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Posttraumatische und postoperative Schultersteife

Trauma, Rotatorenmanschettenrekonstruktion, Instabilitätsoperationen und Arthroplastik

Posttraumatic and postoperative shoulder stiffness

Trauma, rotator cuff reconstruction, instability operations and shoulder arthroplasty

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Zusammenfassung

Von der primären oder idiopathischen „frozen shoulder“ (Schultersteife) lässt sich die sekundäre Form nach einem Trauma oder einer Operation an der Schulter unterscheiden. Ursachen dieser sekundären Formen sind vielfältig; sie werden in intra- und extraartikuläre Faktoren unterteilt. Mikro- und Makrotraumata können auf unterschiedliche Weise eine entsprechende Schultersteife provozieren. Erstere ähneln von Erscheinungsbild und Verlauf der primären Form, da oft kein pathomorphologisches Korrelat nachweisbar ist. Daher orientiert sich die Therapie an derjenigen der primären Schultersteife. Nach einem Makrotrauma kann es durch Narbenbildung und Verklebung von Gleitschichten zur Schultersteife kommen. Bei nichteinsetzender Resolution ist häufig ein operativer Eingriff erforderlich. Vor allem im postoperativen Setting ist aufgrund der vielfältigen Schultereingriffe und Operationstechniken mit unterschiedlichen Zugängen und unterschiedlichen Ausmaßen der Weichteiltraumatisierung sowie Veränderungen des Gelenkvolumens die individuelle Ursachenabklärung nötig, speziell im Rahmen der Endoprothetik. Aufgrund der Seltenheit einer postoperativen Schultersteife bei normalen, jedoch deutlich erhöhten Raten bei komplikationsbehaftetem Verlauf ist die weitergehende Abklärung dringend zu empfehlen. Es lassen sich implantat-, operations- oder patientenbedingte Ursache abgrenzen, die individuell zu beurteilen sind. Auch im postoperativen Rahmen kann eine entzündliche Form der Schultersteife auftreten, analog der Steife nach einem Mikrotrauma. Am häufigsten wurde in der Literatur über eine postoperative Schultersteife nach Rotatorenmanschettenrekonstruktionen berichtet, gefolgt von Frakturversorgungen, Instabilitätsoperationen und schließlich der Endoprothetik.

Abstract

Apart from primary or idiopathic frozen shoulder, the secondary form of glenohumeral stiffness can also develop after trauma or surgery. The cause for these secondary forms of restricted range of motion can be distinguished into intra-articular and extra-articular factors. Posttraumatic stiffness can develop after minor or major trauma to the bony or soft tissues of the shoulder girdle. After minor trauma the course and clinical presentation is similar to the primary form as pathomorphological correlates are often not detectable; therefore, treatment protocols are adapted according to those for primary shoulder stiffness. Shoulder stiffness after major trauma is mainly caused by scarring and adhesions of gliding structures and often necessitates surgical release if resolution under conservative treatment fails. Postoperative shoulder stiffness is a common problem after rotator cuff surgery or fracture fixation, even though incidences vary widely between different surgical procedures. Apart from the abovementioned scarring, overstuffing implants or tightening of soft tissue structures can lead to restricted range of motion. Stiffness after shoulder arthroplasty is rare and should prompt further diagnostic work-up to differentiate implant, surgery or patient-specific causes. Furthermore, an inflammatory shoulder stiffness similar to the primary or minor trauma form can develop after surgery. Reviewing the literature, shoulder stiffness has been reported most often after rotator cuff reconstruction surgery, followed by fracture fixation surgery, instability operations and lastly shoulder arthroplasty.

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  1. Klinik für Orthopädie, Kantonsspital Aarau, Tellstrasse 25, 5001, Aarau, Schweiz

    Felix Toft

  2. Abteilung für Schulter- und Ellenbogenchirurgie, Schulthess Klinik, Lengghalde 2, 8008, Zürich, Schweiz

    Fabrizio Moro &  Markus Scheibel

  3. Abteilung für Schulter- und Ellenbogenchirurgie, Charité – Universitätsmedizin Berlin, 10115, Berlin, Deutschland

    Markus Scheibel

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Toft, F., Moro, F. & Scheibel, M. Posttraumatische und postoperative Schultersteife. Unfallchirurg 122, 925–933 (2019). https://doi.org/10.1007/s00113-019-00726-0

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