Zusammenfassung
Das Impingement des oberen Sprunggelenks (OSG) ist häufig die Ursache für schmerzhafte Bewegungseinschränkungen des sportlich aktiven Menschen. Wiederholte Traumen, chronische Instabilitäten und/oder chronische Überlastung gelten durch konsekutive Narbenbildung, Weichteilhypertrophie sowie Bildung knöcherner Exophyten mit umgebender Synovialitis als Hauptursache für die Impingement-Symptomatik, wobei diese ebenso durch freie Gelenkkörper ausgelöst werden kann. Wurden in der Vergangenheit zumeist englische Synonyme für die Pathologie verwendet (z. B. „soccer’s ankle“, „athlet’s ankle“, „dancer’s ankle“), wird die Symptomatik mittlerweile anhand der Lokalisation sowie der hauptanteilsmäßigen Veränderung in ein weichteiliges und ein knöchernes/gelenkkörperassoziiertes Impingement klassifiziert. Klinisch imponieren rezidivierende, schmerzhafte Einklemmungsepisoden, ggf. mit mechanischer oder nozizeptiv bedingter Bewegungseinschränkung. Für das ossäre Impingement ist die Röntgenuntersuchung, ggf. in Ergänzung mit einer Schrägaufnahme, oft schon wegweisend, wohingegen die Magnetresonanztomographie (MRT) eine hohe Sensitivität und Spezifität v. a. für das weichteilige Impingement aufweist. Insbesondere beim weichteiligen Impingement können zu Beginn konservative Maßnahmen erfolgreich sein. Bei ausbleibendem Erfolg oder bei primär nachweisbarem ossärem Impingement ist die operative Entfernung der mechanisch auslösenden Pathologie und der ursächlichen oder konsekutiven lokalen Synovialitis die Methode der Wahl.
Abstract
Impingement syndrome of the ankle joint is often the cause of painful limitations in movement in people active in sports. Repetitive trauma, chronic instability and/or chronic overstress are the main causes of impingement symptoms due to subsequent scar formation, soft tissue hypertrophy and formation of bony outgrowths with surrounding synovitis but can also be triggered by free joint bodies. In the past English synonyms have mostly been used for the pathology (e.g. footballer’s ankle, athlete’s ankle and dancer’s ankle) but the symptoms are now described based on the localization and the main alterations and classified as soft tissue and bony/joint body-associated impingement. Clinically impressive are recurrent, painful entrapment episodes, sometimes with mechanical or nociceptive-related movement restrictions. The X‑ray investigations, if necessary supplemented by an oblique image, may often lead to the diagnosis of an osseous impingement whereas magnetic resonance imaging (MRI) is characterized by a high sensitivity and specificity especially in the visualization of soft tissue impingement. In the beginning, conservative measures can be successful particularly for soft tissue impingement; however, in cases of persisting pain or primarily diagnosed osseous impingement, arthroscopic removal of the mechanically triggering pathology and the original or subsequent local sinovitis is regarded as the procedure of choice.
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Best, R., Ahrens, P. Impingement-Syndrom des oberen Sprunggelenks. Arthroskopie 31, 134–140 (2018). https://doi.org/10.1007/s00142-018-0197-7
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DOI: https://doi.org/10.1007/s00142-018-0197-7
Schlüsselwörter
- Bewegungseinschränkung
- Lokale Synovialitis
- Anterolaterales Impingement
- Sprunggelenkinstabilität
- Bildgebung