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Das ABC der posterioren Schulterstabilisierung

The ABC guide for the treatment of posterior shoulder instability

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Zusammenfassung

Hintergrund

Die posteriore glenohumerale Instabilität (PGHI) wird aufgrund der vielfältigen klinischen Manifestationen häufig nicht erkannt oder fehldiagnostiziert. Eine umfassende und therapierelevante Einteilung der verschiedenen Typen der PGHI ist bisher nicht etabliert.

Klassifikation

Um die Diagnose und Therapiefindung zu erleichtern, wurde die ABC-Klassifikation für PGHI unter Berücksichtigung der zugrunde liegenden pathomechanischen Prinzipien sowie der gegenwärtigen Behandlungsstandards geschaffen. Aufgrund der Art der Instabilität werden 3 Hauptgruppen unterteilt: A (erstmalig), B (dynamisch), C (statisch). Auf Basis der spezifischen pathomechanischen Ursache der Instabilität werden die Hauptgruppen in je 2 Subtypen unterteilt, welche eine Richtlinie für die Therapiefindung darstellen: A1 – Subluxation, A2 – Dislokation; B1 – funktionell, B2 – strukturell; C1 – konstitutionell, C2 – erworben.

Therapie

Während ein konservativer Therapieversuch bei den meisten Patienten mit einer PGHI vom Typ 1 (A1, B1, C1) empfehlenswert ist, sollte bei Patienten mit einer PGHI vom Typ 2 (A2, B2, C2) eine chirurgische Intervention auf individueller Basis erwogen werden, wobei zu bedenken ist, dass die verschiedenen Gruppen und Subtypen sich überlappen, koexistieren oder im Verlauf der Zeit ineinander übergehen können. Natürlich hängt die Notwendigkeit einer chirurgischen Intervention vom Ausmaß der strukturellen Schäden, der Schwere der Symptome, der Chronizität sowie dem funktionellen Anspruch, Alter und allgemeinen Gesundheitszustand des Patienten ab. Dennoch stellt die ABC-Klassifikation ein Hilfsmittel zur korrekten Diagnose- und Therapiefindung bei PGHI dar.

Abstract

Background

Posterior glenohumeral instability (PGHI) is an often unrecognized or misdiagnosed type of shoulder instability due to its heterogenic clinical and radiological presentation.

Classification

The ABC classification for PGHI is based on the different pathomechanisms and recommended treatment standards and is therefore a guide to finding the correct diagnosis and therapy for affected patients. There are different types of PGHI: A (first time), B (dynamic), C (static). These groups are further classified based on pathomechanical principles: A1: subluxation, A2: dislocation; B1: functional, B2: structural; C1: constitutional, C2: acquired.

Therapy

In patients with type 1 PGHI (A1, B1, C1) conservative treatment is recommended while in patients with type 2 PGHI (A2, B2, C2) surgical treatment can be considered based on structural defects, clinical symptoms, chronicity, age, functional demand, and patient-specific health status. In addition it has to be considered, that there is the possibility of coexisting or overlapping subtypes as well as the chance of progression from one category into another over time.

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Abbreviations

AGHI:

Anteriore glenohumerale Schulterinstabilität

CT:

Computertomographie

HAGL:

Humerale Avulsion des glenohumeralen Ligaments

MRT:

Magnetresonanztomographie

PGHI:

Posteriore glenohumerale Instabilität

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Authors and Affiliations

  1. Abteilung für Schulter- und Ellenbogenchirurgie, Centrum für Muskuloskeletale Chirurgie, Charité – Universitätsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, 13353, Berlin, Deutschland

    P. Moroder, V. Danzinger, M. Minkus & M. Scheibel

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  1. P. Moroder
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  2. V. Danzinger
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  3. M. Minkus
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  4. M. Scheibel
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Correspondence to P. Moroder.

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Interessenkonflikt

M. Scheibel und P. Moroder sind Berater der Firma Arthrex. V. Danzinger und M. Minkus geben an, dass kein Interessenkonflikt besteht.

Sämtliche ethischen Richtlinien wurden bei der Erstellung dieses Manuskriptes eingehalten. Alle Patienten, die über Bildmaterial oder anderweitige Angaben innerhalb des Manuskripts zu identifizieren sind, haben hierzu ihre schriftliche Einwilligung gegeben.

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Moroder, P., Danzinger, V., Minkus, M. et al. Das ABC der posterioren Schulterstabilisierung. Orthopäde 47, 139–147 (2018). https://doi.org/10.1007/s00132-017-3513-4

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