Instabilität des Schultergelenks – Teil 2: Therapie und Outcome

Die primäre Therapie einer Schulterinstabilität ist konservativ, wobei selbst die Erstluxation ohne Rezidiv mit einem signifikanten Arthroserisiko einhergeht. Wird eine chirurgische Therapie durchgeführt, ist eine gezielte Nachbehandlung essenziell. Das Therapieergebnis hängt von vielen Faktoren ab, u. a. sportlicher und beruflicher Anspruch, sportliches und berufliches Risiko, Compliance, erfolgreiche Rehabilitation mit entsprechender Zeit u. a.

Kernaussagen

• Die primäre Therapie einer Schulterinstabilität ist konservativ. Die konservative Therapie kann nicht in jedem Falle Rezidivluxationen verhindern, ist aber sehr oft hilfreich in der Verbesserung der Schulterfunktion und Linderung von Instabilitätssymptomen.

• Nicht jede Schulterinstabilität muss operativ behandelt werden, aber jede operativ stabilisierte Schulter muss gezielt nachbehandelt werden.

• Auch die Erstluxation ohne Rezidiv geht mit einem signifikanten Arthroserisiko einher, was sich schon nach 25 Jahren manifestieren kann („Schwedenstudie“).

• Bei Weichteilstabilisierungen ist immer ein gewisses Maß an Kapselshift notwendig, abhängig vom Vorliegen einer Hyperlaxität und der individuellen Pathologie.

• Knöcherne Bankart-Läsionen und chronische Pfannenranddefekte gehen mit einem sehr hohen Rezidivrisiko einher. Bei der Beurteilung müssen immer beide Gelenkpartner in die Betrachtung einfließen, ggf. müssen die Hill-Sachs-Läsion und das Glenoid gleichzeitig adressiert werden.

• Je größer die Hill-Sachs-Läsion und je kleiner die effektiv verbleibende tragende glenoidale Gelenkfläche, desto größer ist das Rezidivrisiko.

• HAGL-Läsionen (Avulsion des Lig. glenohumerale inferior) werden leicht übersehen, bergen aber ein hohes Rezidivpotenzial.

• Das Therapieergebnis hängt von vielen Faktoren ab, nicht nur von der Therapie selbst. Sehr wichtig sind sportlicher und beruflicher Anspruch, sportliches und berufliches Risiko, Compliance, erfolgreiche Rehabilitation mit entsprechender Zeit u. v. a. Faktoren.

• Je besser die Wiederherstellung der anatomischen Strukturen bei einer Operation gelingt, desto größer ist die Chance auf eine Normalisierung der Schulterfunktion.

Schlüsselwörter

Schulterinstabilität - skapulothorakale Dyskinesie - Glenohumeralgelenk - Bankart-Läsion - Hill-Sachs-Läsion - Schulterluxation

Publication History

Article published online:
29 September 2024

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