Handball
Shoulder diseases and injuries
Shoulder injuries in soccer and skiing are leading, while third most shoulder injuries occur in handball. About 2.5 injuries in 1000 playing hours of handball are happening. Most at risk are handball amateur athletes. In professional players shoulder lessions occur much more in competitive handball games. Statistically about 40% of all handball athletes have had shoulder pain within the last 6 month. The higher the handball league the more severe are the shoulder injuries. 2/3 of all shoulder injuries are happening during attacking and about 1/3 in defense. The throwing handball athletes is suffering from the most shoulder problems and injuries.
Shoulder instabilities are a common problem in handball athletes. They are occuring as an acute lesion in form of a shoulder dislocation. The humeral head goes out of the glenoid / shoulder joint in the anterior and inferior direction and the labrum is torn. This is called a TUBS lesion and an abbreviation for: a traumatic, unidirectional, Bankart lesion, surgery.
In professional handball athletes these TUBS lesion have to be stabilized as soon as possible, arthroscopically - even in first time dislocators. You can read more about it here. Because of handball being a contact sports an open stabilization might be necessary, sometimes
Even more chronic instabilities are being observed in handball players. Due to microtraumata for month and years the shoulder joint capsule and the stabilizing ligaments are stretched and the affected shoulder " gets loose". Pain with or without concomitant cracking or snapping is a typical complaint of theses handball athletes suffering from it. Sportsphysiotherapy is the first method of choice. If this does not work an arthroscopic stabilization is performed.
Some people are having a genetically determined elastic shoulder / joint capsules. These might have advantages in sports, but it could make an athlete more susceptible for shoulder lesions / injuries.
In handball fractures, if happening, occur at the clavicle, most.
Regularly, we are observing handball athletes with unclear shoulder pain, suffering from it for month or years. In these cases partial tears of the rotator cuff, SLAP lesions and a posterosuperior impingement are observed, often. Performing a shoulder arthroscopy in these cases we see partial tears of the articular side of the rotator cuff, most. Every sports has it´s special loads on the shoulder. In handball certain parts of the rotator cuff are strenghtened due to an overload for years, while other parts of the rotator cuff are untrained and gettting weak. In sports medicine this called the "dynamic overload". If these problems are starting and in it´s initial phase they have to be treated at once - with sports physiotherapy otherwise they could be refractory to treatment for a long time. If being missed a static overload develops. Muscular imbalance is leading to an inflammation and the overuse might cause an additional instability by stretching the shoulder capsule and it´s stabilizing ligaments. The more unstable the affected shoulder is the more the shoulder muscles have to act to stabilze the shoulder. Especially, the external rotators are affected most. A posterosuperior impingement and sometimes an additional instability will develop, which have to be treated arthroscopically with a stabilizing procedure.
Another important concept in handball athletes and in other overhead sports is the "sick scapula". This means that pathologic movements of the the bladebone occur.
Das Schulterblatt spielt eine sehr wichtige Rolle bei der Übertragung der kinetischen Energie ( z. B. bei einem Sprungwurf, o.ä.) von den Beinen, über den Rumpf in die Arme ! Es ist wichtig, dass sich die Behandler das Schulterblatt ( Stellung, Laufverhalten ) ansehen und entsprechend - in der Phase des dynamischen Overload - therapieren.
Der Vollständigkeit halber sei auf ein drittes wichtiges sportmedizinisches Konzept hingewiesen: die Verkürzung der hinteren, unteren Schulterkapsel. Durch ständige Wurfbewegungen ( die klassische Sportart, bei der das eine ganz wichtige Rolle spielt, ist der Baseball - mit wesentlich mehr Wurfbewegungen des Pitchers als beim Handballspieler ) verkürzt sich die hintere, untere Schulterkapsel, das Rotationszentrum der Schulter verlagert sich und es entstehen die sog. SLAP Läsionen an der oberen Pfannenlippe der Schulter. Parallel geht das mit einer Überdehnung der vorderen Kapselstruktutren an der Schulter einher. Hinten unten ist es zu kurz und vorne am Gelenk entsteht eine überdehnte Kapsel bis hin zur Instabilität. Der gesamte Bewegungsablauf an der Sportlerschulter läuft aus dem Ruder. Die SLAP Läsionen entstehen regelmässig auch durch Stürze auf den ausgestreckten Arm, direkte Anprallverletzungen sowie Verletzungen durch Zug am Arm ( sog. Traktionsverletzungen ).
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Other themes & sites arround the shoulder:
Diseases of the shoulder ( german ): http://www.schulterinfo.de , http://www.schulter.info
Diseases of the shoulder ( english ): http://www.shoulderinformation.com
Shoulder arthroplasty: http://www.schulterprothesen.net , http://www.schulterprothesen.com , http://www.shoulderprosthesis.com , http://www.prothesenatlas.de
Frozen shoulder ( german ): http://www.schultersteife.de
Shoulder specialists ( german ): http://www.schulterspezialisten.de
Shoulder examination ( german ): http://www.schulteruntersuchung.de
Shoulder videos ( german ): http://www.schultervideo.de