Schulterverletzungen bei Patienten mit Epilepsie – Ein multidisziplinärer Behandlungsansatz

Zusammenfassung

Die Behandlung von Schulterverletzungen infolge epileptischer Anfälle stellt eine besondere Herausforderung dar. Die häufig komplexen Verletzungsmuster reichen von Luxationen über Frakturen bis hin zu Schädigungen der Rotatorenmanschette. Ein Rezidivanfall in der Heilungsphase kann das Outcome maßgeblich beeinträchtigen und muss als zentraler Risikofaktor bei der Wahl des Therapieverfahrens berücksichtigt werden. Insofern erfordern diese Verletzungen, sowohl in der Diagnostik als auch in der Therapie, eine enge interdisziplinäre Zusammenarbeit zwischen Orthopädie/Unfallchirurgie, Neurologie bzw. Epileptologie und Physiotherapie. Trotz der klinischen Relevanz fehlen bislang standardisierte Therapiealgorithmen und die wissenschaftliche Datenlage ist begrenzt. Dieser Übersichtsartikel thematisiert die Besonderheiten anfallsbedingter Schulterverletzungen im Kontext eines multidisziplinären Ansatzes. Dabei werden epidemiologische Aspekte einschließlich pathomechanischer Grundlagen, diagnostische Herausforderungen und aktuelle konservative sowie operative Behandlungsoptionen erläutert.

Shoulder injuries in patients with epilepsy – facts to go!

• Need for interdisciplinary management between orthopaedics/trauma surgery, neurology/epileptology and physiotherapy

• Recurrence is the main risk factor for the success of therapy

  1. Consideration of the indication for antiseizure medication after a first seizure; if necessary, adjustment of therapy for chronic epilepsy

  2. Avoiding potentially provocative factors

• Seizure control is critical!

• Consideration of specific pathology – including deeper and larger Hill-Sachs lesions than in classic traumatic dislocations

• Individual treatment choice taking into account the underlying pathology, seizure activity, functional demands and compliance

• Conservative therapy often yields inadequate results

• Bone stabilisations are superior to soft tissue procedures for seizure-related instability.

• Postoperative neurological/epileptological care with the aim of the best possible seizure control as an integral part of surgical management

Schulterverletzungen bei Patienten mit Epilepsie – Facts to go!

• Notwendigkeit eines interdisziplinären Managements zwischen Orthopädie/Unfallchirurgie, Neurologie/Epileptologie und Physiotherapie

• zentraler Risikofaktor des Therapieerfolges ist der Rezidivanfall

  1. Indikationsprüfung einer antisuppressiven Medikation nach einem ersten Anfall, ggf. Therapieanpassung bei chronischer Epilepsie

  2. Vermeidung potenzieller Provokationsfaktoren

  3. Förderung der Compliance

• Die Anfallskontrolle ist entscheidend!

• Berücksichtigung der spezifischen Pathologie – u. a. tiefere und größere Hill-Sachs Läsionen als klassisch traumatische Luxationen

• Individuelle Therapiewahl unter Berücksichtigung der zugrunde liegenden Pathologie, Anfallsaktivität sowie funktionellen Anspruch und Compliance

• Konservative Therapie zeigt oft unzureichende Ergebnisse

• Knöcherne Stabilisierungen sind weichteiligen Verfahren bei anfallsbedingter Instabilität überlegen – Prüfung alternativer Knochengrafts

• Postoperativ neurologische/epileptologische Betreuung mit dem Ziel der bestmöglichen Anfallskontrolle als integraler Bestandteil des operativen Managements

Schlüsselwörter

Epilepsie - Schulterluxation - Schulter - Krampfanfall - Instabilität

Publication History

Received: 30 July 2025

Accepted: 01 October 2025

Article published online:
19 January 2026

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