Unfall, Sport, Alter, Diabetes – Die Ursachen für Schulterschmerz sind vielfältig
DKOU-Experten raten zur sorgfältigen Abklärung bei Schulterschmerz
Berlin – Etwa 70 Prozent aller Menschen leiden mindestens einmal im Leben an Schulterschmerzen – unabhängig von Geschlecht, Alter oder Beruf. Die Ursachen sind divers und umfassen etwa Unfälle, Sportverletzungen oder altersbedingte Abnutzung. Was viele nicht wissen: Auch Erkrankungen der inneren Organe, Diabetes oder Funktionsstörungen der Schilddrüse können Schulterschmerzen auslösen. Entsprechend individuell muss der behandelnde Orthopäde oder Unfallchirurg bei seiner Behandlung vorgehen. Auf dem Deutschen Kongress für Orthopädie und Unfallchirurgie (DKOU) vom 22. bis 25. Oktober 2019 in Berlin diskutieren Experten, wie man einer Erkrankung des Schultergelenks vorbeugen kann, welche Sportarten und Vorerkrankungen diese begünstigen und wie die jeweiligen Erkrankungsformen behandelt werden. Sie beleuchten dabei auch, welchen therapeutischen Stellenwert die Schulterarthroskopie inzwischen einnimmt und unter welchen Voraussetzungen eine Schulterendoprothese eine gute Entscheidung ist.
Schulterschmerzen sind nach Rücken- und Knieschmerzen die dritthäufigste Erkrankung des Bewegungs- und Halteapparats. Die Ursache können Muskelverspannungen, Erkrankungen von Knochen und Gelenken, Haltungsschäden, Muskel- und Bandverletzungen aber auch Tumore sein. Doch nicht immer rührt der Schulterschmerz aus dem Schultergelenk selbst. So kann einseitiger akut auftretender Schulterschmerz während sportlicher Aktivität auch ein Hinweis auf Herzinfarkt sein. „Vielen ist nicht bewusst, dass auch die Bereiche Arm, Nacken und Wirbelsäule oder eine Erkrankungen der inneren Organe eine Rolle bei Schmerzen in der Schulter spielen können“, erklärt Dr. med. Casper Grim, Vizepräsident der Gesellschaft für Orthopädisch-Traumatologische Sportmedizin (GOTS) und Leitender Verbandsarzt der Deutschen Triathlon Union (DTU) und Verbandsarzt beim Deutschen Ringer Bund (DRB) im Vorfeld des DKOU 2019.
Andere Erkrankungen als Ursache für Schulterschmerz
Ebenso können eine Funktionsstörung der Schilddrüse, Diabetes mellitus und rheumatische Erkrankungen mit chronischem Schmerz in der Schulter assoziiert sein. „Patienten mit Diabetes und Schilddrüsenerkrankungen erkranken beispielsweise häufiger an der `Frozen Shoulder´“, führt Grim, Leitender Oberarzt an der Klinik für Orthopädie, Unfall- und Handchirurgie in Osnabrück aus. Hier schränkt eine geschrumpfte Schultergelenkkapsel die Beweglichkeit der Schulter schmerzhaft ein. So leidet etwa jeder fünfte Diabetespatient unter Schulterschmerzen und Bewegungseinschränkungen. Der Grund hierfür ist bislang noch nicht geklärt, im Fokus der Untersuchungen stehen Entzündungsprozesse, Durchblutungsstörungen und Zuckeranhaftungen an Bindegewebsfasern. „Mit der Zunahme an Stoffwechselerkrankungen – insbesondere bei einer immer älter werdenden Bevölkerung – haben Orthopäden auch immer häufiger mit diesen Erkrankungszusammenhängen zu tun und müssen es bei der Diagnose berücksichtigen“, erklärt Professor Dr. med. Carsten Perka, Kongresspräsident des DKOU aus Berlin. Eine ausführliche Anamnese sei daher unabdingbar.
Die Arthroskopie ersetzt zunehmend Operationen
Funktionelle Therapiemaßnahmen wie Physiotherapie und eine medikamentöse Behandlung helfen vielen Schulterschmerz-Patienten bereits. Häufige Erkrankungsformen wie Impingement (eine Einengung zwischen Schulterdach- und Oberarmknochen, die die Sehnen beeinträchtigt), Kalkschulter oder Schulterarthrose können bei milder Ausprägung mit einer Stoßwellentherapie behandelt werden und eine Operation verhindern. Ist eine konservative Therapie erfolglos, hilft häufig auch die Arthroskopie (Gelenkspiegelung). Hierbei kann der Arzt minimalinvasiv Verkalkungen entfernen und entstandene Sehnenverletzungen beheben. „Wir haben in der Arthroskopie erhebliche Fortschritte gemacht“, betont Professor Dr. med. Markus Scheibel, Präsident der Deutschen Vereinigung für Schulter- und Ellenbogenchirurgie e. V. (DVSE). „Selbst komplexe rekonstruktive Eingriffe sind mittlerweile per Gelenkspiegelung mit deutlich weniger Risiken möglich.“ Insbesondere bei Schulterinstabilitäten, bei denen durch Unfälle oder anatomische Fehlstellungen das Schultergelenk „instabil“ wird und eventuell ausrenkt, sei die Arthroskopie inzwischen einer offenen Operation vorzuziehen, so der Chefarzt für Schulter- und Ellenbogenchirurgie an der Schulthess Klinik in Zürich. Auf dem DKOU stellen Experten der DVSE neue Methoden und Anwendungsbereiche der Arthroskopie vor.
Wie kann man Schulterschmerzen vorbeugen?
Das Schultergelenk ist eines der am häufigsten von Sportverletzungen betroffenen Gelenke. Beim Turnen, Rudern und Kampfsport ist das Schultergelenk besonders strapaziert. „Bei diesen Sportarten leiden durchschnittlich ein Drittel der Sportlerinnen und Sportler unter Schulterschmerzen“, berichtet Grim. Um insbesondere Verletzungen vorzubeugen, rät der Experte Sportlern, aber auch Patienten mit bereits bestehenden Schulterproblemen, die Muskulatur um das Schultergelenk herum zu stärken, weil diese das Gelenk stabilisiert.
„Ein besonderer Fokus sollte dabei auf Dehn- und Kräftigungsübungen liegen, die zu einer besseren aktiven Schulterblatt-Anbindung und einer Optimierung der koordinierten Schulterblatt-Brustkorb-Gleitbewegung beitragen“, erklärt Grim. Der so genannte „Sleepers Stretch“ eignet sich beispielsweise gut als Dehnübung für die Gelenkkapsel. Kräftigungsübungen der Schultermuskulatur verbessern hingegen die Außenrotationskraft. Die Beweglichkeit der Brustwirbelsäule und eine Verbesserung der gesamten Bewegungsabläufe ist ebenfalls ein fester Bestandteil von Präventionsprogrammen für das Schultergelenk.
Wichtig sei zunächst eine genaue Diagnose und professionelle Anleitung durch Orthopäden und Physiotherapeuten. Vor ungezielten Übungen bei fehlender Diagnose warnt der Experte.
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