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Das subakromiale Impingementsyndrom

Ätiologie, Klassifikation und arthroskopische subakromiale Dekompression

  • Leitthema
  • Published:
Arthroskopie Aims and scope

Zusammenfassung

Die Ursachen einer klinischen Impingementsymptomatik können vielfältig sein, und vor einer undifferenzierten Anwendung der Akromioplastik kann nur gewarnt werden. Der Operateur sollte alle Erscheinungsformen funktioneller und sekundärer Impingementsyndrome kennen und mittels bildgebender, klinischer und schließlich arthroskopischer Diagnostik differenzieren. Nur die Kenntnis und Berücksichtigung der vielfältigen Schulterpathologien ermöglichen es, geeignete Patienten zur Akromioplastik zu finden oder andere Behandlungen durchzuführen.

Die subakromiale Dekompression ist heute in arthroskopischer Technik ein Routineverfahren, das der offenen Durchführung aufgrund der geringeren Traumatisierung eindeutig überlegen ist. Eine Voraussetzung ist die technische Fähigkeit des Operateurs, den Eingriff arthroskopisch adäquat durchzuführen, eine weitere, sehr wichtige Bedingung ist allerdings eine korrekte Indikationsstellung, d. h. das Vorliegen eines Outletimpingements.

Abstract

The causes of clinical impingement symptoms can be multifaceted and caution is warranted before performing undifferentiated acromioplasty. The surgeon should know all manifestations of functional and secondary impingement syndromes and distinguish them by imaging techniques, clinical diagnosis, and arthroscopy. Only the knowledge and consideration of the various shoulder pathologies make it possible to recognize patients suited for acromioplasty or to implement other treatment modalities.

Subacromial decompression as an arthroscopic technique has now become a routine procedure, which is far superior to an open approach because it is less traumatic. Prerequisite is an adequate technical ability of the surgeon to perform the arthroscopic intervention. Another, very important requirement is that the indication is indeed correct, i.e., presence of an outlet impingement has been verified.

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Literatur

  1. Altcheck DW, Warren RF, Wickiewicz TL, Skyhar MJ, Oritz G, Schwarz E (1990) Arthroscopic acromioplasty. J Bone Joint Surg (Am) 72:1198–1207

    Google Scholar 

  2. Aoki M, Ishi J, Usui M (1986) The slope of the acromion and rotator cuff impingement. Orthop Trans 10:228–231

    Google Scholar 

  3. Armstrong JR (1949) Excision of the acromion and treatment of the supraspinatus syndrome. Report of ninety-five excisions. J Bone Joint Surg (Br) 31:436–442

    Google Scholar 

  4. Barthel T, Gohlke F, Gandorfer A, Eulert J (1995) Die Akromionmorphologie und ihre Darstellbarkeit in der Supraspinatustunnelaufnahme. Arthroskopie 8/5:218–223

    Google Scholar 

  5. Biedert R, Kentsch A (1989) Arthroskopische Revision des subacromialen Raumes beim Impingementsyndrom. Unfallchirurg 92: 500–504

    CAS  PubMed  Google Scholar 

  6. Bigliani LU, Morrison DS, April EW (1986) The morphology of the acromion and rotator cuff impingernent. Orthop Trans 10:228–233

    Google Scholar 

  7. Bigliani LU (1991) Impingement syndrome: etiology and overview. In: Watson MS (ed) Surgical disorders of the shoulder. Churchill Livingstone, New York, pp 237–245

  8. Bigliani LU, D'Alessandro DF, Duvalde XA, Mcllveen SJ (1989) Anterior acromioplasty for subacromial impingement in patients younger than 40 years of age. Clin Orthop 248:111–115

    Google Scholar 

  9. Bigliani LU, Norris TR, Fischer J, Neer CS (1983) The relationship between the unfused acromial epiphysis and subacromial impingement lesions. Orthop Trans 7:138–143

    Google Scholar 

  10. Codman EA (1911) On stiff and painful shoulders, as explained by subacromial bursitis and partial rupture of the tendon of the supraspinatus. Boston Med Surg J 4:115–120

    Google Scholar 

  11. Codman EA (1934) The shoulder. Rupture of the supraspinatus tendon and other lesions in or about the subacromial bursa. Tod, Boston

  12. Cofield RH (1985) Current concept review: rotator cuff disease of the shoulder. J Bone Joint Surg (Am) 67:974–979

    Google Scholar 

  13. Cotton RE, Rideout DF (1984) Tears of the humeral rotator cuff. A radiological and pathological necropsy survey. J Bone Joint Surg (Br) 48:314–319

    Google Scholar 

  14. DePalma AF (1973) Surgery of the shoulder, 2. edn. Lippincott, Philadelphia

  15. Desplates H (1878) De l'atrophie musculaire dans la péri-arthrite scapulo humérale. G Hebdorn Méd Chir 24:371

  16. Drillings G, Nuber G, Swartz S (1991) Stain measurements of the undersurface of the acromion (paper 387). Scientific Program of the 58th Annual Meeting of the American Academy of Orthopaedic Surgeons, Anaheim, Ca., pp 237–241

  17. Duplay S (1872) De la périarthrite scapulo-humérale et de raindeurs de l'épaule qui en sont la conséquence. Arch Gn Med 11:513–542

    Google Scholar 

  18. Duron EA (1873) Essai sur la scapulalgie

  19. Ellman H, Hauker G, Bayer M (1988) Repair of the rotator cuff. End-result stuy of factor influencing reconstruction. J Bone Joint Surg (Am) 68:1138–1144

    Google Scholar 

  20. Ellman H (1987) Arthroscopic subacromial decompression. Analysis of one to three year results. J Arthros Relat Surg 3:173–181

    CAS  Google Scholar 

  21. Ellman H, Kay SP (1991) Arthroscopic subacromial decompression for chronic impingement. J Bone Joint Surg (Br) 73:395–398

    Google Scholar 

  22. Ellman H, Kay SP (1989) Arthroscopic subacromial decompression: new techniques and results. American Academy of Orthopedic Surgeons, 56th Annual Meeting, Las Vegas, USA

    Google Scholar 

  23. Ellman H (1985) Arthroscopic subacromial decompression. A preliminary report. Orthop Trans 9:49

    Google Scholar 

  24. Fischer BW, Gross RM, McCarthy JA, Arroyo JS (1999) Incidence of acromiosclavicular joint compliacations after arthroscopic subacromial decompression. J Arthros Relat Surg 3:241–248

    Google Scholar 

  25. Flatow EL, Rodoski MW, Yamaguchi K, Self EB, Pollock RG, Bigliani LU (1996) Coracoacromial preservation in rotatory cuff surgery. J Shoulder Elbow Surg 5:242

    Google Scholar 

  26. Fu FH, Harner CD, Klein AH (1991) Shoulder impingement syndrome. A critical review. Clin Orthop 269:162–173

    PubMed  Google Scholar 

  27. Gartsman GM (1990) Arthroscopic acromioplasty for lesions of the rotator cuff. J Bone Joint Surg (Am) 72:169–180

    Google Scholar 

  28. Gartsman GM, Blair MJ, Noble PC, Benett JB, Tullos HS (1988) Arthroscopic subacromial decompression. An anatomical study. Am J Sports Med 16:48–50

    CAS  PubMed  Google Scholar 

  29. Gerber CH, Terrier T, Ganz R (1985) The role of the coracoid process in the chronic impingement syndrome. J Bone Joint Surg (Br) 67:703–708

    Google Scholar 

  30. Glousman RE (1993) Instability versus impingement syndrome in the trowing athlete. Orthop Clin North Am 24:89–99

    CAS  PubMed  Google Scholar 

  31. Gohlke F, Janssen E, Leidel J, Heppelmann B, Eulert J (1989) Histomorphologische Befunde zur Propriozeption am Schultergelenk. Orthopäde 8/98:510–516

  32. Gohlke F, Müller T, Janssen E, Leidel J, Schmitz F, Messlinger K, Eulert J (1996) Distribution and morphology of mechanoreceptors in the shoulder joint. J Shoulder Elbow Surg 5:104

    Google Scholar 

  33. Golding FC (1962) The shoulder: the forgotten joint. Br J Radiol 35:149–154

    CAS  Google Scholar 

  34. Grant JCB (1940) The upper limb. In: A method of anatomy, 2nd edn. Willliams & Wilkins, Baltimore, pp 72–76

  35. Ha'eri GB, Orth MC, Wiley AM (1982) Shoulder impingement syndrome. Clin Orthop 168:128–132

    PubMed  Google Scholar 

  36. Hamada K, Fukuda H, Mikasa M, Kobayashi Y (1990) Roentgenographic findings in massive rotator cuff tears: a long term observation. Clin Orthop 254:92–96

    PubMed  Google Scholar 

  37. Hammond G (1962) Comptete acromionectomy in the treatment of chronic tendinitis of the shoulder. J Bone Joint Surg (Am) 44:494–504

    Google Scholar 

  38. Hawkins RJ, Brock RM, Abrams JS, Hobeika P (1988) Acromioplasty for impingement with an intact rotator cuff. J Bone Joint Surg (Br) 70:795–797

    Google Scholar 

  39. Hawkins RJ, Kennedy JC (1980) Impingement syndrome in athletes. Am J Sports Med 8:151–158

    CAS  PubMed  Google Scholar 

  40. Hutchinson MR, Veenstra MA (1993) Arthroscopic decompression of shoulder impingement secondary to os acromiale. Arthroscopy 9:28–32

    CAS  PubMed  Google Scholar 

  41. Ide K, Shirai Y, Ito H (1996) Sensory nerve supply in the human subacromial bursa. J Shoulder Elbow Surg 5:371–382

    CAS  PubMed  Google Scholar 

  42. Jarjavay JF (1867) Sur la luxation du tendon de la longue portion du muscle biceps humeral; sur la luxation des tendons des muscle peroniers latéraux. G Hebdom Med Chir 21:325

    Google Scholar 

  43. Jerosch J, Castro WHM, Sons HU, Moersler M (1989) Zur Ätiologie des subacromialen Impingement-Syndroms: Eine biomechanische Untersuchung. Beitr Orthop Traumatol 36:411–418

    CAS  PubMed  Google Scholar 

  44. Jerosch J, Castro WHM, Zauder F (1993) Intramuskulärer Druck des M. supraspinatus in Abhängigkeit von der Gelenkstellung. Orthop Prax 29:100–104

    Google Scholar 

  45. Jerosch J (1990) Einfluss der Gelenkmobilität auf die Ergebnisse der transarthroskopischen subacromialen Dekompression. Arthroskopie 3:146–152

    Google Scholar 

  46. Jerosch J, Steinbeck J, Strauss JM, Schneider T (1994) Arthroskopische subacromiale Dekompression—Indikation beim Os acromiale? Unfallchirurg 97:69–73

    CAS  PubMed  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 impingement. Orthop Rev 18:963–975

    CAS  PubMed  Google Scholar 

  48. Jobe FW (1989) Impingement problems in the athlete. Instr Course Lect 38:205–209

    CAS  PubMed  Google Scholar 

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

    CAS  PubMed  Google Scholar 

  50. Kessel L, Watson M (1977) The painful arc syndrome. Clinical classification as a guide to management. J Bone Joint Surg (Br) 59/2:166–172

    Google Scholar 

  51. Klein W, Dann P, Hillen R, Jensen KU (1991) Die endoskopische subacromiale Dekompression. Arthroskopie 4:89–97

    Google Scholar 

  52. Koydl P (1983) Druckkräfte im Schulterdach bei Abduktlon des Armes—eine experimentelle Studie. Z Orthop 121:389–390

    Google Scholar 

  53. Lieberson E (1937) Os acromiale... a contested anomaly. J Bone Joint Surg (Am) 19:683–689

    Google Scholar 

  54. McLaughlin HL (1944) Lesions of the musculotendineous cuff of the shoulder. The exposure and treatment of tears with retraction. J Bone Joint Surg 26:31–51

    Google Scholar 

  55. Morisawa A, Sadahiro T, Yamamoto H (1992) Mechanoreceptors in the coracoacromial ligament—a study of its morphology and distribution. Acta Orthop Scand 63 [suppl] 247:22

    Google Scholar 

  56. Morisawa A, Sadahiro T, Kawakami T, Yamamoto H (1996) A study on the mechanoreceptors in the ortator cuff, the subacromial bursa and the coracoacromial ligament—morphology and distribution. J Shoulder Elbow Surg 5/2:54

    Google Scholar 

  57. Mudge MK, Wood VE, Feykman OK (1984) Rotator cuff tears associated with os acromiale. J Bone Joint Surg (Am) 66:427–429

    Google Scholar 

  58. Neer CS (1972) Anterior acromioplasty for the chronic impingement syndrome in the shoulder. A preliminary report. J Bone Joint Surg (Am) 54:41–50

    Google Scholar 

  59. Neer CS, Bigliani LU, Hawkins RJ (1977) Ruptures of the long head of the biceps related to subacromial impingement. Orthop Trans 1:111–116

    Google Scholar 

  60. Neer CS (1990) Shoulderreconstruction. Saunders, Philadelphia, p 97

  61. Neer CS (1983) Impingement lesions. Clin Orthop 173:70–77

    PubMed  Google Scholar 

  62. Neviaser RJ, Neviaser TJ (1990) Observation on impingement. Clin Orthop 254:60–63

    PubMed  Google Scholar 

  63. Nirschl RP (1989) Rotator cuff tendinitis: basic concepts of pathoetiology. Instr Course Lect 38:439–445

    CAS  PubMed  Google Scholar 

  64. Ogon P, Habermeyer P (1994) Behandlungskonzept bei Rotatorenmanschettenrupturen. In: Jürgens C, Hertel P, Wolter D (Hrsg) Arthroskopische Chirurgie im Schulter- und Kniegelenksbereich. Springer, Berlin Heidelberg New York, S 68–75

  65. Painter CF (1907) Subdeltoid bursitis. Boston Med Surg J 156:345–349

    Google Scholar 

  66. Patte D (1990) The subcoracoid impingement. Clin Orthop 254:55–59

    PubMed  Google Scholar 

  67. Pedersen HE, Key JA (1951) Pathology of calcareous tendinitis and subdeltoid bursitis. Arch Surg 62:50–63

    Google Scholar 

  68. Petersson CJ, Gentz CF (1983) Ruptures of the supraspinatus tendon. The significance of distally pointing acromioclavicular osteophytes. Clin Orthop 174:143–148

    PubMed  Google Scholar 

  69. Petersson CJ, Redlund-Johnell I (1984) The subacromial space in normal shoulder radiographs. Acta Orthop Scand 55:57–62

    CAS  PubMed  Google Scholar 

  70. Pingaud, Charvot (1879) Scapulalgie. In: Dechambre (ed) Dictionaire encyclopédique des sciences médicales, vol II, Paris, p 232

  71. Post M, Cohen J (1986) Impingement syndrome. Clin Orthop 207:126–132

    PubMed  Google Scholar 

  72. Post M, Cohen J (1985) Impingement syndrome: a review of late stage II and early stage III lesions. Orthop Trans 9:48–50

    Google Scholar 

  73. Pujadas GM (1964) Coraco-acromial ligament syndrome. J Bone Joint Surg (Am) 52:1261–1262

    Google Scholar 

  74. Raggio CC, Warren RF, Sculco T (1985) Surgical treatment of impingement syndrome: 4 year follow up. Orthop Trans 9:48–49

    Google Scholar 

  75. Rathburn JB, Macnab I (1970) The microvascular pattern of the rotator cuff. J Bone Joint Surg (Br) 52:540–553

    Google Scholar 

  76. Refior HJ, Tempka A, Stauch E (1984) Autoptische Untersuchungen zur Makro- und Mikromorphologie der Rotatorenmanschette. In: Reichelt A (Hrsg) Periartikuläre Schultererkrankungen. Buchreihe für Orthopädie und orthopädische Grenzgebiete, Bd 8, S 26–28

  77. Reichelt A (1985) Die Rotatorenmanschettenruptur. Operative Ergebnisse in Abhängigkeit vom Zugang. Z Orthop 123:38–43

    CAS  PubMed  Google Scholar 

  78. Reichelt A (1993) Sog. Periarthritis humeroscapularis im engeren Sinne. In: Reichelt A (Hrsg) Orthopädie. Enke, Stuttgart, S 267–271

  79. Rockwood jr CA, Lyons FR (1993) Shoulder impingement syndrome, diagnosis, radiographic evaluation, and treatment with a modified Neer acromioplasty. J Bone Joint Surg (Am) 75:409–424

    Google Scholar 

  80. Skruodies B, Kölbel R (1987) Operative Dekompression am Fornix humeri. Vergleich zweier Verfahren: Ligamentresektion und vordere Akromioplastik nach Neer. Z Orthop 125:644–647

    CAS  PubMed  Google Scholar 

  81. Smith-Petersen MN, Aufranc OE, Larson CB (1943) Useful surgical procedures for rheumatoid arthritis involving joints of upper extremity. Arch Surg 46:764–770

    Google Scholar 

  82. Stieda A (1908) Zur Pathologie der Schultergelenkschleimbeutel. Arch Klein Chir 85:910–924

    Google Scholar 

  83. Tibone JE, Jobe FW, Kerlan RK, Carter VS (1985) Shoulder impingement syndrome in athletes treated by an anterior acromioplasty. Clin Orthop 198:134–140

    PubMed  Google Scholar 

  84. Tillmann B, Tichy P (1986) Funktionelle Anatomie der Schulter. Unfallchirurg 89:389–397

    CAS  PubMed  Google Scholar 

  85. Uhthoff HK, Hammond DI, Sarker K, Hooper GJ, Papoff WF (1988) The role of the coracoacromial ligament in the impingement syndrorne: a clinical, radiological and histological study. Int Orthop 12:97–104

    CAS  PubMed  Google Scholar 

  86. Walch G, Boileau P, Noel E, Donell ST (1992) Impingement of the deep surface of the supraspinatus tendon on the posterosuperior glenoid rim: an arthroscopic study. J Shoulder Elbow Surg 1:238–245

    Google Scholar 

  87. Watson-Jones R (1960) Fractures and joint injures, 4th edn. WiIliams & Wilkins, Baltimore, pp 449–451

  88. Weiner DS, Macnab I (1970) Superior migration of the humeral head: a radiological aid in the diagnosis of tears of the rotator cuff. J Bone Joint Surg (Br) 52:524–529

    Google Scholar 

  89. Neer CS II (1972) Anterior acromioplasty for the chronic impingement syndrome in the shoulder. J Bone Joint Surg (Am) 54:41–50

    Google Scholar 

  90. Ellman H, Hauker G, Bayer M (1988) Repair of the rotator cuff. End-result study of factor influencing reconstruction. J Bone Joint Surg (Am) 68:1138–1144

    Google Scholar 

  91. Ellman H (1987) Arthroscopic subacromial decompression. Analysis of one to three year results. J Arthros Relat Surg 3:173–181

    CAS  Google Scholar 

  92. Ellmann H, Kay SP (1991) Arthroscopic subacromial decompression for chronic impingement. J Bone Joint Surg (Br) 73:395–398

    Google Scholar 

  93. Ellman H, Kay S (1989) Arthroscopic subacromial decompression: new techniques and results. American Academy of Orthopedic Surgeons, 56th Annual Meeting, Las Vegas, USA, 1989

    Google Scholar 

  94. Ellmann H, Gartsmann GM (1993) Arthroskopic shoulder surgery and related procedures. Lea & Febiger, Philadelphia London

  95. Fischer BW, Gross RM, McCarthy JA, Arroyo JS (1999) Incidence of acromiosclavicular joint complications after arthroscopic subacromial decompression. J Arthros Relat Surg 3:241–248

    Google Scholar 

  96. Gartsman GM (1990) Arthroscopic acromioplasty for lesions of the rotator cuff. J Bone Joint Surg (Am) 72:169–180

    Google Scholar 

  97. Gohlke F, Janssen E, Leidel J, Heppelmann B, Eulert J (1998) Histomorphologische Befunde zur Propriozeption am Schultergelenk. Orthopäde 8:510–516

    Google Scholar 

  98. Imhof AB, Roscher E, König U (1998) Arthroskopische Schulterstabilisierung, differenzierte Behandlungsstrategie mit Suretac, Fastak, Holmium:YAG-Laser und Elektrochirurgie. Orthopäde 8:518–528

    Google Scholar 

  99. Liotard JP, Cochard P, Walch G (1991) Zwei Röntgenzielaufnahmen für den Subacromial vor und nach Akromioplastik. Orthopäde 20:310–314

    Google Scholar 

  100. Morisawa A, Sadahiro T, Yamamoto H (1992) Mechanoreceptors in the coracoacromial ligament—a study of its morphology and distribution. Acta Orthop Scand 63 [suppl] 247:22

    Google Scholar 

  101. Morisawa A, Sadahiro T, Kawakami T, Yamamoto H (1996) A study on the mechanoreceptors in the rotator cuff, the subacromial bursa and the coracoacromial ligament—morphology and distribution. J Shoulder Elbow Surg 5/2:54

    Google Scholar 

  102. Roberts MR, Tasto JP, Hazel M (1997) The effects of acromioclavicular joint stability after arthroscopic co-planing. Specialty Day, Shoulder and Elbow Society, San Francisco, CA

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  1. Sportorthopädische Gemeinschaftspraxis Ogon/Schneider, Freiburg

    P. Ogon

  2. Orthopädisches Spital Speising Gmbh, Wien

    M. Ogon

  3. Sportorthopädische Gemeinschaftspraxis Ogon/Schneider, Kaiser-Joseph-Str. 261, 79098 , Freiburg

    P. Ogon

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Ogon, P., Ogon, M. Das subakromiale Impingementsyndrom . Arthroskopie 16, 158–177 (2003). https://doi.org/10.1007/s00142-003-0229-8

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