Advertisement

Multidirektionale Schulterinstabilität

Klassifikation, Klinik, Differentialdiagnose, Behandlungsmethoden
  • U. König
  • A. B. Imhoff
Chapter
  • 29 Downloads

Zusammenfassung

Die operative Therapie der Schulterinstabilität erlebte in den letzten Jahren einen enormen Wandel. Zusätzlich zur Wiederherstellung der Stabilität und Minimierung der Reluxationsrate wird vor allem bei sportlich aktiven Patienten zunehmend auf die Bedeutung der Kraft und der vollen postoperativen Beweglichkeit Wert gelegt. Neben den etablierten offenen Operationsmethoden (z.B. Kapselshift nach Neer) gelingt dies vor allem durch die exakte Rekonstruktion der anatomischen Verhältnisse mittels der arthroskopischen OP-Technik [42]. Als sehr komplexes Problem im Hinblick auf Diagnostik und Therapie stellen sich Schulterinstabilitäten dar, die in verschiedene Richtungen ausgeprägt sind. Diese multidirektionalen Instabilitäten (MDI) sind mit 2 % der Gesamtzahl aller Instabilitäten relativ selten und wurden früher in der Regel konservativ therapiert. Aber nicht zuletzt aufgrund der Kenntnis von Übergangsformen zwischen diesen multidirektionalen und den häufigen unidirektionalen Instabilitäten tritt die operative Therapie immer mehr in den Vordergrund [7, 9, 13, 17, 24, 47, 57-59, 64, 71, 75]. Um die optimale Therapieform einzusetzen, ist die Kenntnis der Begriffe Laxität und Instabilität sowie die Kenntnis einer differenzierten Klassifikation der Schulterinstabilität Vorraussetzung [24, 78].

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

Literatur

  1. 1.
    Altchek DW, Warren RF, Skyhar MJ, Ortiz G (1991) T-plasty modification of the Bankart procedure for multidirectional instability of the anterior and inferior types. J Bone Joint Surg 73A:105–112Google Scholar
  2. 2.
    Barthel T, König U, Gohlke F (1998) Anatomie des anterosuperioren Labrum-Kapsel-Komplexes. Z Orthop 136:A141Google Scholar
  3. 3.
    Barthel T, König U, Gohlke F, Löhr J (1999) Anatomie und Histologie des Labrum glenoidale unter besonderer Berücksichtigung des sublabralen Foramen und der SLAP-Läsionen. Orthopäde 28Google Scholar
  4. 4.
    Bateman JE (1978) The Shoulder and Neck, 2nd Ed. Saunders, Philadelphia p 515Google Scholar
  5. 5.
    Belle RM (1989) Collagen typing in multidirectional instability of the shoulder. Orthop Trans 13:680–681Google Scholar
  6. 6.
    Berg EE, Ciullo JV (1998) A clinical test for superior glenoid labral or SLAP-lesions. Clin J Sports Med 8:121–123CrossRefGoogle Scholar
  7. 7.
    Bigliani LU (1989) Anterior and posterior capsular shift for multidirectional instability of the shoulder. Orthop Trans 13:680–681Google Scholar
  8. 8.
    Bigliani LU, Kurzweil PR, Schwartzbach CC, Wolfe IN, Flatow EL (1994) The inferior capsular shift procedure for anterior-inferior shoulder instability in athletes Am J Sports Med 22:578–584PubMedCrossRefGoogle Scholar
  9. 9.
    Bigliani LU, Pollock RG, Owens JM, McIlveen SJ, Flatow EL(1993) The inferior capsular shift procedure for multidirectional instability of the shoulder. Orthop Trans 17:576Google Scholar
  10. 10.
    Burkart A, Imhoff AB (1999) Adverse reactions to bioabsorbable suretac device in arthroscopic shoulder stabilisation. Arthroscopy 16:91–95Google Scholar
  11. 11.
    Burkhead WZ Jr, Rockwood CA Jr (1992) Treatment of instability of the shoulder with an exercise program. J Bone Joint Surg 74A:890–896Google Scholar
  12. 12.
    Carter C, Sweetnam R 1960) Recurrent dislocation of the patella and of the shoulder. Their association with familial joint laxity. J Bone Joint Surg 42B:721–727Google Scholar
  13. 13.
    Cooper RA, Brems JJ (1992) The inferior capsular-shift procedure for multidirectional instability of the shoulder. J Bone Joint Surg 74A:1516–1521Google Scholar
  14. 14.
    Cordasco FA, Pollock RG, Flatow EL, Bigliani LU (1993) Management of multidirectional instability. Op Tech Sports Med 1:293–300Google Scholar
  15. 5.
    DePalma AF (1973) Surgery of the Shoulder, 2nd Ed. Lippincott, Philadelphia, pp 425Google Scholar
  16. 16.
    Dowdy PA, O’Driscoll SW (1993) Shoulder Instability. An analysis of family history. J Bone Joint Surg 75B:782–784Google Scholar
  17. 17.
    Duncan R, Savoie FH III (1993) Arthroscopic inferior capsular shift for multidirectional instability of the shoulder: a preliminary report. Arthroscopy 9:24–27PubMedCrossRefGoogle Scholar
  18. 18.
    Emery RJH, Mulli AB (1991) Glenohumeral joint instability in normal adolescents. Incidence and significance. J Bone Joint Surg 73B:406–408Google Scholar
  19. 19.
    Fanton GS, Wall MS, Markel MD Electrothermally assisted capsule shift (ETACS) procedure for shoulder instability. Oratec Company (in press)Google Scholar
  20. 20.
    Field LD, Warren RF, O’Brien SJ, Altchek DW, Wickiewicz TL (1995) Isolated closure of rotator interval defects for shoulder instability. Am J Sports Med 23:557–563PubMedCrossRefGoogle Scholar
  21. 21.
    Finnsterbush A, Pogrund H (1982) The hypermobility syndrome. Musculoskeletal complaints in 100 consecutive cases of generalized joint hypermobility. Clin Orthop 168:124–127Google Scholar
  22. 22.
    Flatow EL (1992) Multidirectional instability. In: Kohn DCJ Wirth CJ (Hrsg) Die Schulter: Aktuelle operative Therapie. Thieme, Stuttgart, S 180–187Google Scholar
  23. 23.
    Flatow EL (1996) Multidirectional instability. In: Bigliani LU (ed) The unstable shoulder. Am Acad Orthop Surgeons, Rosemont, Illinois pp 79–90Google Scholar
  24. 24.
    Flatow EL, Warner JP (1998) Instability of the shoulder: complex problems and failed repairs. J Bone Joint Surg 80A:122–140Google Scholar
  25. 25.
    Foster CR (1983) Multidirectioal instability of the shoulder in the athlete. Clin Sports Med 2:355–368PubMedGoogle Scholar
  26. 26.
    Fredrich H Imhoff AB Höfler H (1998) Biomechanische und histomorpho-logische Untersuchungen zur Laserwirkung an der Schultergelenkskapsel Z Orthop 136:A119-120Google Scholar
  27. 27.
    Friedman RJ, Bonutti PM, Genez B, Norfray JF (1993) Cinemagnetic resonance imaging of the glenohumeral joint. Orthop Trans 17:1018–1019Google Scholar
  28. 28.
    Fu F, Ticker JB, Imhoff AB (1997) An atlas of shoulder surgery. Dunitz, LondonGoogle Scholar
  29. 29.
    Hardy P, Thabit G 3rd, Fanton GS, Blin JL, Lortat-Jacob A, Benoit J (1996) Arthroscopic management of recurrent anterior shoulder dislocation by combining a labrum suture withn antero-inferior holmium:YAG laser capsular shrinkage. Orthopäde 25:91–93PubMedGoogle Scholar
  30. 30.
    Hawkins RJ, Bokor DJ (1990) Clinical evaluation of shoulder problems. In: CA Rockwood CA Jr, Matsen FA III (eds) The Shoulder, Vol 1. Saunders, Philadelphia, pp 149–177Google Scholar
  31. 31.
    Hawkins RJ, Kunkel SS, Nayak NK (1991) Inferior capsular shift for multidirectional instability of the shoulder: 2-5 year follow-up. Orthop Trans 15:765Google Scholar
  32. 32.
    Huber H, Gerber C (1994) Voluntary subluxation of the shoulder in children. A long-term follow-up study of 36 shoulders. J Bone Joint Surg 76B:118–122Google Scholar
  33. 33.
    Imhoff A (1995) The use of lasers in orthopaedic surgery. Controversial topics in sports medicine. Operat Tech Orthop 5:192–203CrossRefGoogle Scholar
  34. 34.
    Imhoff A, De Simoni C (1996) Die arthroskopische Schulterstabilisierung mit Suretacs-eine Komplikationsanalyse. 2. Zentraleuropäischer Unfallkongress Davos. Swiss Surgery 2:30Google Scholar
  35. 35.
    Imhoff A, Ledermann T (1995) Arthroscopic subacromial decompression with and without Holmium:YAG-Laser-a prospective comparative study. Arthroscopy 11:549–556PubMedCrossRefGoogle Scholar
  36. 36.
    Imhoff A, Perrenoud A, Neidl K (1992) MRI bei Schulterinstabilität-Korrelation zum Arthro-CT und zur Arthroskopie der Schulter. Arthroskopie 5:122–129Google Scholar
  37. 37.
    Imhoff AB (1997) Arthroscopic shoulder stabilisation and capsular shift with Fastak and laser assisted capsular shift-procedure (LACS). 5th Symposium of the Korean Arthroscopy Association. Seoul, KoreaGoogle Scholar
  38. 38.
    Imhoff AB (1997) The role of capsuloligamentous structure in the unstable shoulder-a biomechanical and arthroscopical approach. 24th Annual Meeting of the Japan Shoulder Society. Kyoto, JapanGoogle Scholar
  39. 39.
    Imhoff AB, Burkart A, Röscher E (1998) Adverse reactions to bioabsorbable suretac device in arthroscopic shoulder stabilisation and SLAP-refixation. 8th Congress of the European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA) Nizza, France, p 163Google Scholar
  40. 40.
    Imhoff AB, Debski RE, Warner JJP, Patel PR, Demirhan M, Fu FH, Woo SL-Y (1995) Biomechanical function of the glenohumeral ligaments-a quantitative assessment. AOSSM Toronto, Canada pp 87–88Google Scholar
  41. 41.
    Imhoff AB, König U Die multidirektionale Schulterinstabilität In: Imhoff AB, König U (Hrsg) Schulterinstabilität, Rotatorenmanschette. Steinkopff, Darmstadt (in Druck)Google Scholar
  42. 42.
    Imhoff AB, Röscher E, König U (1998) Arthroskopische Schulterstabilisierung: Differenzierte Behandlungsstrategie mit Suretac, Fastak, Holmium: YAG-Laser und Elektrochirurgie. Orthopäde 27:518–531PubMedGoogle Scholar
  43. 43.
    Jalovaara P, Myllylä V, Päivännsalo M (1992) Autotraction stress roentgenography for demonstration anterior and inferior instability of the shoulder joint. Clin Orthop 284:136–143PubMedGoogle Scholar
  44. 44.
    Jerosch J, Castro WH (1992) Shoulder instability in Ehlers-Danlos syndrome. An indication for surgical treatment? Acta Orthop Belgica 56:451–453Google Scholar
  45. 45.
    Jobe C (1990) Symposium on anterior instability. Read at the Fourth Congress of the European Society for Surgery of the Shoulder and the Elbow. Milano, ItalyGoogle Scholar
  46. 46.
    Jobe CM (1996) Anatomy and surgical approaches. In: Jobe FW (ed) Operative techniques in upper extremity sports injuries. Mosby, St Louis, pp 124–153Google Scholar
  47. 47.
    Jobe FW, Giangarra CE, Kvitne RS, Glousman RE (1991) Anterior capsulolabral reconstruction of the shoulder in athletes in overhand sports. Am J Sports Med 19:428–434PubMedCrossRefGoogle Scholar
  48. 48.
    Jobe FW, Kvitne RS, Giangarra CE (1989) Shoulder pain in the overhand or throwing athlete: The relationship of anterior instability and rotator cuff impingement. Orthop Rev 18:963–975PubMedGoogle Scholar
  49. 49.
    König U, Imhoff AB Anatomie und Histologie des Labrum-Kapsel-Komplexes. In: Imhoff AB, König U (Hrsg) Schulterinstabilität Rotatorenmanschette. Steinkopff, Darmstadt (in Druck)Google Scholar
  50. 50.
    Kronberg M, Broström LA, Nemeth G (1991) Differences in shoulder muscle activity between patients with generalized joint laxity and normal controls. Clin Orthop 269:181–192PubMedGoogle Scholar
  51. 51.
    Lebar RD, Alexander AH (1992) Multidirectional shoulder instability. Clinical results of inferior capsular shift in an active-duty population. Am J Sports Med 20:193–198PubMedCrossRefGoogle Scholar
  52. 52.
    Lephart SM, Warner JJP, Borsa PA, Fu FH (1994) Proprioception of the shoulder joint in healthy unstable and surgically repaired shoulders. J Shoulder Elbow Surg 3:371–380CrossRefGoogle Scholar
  53. 53.
    Lusardi DA, Wirth MA, Wurtz D et al (1993) Loss of external rotation following anterior capsulorrhaphy of the shoulder. J Bone Joint Surg 75A:1185–1192Google Scholar
  54. 54.
    Mallon WJ, Speer KP (1995) Multidirectioal instability: current concepts. J Shoulder Elbow Surg 4:54–64PubMedCrossRefGoogle Scholar
  55. 55.
    Mclntyre LF, Caspari RB, Savoie FH 3rd (1997) The arthroscopic treatment of multidirectional shoulder instability: two-year results of a multiple suture technique. Arthroscopy 13:418–425CrossRefGoogle Scholar
  56. 56.
    Mizuno K, Itakura Y, Muratsu H (1992) Inferior capsular shift for inferior and multidirectional instability of the shoulder in young children: report of two cases. J Shoulder Elbow Surg 1:200–206CrossRefGoogle Scholar
  57. 57.
    Neer CS II Foster CR (1980) Inferior capsular shift for involuntary inferior and multidirectional instability of the shoulder. A preliminary report. J Bone Joint Surg 62A:897–908Google Scholar
  58. 58.
    Neer CS II (1985) Involuntary inferior and multidirectional instability of the shoulder: etiology, recognition and treatment. In: American Academy of Orthopaedic Surgeons (eds) Instructional Course Lectures, Vol 34. Park Ridge, Illinois, pp 232–238Google Scholar
  59. 59.
    Neer CS II (1990) Shoulder Reconstruction. Saunders, Philadelphia pp 273–341Google Scholar
  60. 60.
    Oettl G, Imhoff AB, Merl T, Keydel M (1998) Physical examination MRI, MRA and Arthroscopy of SLAP-Lesions-a prospective comparison. 8th Congress of the European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA). Nizza, France, p 422Google Scholar
  61. 61.
    Resch H, Povacz P, Wambacher M, Sperner G, Golser K (1997) Arthroscopic extra-articular Bankart repair for the treatment of recurrent anterior shoulder dislocation. Arthroscopy 13:188–200PubMedCrossRefGoogle Scholar
  62. 62.
    Richardson AB, Jobe FW, Collins HR (1980) The shoulder in competitive swimming. Am J Sports Med 8:159–163PubMedCrossRefGoogle Scholar
  63. 63.
    Rockwood CA Jr (1994) Management of patients with multidirectional instability of the shoulder. Orthop Trans 18:328Google Scholar
  64. 64.
    Rowe CR, Patel D, Southmayd WW (1978) The Bankart procedure. A long-term end-result study. J Bone Joint Surg 60A:1–16Google Scholar
  65. 65.
    Rowe CR, Pierce DS, Clark JG (1973) Voluntary dislocation of the shoulder. A preliminary report on a clinical electromyographic and psychiatric study of twenty-six patients. J Bone Joint Surg 55A:445–460Google Scholar
  66. 66.
    Rowe CR, Zarins B (1981) Recurrent transient subluxation of the shoulder. J Bone Joint Surg 63A:863–872Google Scholar
  67. 67.
    Silliman JF, Hawkins RJ (1993) Classification and physical diagnosis of instability of the shoulder. Clin Orthop 291:7–19PubMedGoogle Scholar
  68. 68.
    Snyder SJ, Karzel RP, DelPizzo W, Ferkel RD, Friedman MJ (1990) SLAP lesions of the shoulder. Arthroscopy 6:274–279PubMedCrossRefGoogle Scholar
  69. 69.
    Speer KP, Deng X, Borrero S, Torzilli PA, Altchek DA, Warren RF (1994) Biomechanical evaluation of a simulated Bankart lesion. J Bone Joint Surg 76A:1819–1826Google Scholar
  70. 70.
    Thabit G III (1994) Laser-assisted capsular shift for treatment of glenohumeral instability. Orthop Spec Ed 3:10–12Google Scholar
  71. 71.
    Thomas SC, Matsen FA III (1989) An approach to the repair of avulsion of the glenohumeral ligaments in the management of traumatic anterior glenohumeral instability. J Bone Joint Surg 71A:506–513Google Scholar
  72. 72.
    Walch G, Agostini JY, Levigne C, Nové-Josserand L(1995) Recurrent anterior and multidirectional instability of the shoulder. Rev Chir Orthop Réparatrice Appar Mot 81:682–690PubMedGoogle Scholar
  73. 73.
    Walch G, Liotard JP, Boileau P, Noel E (1993) Postero-superior glenoid impingement. Another impingement of the shoulder. J Radiol 74:47–50PubMedGoogle Scholar
  74. 74.
    Warner JJ, Deng XH, Warren RF, Torzilli PA (1992) Static capsuloligamentous restraints to superior-inferior translation of the glenohumeral joint. Am J Sports Med 20:675–685PubMedCrossRefGoogle Scholar
  75. 75.
    Warner JJ, Kann S, Marks P (1994) Arthroscopic repair of combined Bankart and superior labral detachment anterior and posterior lesions: technique and preliminary results. Arthroscopy 10:383–391PubMedCrossRefGoogle Scholar
  76. 76.
    Warner JJ, Miller MD, Marks P, Fu FH (1995) Arthroscopic Bankart repair with Suretac device Part I: clinical observations. Arthroscopy 11:2–13PubMedCrossRefGoogle Scholar
  77. 77.
    Warner JJP, Johnson DL, Miller MD, Caborn DNM (1994) The concept of a “selective capsular shift” for anterior-inferior instability of the shoulder. Orthop Trans 18:1183Google Scholar
  78. 78.
    Warner JJP, Schulte R Kary, Imhoff AB (1995) Current concepts in shoulder instability. Adv Op Orthop 3:217–248Google Scholar
  79. 79.
    Welsh RP, Trimmings N (1987) Multidirectional instability of the shoulder. Orthop Trans 11:231Google Scholar
  80. 80.
    Yamaguchi K, Flatow EL (1995) Management of multidirectional instability. Clin Sports Med 14:885–902PubMedGoogle Scholar
  81. 81.
    Zuckerman JD, Matsen FA 3rd (1984) Complications about the glenohumeral joint related to the use of screws and staples. J Bone Joint Surg 66A:175–180Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2001

Authors and Affiliations

  • U. König
  • A. B. Imhoff

There are no affiliations available

Personalised recommendations