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Stabilität versus Mobilität der Schulter

Biomechanische Aspekte beim Sportler

Stability versus mobility of the shoulder

Biomechanical aspects in athletes

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Zusammenfassung

Die Sportlerschulter bewegt sich in einem Zwiespalt zwischen gewünschter maximaler Beweglichkeit und unerwünschter Instabilität des Gelenks. Grundsätzlich kann dabei zwischen traumatischer Makroinstabilität und atraumatischer Mikroinstabilität unterschieden werden.

Insbesondere bei Überkopfsportarten kommt es im Rahmen der repetitiven Bewegungsausführung zu Anpassungserscheinungen der kapsulären Gelenkstabilisatoren: Elongation (Insuffizienz) der anterioren Kapsel und Kontraktur der posterioren Kapsel. Hieraus können neben dem Symptom einer anterioren Mikroinstabilität durch die vermehrte Auslenkung des Humeruskopfs auch glenohumerale Impingementphänome resultieren. Bei der Werferschulter stellt das posterosuperiore Impingement (PSI) das Kernproblem da, welches einen pathologischen Kontakt der Supraspinatus- und Infraspinatussehne am hinteren Glenoid beinhaltet und auch mit Superior-labrum-anterior-to-posterior(SLAP)-Läsionen assoziiert ist. Bei der Schwimmerschulter ist zusätzlich das anterosuperiore Impingement bei kombinierter Anteversion, Adduktion und Innenrotation des Arms relevant.

Die traumatische Schulterinstabilität des Kontaktsportlers lässt sich als Entität von der Mikroinstabilität des Überkopfsportlers abgrenzen. Kennzeichen ist die eindeutige Schulterluxation bei adäquatem Trauma und eine hierdurch verursachter struktureller Schaden am Gelenk. Zusätzlich zum hohen empirischen Rezidivrisiko junger Kontaktsportler beinhalten aus biomechanischer Sicht knöcherne Defekte des Glenoids ein hohes Gefährdungspotenzial. Kontaktsportler mit traumatischer Schulterinstabilität sollten daher im Verdachtsfall gezielt mittels CT-Untersuchung auf Glenoiddefekte hin untersucht und ggf. mittels knochenaufbauender Verfahren therapiert werden.

Abstract

The demand profile of athletes shoulders is high. On the one hand the shoulder has to provide a maximum active range of motion that allows rapid movements of the arm and on the other hand it has to be sufficiently stabilized to decelerate rapid movements and to neutralize the resulting translational forces. Two general types of instability can be differentiated in athletes shoulders: the macroinstability typically occurring in athletes involved in contact sports and the microinstability occurring in athletes involved in overhead sports.

Repetitive abduction and external rotation movements of athletes involved in overhead sports lead to adaptation of the glenohumeral joint capsule and ligaments. The anterior capsule becomes stretched while the posterior capsule develops tightness. These adaptations can result in an anterior microinstability as well as posterosuperior impingement (PSI) which implicates a pathological contact of the posterosuperior rotator cuff with the posterior glenoid and which is also associated with SLAP lesions. In contrast the shoulders of swimmers are prone to anterosuperior impingement because the arm stroke involves a forceful combined anteflexion, adduction and internal rotation of the arm.

The macroinstability of contact athletes is caused by sufficient trauma and characterized by a structural lesion of capsulolabral or bony lesion. While the empirical recurrence risk of young contact athletes is already high, it can be further impaired by bony defects of the glenoid. In suspected cases, critical glenoid defects should be quantified by computed tomography (CT) scans and treated by bony augmentation of the glenoid.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. M. Wellmann, M.F. Pastor, T. Smith, M. Struck geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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  1. Orthopädische Klinik, Medizinische Hochschule Hannover im Annastift, Anna-von-Borries-Str. 1–6, 30625, Hannover, Deutschland

    M.F. Pastor, T. Smith, M. Struck &  M. Wellmann

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  1. M.F. Pastor
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Correspondence to M. Wellmann.

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Pastor, M., Smith, T., Struck, M. et al. Stabilität versus Mobilität der Schulter. Orthopäde 43, 209–214 (2014). https://doi.org/10.1007/s00132-013-2142-9

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