, Corbett S et al (2007) Arthroscopic release of suprascapular nerve entrapment at the suprascapular notch: technique and preliminary results. Arthroscopy 23:34–42

    Article  PubMed  Google Scholar 

  10. Lichtenberg S, Magosch P, Habermeyer P (2004) Compression of the suprascapular nerve by a ganglion cyst of the spinoglenoid notch: the arthroscopic solution. Knee Surg Sports Traumatol Arthrosc 12:72–79

    Article  PubMed  Google Scholar 

  11. McCann PD, Cordasco FA, Ticker JB et al (1994) An anatomic study of the subscapular nerves: a guide for electromyographic analysis of the subscapularis muscle. J Shoulder Elbow Surg 3:94–99

    Article  CAS  PubMed  Google Scholar 

  12. McFarland EG, Caicedo JC, Guitterez MI et al (2001) The anatomic relationship of the brachial plexus and axillary artery to the glenoid. Implications for anterior shoulder surgery. Am J Sports Med 29:729–733

    CAS  PubMed  Google Scholar 

  13. Millett PJ, Barton RS, IVAN HP, Gobezie R (2006) Suprascapular nerve entrapment: technique for arthroscopic release. Tech Shoulder Elbow Surg 7:89–94

    Article  Google Scholar 

  14. Price MR, Tillett ED, Acland RD, Nettleton GS (2004) Determining the relationship of the axillary nerve to the shoulder joint capsule from an arthroscopic perspective. J Bone Joint Surg Am 86-A:2135–2142

  15. Rengachary SS, Burr D, Lucas S, Bracket CE (1979) Suprascapular entrapment neuropathy: a clinical, anatomical, and comparative study. Part 3: comparative study. Neurosurgery 5:452–455

    Article  CAS  PubMed  Google Scholar 

  16. Robinson P, White LM, Lax M et al (2007) Quadrilateral space syndrome caused by glenoid labral cyst. AJR Am J Roentgenol 175:1103–1105

    Article  Google Scholar 

  17. Scheibel M, Tsynman A, Magosch P et al (2006) Postoperative subscapularis muscle insufficiency after primary and revision open shoulder stabilization. Am J Sports Med 34:1586–1593

    Article  PubMed  Google Scholar 

  18. Scheibel M, Nikulka C, Dick A et al (2007) Structural integrity and clinical function of the subscapularis musculotendinous unit after arthroscopic and open shoulder stabilization. Am J Sports Med 35:1153–1161

    Article  PubMed  Google Scholar 

  19. Schroder CP, Skare O, Stiris M et al (2008) Treatment of labral tears with associated spinoglenoid cysts without cyst decompression. J Bone Joint Surg Am 90:523–530

    Article  PubMed  Google Scholar 

  20. Tubbs RS, Loukas M, Shahid K et al (2007) Anatomy and quantitation of the subscapular nerves. Clin Anat 20:656–659

    Article  PubMed  Google Scholar 

  21. Warner JP, Krushell RJ, Masquelet A, Gerber C (1992) Anatomy and relationships of the suprascapular nerve: Anatomical constraints to mobilization of the supraspinatus and infraspinatus muscles in the management of massive rotator-cuff tears. J Bone Joint Surg Am 74:36–45

    CAS  PubMed  Google Scholar 

  22. Werner C, Nagy L, Gerber C (2007) Combined intra- and extra-articular arthroscopic treatment of entrapment neuropathy of the infraspinatus branches of the suprascapular nerve caused by periglenoidal ganglion cyst. Arthroscopy 23:328.e1–328.e3

    Article  PubMed  Google Scholar 

  23. Zehetgruber H, Noske H, Lang T, Wurnig C (2002) Suprascapular nerve entrapment. A meta-analysis. Int Orthop 26:339–343

    Article  PubMed Central  PubMed  Google Scholar 

Download references

Einhaltung ethischer Richtlinien

Interessenkonflikt. J.D. Agneskirchner und L. Lafosse besitzen einen Beratervertrag mit der Fa. Depuy Synthes. M. Haag gibt an, dass kein Interessenkonflikt besteht. Alle im vorliegenden Manuskript beschriebenen Untersuchungen am Menschen wurden mit Zustimmung der zuständigen Ethik-Kommission, im Einklang mit nationalem Recht sowie gemäß der Deklaration von Helsinki von 1975 (in der aktuellen, überarbeiteten Fassung) durchgeführt. Von allen beteiligten Patienten liegt eine Einverständniserklärung vor. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

Author information

Authors and Affiliations

  1. Sportclinic Germany, Uhlemeyerstr. 16, 30175, Hannover, Deutschland

    J.D. Agneskirchner

  2. Praxisklinik Fellbach, Fellbach, Deutschland

    M. Haag

  3. Alps Surgery Institute, Clinique Generale, Annecy, Frankreich

    L. Lafosse

Authors
  1. J.D. Agneskirchner
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. Haag
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. L. Lafosse
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to J.D. Agneskirchner.

Additional information

Die elektronische Version dieses Beitrags (zu finden unter dx.doi.org/10.007/s00064-013-0278-8) enthält als „Supplementary Material“ zusätzliche Videos zur Dekompression des N. suprascapularis und zur Dekompression des N. axillaris.

Zusatzmaterial online

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Agneskirchner, J., Haag, M. & Lafosse, L. Arthroskopische Neurolyse und Therapie periglenoidaler Ganglien am Schultergelenk. Oper Orthop Traumatol 26, 277–287 (2014). https://doi.org/10.1007/s00064-013-0278-8

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00064-013-0278-8

Schlüsselwörter

Keywords

Search

Navigation