Bizepssehnenverletzungen

Zusammenfassung

Neben der Arthrose des Schultergelenks sowie Pathologien des Weichteilmantels der Schulter wie der Rotatorenmanschette wird insbesondere die lange Bizepssehne als Motor des Schulterschmerzes gesehen. Federführende Befunde sind u. a. degenerative Tendinopathien der Sehne, Instabilitäten, Spontanrupturen und auch begleitende Läsionen der Rotatorenmanschette. In den meisten Fällen ist zunächst eine konservative Therapie indiziert. Bei Beschwerdepersistenz sollte eine operative Versorgung in Form einer Tenotomie mit oder ohne Tenodese in Betracht gezogen werden. Hinsichtlich der Wahl des Operationsverfahrens sollte bei jungen schlanken Patienten auf die Erhaltung der Form des Oberarms geachtet werden. Somit erscheint bei der Ruptur der langen Bizepssehne bei diesen Patienten zur Vermeidung einer kosmetischen Deformität die Tenodese sinnvoll. Läsionen der distalen Bizepssehne sind meist traumatisch bedingt und gehen mit einem deutlichen Kraftverlust bei Supination des Unterarms und Flexion im Ellenbogen einher. Die konservative Therapie führt meist zu funktionell unbefriedigenden Ergebnissen, sodass dem Patienten die operative Refixation als Therapie der Wahl empfohlen werden sollte.

Abstract

Along with degenerative arthritis of the shoulder joint and pathologies of the shoulder soft tissues such as rotator cuff lesions, the long head of the biceps tendon presents a common reason for shoulder pain. Leading findings in this context include degenerative tendinopathy, instability, and spontaneous ruptures of the tendon along with associated rotator cuff lesions. In most cases, primary conservative treatment is indicated. If this fails to alleviate the pain, surgical treatment should be considered, including tenotomy with or without tenodesis. When choosing the surgical procedure for young and slim patients, care should be taken to preserve the shape of the upper arm. If such patients suffer from ruptures of the long head of the biceps tendon, they may benefit from tenodesis, which may help to avoid cosmetic deformities. Lesions of the distal biceps tendon are mainly caused by trauma and lead to a significant loss of strength in supination and flexion of the lower arm. Conservative treatment mostly results in unsatisfactory functional outcomes, so surgical treatment should be the treatment of choice.

^* S. Siebenlist und A. Buchholz haben zu gleichen Teilen zum vorliegenden Artikel beigetragen.

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