Verletzungen des Acromioclavicular- und Sternoclaviculargelenkes

Zusammenfassung

Das Schlüsselbein mit Akromioklavikulargelenk (ACG) als laterale und Sternoklavikulargelenk (SCG) als mediale Begrenzung bildet die einzige knöcherne Abstützung des gesamten Schultergürtels und der oberen Extremität hin zum knöchernen Brustkorb. Verletzungen des ACG und SCG können zu Instabilitäten und damit einhergehenden funktionellen Defiziten führen, die sich mit eingeschränkter Schulterfunktion und/oder Schmerzen äußern können. Darüber hinaus kann es zu ästhetisch störenden Deformitäten kommen mit Pseudo-Schlüsselbeinhochstand (ACG) lateral oder Schlüsselbeinvorstand (SCG) medial. Die adäquate Diagnostik ist entscheidend zum Erkennen der Pathologie, ihres Schweregrades und der richtigen Therapie. Während sowohl bei ACG als auch SCG die Gelenkkapsel eine entscheidende Rolle für die Stabilität spielen, wird das ACG zusätzlich durch die korakoklavikulären (CC) Bänder in Position gehalten. Die korrekte Diagnostik und Therapie von Verletzungen des ACG/SCG wird von Unfallchirurgen und Orthopäden kontrovers diskutiert. Mehrere Operationstechniken sind zur chirurgischen Versorgung publiziert. In den letzten Jahren hat sich die minimalinvasive arthroskopisch assistierte ACG-Rekonstruktion neben der klassischen Hakenplatte als Goldstandard etabliert. Interventionsbedürftige SCG-Verletzungen stellen nicht zuletzt aufgrund ihrer exponierten anatomischen Nähe zu den großen thorakalen Gefäßen den Operateur vor besondere Herausforderungen. Im Folgenden soll auf Diagnostik und Therapie von akuten und chronischen ACG- und SCG-Verletzungen unter Berücksichtigung selektiver Literatur eingegangen werden.

Schulterverletzungen der kleinen Gelenke, wie AC- und SC-Gelenk, können leicht übersehen werden. Beide Gelenke haben wesentlichen Einfluss auf die biomechanische Abstützfunktion des gesamten Schultergürtels gegenüber dem Thorax („strut function“). Bereits kleine Bewegungen bei horizontaler, vertikaler oder Rotationsinstabilität können zu Schmerzen und Funktionsverlust führen. Die adäquate Diagnostik zur Beurteilung des Schweregrades und dessen therapeutische Konsequenz sind in der Behandlung von AC- und SC-Verletzungen entscheidend und sollen im folgenden Beitrag beleuchtet werden.

Abstract

The clavicle with the acromioclavicular joint (ACJ) as the lateral and the sternoclavicular joint (SCJ) as the medial boundary forms the only bony support for the entire shoulder girdle and the upper extremity towards the chest. Injuries to the ACJ and SCJ can lead to instability and associated functional deficits, which can manifest as limited shoulder function and/or pain. In addition, aesthetically disturbing deformities can occur with pseudo-collarbone elevation (ACJ) laterally or protrusion of the clavicle (SCJ) medial. Adequate diagnostics are crucial for recognizing the pathology, its degree of severity and the right therapy. While the joint capsule plays a critical role in stability in both ACJ and SCJ, the ACJ is additionally held in place by the coracoclavicular (CC) ligaments. The correct diagnosis and therapy of injuries of the ACJ/SCJ is controversially discussed by trauma and orthopedic surgeons. Several surgical techniques have been published for surgical treatment. In recent years, minimally invasive arthroscopically assisted ACJ reconstruction has become the gold standard alongside the classic hook plate. SCJ injuries requiring intervention need special requirements, not least because of their exposed anatomical proximity to the large thoracic vessels. In the following, the diagnosis and therapy of acute and chronic ACJ and SCJ injuries will be discussed and recent literature reviewed.

Schlüsselwörter

Acromioclavicular - Sternoclavicular - Instabilität - arthroskopisch-assistiert - Rekonstruktion

Keywords

acromioclavicular - sternoclavicular - instability - arthroscopically-assisted - reconstruction

Publication History

Article published online:
04 August 2022

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