Multidirektionale atraumatische Schulterinstabilität

Zusammenfassung

Patienten mit multidirektionaler Instabilität (MDI) weisen häufig sehr starke Beeinträchtigungen im Alltag mit habituellen Luxationen und Schmerzen auf. Diese lassen sich jedoch in vielen Fällen mit konservativen Maßnahmen verbessern.

Der hier vorgestellte Fallbericht zeigt, dass bei MDI-Patienten mit abnormaler Muskelaktivierung durch die Therapie des pathologischen Muskelpatternings die selektive Aktivierung der Rotatorenmanschette und die Schulung der proximalen Stabilität des Rumpfes erfolgreich behandelt werden können. Weitere wichtige Behandlungsinhalte waren die Vermeidung luxationsauslösender Bewegungen, Aufklärung und Heimübungen. Im Laufe der Therapie verringerten sich die Luxationshäufigkeit und die Schmerzen.

Abstract

Patients with multidirectional instability (MDI) often suffer from impairments in activities of daily living with habitual luxation and pain. In many cases this can be improved using conservative treatment modalities.

This case study demonstrates that in MDI-patients with abnormal muscle activation can be successfully treated by addressing the abnormal muscle patterns, selective activation of the rotatory cuff and training of proximal trunk stability. Education in prevention of luxation provoking movements, patient information and home exercise were additional important treatment interventions. During the course of treatment both luxation frequency and pain were reduced.

Schlüsselwörter

multidirektionale Instabilität - habituelle Luxationen - Schmerzen - Muskelpatterning

Keywords

multidirectional instability - habitual luxation - pain - muscle patterning

• Literatur

• 1 Altchek DW, Warren RF, Skyhar MJ et al. T-plasty modification of the Bankart procedure for multidirectional instability of the anterior and inferior types. J Bone Joint Surg 1991; 73A: 105-112
• 2 An YH, Friedman RJ. Multidirectional instability of the glenohumeral joint. Orthop Clin North Am 2000; 31: 275-285
• 3 Bahu MJ, Trentacosta N, Vorys GC et al. Multidirectional instability: evaluation and treatment options. Clin Sports Med 2008; 27: 671-689
• 4 Barden JM, Balyk R, Raso VJ et al. Dynamic upper limb proprioception in multidirectional shoulder instability. Clin Orthop Relat Res 2004; 420: 181-189
• 5 Bayley I. The Classification of shoulder instability – New light through old windows. 17th Congress of ESSSE/SECEC in Heidelberg 2003
• 6 Beasley L, Faryniarz DA, Hannafin JA. Multidirectional instability of the shoulder in the female athlete. Clin Sports Med 2000; 19: 331-349
• 7 Brown GA, Tan JL, Kirkley A. The lax shoulder in females: issues, answers but many more questions. Clin Ortop 2000; 372: 110-122
• 8 Bürge E, Spirgi-Gantert I, Suppé B, (Hrsg) FBL Klein-Vogelbach – Functional Kinetics. Ballübungen: Instruktion und Analyse. Heidelberg: Springer; 2013
• 9 Burkhart SS, Morgan CD, Kibler WB. The disabled throwing shoulder: Spektrum of pathology part III: The Sick scapula, scapular dyskinesis, the kinetic chain, and rehabilitation. Arthroscopy 2003; 19: 641-661
• 10 Burkhead WZ, Rockwood CA Jr.. Treatment of instability of the shoulder with an exercise program. J Bone Joint Surg Am 1992; 74: 890-896
• 11 Gerber C, Ganz R. Clinical assessment of instability of the shoulder. With special reference to anterior and posterior drawer tests J Bone Joint Surg Br 1984; 66: 551-556
• 12 Germann G, Harth A, Wind G et al. Standardisierung und Validisierung der deutschen Version 2.0 des “Disability of Arm, Shoulder, Hand“ (DASH)-Fragebogens zur Outcome- Messung an der oberen Extremität. Unfallchirurg 2003; 106: 13-19
• 13 Habermeyer P, Jung D, Ebert T. Behandlungsstrategie bei der traumatischen vorderen Erstluxation der Schulter. Plädoyer für ein Mehrstufenkonzept einer präventiven Erstversorgung Unfallchirurg 1998; 101: 328-341 Diskussion: 327
• 14 Hawkins RJ, Bokor DJ. Clinical evaluation of shoulder problems. In: Rockwood CA, Matsen FH, (eds) The Shoulder Vol. 1. Philadelphia: Saunders; 1990
• 15 Hewitt M, Getelman MH, Snyder SJ. Arthroscopic management of multidirectional instability: pancapsular plication. Orthop Clin North Am 2003; 34: 549-557
• 16 HurleyHurley JA, Anderson TE, Dear W et al. Posterior shoulder instability. Surgical versus conservative results with evaluation of glenoid version Am J Sports Med 1992; 20: 396-400
• 17 Jaggi A. Scapuladyskinesie – The Management of Muscle Patterning Shoulder Instability. In: Brunner UH, (Hrsg) Spezialgebiete aus der Schulter- und Ellenbogenchirurgie, Bd. 2. Darmstadt: Steinkopff; 2007
• 18 Kibler WB. The role of the scapula in athletic shoulder function. Am J Sports Med 1998; 26: 325-337
• 19 Kibler WB, McMullen J. Scapular dyskinesis and its relation to shoulder pain. J Am Acad Orthop Surg 2003; 11: 142-151
• 20 Kiss J, Damrel D, Mackie A et al. Non-operative treatment of multidirectional shoulder instability. Int Orthop 2001; 24: 354-357
• 21 Magosch P. Differentialdiagnose der Schultererkrankungen. In: Habermeyer P, Lichtenberg S, Magosch P, (Hrsg) Schulterchirurgie. München: Urban & Fischer in Elsevier; 2010
• 22 McFarland EG, Kim TK, Park HB et al. The effect of variation in definition on the diagnosis of multidirectional instability of the shoulder. J Bone Joint Surg Am 2003; 85: 2138-2144
• 23 Metcalf MH, Savoie FH, Field LD. Arthroscopic stabilization in posterior or multidirectional instability of the shoulder. Instr Course Lect 2003; 52: 17-23
• 24 Misamore GW, Sallay PI, Didelot W. A longitudinal study of patients with multidirectional instability of the shoulder with seven- to ten-year follow-up. J Shoulder Elbow Surg 2005; 14: 466-470
• 25 Morris AD, Kemp GJ, Frostick SP. Shoulder electromyography in multidirectional instability. J Shoulder Elbow Surg 2004; 13: 24-29
• 26 Nyiri P, Illyés A, Kiss R et al. Intermediate biomechanical analysis of the effect of physiotherapy only compared with capsular shift and physiotherapy in multidirectional shoulder instability. J Shoulder Elbow Surg 2010; 19: 802-813
• 27 O’Driscoll S. Atraumatic Instability: Pathology and Pathogenesis. In: Matsen F, Fu FH, Hawkins RJ, (eds) The Shoulder: a balance of mobility and stability. Rosemont: American Academy of Orthopaedic Surgeons; 1993
• 28 Rockwood CA, Burkhead WZ. Treatment of instability of the shoulder with an exercise program. J Bone Joint Surg 1992; 74A: 890-896
• 29 Rodeo SA, Suzuki K, Yamauchi M et al. Analysis of collagen fibres in shoulder capsule in patients with shoulder instability. Am J Sports Med 1998; 26: 634-643
• 30 Rowe CR. Evaluation of the Shoulder. In: Rowe CR, (ed) The Shoulder. New York: Churchill Livingstone; 1988
• 31 Rubin BD, Kibler WB. Fundamental principles of shoulder rehabilitation: Conservative to postoperative management. Arthroscopy – The Journal of Arthroscopic and Related Surgery 2002; 18: 29-39
• 32 Schneeberger AG, Hersche O, Gerber C. The unstable shoulder. Classification and therapy Unfallchirurg 1998; 101: 226-231
• 33 Sidles JA, Harryman DT, Harris SL. In vivo quantification of glenohumeral stability. Trans Orthop Res Soc 1991; 16: 646-646
• 34 Takwale VJ, Calvert P, Rattue H. Involuntary positional instability of the shoulder in adolescents and young adults. Is there any benefit from treatment? J Bone Joint Surg Br 2000; 82: 719-723
• 35 Werner A. Multidirectional shoulder instability. Nonoperative and operative treatment strategies Orthopäde 2009; 38: 64-69