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Risikofaktoren für Rotatorenmanschettenrupturen bei Paraplegikern

Eine Querschnittstudie

Risk factors for the development of rotator cuff tears in individuals with paraplegia

A cross-sectional study

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Zusammenfassung

Fragestellung

Rollstuhlpatienten leiden sehr häufig an Schulterbeschwerden und Rotatorenmanschettenrupturen. Ziel dieser Studie war die Erfassung der spezifischen Risikofaktoren für die Entstehung der Rotatorenmanschettenruptur bei paraplegischen Patienten.

Methoden

In diese Querschnittstudie (Evidenzlevel III) wurden 217 Paraplegiker mit kompletter Rollstuhlabhängigkeit eingeschlossen. Das Durchschnittsalter der Studienpopulation betrug 47,9 Jahre. Die durchschnittliche Dauer der Rollstuhlabhängigkeit betrug 24,1 Jahre. Bei allen Patienten der Studie erfolgte eine Erfassung möglicher Risikofaktoren für die Entstehung von Rotatorenmanschettenrupturen, eine standardisierte klinische Untersuchung, die Erhebung des Constant-Murley-Scores und eine MRT beider Schultergelenke.

Ergebnis

Bei 93 von 217 Paraplegikern (42,9 %) fand sich in der MRT-Untersuchung mindestens eine Ruptur an einem Muskel der Rotatorenmanschette. Multiple logistische Regressionsanalysen zeigten eine Assoziation folgender Risikofaktoren mit dem Vorkommen einer Rotatorenmanschettenruptur: höheres Alter, längere Lähmungsdauer, weibliches Geschlecht und höhere sportliche Aktivität. Weder BMI noch das Lähmungsniveau stellen in der untersuchten Studienpopulation Risikofaktoren dar. Die statistische Analyse ergab eine Odds-Ratio von 1,11 für das Alter, was eine Risikosteigerung für die Entwicklung einer Rotatorenmanschettenruptur um 11 % für jedes weitere Lebensjahr bedeutet. Des Weiteren zeigt die Analyse eine Odds-Ratio von 1,06 für die Lähmungsdauer, was wiederum eine Risikosteigerung der Entwicklung einer Rotatorenmanschettenruptur um 6 % für jedes folgende Jahr der Rollstuhlabhängigkeit bedeutet. Weibliche Studienteilnehmer haben im Vergleich zu Männern ein 2,6fach höheres Risiko, eine Rotatorenmanschettenruptur zu entwickeln. Sportliche Rollstuhlaktivität steigert das Risiko der Entwicklung einer Rotatorenmanschettenruptur um den Faktor 2,3.

Diskussion

Es zeigt sich eine hohe Prävalenz der Rotatorenmanschettenruptur bei rollstuhlabhängigen Paraplegikern. Risikofaktoren wie Alter, Geschlecht, Lähmungsdauer und regelmäßiger Rollstuhlsport können eine entscheidende Rolle bei der Entwicklung der Rotatorenmanschettenruptur spielen.

Abstract

Question

Shoulder pain and rotator cuff tears are highly prevalent among wheelchair dependent individuals with paraplegia. The purpose of this study was to identify potential risk factors associated with the development of rotator cuff tears in this population.

Methods

A total of 217 wheelchair dependent individuals with paraplegia were included in this cross-sectional study (level of evidence III). The mean age of this population was 47.9 years and the mean duration of wheelchair dependence was 24.1 years. Each individual was asked to complete a questionnaire designed to identify risk factors for rotator cuff tears and underwent a standardized clinical examination with the documentation of the Constant-Murley shoulder outcome score and magnetic resonance imaging (MRI) of both shoulder joints.

Results

MRI analysis revealed at least one rotator cuff tear in 93 patients (43%). Multiple logistic regression analysis identified the following factors to be associated with the presence of rotator cuff tear: patient age, duration of spinal cord injury/wheelchair dependence, gender, and wheelchair athletic activity. Neither BMI nor the level of spinal cord injury was found to pose a risk factor in the population studied. With respect to patient age, the risk of developing a rotator cuff tear increased by 11% per annum. In terms of duration of spinal cord injury, the analysis revealed a 6% increased risk per year of wheelchair dependence (OR = 1.06). Females had a 2.6-fold higher risk of developing rotator cuff tears than males and wheelchair sport activity increased the risk 2.3-fold.

Discussion

There is a high prevalence of rotator cuff tears in wheel-chair dependent persons with paraplegia. Risk factors such as age, gender, duration of paraplegia, and wheel chair sport activity seem to play an important role in the development of rotator cuff tears.

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Abb. 1

Abbreviations

BMI:

Body-Mass-Index

DASH:

„Disabilities of the arm, shoulder and hand“

HWS:

Halswirbelsäule

NPP:

Nucleus-pulposus-Prolaps

RMR:

Rotatorenmanschettenruptur

SCIM:

Spinal Cord Independence Measure

WUSPI:

Wheelchair User’s Shoulder Pain Index

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Förderung

Die Studie wurde von der Deutschen Gesetzlichen Unfallversicherung (DGUV) finanziell unterstützt.

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Authors and Affiliations

  1. Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200A, 69118, Heidelberg, Deutschland

    W. Pepke, M. Brunner, R. Abel, H. Almansour, F. Zeifang, Y. Kentar &  M. Akbar

  2. Institut für Medizinische Biometrie und Informatik, Universität Heidelberg, Heidelberg, Deutschland

    T. Bruckner

  3. Klinik für Paraplegiologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland

    H. J. Gerner & A. Hug

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  1. W. Pepke
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  2. M. Brunner
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  3. R. Abel
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  5. H. J. Gerner
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  6. A. Hug
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  7. F. Zeifang
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  8. Y. Kentar
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  9. T. Bruckner
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  10. M. Akbar
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Corresponding author

Correspondence to M. Akbar.

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Interessenkonflikt

W. Pepke, M. Brunner, R. Abel, H. Almansour, H. J. Gerner, A. Hug, F. Zeifang, Y. Kentar, T. Bruckner und M. Akbar geben an, dass kein Interessenkonflikt besteht.

Alle 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.

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Pepke, W., Brunner, M., Abel, R. et al. Risikofaktoren für Rotatorenmanschettenrupturen bei Paraplegikern. Orthopäde 47, 561–566 (2018). https://doi.org/10.1007/s00132-018-3546-3

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