Tendopathien der oberen Extremität II (Schulter)

Tendopathien der Schulter sind eine häufige Pathologie und können zu erheblichem Leidensdruck mit deutlichen schmerzhaften Einschränkungen führen. Im Wesentlichen wird zwischen Tendopathien der Rotatorenmanschette und der langen Bizepssehne unterschieden, wobei die Beschwerden sowohl entzündlich als auch degenerativ oder mechanisch bedingt sein können. Die Therapie kann sich häufig langwierig gestalten und sollte primär konservativ geprägt sein. Erst bei Versagen sollten operative Maßnahmen erwogen werden.

Kernaussagen

• Tendopathien der langen Bizepssehne (LBS) und/oder der Rotatorenmanschette (RM) sind eine häufige Ursache von Schulterschmerzen.

• In der Diagnostik ist die Korrelation zwischen Anamnese, klinischer Untersuchung und Bildgebung von enormer Bedeutung. Gelegentlich kann eine Tendopathie erst durch eine diagnostische Infiltration oder Arthroskopie gesichert werden.

• Die konservative Therapie hat sowohl bei der LBS- als auch der RM-Tendopathie den höchsten Stellenwert. Zentraler Bestandteil sollte eine physiotherapeutische, auf die Betroffenen zugeschnittene Behandlung sein.

• Kortisoninjektionen haben eine potenziell sehnentoxische Wirkung. Nebenwirkungen und Kontraindikationen sollten bei der Anwendung unbedingt beachtet werden.

• Unter der konservativen Therapie können Tendopathien einen Progress zu (Teil-)Läsionen aufweisen. Partialdefekte stellen eine Schwachstelle dar, welche sich schon durch Bagatelltraumata zu Komplettrupturen ausweiten können.

• Erst bei Versagen der konservativen Therapie sollten operative Maßnahmen ergriffen werden. Begleitpathologien sollten beachtet und mit behandelt werden.

• Sonderformen der LBS-Pathologien sind SLAP- (superiores Labrum von anterior nach posterior) und Pulley-Läsionen. Eine Sonderform der RM-Tendopathie ist die Tendinosis calcarea.

Schlüsselwörter

Tendopathie - Rotatorenmanschette - lange Bizepssehne - Schulter

Publication History

Article published online:
04 June 2025

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