Zusammenfassung
Zur Schulterinstabilität können sowohl strukturelle als auch nicht strukturelle Komponenten
beitragen. Damit die Wiederherstellung der funktionellen Stabilität gelingen kann,
müssen diese Faktoren bei der Klassifikation der Beschwerden und folglich auch bei
ihrer Behandlung berücksichtigt werden. In diesem Artikel wird einerseits ein Klassifikationssystem
diskutiert, das die Schulterinstabilität unter Berücksichtigung der strukturellen
und nicht strukturellen Komponenten in 3 Klassen einteilt, und andererseits die Tatsache,
dass die entsprechenden Pathologien ein Kontinuum darstellen. Strukturelle Ursachen
lassen sich chirurgisch behandeln, aber nicht strukturelle Ursachen (z. B. veränderte
neuromuskuläre Kontrolle innerhalb der Rotatorenmanschette) sollten auf konservative
Weise behandelt werden.
Das Ziel dieses Artikels bestand in einer Beschreibung der verschiedenen Formen der
Instabilität und einer Anleitung zu angemessener Behandlung, die unnötige chirurgische
Eingriffe vermeiden und eine effektive Rehabilitation gewährleisten soll.
Abstract
Both structural and non-structural components can contribute to shoulder instability.
Classification and therefore management must recognise these factors to achieve functional
stability. This paper discusses a classification system proposing three types of shoulder
instability recognising the structural and non-structural components and that a continuum
exists between pathologies. Structural causes can be addressed with surgical intervention,
but non-structural causes such as altered neuromuscular control within the rotator
cuff should be addressed conservatively.
The purpose of this article is to describe the types of instability and guide appropriate
management, helping to avoid surgery in inappropriate cases and ensure that effective
rehabilitation has been achieved.
Schlüsselwörter
Schulterinstabilität - Klassifikationssystem - Behandlung - Rehabilitation
Key words
shoulder instability - classification system - management - rehabilitation
Literatur
- 1
Abboud J A, Soslowsky L J.
Interplay of the static and dynamic restraints in glenohumeral instability.
Clin Orthop Relat Res.
2002;
1
48-57
- 2
Bitter N L, Clisby E F, Jones M A et al.
Relative contributions of infraspinatus and deltoid during external rotation in healthy
shoulders.
J Shoulder Elbow Surg.
2007;
16
563-568
- 3
Braun S, Kokmeyer D, Millett P J.
Shoulder injuries in the throwing athlete.
J Bone Joint Surg Am.
2009;
91
966-978
- 4
Burkhart S S, Morgan C D, Kibler W B.
The disabled throwing shoulder: spectrum of pathology. Part III: The SICK scapula,
scapular dyskinesis, the kinetic chain, and rehabilitation.
Arthroscopy.
2003;
19
641-661
- 5
Burkhead W Z, Rockwood Jr C A.
Treatment of instability of the shoulder with an exercise program.
J Bone Joint Surg Am.
1992;
74
890-896
- 6
Calvert Jr P.
Mini-Symposium: shoulder instability (ii). Classification and clinical assessment.
Curr Orthop.
1996;
10
151-157
- 7
Chu J C, Kane E J, Arnold B L et al.
The effect of a neoprene shoulder stabilizer on active joint-reposition sense in subjects
with stable and unstable shoulders.
J Athl Train.
2002;
37
141-145
- 8
David G, Magarey M E, Jones M A et al.
EMG and strength correlates of selected shoulder muscles during rotations of the glenohumeral
joint.
Bristol – Clin Biomech.
2000;
15
95-102
- 9
Gibson J C.
Mini-symposium: shoulder instability (iii) rehabilitation after shoulder instability
surgery.
Current Orthop.
2004;
18
197-209
- 10
Gibson J, Elphinston J.
Shoulder instability. Part III: Treatment and rehabilitation of shoulder instability.
Sportex Medicine.
2005;
24
18-22
- 11
Griffin E, Letha Y.
Neuromuscular training and injury prevention in sports.
Clinic Orthop Relat Res.
2003;
409
53-60
- 12
Handoll H HG, Almaiyah M A, Rangan A.
Surgical versus non-surgical treatment for acute anterior shoulder dislocation.
Cochrane Database of Syst Rev.
2004;
CD004325
- 13
Ide J, Maeda S, Yamaga M et al.
Shoulder-strengthening exercise with an orthosis for multidirectional shoulder instability:
quantitative evaluation of rotational shoulder strength before and after the exercise
program.
J Shoulder Elbow Surg.
2003;
12
342-345
- 14
Jaggi A, Malone A A, Cowan J et al.
Prospective blinded comparison of surface versus wire electromyographic analysis of
muscle recruitment in shoulder instability.
Physiother Res Int.
2009;
14
17-29
- 15 Kendall F P, McCreary E K, Provance P G. Muscles: testing and function with posture
and pain.. Chapter 4: Neck. 4th. ed. Baltimore: Williams & Wilkins; 1993
- 16
Kibler W B.
The role of the scapula in athletic shoulder function.
Am J Sports Med.
1998;
26
325-337
- 17
Kibler W B.
Closed kinetic chain rehabilitation for sports injuries.
Phys Med Rehabil Clin N Am.
2000;
11
369-384
- 18
Kibler W B, Press J, Sciascia A.
The role of core stability in athletic function.
Sports Med.
2006;
36
189-198
- 19
Kibler W B, Sciascia A.
Rehabilitation of the athlete’s shoulder.
Clin Sports Med.
2008;
27
821-831
- 20
Kibler W B, Sciascia A.
Scapular dyskinesis: current concepts.
Br J Sports Med.
2010;
44.
DOI: 10.1136/bjsm.2009.058834
- 21
Kim S H, Ha K I, Jung M W et al.
Accelerated rehabilitation after arthroscopic Bankart repair for selected cases: a
prospective randomized clinical study.
Arthroscopy.
2003;
19
722-731
- 22
Kuroda S, Sumiyoshi T, Moriishi J et al.
The natural course of atraumatic shoulder instability.
J Shoulder Elbow Surg.
2001;
10
100-104
- 23
Labriola J E, Lee T Q, Debski R E et al.
Stability and instability of the glenohumeral joint: the role of shoulder muscles.
J Shoulder Elbow Surg.
2005;
14
32S-38S
- 24
Lehman G J.
An unstable support surface is not a sufficient condition for increases in muscle
activity during rehabilitation exercise.
J Can Chiropr Assoc.
2007;
51
139-143
- 25
Lehman G J, Gilas D, Patel U.
An unstable support surface does not increase scapulothoracic stabilizing muscle activity
during push up and push up plus exercises.
Man Ther.
2008;
13
500-506
- 26
Lephart S M, Henry T J.
The Physiological basis for open and closed kinetic chain rehabilitation for the upper
extremity.
J Sports Rehab.
1996;
5
71-87
- 27
Lewis A, Kitamura T, Bayley J IL.
Mini symposium: shoulder instability (ii). The classification of shoulder instability:
new light through old windows!.
Curr Orthop.
2004;
18
97-108
- 28
Lippett S, Vanderhooft J, Harris S L et al.
Glenohumeral stability from concavity compression: a quantitative analysis.
J Shoulder Elbow Surg.
1993;
2
27-35
- 29
Ludewig P M, Phadke V, Braman J P et al.
Motion of the shoulder complex during multiplanar humeral elevation.
J Bone Joint Surg Am.
2009;
91
378-389
- 30
Magarey M E, Jones M A.
Dynamic evaluation and early management of altered motor control around the shoulder
complex.
Man Ther.
2003;
8
195-206
- 31
Magarey M E, Jones M A.
Specifi c evaluation of the function of force couples relevant for stabilization of
the glenohumeral joint.
Man Ther.
2003;
8
247-253
- 32 Malone A A, Jaggi A, Calvert P T. et al .Muscle patterning instability – classification
and prevalence in reference shoulder service. In: Norris T R, Zuckerman J D, Warner J JP,
[eds]. Surgery of the shoulder and elbow: an international perspective.. Illinois:
American Academy of Orthopaedic Surgeons; 2006
- 33
McAuliffe T B, Pangayatselvan T, Bayley I.
Failed surgery for recurrent anterior dislocation of the shoulder. Causes and management.
J Bone Joint Surg Br.
1988;
70
798-801
- 34
Myers J B, Lephart S M.
Sensorimotor deficits contributing to glenohumeral instability.
Clin Orthop Relat Res.
2002;
400
98-104
- 35
Myers J B, Wassinger C A, Lephart S M.
Sensorimotor contribution to shoulder stability: effect of injury and rehabilitation.
Man Ther.
2006;
11
197-201
- 36
Takwale V J, 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
- 37
Tennent T D, Beach W R, Meyers J F.
A review of the special tests associated with shoulder examination. Part II: laxity,
instability, and superior labral anterior and posterior (SLAP) lesions.
Am J Sports Med.
2003;
31
301-307
- 38
Thomas S C, Matsen F A.
An approach to the repair of avulsion of the glenohumeral ligaments in the management
of traumatic anterior glenohumeral instability.
J Bone Joint Surg Am.
1989;
71
506-513
- 39
Tokish J M, Decker M J, Ellis H B et al.
The belly-press test for the physical examination of the subscapularis muscle: electromyographic
validation and comparison to the lift-off test.
J Shoulder Elbow Surg.
2003;
12
427-430
- 40
Ulkar B, Kunduracioglu B, Cetin C et al.
Effect of positioning and bracing on passive position sense of shoulder joint.
Br J Sports Med.
2004;
38
549-552
- 41
Van Vliet P M, Heneghan N R.
Motor control and the management of musculoskeletal dysfunction.
Man Ther.
2006;
11
208-213
- 42
Walton J, Paxinos A, Tzannes A et al.
The unstable shoulder in the adolescent athlete.
Am J Sports Med.
2002;
30
758-767
- 43
Warner J P, Caborn D N.
Overview of shoulder instability.
Crit Rev Phys Rehab Med.
1992;
4
145-198
- 44
Werner C M, Favre P, Gerber C.
The role of the subscapularis in preventing anterior glenohumeral subluxation in the
abducted, externally rotated position of the arm.
Clin Biomech.
2007;
22
495-501
- 45
Wilk K E, Meister K, Andrews J R.
Current concepts in the rehabilitation of the overhead throwing athlete.
Am J Sports Med.
2002;
30
136-151
1 Der Originalartikel Rehabilitation for Shoulder Instability ist erschienen in British
Journal of Sports Medicine 2009; 44: 333 – 340.
Anju Jaggi
Shoulder & Elbow Unit, Royal National Orthopaedic Hospital
Brockley Hill
Stanmore HA 7 4LP
United Kingdom
Email: anju.jaggi@rnoh.nhs.uk
