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Zentrales Aktivierungsdefizit des M. deltoideus bei traumatischer Schulterinstabilität

Central activation deficit of the deltoid muscle in traumatic shoulder instability

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Zusammenfassung

Die chronisch rezidivierende Schulterinstabilität (TSI) ist insbesondere bei jüngeren Patienten eine häufige Komplikation nach traumatischer ventraler Schulterluxation. Unklar ist, ob durch die traumatisch bedingte Störung der Propriozeption bei Patienten mit TSI auch zentrale, neuromuskuläre Adaptationsprozesse stattfinden. Die vorliegende Arbeit untersucht dementsprechend die kortikospinale Erregbarkeit des M. deltoideus (MD), der in Bezug auf die Schultergelenksfunktion eine Schlüsselrolle spielt, mittels der transkraniellen Magnetstimulation (TMS). Als Parameter der zentralen Erregbarkeit wurden die Amplituden der magnetisch evozierten Potentiale (MEP) des MD auf beiden Seiten bei zunehmender TMS-Reizintensität im Sinne von Reiz-Antwort-Kurven unter Ruhebedingungen sowie unter leichter Willküraktivierung des MD bei Patienten mit TSI ermittelt. Die Ergebnisse wurden mit den Werten einer nach Alter, Geschlecht und Handpräferenz gematchten gesunden Kontrollgruppe verglichen. Bei Patienten und Kontrollgruppe zeigten sich unter Ruhebedingungen vergleichbare MEP des MD nach TMS. Im Gegensatz dazu fanden sich bei leichter Vorinnervation des MD in der Patientengruppe signifikant geringere MEP des MD und zwar sowohl auf der betroffenen als auch auf der nichtbetroffenen Seite. Diese insuffiziente Fazilitierung durch Willkürinnervation deutet auf ein zentrales bilaterales Aktivierungsdefizit des MD in der Patientengruppe hin. Zusammenfassend weisen unsere Untersuchungen auf Adaptationsvorgänge im Bereich des Motorkortex als Reaktion auf die gestörte sensomotorische Rückkopplung bei TSI hin und sollten im Rahmen der Therapie und Rehabilitation von Patienten mit TSI beachtet werden.

Abstract

Chronic recurrent anterior shoulder instability (TSI) after primary anterior traumatic shoulder dislocation is a common musculoskeletal problem especially in younger patients. It is unclear if the proprioceptive deficits in patients with TSI lead to central neuromuscular changes. Therefore, this recent study investigated the corticospinal excitability of the deltoid muscle (MD), a key muscle of shoulder function, with transcranial magnetic stimulation (TMS). To achieve this objective the motor-evoked potentials (MEP) in response to TMS of the MD on both sides at rest and low level voluntary activation were obtained from patients with unilateral TSI and compared with age, gender and handedness-matched healthy control subjects. During resting conditions the MEP of the MD showed no differences on both sides between patients and healthy controls. In contrast, the MEP of the MD demonstrated a bilateral hypo-excitability during voluntary activation of MD in patients. This insufficient facilitation of the MD points toward a bilateral central activation deficit. The findings seem to be assigned to adaptive changes in the motor cortex as a consequence of TSI and neuromuscular alteration of the MD should be considered when treating patients with TSI.

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Authors and Affiliations

  1. Orthopädische Universitätsklinik, Universitätsklinikum Magdeburg A.ö.R., Leipziger Str. 44, 39120, Magdeburg, Deutschland

    A. Berth & F. Awiszus

  2. Orthopädisch-Traumatologisches Zentrum, Park-Krankenhaus Leipzig-Südost, Leipzig, Deutschland

    G. Pap

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  1. A. Berth
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Correspondence to A. Berth.

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Diese Arbeit wurde unterstützt durch die Deutsche Arthrose Hilfe e.V.

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Berth, A., Pap, G. & Awiszus, F. Zentrales Aktivierungsdefizit des M. deltoideus bei traumatischer Schulterinstabilität. Obere Extremität 4, 16–22 (2009). https://doi.org/10.1007/s11678-009-0013-0

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