Skip to main content
SpringerLink
Log in

Schulterinstabilität und Rotatorenmanschettenruptur

Shoulder instability and rotator cuff tear

  • Leitthema
  • Published:
Der Orthopäde Aims and scope Submit manuscript

Zusammenfassung

Rotatorenmanschetten- (RM-)Läsionen werden im Zusammenhang mit einer anterioren Schulterluxation insbesondere bei >40-jährigen Patienten beschrieben. Die Häufigkeit dieser Begleitverletzung korreliert mit dem Patientenalter und der Anzahl der Reluxationsereignisse. Lokalisation und Ausdehnung sind altersabhängig. Inwieweit diese RM-Rupturen Ursache oder Folge der Schulterluxation sind, bleibt häufig ungeklärt. RM-Läsionen und glenohumerale Instabilität beeinflussen sich gegenseitig.

Die Literatur weist zu dieser Problematik nur wenige Studien mit kleinen Fallzahlen auf, anhand derer in Abhängigkeit von Patientenalter, -aktivität und funktionellem Anspruch Therapiekonzepte abgeleitet werden: bei <60-Jährigen, hohem funktionellen Anspruch und bei Rezidivluxationen wird sowohl die arthroskopische Rekonstruktion der RM-Ruptur, als auch der Kapsel-Labrum-Läsion empfohlen; bei weniger aktiven >60-Jährigen genügt oft die alleinige RM-Rekonstruktion zur Stabilisierung des Schultergelenks. Gemäß dieses Therapiekonzepts wird von überwiegend guten Ergebnissen berichtet. Als Sonderform einer anterioren Schulterluxation mit RM-Ruptur und Plexus-brachialis-Läsion wird die „terrible triad of the shoulder“ beschrieben.

Abstract

A rotator cuff tear as a complication of anterior shoulder dislocation is well known in patients over 40 years old. The incidence of this accompanying injury correlates with the patient’s age and the number of redislocations. The tear localization and dimension depend on the patient’s age. To what extent these tears are a complication of shoulder dislocation is often unclear, as rotator cuff tears and glenohumeral instability interact. Reports on this combined injury pattern are rare, but based on the patient’s age, activity level, and functional demand, therapeutic concepts have been devised. In active patients younger than 60 years and in cases of redislocation, both the rotator cuff tear and the capsule-labrum-ligament lesion should be reconstructed arthroscopically. In lesser active patients age 60 years or older, an isolated rotator cuff reconstruction is often sufficient to stabilize the glenohumeral joint. This treatment concept shows a predominantly good outcome.

As a special form of anterior shoulder dislocation, a rotator cuff tear and a plexus brachialis lesion – the“terrible triad of the shoulder” – is described here.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1

Literatur

  1. Araghi A, Prasarn M, St. Clair S, Zuckerman JD (2005) Recurrent anterior glenohumeral instability with onset after fourty years of age. Bull Hosp Joint Dis 62: 99–101

    Google Scholar 

  2. Berbig R, Weishaupt D, Prim J, Shahin O (1999) Primary anterior shoulder dislocation and rotator cuff tears. J Shoulder Elbow Surg 8: 220–225

    Article  PubMed  CAS  Google Scholar 

  3. Craig EC (1984) The posterior mechanism of acute anterior shoulder dislocations. Clin Orthop 180: 212–216

    Google Scholar 

  4. Gonzalez D, Lopez R (1991) Concurrent rotator cuff tear and brachial plexus palsy associated with anterior dislocation of the shoulder. A report of two cases. J Bone Joint Surg Am 73: 620–621

    PubMed  CAS  Google Scholar 

  5. Groh G, Rockwood C (1995) The terrible triad: anterior dislocation of the shoulder associated with rupture of the rotator cuff and injury to the brachial plexus. J Shoulder Elbow Surg 4: 51–54

    Article  PubMed  CAS  Google Scholar 

  6. Gumina S, Postaccini F (1997) Anterior dislocation of the shoulder in elderly patients. J Bone Joint Surg Br 79: 540–543

    Article  PubMed  CAS  Google Scholar 

  7. Habermeyer P, Lichtenberg S, Magosch P (2007) Rotatorenmanschettenruptur und Schulterinstabilität. Arthroskopie 20: 217–222

    Article  Google Scholar 

  8. Habermeyer P, Jung D, Ebert T (1998) Behandlungsstrategie bei der traumatischen vorderen Erstluxation der Schulter. Unfallchirurg 101: 328–341

    Article  PubMed  CAS  Google Scholar 

  9. Hawkins RJ, Morin WD, Bonutti PM (1999) Surgical treatment of full-thickness rotator cuff tears in patients 40 years of age or younger. J Shoulder Elbow Surg 8: 259–265

    Article  PubMed  CAS  Google Scholar 

  10. Lähteenmäki HE, Virolainen P, Hiltunen A et al (2006) Results of early operative treatment of rotator cuff tears with acute symptoms. J Shoulder Elbow Surg 15: 148–153

    Article  PubMed  Google Scholar 

  11. Levy O, Pritsch M, Rath E (1999) An operative technique for recurrent shoulder dislocations in older patients. J Shoulder Elbow Surg 8: 452–457

    Article  PubMed  CAS  Google Scholar 

  12. Loew M, Thomsen M, Rickert, Simank HG (2001) Verletzungsmuster bei der Schulterluxation des älteren Patienten. Unfallchirurg 104: 115–118

    Article  PubMed  CAS  Google Scholar 

  13. McLaughlin H, MacLellan DI (1967) Recurrent anterior dislocation of the shoulder. A comparative study. J Trauma 7: 191–201

    Article  PubMed  CAS  Google Scholar 

  14. Milgrom C, Schaffler M, Gilbert S, van Holsbeeck M (1995) Rotator-cuff changes in asymptomatic adults: The effect of age, hand dominace and gender. J Bone Joint Surg Br 77: 296–298

    PubMed  CAS  Google Scholar 

  15. Neer CS 2nd, Craig EV, Fukuda H (1983) Cuff-tear arthropathy. J Bone Joint Surg Am 65: 1232–1244

    PubMed  Google Scholar 

  16. Nevasier R, Nevasier T (1995) Recurrent instability of the shoulder after age 40. J Shoulder Elbow Surg 4: 416–418

    Article  Google Scholar 

  17. Pouliart N, Gagey O (2006) Concomitant rotator cuff and capsuloligamentous lesions of the shoulder: A cadaver study. Arthroscopy 22(7): 728–735

    PubMed  Google Scholar 

  18. Porcellini G, Paladini P, Campi F, Paganelli M (2006) Shoulder instability and related rotator cuff tears: Arthroscopic finding and treatment in patients aged 40 to 60 years. Arthroscopy 22(3): 270–276

    PubMed  Google Scholar 

  19. Robinson CM, Kelly M, Wakefield AE (2002) Redislocations of the shoulder during the first six weeks after a primary anterior dislocation: Risk factors and results of treatment. J Bone Joint Surg Am 84(9): 1552–1559

    Article  PubMed  Google Scholar 

  20. Rühmann O, Schmolke S, Bohnsack M et al (2004) Schulterarthrodese. Indikation, technik, ergebnisse, komplikationen. Orthopaede 33(9): 1061–1081

    Google Scholar 

  21. Sher JS, Uribe JW, Posada A et al (1995) Abnormal findings on magnetic resonance images of asymtomatic shoulders. J Bone Joint Surg Am 77: 10–15

    PubMed  CAS  Google Scholar 

  22. Simank HG, Dauer G, Schneider S, Loew M (2006) Incidence of rotator cuff tears in shoulder dislocations and results of therapy in older patients. Arch Orthop Trauma Surg 126: 235–240

    Article  PubMed  Google Scholar 

  23. Simonich SD, Wright TW (2003) Terrible triad of the shoulder. J Shoulder Elbow Surg 12: 566–568

    Article  PubMed  Google Scholar 

  24. Steinmann SP, Moran EA (2001) Axillary nerve injury: diagnosis and treatment. J Am Acad Orthop Surg 9(5): 328–335

    PubMed  CAS  Google Scholar 

  25. Voos JE, Pearle AD, Mattern CJ et al (2007) Outcomes of combined arthroscopic rotator cuff and labral repair. Am J Sports Med 35(7): 1174–1179

    Article  PubMed  Google Scholar 

  26. Walch G, Boileau P (1997) Rotator cuff tears associated with anterior instability. In: Warner JJP, Iannotti JP, Gerber C (eds) Complex and revision problems in shoulder surgery. Lippincott-Raven, Philadelphia

  27. Yamaguchi K, Ditsios K, Middleton WD et al (2006) The demographic an morphological features of rotator cuff disease. J Bone Joint Surg Am 88(8): 1699–1704

    Article  PubMed  Google Scholar 

  28. Yiannakopoulos CK, Mataragas E, Antonogiannakis E (2007) A comparison of the spectrum of intraarticular lesions in acute and chronic anterior shoulder instability. Arthroscopy 23(9): 985–990

    PubMed  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Klinik für Unfall- und Wiederherstellungschirurgie, Diakoniekrankenhaus Friederikenstift gGmbH, Humboldtstraße 5, 30169, Hannover, Deutschland

    C. Voigt & H. Lill

Authors
  1. C. Voigt
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. H. Lill
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to C. Voigt.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Voigt, C., Lill, H. Schulterinstabilität und Rotatorenmanschettenruptur. Orthopäde 38, 70–74 (2009). https://doi.org/10.1007/s00132-008-1356-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00132-008-1356-8

Schlüsselwörter

Keywords

Search

Navigation