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Neue Therapie der Kalkschulter - Diagnostik der Kalkschulter
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Die microinvasive Kalkentfernung, eine schonende neue Therapie bei der Kalkschulter

Durch eine ultraschallgestützte Nadel-Lavage lassen sich Kalkherde an der Schulter schnell und schonend entfernen. Mit mehr als 1500 durchgeführten Behandlungen, verfügen wir über eine große Erfahrung mit dieser Therapie.

Unsere Kalkschulter-Hotline: 06831/5031766

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Diagnostik einer Kalkschulter

Da die Symptome der Kalkschulter so extrem unterschiedlich sind, ist die klinische Untersuchung durch den Arzt leider nicht zielführend. Um die Diagnose Kalkschulter zu bestätigen ist man auf ein bildgebendes Verfahren angewiesen.
kalkschulter-ultraschallDie mit Sicherheit schnellste, sicherste und zugleich schonendste Methode ist die Ultraschalluntersuchung. Da bei dieser Untersuchung durch Drehung des Arms alle Sehnenabschnitte beurteilt werden können, werden Kalkherde sehr schnell erkannt und die Größe und Lage läßt sich sehr gut bestimmen. Die rechte Abbildung zeigt das typische Bild eines Kalkherdes in der Supraspinatussehne. Der Kalkherd wurde rot mit einem Pfeil markiert. Für den Laien ist die Orientierung auf einem Ultraschallbild oft schwierig. Der geübte Ultraschaller kann einem solchen Bild jedoch viele Informationen entnehmen.

kalkschulter-roentgen-300Auch mit der Röntgenuntersuchung lassen sich Kalkherde oftmals sehr schön darstellen. Hier sind jedoch meist Aufnahmen aus verschiedenen Richtungen notwendig, um Kalkherde die z.B. durch den Oberarmkopf überlagert werden sicher darstellen zu können.
Die Abbildung links zeigt eine Röntgenaufnahme der Schulter mit einem großen Kalkherd in der Supraspinatussehne.

 


Zur Einteilung der Röntgenbilder hat sich die Gärtner und Heyer Klassifikation der Kalkschulter (Tendinitis calcarea) durchgesetzt. Sie orientiet sich an den einzelnen Phasen der Erkrankung und versucht das Stadium der Erkrankung zu erfassen.
Die Einteilung der Kalkherde orientiert sich an dem Aussehen im Röntgenbild. Die Einteilung erfolgt in 3 Graden.

  • Grad 1: Scharf umschriebener dichter Kalkherd im Röntgenbild. Entspricht der Phase 1 der Kalkschulter in der sich er Kalkherd bildet.
  • Grad 2: Dieser Grad wird oft zweigeteilt in Kalkherde die zwar scharf begrenzt aber durchscheinend sind d.h. nicht ganz röntgendicht und in Kalkherde die zwar röntgendicht aber nicht scharf begrenzt sondern etwas wolkig erscheinen. Diese Phase kann der Ruhephase des Kalkherdes entsprechen oder aber dem Übergang zur resorptiven, d.h. auflösungs Phase.
  • Grad3: Wolkiger durchscheinender Kalkherd der nicht scharf umschrieben ist. Dieses Aussehen im Röntgenbild entspricht der resorptiven (auflösungs) Phase der Kalkschulter Erkrankung.

 



Kalkschulter-Kernspin-vergroessertIn der Kernspintompgraphie (MRT) kann die Darstellung von Kalkherden schwierig sein. Eine Unterscheidung zwischen einem Sehnendefekt und einem Kalkherd ist nicht immer einfach, so dass oftmals zusätzlich eine Röntgenuntersuchung oder Ultraschalluntersuchung gewünscht wird. Grundsätzlich macht es wenig Sinn zur Diagnostik einer Kalkschulter als erstes Bildgebendes Verfahren die Kernspintomographie zu wählen. Bereits die einfache Ultraschalluntersuchung ist zur Darstellung der Kalkherde der Kernspintomographie überlegen.