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Schultereckgelenksprengung bei Profisportlern

Acromioclavicular injuries in professional athletes

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Zusammenfassung

Hintergrund

Schultereckgelenksprengungen stellen im Sport die häufigste Verletzung des Schultergürtels dar. Dabei sind leichtgradige Akromioklavikulargelenk(ACG)-Verletzungen wesentlich häufiger als hochgradige. Als Unfallmechanismen kommen grundsätzlich ein Direktrauma auf die Schulter bzw. ein Sturz auf den adduzierten Ellenbogen mit Fortleitung zum ACG in Frage.

Diagnostik

Entscheidend ist eine akkurate Röntgendiagnostik mit Durchführung von Stressaufnahmen zur Detektion einer horizontalen Instabilitätskomponente. Die vollständige Bildgebung erlaubt eine korrekte Klassifizierung der ACG-Verletzung.

Therapie

Die meisten ACG-Verletzungen können konservativ mit kurzfristiger Immobilisierung, oraler Analgesie und schmerzorientierter frühfunktioneller Behandlung behandelt werden. Eine grundsätzliche Operationsindikation besteht bei hochgradigen Instabilitäten im Sinne von Grad-IV- und -V-Luxationen nach Rockwood. Allerdings sind gerade beim Profisportler individuelle Faktoren wie Sportart, Händigkeit, Karriereentwicklung und Wirtschaftlichkeit in diesen Entscheidungsprozess mit einzubeziehen. Akute ACG-Verletzungen werden arthroskopisch mit korakoklavikulärer und additiver akromioklavikulärer Stabilisierung bei zusätzlicher horizontaler Instabilität versorgt. Chronische ACG-Instabilitäten werden mittels autologer korakoklavikulärer Semitendinosussehnenbandersatzplastik behandelt.

Ausblick

Nach eher restriktiver Nachbehandlung mit Ruhigstellung für 6 Wochen ist mit Wettkampffähigkeit nach etwa 3 bis 4 Monaten bei akuten und 6 Monaten bei chronischen Verletzungen zu rechnen.

Abstract

Background

Acromioclavicular joint (ACJ) dislocations represent the most frequent injuries of the shoulder girdle among athletes. Low grade injuries are more common than high grade injuries. Possible injury mechanisms are either a direct trauma to the shoulder or a fall on an adducted elbow with indirect trauma to the ACJ.

Diagnostics

Accurate radiological diagnostics, including stress recordings for detection of a horizontal instability component are of utmost importance and allow correct classification of the ACJ injury.

Therapy

Most ACJ injuries can be treated non-operatively with short-term immobilization, oral analgesia therapy and pain-oriented functional physiotherapeutic treatment. In principle, surgical indications are high grade injuries in the sense of Rockwood dislocations types IV and V; however, individual factors, such as the type of sport, handedness, career perspectives and economic aspects have to be involved in the decision-making process, particularly in professional athletes. Acute ACJ dislocations are treated arthroscopically including coracoclavicular and additional acromioclavicular stabilization in cases of horizontal instability. Chronic ACJ dislocations require coracoclavicular ligament reconstruction using autologous semitendinosus tendon grafting.

Perspectives

After relatively restrictive postoperative care including a 6-week immobilization period, competitive sport is normally possible after 3–4 months in cases of acute injury and after 6 months in cases of chronic injury.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. M. Tauber weist auf folgende Beziehung hin: der Autor ist als Berater für die Fa. Arthrex, Karlsfeld, tätig. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Zentrum für Schulter- und Ellenbogenchirurgie, ATOS Klinik München, Effnerstr. 38, 81925, München, Deutschland

    M. Tauber

  2. Paracelsus Medizinische Privatuniversität Salzburg, Salzburg, Österreich

    M. Tauber

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Correspondence to M. Tauber.

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Tauber, M. Schultereckgelenksprengung bei Profisportlern. Orthopäde 43, 249–255 (2014). https://doi.org/10.1007/s00132-013-2148-3

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