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Orthopädie und Unfallchirurgie up2date 2019; 14(04): 383-405
DOI: 10.1055/a-0653-9614
Schultergürtel und obere Extremität
Georg Thieme Verlag KG Stuttgart · New York

Weichteilerkrankungen der Schulter und Subakromialsyndrome

Jörg Nowotny
,
Philip Kasten
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Publication History

Publication Date:
30 July 2019 (online)

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Die Schulter ist ein weichteilig geführtes Bewegungsorgan mit einer hohen Bewegungsfreiheit. Als kraftschlüssiges Gelenk ist zur ausreichenden Stabilisation ein komplexer statischer und dynamischer Weichteilmantel erforderlich. Es liegt daher nahe, dass multiple Erkrankungen der Schulter pathophysiologisch auf dem Boden von Weichteilerkrankungen und -schäden entstehen, die jedoch ganz überwiegend konservativ behandelt werden können.
Kernaussagen

  • Schulterschmerzen sind ein häufiges muskuloskelettales Beschwerdebild; das Impingement-Syndrom ist dabei eine häufig gestellte Diagnose.

  • Zur Evaluierung wird ein stufendiagnostisches Vorgehen empfohlen:

    • Die klinische Untersuchung bildet die Basis der Diagnostik, immer in der Zusammenschau mit der Anamnese.

    • Die bildgebenden Verfahren werden eingesetzt:

      • Röntgen (in 3 Ebenen: true a.–p., axial und ggf. Outlet View),

      • Sonografie,

      • ggf. MRT,

      • ggf. Computertomografie (selten).

  • Die Therapie besteht beim Impingement-Syndrom in 80 – 90% der Fälle aus einer konservativen Behandlung. Sofern operiert wird, kommt die subakromiale Dekompression zur Anwendung.

  • Auch die Therapie der Rotatorenmanschettenpartialläsion erfolgt primär konservativ. Die Indikation zur chirurgischen Refixation der Sehnen ist bei traumatischen Läsionen, Rupturen des Subscapularis oder symptomatischen degenerativen Sehnenrissen gegeben.

  • Aufgrund des meist selbstlimitierenden Krankheitsverlaufs ist bei der Tendinosis calcarea (Kalkschulter) die Therapie ebenfalls überwiegend konservativ.

  • Das Gleiche gilt für die Schultersteife („frozen Shoulder“), die bei fehlender Besserung durch arthroskopische Arthrolyse angegangen werden kann.

  • Die operative Therapie von Weichteilerkrankungen der Schulter wird in der Regel arthroskopisch durchgeführt.

Schlüsselwörter

Schultersteife - Rotatorenmanschette - subakromiales Impingement - adhäsive Kapsulitis - Frozen Shoulder - Kalkschulter - Tendinosis calcarea
 

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