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Arthroskopische Therapie von Nervenentrapmentläsionen und periglenoidalen Ganglien am Schultergelenk

Arthroscopic treatment of nerve entrapment lesions and periglenoidal ganglion cysts of the shoulder joint

  • Leitthema
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Arthroskopie Aims and scope

Zusammenfassung

Einengungen der Nervenbahnen rund um das Schultergelenk sind im Vergleich zu den häufigen strukturellen Weichteilläsionen an Labrum und Rotatorenmanschette selten. Dabei können Entrapmentsyndrome der Schulternerven erhebliche Schmerzen und eine deutliche funktionelle Beeinträchtigung der betroffenenen Schultern zur Folge haben. Betroffen ist vor allem der N. suprascapularis, der im Bereich seines Hauptstamms in der Incisura scapulae oder im Bereich des Astes für den Infraspinatus im Bereich der spinoglenoidalen Notch beeinträchtigt wird. Relevant für den Arthroskopeur sind aber auch die Nn. axillaris und subscapulares, die bei extraartikulären Prozeduren wie z. B. der arthroskopischen Refixation retrahierter Subskapularisrisse gefährdet sind und deren arthroskopische Darstellung daher sinnvoll sein kann. Für den Arthroskopeur der Schulter sind exakte anatomische Kenntnisse der topographischen Lagebeziehungen dieser Nervenbahnen daher unabdingbar. Im Zuge der zunehmenden Entwicklung extraartikulärer arthroskopischer Präparationen bietet sich wie bei keinem anderen Gelenk die Möglichkeit, diese Nervenbahnen bei Bedarf auch direkt arthroskopisch zu visualisieren und ggf. sogar zu therapieren.

Abstract

Nerve entrapment lesions around the shoulder are relatively rare compared to structural lesions of the labrum, glenohumeral ligaments or the rotator cuff. However, these lesions can cause significant pain and functional impairment for the patients. The suprascapular nerve is most commonly affected either proximally in the suprascapular notch or distally in the area of the spinoglenoid notch at its motor branch for the infraspinatus muscle. During arthroscopic repair of retracted subscapularis tendon tears the axillary and subscapularis nerves are in danger of iatrogenic lesions. Arthroscopists must have a thorough understanding of the anatomic relationship of these nerve tracts. With the development of extra-articular arthrosocopic procedures shoulder arthroscopy allows a direct visualization of some shoulder nerves, in contrast to almost any other joint, with the option to even treat pathologies which can lead to nerve entrapment.

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Authors and Affiliations

  1. Sportsclinic Germany, Uhlemeyerstr. 16, 30175, Hannover, Deutschland

    J.D. Agneskirchner

  2. Centre de l’ Appareil Locomoteur, de Mide-cine du Sport et de Privention, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg

    M. Haag

  3. Alps Surgery Institute, Clinique Generale, Annecy, Frankreich

    L. Lafosse

Authors
  1. J.D. Agneskirchner
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  2. M. Haag
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  3. L. Lafosse
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Correspondence to J.D. Agneskirchner.

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142_2010_582_MO1_ESM.mov

Video: Arthroskopisches Release des N. suprascapularis und arthroskopische Darstellung des N. axillaris (QuickTime-Datei, 111 MB)

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Agneskirchner, J., Haag, M. & Lafosse, L. Arthroskopische Therapie von Nervenentrapmentläsionen und periglenoidalen Ganglien am Schultergelenk. Arthroskopie 23, 304–315 (2010). https://doi.org/10.1007/s00142-010-0582-3

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  • DOI: https://doi.org/10.1007/s00142-010-0582-3

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