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Arthroskopie

, Volume 30, Issue 3, pp 216–222 | Cite as

Anterosuperiore Rotatorenmanschettenläsion beim jungen Patienten

Ruptur der Subskapularis- und Supraspinatussehne
  • F. Plachel
  • P. Moroder
  • C. Gerhardt
  • M. ScheibelEmail author
Leitthema

Zusammenfassung

Einleitung

Die anterosuperiore Rotatorenmanschettenläsion (ASRML) bezeichnet die kombinierte Verletzung der Subskapularis- und der Supraspinatussehne, welche i. d. R. mit einer Pathologie am Rotatorenintervall assoziiert ist. Das Vollbild der ASRML reicht von der höhergradigen Pulley-Läsion über die transmurale Ruptur der Supraspinatussehne kombiniert mit einer partiellen Läsion der Subskapularissehne (z. B. „hidden lesion“) bis hin zur anterosuperioren Massenruptur.

Diagnostik

Die Diagnose der ASRML basiert primär auf einer gezielten Anamnese, weshalb zu Beginn zwischen einem akuten Trauma und einer degenerativen Ursache zu unterscheiden bzw. der individuelle Anspruch zu erfragen ist. Eine strukturierte klinische Untersuchung mit isolierter und ganzheitlicher Evaluierung der entsprechenden Rotatorenmanschette ist wesentlicher Bestandteil der Diagnostik. Als Goldstandard der radiologischen Bildgebung gilt die Magnetresonanztomographie, wenngleich v. a. partielle kraniale Läsionen der Subskapularissehne (z. B. Pulley-Läsion) häufig als falsch-negativ interpretiert werden.

Therapie

Die Therapie der ASRML ist multifaktoriell bedingt und muss nach Zusammenschau der funktionellen Ansprüche und diagnostischen Befunde individuell entschieden werden. Die arthroskopische Versorgung gilt als Mittel der Wahl. Insbesondere beim jungen und aktiven Patienten ist die anatomische Rekonstruktion der Rotatorenmanschette vorzuziehen. Als Salvage-Operation konnten mittels Muskeltransfer bzw. Implantation einer inversen Endoprothese zufriedenstellende langfristige Ergebnisse erzielt werden.

Schlüsselwörter

Rotatorenmanschette Pulley-Läsion Supraspinatussehne Subskapularissehne Anatomische Rekonstruktion 

Anterosuperior rotator cuff defects in young patients

Tear of the supraspinatus and subscapular tendons

Abstract

Introduction

The anterosuperior rotator cuff lesion (ASRCL) denotes the concomitant injury of the subscapularis and supraspinatus tendons, which is usually associated with a pathology on the rotator interval. The full-scale of the ASRCL ranges from the higher-grade lesion of the biceps pulley through the transmural tear of the supraspinatus tendon combined with a partial lesion of the subscapular tendon (e. g. hidden lesion) to the massive anterosuperior rotator cuff tear.

Diagnosis

The diagnosis of ASRCL is primarily based on anamnestic history, making it necessary to differentiate between an acute trauma and a degenerative cause and to determine the individual’s physical use and demand. A structured clinical examination with isolated and complete evaluation of the respective rotator cuff is an essential component of the diagnosis. Magnetic resonance imaging is considered the gold standard of radiological imaging, although partial cranial lesions of the subscapular tendon (e. g. lesion of the biceps pulley) are often misdiagnosed.

Therapy

The therapy of ASRCL is multifactorial and must be decided on an individual basis after determination of all the functional requirements and diagnostic findings. Arthroscopic surgery is considered the treatment of choice. Anatomical reconstruction of the rotator cuff is especially preferred in young and active patients. Satisfactory long-term results have been achieved by means of muscle transfer or reverse shoulder prosthesis used as a salvage operation.

Keywords

Rotator cuff Lesion of the biceps pulley Supraspinatus tendon Subscapularis tendon Anatomical reconstruction 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

F. Plachel, P. Moroder, C. Gerhardt und M. Scheibel geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

Supplementary material

Video 1. Linke Schulter. Blick von dorsal über das posteriore Standardportal. Es zeigt sich eine klinisch asymptomatische, degenerative Veränderung des Bizepssehnenankers und des anterosuperioren Labrums (SLAP-Läsion Typ 1). Die Subskapularissehne (SSC) erscheint partiell rupturiert (Grad 1) und zusätzlich zeigt sich eine ventrale transmurale Ruptur der Supraspinatussehne (SSP). Das korakohumerale Ligament (CHL) und das superiore glenohumerale Ligament (SGHL) sind rupturiert und aufgefasert (Pulley-Läsion Typ 4). Die lange Bizepssehne (LBS) ist statisch im Sulcus bicipitalis zentriert

Video 2. Linke Schulter. Blick von dorsal über das posteriore Standardportal. Es zeigt sich eine anatomisch rekonstruierte Rotatorenmanschette. Prüfung der Rekonstruktion und Stabilität der langen Bizepssehne (LBS) mittels Tasthaken über das anteroinferiore Portal

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Copyright information

© Springer Medizin Verlag GmbH 2017

Authors and Affiliations

  • F. Plachel
    • 1
  • P. Moroder
    • 1
  • C. Gerhardt
    • 1
  • M. Scheibel
    • 1
    Email author
  1. 1.Centrum für Muskuloskeletale ChirurgieCharité-Universitätsmedizin BerlinBerlinDeutschland

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