Schulterinstabilität bei Epilepsie

Glenohumeral instability due to epilepsy is usually considered to be of the posterior type. In the literature, however, inconsistent data on the predominant direction of instability caused by epilepsy is provided. The largest reported series of 34 shoulders in 26 patients with primary dislocation caused by epileptic seizures showed a comparable incidence of anterior and posterior instability. We report the case of a 26-year-old woman with epilepsy and instability including hyperlaxity of both shoulders known since childhood who presented with a recurrent dislocation of the right shoulder after a fall downstairs. Clinical and radiological evaluation revealed unidirectional anteroinferior shoulder instability with hyperlaxity (type B3 according to Gerber). Thus, arthroscopic stabilization had to be considered. As pharmacological treatment of epilepsy was insufficient so far, conservative treatment was recommended including optimizing anticonvulsive medication and scapulothoracic dyskinesia. Four months later, symptoms of anterior instability had only slightly improved, and arthroscopic anteroinferior and posteroinferior stabilization was performed. Intraoperatively, a partial lesion of the anteroinferior labrum, a superficial Hill-Sachs lesion and extensive enlargement of the anterior and posterior capsular volume were found. In patients with shoulder instability due to epilepsy, recognition of unidirectional anterior instability with hyperlaxity is of importance regarding the high risk of recurrent instability.