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Konservative Therapie der Schulterinstabilität

Conservative treatment of shoulder instability

  • Leitthema
  • Published:
Arthroskopie Aims and scope

Zusammenfassung

Der Erfolg der konservativen und operativen Therapie der Schulterinstabilität hängt neben verschiedenen extrinsischen und intrinsischen Prognosefaktoren von der korrekten Diagnose- und Indikationsstellung ab. Die Indikation zur konservativen Therapie der traumatischen Erstluxation hängt vom Alter, den Funktionsansprüchen und der Compliance des Patienten ab. Bei der posttraumatischen Schulterinstabilität ist die konservative Therapie wenig erfolgversprechend. Hat sich bereits ein pathologisches Bewegungsmuster mit unphysiologischer Muskelrekrutierung eingestellt, empfiehlt es sich, ein physiologisches Bewegungsmuster vor dem operativen Eingriff zu erarbeiten. Die atraumatische Schulterinstabilität kann konservativ behandelt werden. Im Vordergrund stehen die Erarbeitung eines normalen Muskelpatternings und die Koordination der glenohumeralgelenk- und skapulastabilisierenden Muskulatur.

Der Artikel gibt eine Übersicht über die Indikationen und die Therapieprinzipien der konservativen Therapie der Schulterinstabilität sowie der in der Literatur beschriebenen Ergebnisse.

Abstract

Success of conservative treatment of shoulder instability depends on correct diagnosis and indication as well as several factors of prediction. Indications for conservative treatment of primary traumatic dislocation depends on age, functional demand and compliance of the patient. For posttraumatic shoulder instability conservative management is often unsuccessfully. Atraumatic instability of the shoulder can be treated conservatively. A normal musclepatterning and good coordination of glenohumeral and scapula stabilizing muscles should be acquired. A survey of indications, principles of conservative management and results of shoulder instability is given.

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Literatur

  1. Arciero RA (1996) Acute traumatic anterior dislocation of the shoulder. In: Bigliani LU (ed) The unstable shoulder. American Academy Orthopaedic Surgeons, Monograph series, pp 37–45

  2. Aronen JG, Regan K (1984) Decreasing the incidence of recurrence of first-time anterior shoulder dislocations with rehabilitation. Am J Sports Med 12:283–291

    CAS  PubMed  Google Scholar 

  3. Bayley I (2003) The Classification of shoulder instability—new light through old windows. 17th Congress of ESSSE, Heidelberg, Germany

  4. Benedetto KP, Glotzer W (1992) Arthroscopic Bankart procedure by suture technique: indications, technique, and results. Arthroscopy 8(1):111–115

    CAS  PubMed  Google Scholar 

  5. Bigliani LU, Newton PM, Steinmann SP, Connor PM, Mcllveen S (1998) Glenoid rim lesions associated with recurrent anterior dislocation of the shoulder. Am J Sports Med 26:41–45

    CAS  PubMed  Google Scholar 

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

    Google Scholar 

  7. Burkhart SS, De Beer JF (2000) Traumatic glenohumeral bone defects and their relationship to failure of arthroscopic Bankart repairs: significance of the inverted-pear glenoid and the humeral engaging Hill-Sachs lesion. Arthroscopy 16(7):677–694

    CAS  PubMed  Google Scholar 

  8. Cole BJ, L’Insalata J, Irrgang J, Warner JJ (2000) Comparison of arthroscopic and open anterior shoulder stabilization. A two to six-year follow-up study. J Bone Joint Surg [Am] 82-A(8):1108–1114

  9. Dines DM, Levinson M (1995) The conservative management of the unstable shoulder including rehabilitation. Clin Sports Med 14:797–816

    CAS  PubMed  Google Scholar 

  10. Edmonds G, Kirkley A, Birmingham TB, Fowler PJ (2003) The effect of early arthroscopic stabilization compared to nonsurgical treatment on proprioception after primary traumatic anterior dislocation of the shoulder. Knee Surg Sports Taumatol Arthrosc 11:116–121

    Google Scholar 

  11. Green MR, Christensen KP (1995) Arthroscopic Bankart procedure: two- to five-year followup with clinical correlation to severity of glenoid labral lesion. Am J Sports Med 23(3):276–281

    CAS  PubMed  Google Scholar 

  12. Habermeyer P, Gleyze P, Rickert M (1999) Evolution of lesions of the labrum-ligament complex in posttraumatic anterior shoulder instability: a prospective study. J Shoulder Elbow Surg 8:66–74

    Article  CAS  PubMed  Google Scholar 

  13. Habermeyer P, Jung D, Ebert T (1998) Behandlungsstrategie bei der traumatischen vorderen Erstluxation der Schulter. Unfallchirurg 101:328–341

    Article  CAS  PubMed  Google Scholar 

  14. Henry JH, Genung JA (1982) Natural history of glenohumeral dislocation revised. Am J Sports Med 10:135–137

    CAS  PubMed  Google Scholar 

  15. Hermodsson J (1934) Röntegenologische Studien über die traumatischen und habituellen Schultergelenkverrenkungen nach vorn und nach unten. Acta Radiol 20 [suppl]:1–173

    Google Scholar 

  16. Hertz H, Kwasny O, Wöhry G (1991) Therapeutisches Vorgehen bei erstmaliger traumatischer Schulterluxation. Unfallchirurgie 17:76–79

    CAS  PubMed  Google Scholar 

  17. Hoelen MA, Burgers AM, Rozing PM (1990) Prognosis of primary anterior shoulder dislocation in young adults. Arch Orthop Trauma Surg 110:51–54

    CAS  PubMed  Google Scholar 

  18. Hovelius L (1978) Shoulder dislocation in Swedish ice hockey players. Am J Sports Med 6:373–377

    CAS  PubMed  Google Scholar 

  19. Hovelius L, Augustini BG, Fredin H, Johannson O, Norlin R, Thorling J (1996) Primary anterior dislocation of the shoulder in young patients. J Bone Joint Surg 78-A:1677–1684

    Google Scholar 

  20. Hurley JA, Anderson TE, Dear W, Andrish JT, Bergfeld JA, Weiker GG (1992) Posterior shoulder instability. Surgical versus conservative results with evaluation of glenoid version. Am J Sports Med 20:396–400

    CAS  PubMed  Google Scholar 

  21. Ide J, Maeda S, Yamaga M, Morisawa K, Takagi K (2003) Shoulder-strengthening exercise with an orthosis for multidirectional shoulder instability: quantitative evaluation of rotational shoulder strength before and after the exercise program. J Shoulder Elbow Surg 12:342–345

    Article  PubMed  Google Scholar 

  22. Itoi E, Hatakeyama Y, Kido T, Minagawa H, Wakabayashi I, Kobayashi M (2003) A new method of immobilization after traumatic anterior dislocation of the shoulder: a prelininary study. J Shoulder Elbow Surg 12:413–415

    Article  PubMed  Google Scholar 

  23. Itoi E, Sashi R, Minagawa H, Shimizu T, Wakabayashi I, Sato K (2001) Position of immobilization after dislocation of the glenohumeral joint. J Bone Joint Surg 83-A(5):661–667

    Google Scholar 

  24. Jobe FW, Moynes DR, Brewster CE (1987) Rehabilitation of the shoulder joint instabilities. Orthop Clin North Am 18:473–482

    CAS  PubMed  Google Scholar 

  25. Kandziora F, Jager A, Bischof F, Herresthal J, Starker M, Mittlmeier T (2000) Arthroscopic labrum refixation for post-traumatic anterior shoulder instability: suture anchor versus transglenoid fixation technique. Arthroscopy 16(4):359–366

    Article  CAS  PubMed  Google Scholar 

  26. Kim SH, Ha KI, Cho YB, Ryu BD, Oh I (2003) Arthroscopic anterior stabilization of the shoulder: two to six-year follow-up. J Bone Joint Surg [Am] 85-A(8):1511–1518

  27. Kim SH, Ha KI, Kim SH (2002) Bankart repair in traumatic anterior shoulder instability: open versus arthroscopic technique. Arthroscopy 18(7):755–763

    Article  PubMed  Google Scholar 

  28. Kiviluoto O, Pasila M, Jaroma H, Sundholm A (1980) Immobilization of the primary dislocations of the shoulder. Acta Orthop Scand 51:915–919

    CAS  PubMed  Google Scholar 

  29. Kuroda S, Sumiyoshi T, Moriishi J, Maruta K, Ishige N (2001) The natural course of atraumatic shoulder instability. J Shoulder Elbow Surg 10:100–104

    Article  CAS  PubMed  Google Scholar 

  30. Lill H, Verheyden P, Korner J, Hepp P, Josten C (1998) Konservative Behandlung nach traumatischer Schulterluxation? Chirurg 69:1230–1237

    Article  CAS  PubMed  Google Scholar 

  31. Mc Laughlin HL, Mc Lellan DI (1967) Recurrent anterior dislocation of the shoulder II. A comparative study. J Trauma 7:191–201

    PubMed  Google Scholar 

  32. Molé D, Coudane H, Frank A, Benazet JP, Kelberine F (1996) Contribution of arthroscopy in diagnosing lesions and in determining prognostic factors after first antero-medial shoulder dislocation: prospective study of 30 cases. J Traumatol Sport

  33. Mosleley HF (1961) Recurrent dislocations of the shoulder. Mc Gill University Press, Montreal

  34. Neer CS, Welsh RP (1977) The shoulder in sports. Orthop Clin North Am 8:583–591

    PubMed  Google Scholar 

  35. O’Driscoll SW (1993) Atraumatic instability: pathology and pathogenesis. In: Matsen FA, Fu FH, Hawkins RJ (eds) The shoulder: a balance of mobility and stability. AAOS, Rosemont, pp 305–316

  36. Pagnani MJ, Warren RF, Altchek DW, Wickiewicz TL, Anderson AF (1996) Arthroscopic shoulder stabilization using transglenoid sutures. A four-year minimum followup. Am J Sports Med 24(4):459–467

    CAS  PubMed  Google Scholar 

  37. Porcellini G, Campi F, Paladini P (2002) Arthroscopic approach to acute bony Bankart lesion. Arthroscopy 18(7):764–769

    Article  PubMed  Google Scholar 

  38. Postacchini F, Gumina S, Cinotti G (2000) Anterior shoulder dislocation in adolescents. J Shoulder Elbow Surg 9:470–474

    CAS  PubMed  Google Scholar 

  39. Robinson CM, Kelly M, Wakefield (2002) Redislocation of the shoulder during the first six weeks after a primary anterior dislocation: risk factors and results of treatment. J Bone Joint Surg 84-A:1552–1559

  40. Rowe C, Skellarides HT (1961) Factors related to recurrencies of anterior dislocations of the shoulder. Clin Orthop 20:40–48

    CAS  PubMed  Google Scholar 

  41. Rubin BD, Kibler WB (2002) Fundamental principles of shoulder rehabilitation: conservative to postoperative management. Arthroscopy 18:29–39

    Article  PubMed  Google Scholar 

  42. Ryf C, Matter P (1993) Erstmalige traumatische Schulterluxation. Prospektive Studie. Z Unfallchir Versicherungsmed 1 [suppl]:204–212

  43. Saragaglia D, Picard F, Le Bredonchel T, Moncenis C, Sardo M, Tourne Y (2001) Acute anterior instability of the shoulder: short- and mid-term outcome after conservative treatment. Rev Chir Orthop Reparatrice Appar Mot 87:215–220

    CAS  PubMed  Google Scholar 

  44. Savoie FH 3rd, Miller CD, Field LD (1997) Arthroscopic reconstruction of traumatic anterior instability of the shoulder: the Caspari technique. Arthroscopy 13(2):201–209

    Article  PubMed  Google Scholar 

  45. Simonet WT, Cofield RH (1984) Prognosis in anterior shoulder dislocation. Am J Sports Med 12:19–24

    CAS  PubMed  Google Scholar 

  46. Strömsöe K, Senn E, Simmen B, Matter P (1980) Rezidivhäufigkeit nach erstmaliger traumatischern Schulterluxation. Hel Chir Acta 48:551–557

    Google Scholar 

  47. Suder PA, Jakobsen BW (1997) Result of conservative treatment of traumatic primary anterior shoulder dislocation correlated to initial arthroscopic findings. J Shoulder Elbow Surg 6:213 (abstr)

    Google Scholar 

  48. Suder PA, Johannsen HV, Jakobsen BW (2003) Longterm follow-up after conservative treatment of traumatic primary anterior shoulder dislocation. 17th Congress of ESSSE, Heidelberg, Germany

  49. Takwale VJ, Calvert P, Rattue H (2000) Involuntary positional instability of the shoulder in adolescents and young adults. J Bone Joint Surg 82-B:719–723

    Google Scholar 

  50. Taylor DC, Arciero RA (1997) Pathologic changes associated with shoulder dislocations. Am J Sports Med 25:306–311

    CAS  PubMed  Google Scholar 

  51. Te Slaa RL, Wijffles PJM, Brand R, Marti RK (2004) The prognosis following acute primary glenohumeral dislocation. J Bone Joint Surg 86-B:58–64

    Google Scholar 

  52. Vermeiren J, Handelberg F, Castelyn PP, Opdecam P (1993) The rate of recurrence of traumatic anterior dislocation of the shoulder. Int Orthop 17:337–341

    CAS  PubMed  Google Scholar 

  53. Walch G, Boileau P (1997) Rotator cuff tears associated with anterior instability. In: Warner JP, Iannotti JP, Gerber C (eds) Complexe and revision problems in shoulder surgery. Lipincott-Raven, Philadelphia, pp 65–70

  54. Warner JJP, Caborn DN (1992) Overview of shoulder instability. Crit Rev Phys Rehab Med 4:145–198

    Google Scholar 

  55. Warner JJ, Lephart S, Fu FH (1996) Role of proprioception in pathoetiology of shoulder instability. Clin Orthop 330:35–39

    Article  PubMed  Google Scholar 

  56. Werner A, Lichtenberg S, Nikolic A, Habermeyer P (2003) Intraartikuläre Pathologie bei atraumatischer Schulterluxation. Unfallchirurg 106:110–113

    Article  CAS  PubMed  Google Scholar 

  57. Wheeler JH, Ryan JB, Arciero RA, Molinary RN (1989) Arthroscopic versus non-operative treatment of acute shoulder dislocation in young athletes. Arthroscopy 5:213–217

    Article  CAS  PubMed  Google Scholar 

  58. Wintzell G, Haglund Y, Tiedermark J, Wredmark T, Eriksson E (1996) A prospective controlled prospective study of arthroscopic lavage in acute primary anterior dislocation of the shoulder: one year follow-up. Knee Surgs Sports Traumatol Arthrosc 4:43–47

    CAS  Google Scholar 

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  1. ATOS-Klinik Heidelberg

    P. Magosch, P. Habermeyer & S. Lichtenberg

  2. ATOS-Klinik, Bismarckstraße 9–15, 69115 , Heidelberg

    P. Magosch

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  1. P. Magosch
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  2. P. Habermeyer
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  3. S. Lichtenberg
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Correspondence to P. Magosch.

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Magosch, P., Habermeyer, P. & Lichtenberg, S. Konservative Therapie der Schulterinstabilität. Arthroskopie 17, 146–154 (2004). https://doi.org/10.1007/s00142-004-0260-4

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