Sehr geehrte Damen und Herren,
vom 5. bis 20. September wird der Europameister im Basketball ermittelt. Die deutsche Mannschaft spielt in der Gruppenphase in Berlin. Die ohnehin große Erwartungshaltung ist noch gestiegen, seit Dirk Nowitzki seine Teilnahme zugesagt hat. Der 37 Jahre alte Topstar aus der nordamerikanischen Profiliga NBA will das Nationalteam zu Olympia in Rio 2016 führen – und natürlich verletzungsfrei bleiben. Warum die Finger und Handgelenke beim scheinbar „körperlosen Spiel“ gefährdet sind, warum die Wurfkraft nicht aus dem Arm kommt und warum selbst ein Ausnahmespieler wie Nowitzki eine Verletzung schon mal auf die leichte Schulter nimmt, beschreibt Dr. Christoph Lukas im aktuellen Newsletter.
Außerdem möchten wir Sie als GOTS-Mitglieder auf eine sportmedizinische Weiterbildungsveranstaltung hinweisen. Zum Thema „Basketball und Handball aus sportmedizinischer Sicht“ laden Sie die deutschen Basketballärzte in Kooperation mit dem sportmedizinischen Arbeitskreis Ludwigsburg am Samstag, dem 26. September 2015, ins Reha-Zentrum Hess nach Bietigheim-Bissingen ein. Weitere Informationen können Sie dem folgenden Flyer entnehmen. Anmeldungen sind unter der Fax-Nummer 07142 910379 oder per Mail: praxis@drlukas.de erbeten.
Flyer Basketball und Handball aus sportmedizinischer Sicht (PDF)
Mit freundlichen Grüßen
Ihr Andreas Bellinger, presse@gots.org
Basketball: Handverletzungen im scheinbar körperlosen Spiel
Im Gegensatz zu den meisten anderen Sportarten wurde Basketball als „Auftragsarbeit“ entwickelt. James Naismith erhielt als Sportlehrer 1891 die Aufgabe, eine hallentaugliche Sportart ohne übermäßiges Verletzungsrisiko zu entwickeln. Aus sportmedizinischer Sicht war seine wichtigste Überlegung, dass das Ziel horizontal und erhöht sein sollte, um dem neuen Spiel die Härte zu nehmen.
Aus diesem Grundgedanken entwickelte sich die Sportart Basketball. Nach dem Debüt bei Olympia 1936 stieg die Popularität weiter an. Ein regelrechter Boom wurde ausgelöst, als die US-Profis des Dream-Teams um Michael Jordan, Earvin „Magic“ Johnson und Larry Bird 1992 bei den Olympischen Spielen in Barcelona antraten. Heute ist Basketball mit ca. 450 Millionen Spielern die zweitpopulärste Sportart der Welt nach dem Fußball.
Auch wenn die Grundidee noch erhalten ist, hat sich die Sportart in den vergangenen 120 Jahren natürlich gewandelt. Basketball wurde schneller, athletischer und körperbetonter, sodass man heute nicht mehr vom „körperlosen Spiel“ sprechen kann.
Anforderungsprofil:
Es werden komplexe Anforderungen an Ausdauer, Kraft, Schnelligkeit, Beweglichkeit gestellt, außerdem sind erhebliche koordinative Fähigkeiten vonnöten. Die obere Extremität wird vor allem im Rahmen des Ballhandlings, aber auch bei Abwehraktionen beansprucht; etwa beim Blocken eines gegnerischen Wurfes. Im Angriff gilt dies vor allem beim Dribbeln, Passen und Fangen sowie beim Korbwurf. Dabei muss der zwischen 510 und 650 Gramm schwere Ball – zum Beispiel beim Dreipunktewurf – aus einer Entfernung von mehr als 6,70 Metern auf den 3,05 Meter hohen Korb geworfen werden.
Ein Großteil der für den Wurf notwendigen Kraft kommt, anders als beim Handball, dabei jedoch nicht aus den Armen und dem Handgelenk, sondern aus den Beinen. Die Arme sind mehr für die Feinjustierung verantwortlich. Der Ball beschreibt keine gerade Linie, sondern eine hohe Parabel, um von oben durch den horizontalen Ring fallen zu können.
Verletzungsmechanismen und -häufigkeit:
Mit dem intensiver gewordenen Körperkontakt stieg auch die Verletzungshäufigkeit an. Die Verletzungsrate variiert mittlerweile zwischen 2,1 und 18,2 Verletzungen pro 1.000 Basketballeinsätzen. Mit 32 bis 58 Prozent der Verletzungen ist das obere Sprunggelenk am häufigsten betroffen. Die meisten Verletzungen entstehen im Gedränge in der Zone, also in unmittelbarer Korbnähe. Die Verletzungen ereignen sich vor allem im Wettkampf. Wesentliche Geschlechtsunterschiede gibt es nicht.
Die obere Extremität ist zu ca. 25 % an der Gesamtanzahl der Verletzungen beteiligt. Allein um die 16% entfallen hierbei auf die Finger, die somit im Bereich der oberen Extremität das größte Verletzungsrisiko aufweisen. Das Handgelenk ist mit 3,5% eher selten betroffen. Handgelenksverletzungen entstehen meist durch Stürze auf den ausgestreckten Arm. Verletzungen der Finger ereignen sich meist durch ein axiales Stauchungstrauma oder eine Hyperextension, zum Beispiel durch Hängenbleiben am gegnerischen Trikot.
Die häufigsten Verletzungen im Bereich der Hand sind sicherlich die Kapsel-Band-Verletzungen der Finger, aber auch Finger- und Mittelhandfrakturen und Luxationen im PIP- oder DIP-Gelenk (Finger). Häufig treten auch Weichteilverletzungen auf – wie z.B. am TFCC (Handgelenk).
Eine „Verstauchung“ sollte daher diagnostisch nie auf die leichte Schulter genommen werden. Ab einer gewissen Ausprägung sollte obligat geröntgt werden. Auch die Sonographie kann im Finger- und Handgelenksbereich gute Dienste leisten. Bei Unsicherheiten ist weiterführende Diagnostik, CT/MRT oder auch eine diagnostische Arthroskopie erforderlich.
Eher als Rarität sind berichtete Verletzungen mit Fingeramputation durch Hängenbleiben am Netz beim Versuch eines Dunkings einzustufen.
Knobloch konnte 2005 zeigen, dass die Zahl der Fingerverletzungen im Basketball im Schulsport drastisch erhöht ist. Er fand in seiner Untersuchung 65% Fingerverletzungen.
Die oben angegebenen Zahlen zur oberen Extremität beruhen auf einer Untersuchung von Siebert, bei der Basketballer der oberen drei deutschen Ligen befragt wurden.
Dies erklärt auch den Unterschied der Häufigkeit. Im Leistungsbasketball kann man davon ausgehen, dass die Grundtechniken sicher beherrscht werden; im Schulsport dagegen können Mängel, beispielsweise beim Fangen, angenommen werden, die das Risiko erhöhen.
Prävention:
Das Hauptaugenmerk muss sicher auf dem korrekten Erlernen der Grundtechniken liegen, damit diese auch unter Wettkampfdruck schnell und sicher abgerufen werden können. In Bezug auf Fingerverletzungen ist das korrekte Fangen auch im harten Zweikampf hervorzuheben.
Die Korbanlagen wurden, zumindest in den oberen Ligen, optimiert. Größtenteils verfügen sie über Polster (auch an der Brettunterkante) und abklappbare Ringe, die das Verletzungsrisiko verringern. In kleinen Hallen in den unteren Ligen ist in dieser Hinsicht allerdings noch Verbesserungspotenzial vorhanden.
Verletzungen, auch scheinbare Bagatellverletzungen an den Fingern, sollten nach adäquater Diagnostik generell vollständig ausgeheilt werden. Erst dann darf mit dem Balltraining oder gar Spielen wieder begonnen werden. Gegebenenfalls sollten die verletzten Finger durch Tape oder spezielle Polstersleeves geschützt werden.
Gegenbeispiele sind wie in jedem Sport so auch beim Basketball vorhanden: Dirk Nowitzki zum Beispiel lief in den NBA Finals 2011 durch Tape geschützt mit einem frischen knöchernen Sehnenausriss am Finger auf – und wurde mit seinem Club, den Dallas Mavericks, dennoch erster deutscher Champion in der nordamerikanischen Basketball-Profiliga. Und auch John Wall von den Washington Wizards gönnte sich in den diesjährigen Playoffs nur rund eine Woche Pause, nachdem es bei einem Sturz auf die linke Hand laut US-Medien zu fünf Frakturen im Handbereich gekommen war.
Über den Autor:
Dr. med. Christoph Lukas ist Leitender Arzt im Reha-Zentrum Hess in Bietigheim-Bissingen. Der Facharzt für Orthopädie, Sportmedizin, Akupunktur, Chirotherapie und Sozialmedizin ist Mannschaftsarzt der Crailsheim Merlins (Basketball-Bundesliga) und der SGBBM Bietigheim (Handball-Bundesliga, Damen und Herren) sowie Verbandsarzt Basketball Baden-Württemberg und Vorsitzender der deutschen Basketball-Ärzte basketdocs.de
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