Sportverletz Sportschaden 2016; 30(03): 157-162
DOI: 10.1055/s-0042-110011
Übersichtsarbeit
© Georg Thieme Verlag KG Stuttgart · New York

Rehabilitation ligamentärer Ellenbogeninstabilitäten beim Sportler

Rehabilitation of Ligamentous Elbow Instability in Athletes
S. Reuter
1   Abteilung für Unfallchirurgie, Orthopädie und Sportorthopädie, Klinikum München-West, München, Deutschland
,
O. Schmidtlein
2   OSPHYSIO Training & Therapie, München, Deutschland
,
A. B. Imhoff
3   Abteilung für Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, München, Deutschland
,
A. Lenich
1   Abteilung für Unfallchirurgie, Orthopädie und Sportorthopädie, Klinikum München-West, München, Deutschland
› Author Affiliations
Further Information

Publication History

Publication Date:
04 August 2016 (online)

Zusammenfassung

Ligamentäre Ellenbogeninstabilitäten betreffen Athleten in verschiedenen Sportarten und können zu einer dauerhaften Einschränkung der Trainings- und Wettkampffähigkeit führen. Die Weiterentwicklung von klinischer, biomechanischer und arthroskopischer Diagnostik hat zu einem wachsendem Verständnis der Ätiologie von Ellenbogenbeschwerden geführt. So können zunehmend auch ligamentäre Instabilitäten als Ursache für akute und chronische Schmerzen am Ellenbogen bei Athleten identifiziert werden. Dieser Artikel gibt einen Überblick über Ätiologie, Diagnostik und die Rehabilitation von ligamentären Ellenbogeninstabilitäten. Die Rehabilitationsprinzipien bei klinisch symptomatischer Ellenbogeninstabilität werden dargestellt.

Abstract

Ligamentous instability of the elbow is a common pathology affecting athletes in different types of sports. It may lead to a permanent impairment of an athlete’s ability to train and compete. The advancements made in arthroscopic, biomechanical and clinical diagnostic procedures allow for a better understanding of the etiology of elbow discomfort. As a result, ligamentous instability has been increasingly identified as a reason for acute and chronic pain in athletes. This article provides an overview of the etiology as well as diagnostic and rehabilitative procedures for ligamentous instability of the elbow in athletes and presents principles of rehabilitation in patients with symptomatic elbow instability.

 
  • Literatur

  • 1 Marquass B, Josten C. Acute and chronic instability of the elbow joint. Zeitschrift fur Orthopadie und Unfallchirurgie 2010; 148: 725-738 ; quiz 739–740
  • 2 Morrey BF, Tanaka S, An KN. Valgus stability of the elbow. A definition of primary and secondary constraints. Clin Orthop Relat Res 1991; 265: 187-195
  • 3 Morrey BF, An KN. Functional anatomy of the ligaments of the elbow. Clin Orthop Relat Res 1985; 201: 84-90
  • 4 Seiber K, Gupta R, McGarry MH et al. The role of the elbow musculature, forearm rotation, and elbow flexion in elbow stability: an in vitro study. Journal of shoulder and elbow surgery 2009; 18: 260-268
  • 5 Streubel PN, Cohen MS. Posterolateral Rotatory Instability of the Elbow: Diagnosis and Surgical Treatment. Operative Techniques in Sports Medicine 2014; 22: 190-197
  • 6 Kenter K, Behr CT, Warren RF et al. Acute elbow injuries in the National Football League. Journal of shoulder and elbow surgery 2000; 9: 1-5
  • 7 O'Driscoll SW, Morrey BF, Korinek S et al. Elbow Subluxation and Dislocation. Clin Orthop Relat Res 1992; 186: 197
  • 8 Shanley E, Thigpen C. Throwing injuries in the adolescent athlete. International journal of sports physical therapy 2013; 8: 630-640
  • 9 Marquass B, Josten C. Akute und chronische Instabilitäten des Ellenbogengelenks. Z Orthop Unfall 2010; 148: 725-740
  • 10 Patel RM, Lynch TS, Amin NH et al. The thrower's elbow. The Orthopedic clinics of North America 2014; 45: 355-376
  • 11 O'Driscoll SW, Lawton RL, Smith AM. The “moving valgus stress test” for medial collateral ligament tears of the elbow. The American journal of sports medicine 2005; 33: 231-239
  • 12 Ciccotti MG, Atanda Jr A, Nazarian LN et al. Stress sonography of the ulnar collateral ligament of the elbow in professional baseball pitchers: a 10-year study. The American journal of sports medicine 2014; 42: 544-551
  • 13 Regan W, Lapner PC. Prospective evaluation of two diagnostic apprehension signs for posterolateral instability of the elbow. Journal of shoulder and elbow surgery 2006; 15: 344-346
  • 14 Arvind CHV, Hargreaves DG. Table top relocation test – New clinical test for posterolateral rotatory instability of the elbow. Journal of shoulder and elbow surgery 2006; 15: 500-501
  • 15 Langer P, Fadale P, Hulstyn M. Evolution of the treatment options of ulnar collateral ligament injuries of the elbow. British journal of sports medicine 2006; 40: 499-506
  • 16 Jones KJ, Osbahr DC, Schrumpf MA et al. Ulnar collateral ligament reconstruction in throwing athletes: a review of current concepts. AAOS exhibit selection. The Journal of bone and joint surgery American volume 2012; 94: e49
  • 17 Anakwenze OA, Kancherla VK, Iyengar J et al. Posterolateral rotatory instability of the elbow. The American journal of sports medicine 2014; 42: 485-491
  • 18 Charalambous CP, Stanley JK. Posterolateral rotatory instability of the elbow. The Journal of bone and joint surgery British volume 2008; 90: 272-279
  • 19 Wolff AL, Hotchkiss RN. Lateral elbow instability: nonoperative, operative, and postoperative management. Journal of hand therapy 2006; 19: 238-243
  • 20 Anakwenze OA, Kwon D, O'Donnell E et al. Surgical treatment of posterolateral rotatory instability of the elbow. Arthroscopy 2014; 30: 866-871
  • 21 Daluiski A, Schrumpf MA, Schreiber JJ et al. Direct repair for managing acute and chronic lateral ulnar collateral ligament disruptions. The Journal of hand surgery 2014; 39: 1125-1129
  • 22 Kim BS, Park KH, Song HS et al. Ligamentous repair of acute lateral collateral ligament rupture of the elbow. Journal of shoulder and elbow 2013; 22: 1469-1473
  • 23 Lee BPH, Teo LHY. Surgical reconstruction for posterolateral rotatory instability of the elbow. Journal of Shoulder and Elbow Surgery 2003; 12: 476-479
  • 24 Lin KY, Shen PH, Lee CH et al. Functional outcomes of surgical reconstruction for posterolateral rotatory instability of the elbow. Injury 2012; 43: 1657-1661
  • 25 Daluiski A, Schrumpf MA, Schreiber JJ et al. Direct repair for managing acute and chronic lateral ulnar collateral ligament disruptions. J Hand Surg Am 2014; 39: 1125-1129
  • 26 Jones KJ, Dodson CC, Osbahr DC et al. The docking technique for lateral ulnar collateral ligament reconstruction: surgical technique and clinical outcomes. Journal of shoulder and elbow 2012; 21: 389-395
  • 27 Olsen BS, Søjbjerg JO. The treatment of recurrent posterolateral instability of the elbow. The Journal of Bone and Joint Surgery 2003; 85: 342-346
  • 28 Bizzini M, Hancock D, Impellizzeri F. Suggestions from the field for return to sports participation following anterior cruciate ligament reconstruction: soccer. The Journal of orthopaedic and sports physical therapy 2012; 42: 304-312
  • 29 Wilk KE, Macrina LC, Cain EL et al. Rehabilitation of the Overhead Athlete's Elbow. Sports health 2012; 4: 404-414
  • 30 Ellenbecker TS, Wilk KE, Altchek DW et al. Current concepts in rehabilitation following ulnar collateral ligament reconstruction. Sports health 2009; 1: 301-313
  • 31 Kibler WB, Kuhn JE, Wilk K et al. The disabled throwing shoulder: spectrum of pathology-10-year update. Arthroscopy 2013; 29: 141-161 e126
  • 32 Ellenbecker TS, Nirschl R, Renstrom P. Current concepts in examination and treatment of elbow tendon injury. Sports health 2013; 5: 186-194
  • 33 Harada M, Takahara M, Mura N et al. Risk factors for elbow injuries among young baseball players. Journal of shoulder and elbow 2010; 19: 502-507
  • 34 Aguinaldo AL, Chambers H. Correlation of throwing mechanics with elbow valgus load in adult baseball pitchers. The American journal of sports medicine 2009; 37: 2043-2048
  • 35 Oyama S, Yu B, Blackburn JT et al. Effect of excessive contralateral trunk tilt on pitching biomechanics and performance in high school baseball pitchers. The American journal of sports medicine 2013; 41: 2430-2438
  • 36 Westrick RB, Miller JM, Carow SD et al. Exploration of the y-balance test for assessment of upper quarter closed kinetic chain performance. International journal of sports physical therapy 2012; 7: 139-147
  • 37 Garrison M, Westrick R, Johnson MR et al. Association between the functional movement screen and injury development in college athletes. International journal of sports physical therapy 2015; 10: 21-28
  • 38 Janssen RP, Scheffler SU. Intra-articular remodelling of hamstring tendon grafts after anterior cruciate ligament reconstruction. Knee surgery, sports traumatology, arthroscopy 2014; 22: 2102-2108
  • 39 Wilk KE, Yenchak AJ, Arrigo CA et al. The Advanced Throwers Ten Exercise Program: a new exercise series for enhanced dynamic shoulder control in the overhead throwing athlete. The Physician and sportsmedicine 2011; 39: 90-97
  • 40 Bernas GA, Ruberte Thiele RA, Kinnaman KA et al. Defining safe rehabilitation for ulnar collateral ligament reconstruction of the elbow: a biomechanical study. The American journal of sports medicine 2009; 37: 2392-2400
  • 41 Reinold MM, Wilk KE, Reed J et al. Interval sport programs: guidelines for baseball, tennis, and golf. The Journal of orthopaedic and sports physical therapy 2002; 32: 293-298
  • 42 Wilk KE, Macrina LC, Fleisig GS et al. Deficits in glenohumeral passive range of motion increase risk of elbow injury in professional baseball pitchers: a prospective study. The American journal of sports medicine 2014; 42: 2075-2081
  • 43 Bahr R, Engebretsen L. IOC Medical Commission. Sub-Commission on Publications in the Sport Sciences. Sports injury prevention. Chichester, UK; Hoboken, NJ: Wiley-Blackwell; 2009
  • 44 Anz AW, Bushnell BD, Griffin LP et al. Correlation of torque and elbow injury in professional baseball pitchers. The American journal of sports medicine 2010; 38: 1368-1374
  • 45 Davis JT, Limpisvasti O, Fluhme D et al. The effect of pitching biomechanics on the upper extremity in youth and adolescent baseball pitchers. The American journal of sports medicine 2009; 37: 1484-1491