Sportverletz Sportschaden 2020; 34(03): 153-162
DOI: 10.1055/a-1107-8514
Übersicht

Die „Handballer-Schulter“ im Fokus von Diagnostik und Therapie

“Handball shoulder” in the focus of diagnosis and treatment
Pierre Hepp
Klinik für Orthopädie, Unfallchirurgie, plastische Chirurgie, Universität Leipzig
,
Ralf Henkelmann
Klinik für Orthopädie, Unfallchirurgie, plastische Chirurgie, Universität Leipzig
› Author Affiliations

Zusammenfassung

Handball zählt zu den beliebtesten Mannschaftssportarten in Deutschland. Bei Diagnostik und Therapie von Schulterverletzungen und Schulterbeschwerden muss zwischen der sportartspezifischen jahrelangen Adaptation und einer vermeintlichen Dekompensation zwingend unterschieden werden. Im Gegensatz zu reinen Wurfsportarten, wie z. B. Baseball oder Speerwerfen, werden im Handball wegen des gleichzeitigen Gegnerkontaktes die beabsichtigten Bewegungsabläufe durch erlaubte und unerlaubte Behinderungen oft plötzlich und ruckartig beeinflusst. Hierdurch können zusätzliche Verletzungen entstehen. Der Übergang einer physiologisch adaptierten Handballer-Schulter zu einer therapiebedürftigen pathologischen Werfer-Schulter ist meist fließend. Die Werfer-Schulter ist durch eine Leistungseinschränkung charakterisiert, die durch Schmerzen in der Schulter bei wiederholter sportartspezifischer Belastung hervorgerufen wird. Neben einer gründlichen klinischen Untersuchung ist, aufgrund der Tatsache, dass Veränderungen der Handballer-Schulter sich in der Muskultur, den Sehnen und im Knochen im Sinne von Überlastungsreaktionen (bone bruise) darstellen, das MRT die bevorzugte Untersuchungsmethode. Neben einer Sportkarenz und einer suffizienten Schmerztherapie sollte eine gezielte Physiotherapie erfolgen. Die Interpretation der MRT-Ergebnisse sollte immer mit den Symptomen und den klinischen Untersuchungsergebnissen abgeglichen werden. Indikationen zur Operation sind eine ausbleibende Besserung nach gezielter Schmerz- und Physiotherapie, strukturelle Schäden entsprechend der Symptome ohne Heilungschance bzw. mit höherer Gewissheit der Verbesserung der Beschwerden und Funktion durch eine Operation. Nach einer operativen Therapie spielt die anschließende Rehabilitation eine große Rolle. Eine Sportfähigkeit ist je nach Verletzung in bis zu 90 % wieder möglich.

Abstract

Handball is one of the most popular team sports in Germany. In the diagnosis and treatment of shoulder injuries and shoulder complaints, a distinction must be made between sports-specific adaptation over many years and supposed decompensation. In contrast to throwing sports such as baseball or javelin, intended movement sequences in handball are often disrupted suddenly and abruptly by simultaneous contact with an opponent. This can result in a potential for further injuries. There is usually a gradual transition from a physiologically adapted handball shoulder to a pathological throwing shoulder requiring therapy. A throwing shoulder is characterised by a limitation of performance caused by pain in the shoulder during repeated sports-specific stress. In addition to a thorough clinical examination, MRI is the preferred method of examination due to the fact that changes in a handball shoulder are reflected in muscular tissue, tendons and bone in the form of overstrain reactions (bone bruise). Patients should not only take a break from sports and receive adequate pain treatment, but also undergo a specific physiotherapy regimen. MRI results should always be interpreted in due consideration of symptoms and clinical examination results. Surgery is indicated if there is a lack of improvement after specific pain treatment and physiotherapy, or structural damage corresponding to the symptoms without a chance of recovery or with a higher probability of symptoms and function improving in response to surgery. After surgical treatment, the subsequent rehabilitation plays a major role. Depending on the injury, up to 90 % of the patients may be able to return to sports.



Publication History

Article published online:
21 August 2020

© Georg Thieme Verlag KG
Stuttgart · New York

 
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