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Aktuelle Traumatol 2005; 35(5): 280-287
DOI: 10.1055/s-2005-865950
Sporttraumatologie

Georg Thieme Verlag KG Stuttgart · New York

Diagnostik und Therapie der vorderen Erstluxation der Schulter

Diagnostic Pathway and Therapeutic Options of First-Time Anterior Shoulder DislocationG. G. Konrad1 , D. Maier1 , N. P. Südkamp1
  • 1Department für Orthopädie und Traumatologie, Universitätsklinikum Freiburg
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Publication History

Publication Date:
10 October 2005 (online)

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Zusammenfassung

Eine detaillierte Anamneseerhebung und seitenvergleichende klinische Untersuchung beider Schultergelenke sind die entscheidenden klinischen Kriterien zur Differenzierung zwischen einer traumatischen und atraumatischen Schulterluxation. Das Therapiespektrum nach Erstluxation der Schulter reicht von der rein funktionellen Therapie über die Ruhigstellung im Gilchrist-Verband bis zu arthroskopischen oder offenen Stabilisierungsoperationen. Junge Patienten (< 30 Jahre) nach einer traumatischen Erstluxation durch adäquates Trauma, mit unidirektionaler Instabilität, dem Nachweis einer Hill-Sachs-Läsion und sportlicher Aktivität sollten bei Therapiewunsch bereits nach der Erstluxation einer operativen Stabilisierung zugeführt werden. Das Operationsprinzip besteht in einer Refixation des abgerissenen Labrum glenoidale und des anterioren Anteils des inferioren glenohumeralen Bandes am vorderen Glenoidrand. Die Entwicklung arthroskopischer Operationsverfahren ist inzwischen soweit fortgeschritten, dass die Rekonstruktion des traumatisch abgelösten Kapsel-Labrum-Komplexes am Glenoidrand mit verschiedenen Nahttechniken realisierbar ist. Bei Abrissfrakturen des Glenoids (knöcherne Bankart-Läsion) besteht, bedingt durch den Verlust der Gelenkfläche, eine hohe Gefahr der Reluxation. Eine offene Refixation des Bankart-Fragments mittels Schraubenosteosynthese ist die Therapie der Wahl.

Abstract

A detailed history of the patient and a physical examination of both shoulder joints are imperative to differentiate between traumatic and atraumatic shoulder dislocations. Therapeutic options to stabilize the shoulder range from functional therapy and immobilization to arthroscopic or open surgery. Young patients (< 30 years) with a traumatic first-time anterior shoulder dislocation, unidirectional instability, a Hill-Sachs-lesion, and sports activity should be treated surgically. The surgical principle consists of a refixation of the torn labrum and the anterior band of the inferior glenohumeral ligament to the anterior glenoid rim. Repair of the capsule-labrum-complex is feasible with various arthroscopic fixation techniques. A bony Bankart-lesion leads to a high reluxation rate and should be treated with an open screw osteosynthesis.

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Dr. Gerhard G. Konrad

Department Orthopädie und Traumatologie
Universitätsklinikum Freiburg

Hugstetter Straße 55

79106 Freiburg

Phone: 0761/270-2787

Fax: 0761/270-2520

Email: konrad@ch11.ukl.uni-freiburg.de

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