Previous | All articles | Next

An interview with Dr Markus Scheibel | Autumn 2007

Dr Markus Scheibel did his sub speciality training at the Department of Shoulder and Elbow Surgery, ATOS-Clinic Heidelberg. He then moved to the Department of Orthopedics and Sports Medicine at the Technical University of Munich. In 2004 he joined the Center for Musculoskeletal Surgery, Charité-Universitaetsmedizin Berlin where he has become Head of the Shoulder Department. He is an ordinary member of the European Society of Shoulder and Elbow Surgery (SECEC) and has authored many research papers and has contributed to a number of text books on shoulder surgery.  

What are your key research interests?

I have two: the first is the conservative treatment of post traumatic anteroinferior shoulder dislocation using the external rotation method; and the second is the surgical treatment of recurrent shoulder instabilities with a focus on the minimal-invasive technique: for example arthroscopic glenoid reconstruction using the iliac crest bone grafting technique. My other research projects have covered clinical and basic scientific research on arthroscopic rotator cuff repair using foot-print reconstruction techniques; developments of new arthroscopic techniques for acromioclavicular joint reconstructions; bone-preserving shoulder replacement surgery and the application of growth factors in shoulder replacement surgery.

In your recent study 'The influence of duration of immobilization in external rotation after traumatic anterior shoulder dislocation', which you presented at 10th International Congress of Shoulder Surgery (ICSS) in Brazil last month, could you discuss your conclusions, and the relevance of this study over previous treatment methodology?

Immobilization of the shoulder in the external rotation position still represents a relatively new treatment strategy after traumatic anterior shoulder dislocation. In recently presented and published studies the rate of recurrence could be significantly reduced using this new method for three weeks compared to the conventional immobilization in internal rotation. However to date, it has been unclear if a prolonged immobilization would be beneficial to our patients. The aim of our study was to assess the clinical results and recurrence rates after 3 versus 5 weeks of immobilization in 30 degrees of external rotation using the Ultra-Sling ER 30°. In this preliminary study we found an overall recurrence rate of 20% which is lower compared to the conventional immobilization method. However, the results did not show significant differences between the 3 and 5 weeks immobilization groups with regard to recurrence rate, functional scores and patient satisfaction. These findings correlated with a previous MRI study.

We therefore concluded that other factors may play a more important role than the duration of immobilization. Clinical and basic science studies have shown that a higher degree of external rotation combined with some abduction of the shoulder even better approximates the anterior labrum to the glenoid rim. In addition, it seems that a large amount of hematoma formation inside the joint may prevent the labrum to anatomically reduce and finally heal to bone. We are currently planning a clinical trial to investigate these issues.

Looking at your other research work, which area has been of most interest to you, and will have the greatest impact on injury treatment?

Immobilization in external rotation has so far been only recommended as a conservative treatment after traumatic shoulder dislocations. We are currently evaluating if this treatment modality is also effective or beneficial for postoperative immobilization either after arthroscopic instability repair or after rotator cuff surgery. In those studies the hypothesis is that immobilization in external rotation may reduce the amount of stiffness or at least external rotation deficit after the above mentioned procedures.

Could you identify the sport that is responsible for the majority of today's shoulder injuries, in the same way that football seems to be the cause of many metatarsal injuries?

The shoulder is at risk from injury in many sports. Acute shoulder injuries are fractures, dislocations, tendon tears, sprains, and bruises. These are caused by a direct fall onto an outstretched arm or from direct impact to the shoulder. Alpine skiing, snowboarding, rugby, cycling and many other sports are related to this type of injury. Overuse injuries occur mainly in the rotator cuff, biceps tendon and glenoid labrum area. People likely to suffer from overuse injuries are baseball pitchers, golfers, swimmers, and tennis, handball and volleyball players.

Previous | All articles | Next