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06.09.2016 | Instabilitäten am Ellenbogengelenk | Leitthema

Chronische Bandinstabilitäten des Ellenbogengelenks

verfasst von: Dr. M. Hackl, T. Leschinger, L. P. Müller, K. Wegmann

Erschienen in: Die Orthopädie | Ausgabe 10/2016

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Zusammenfassung

Hintergrund

Die chronische ligamentäre Ellenbogeninstabilität ist eine bedeutende Pathologie, da sie mit einer ausgeprägten Dysfunktion einhergeht und einen Risikofaktor für die Arthroseentwicklung darstellt. Die häufigste Form ist die posterolaterale Rotationsinstabilität (PLRI) durch Insuffizienz des lateralen Kollateralbandes (LCL), die meist Folge einer traumatischen Ellenbogenluxation ist. Insbesondere bei Wurfsportlern kann es im Rahmen von chronischer Überbelastung zu einer Insuffizienz des ulnaren Seitenbandes (UCL) mit Valgusinstabilität kommen.

Diagnostik

Klinisch äußert sich eine chronische Ellenbogeninstabilität nicht immer durch Instabilitätsgefühle und rezidivierende Luxationen, sondern ist häufig durch Schmerzen und sekundäre Gelenksteifen geprägt. Es existieren verschiedene klinische Tests, die in Abhängigkeit der Beschwerdesymptomatik jedoch nur eingeschränkte Aussagekraft haben. Ein „drop sign“ im Röntgen sowie der Nachweis von Bandverletzungen und Gelenkinkongruenzen im MRT können die klinische Verdachtsdiagnose stützen. Manchmal lässt sich die Vermutung erst mittels diagnostischer Arthroskopie verifizieren.

Therapie

Die Bandplastik des lateralen ulnaren Kollateralbands (LUCL) bei PLRI weist in der Regel gute klinische Ergebnisse auf, Rezidivinstabilitäten werden jedoch in etwa 8 % der Fälle berichtet. Bei medialer Instabilität führt die UCL-Plastik bei Wurfsportlern zu einer Rekonvaleszenz in etwa 86 % der Fälle. Die Ulnarisneuropathie ist die häufigste Komplikation und tritt bei etwa 6 % auf. Im seltenen Fall einer multidirektionalen Instabilität können das LUCL und UCL simultan mit einem singulären Sehnengraft in Form einer zirkumferenziellen Box-loop-Rekonstruktion ersetzt werden. Bisher wurden hierzu 15 Fälle mit vielversprechenden Ergebnissen publiziert.

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Titel: Chronische Bandinstabilitäten des Ellenbogengelenks
verfasst von: Dr. M. Hackl
T. Leschinger
L. P. Müller
K. Wegmann
Publikationsdatum: 06.09.2016
Verlag: Springer Berlin Heidelberg
Schlagwort: Instabilitäten am Ellenbogengelenk
Erschienen in: Die Orthopädie / Ausgabe 10/2016
Print ISSN: 2731-7145
Elektronische ISSN: 2731-7153
DOI: https://doi.org/10.1007/s00132-016-3324-z

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