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Verletzungen des Bizeps-Labrum-Komplexes

Grundlagen, Pathologien und Behandlungskonzepte

Injuries of the biceps-labrum complex

Principles, pathologies and treatment concepts

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Zusammenfassung

Hintergrund

Der Bizeps-Labrum-Komplex ist aufgrund der anatomischen Gegebenheiten und der hohen Belastung anfällig für akute Läsionen und degenerative Veränderungen. Eine pathologische Veränderung dieser Strukturen stellt einen üblichen Schmerzgenerator am Schultergelenk dar und kann die Funktion signifikant reduzieren. Anatomisch kann der Bizeps-Labrum-Komplex in 3 Zonen eingeteilt werden: Ursprungsbereich, intraartikulärer Verlauf und Bereich im Bizepssehnentunnel.

Diagnostik

Trotz der fokussierten körperlichen Untersuchung und des Fortschritts der bildgebenden Verfahren verbleibt die exakte Lokalisierung der Pathologie eine Herausforderung. Durch eine Arthroskopie lassen sich v. a. Pathologien im Bereich des Ursprungs und im intraartikulären Verlauf gut diagnostizieren, jedoch nur partiell extraartikuläre Pathologien im Bereich des Bizepssehnentunnels.

Therapie

Bei Versagen der konservativen Therapie kann bei korrekter Indikationsstellung operativ eine hohe Patientenzufriedenheit erreicht werden. Während beim jungen aktiven Patienten rekonstruktive Verfahren und die Tenodese der langen Bizepssehne im Vordergrund stehen, lassen sich aber auch durch die Tenotomie hochgradig zufriedenstellende Ergebnisse erreichen. Nichtadressierte pathologische Veränderungen im Bereich des Bizepssehnentunnels können zu einer Schmerzpersistenz führen. In der klinischen Anwendung zur Durchführung der Tenodese zeigen sich sowohl die unterschiedlichen Techniken als auch die verwendeten Implantate als gleichwertig.

Zusammenfassung

Dieser Beitrag beschreibt die anatomischen Grundlagen, pathologische Veränderungen, die fokussierte klinisch-apparative Diagnostik und diskutiert die unterschiedlichen Behandlungsphilosophien und deren Ergebnisse anhand aktueller Literatur.

Abstract

Background

The biceps-labrum complex is prone to acute lesions and degenerative changes due to its anatomical structure and the high load it has to endure. Pathological changes of these structures are common pain generators and can significantly impair shoulder function. Anatomically, the biceps-labrum complex can be divided into three zones: inside, junction and bicipital tunnel.

Diagnostic procedure

Despite the focused physical examination and advancements in imaging techniques, the exact localization of pathologies remains challenging. Arthroscopy can be used to accurately diagnose inside and junctional pathologies but extra-articular changes in the region of the bicipital tunnel can only be partially visualized.

Treatment

In cases of unsuccessful conservative treatment and correct indications, a high level of patient satisfaction can be surgically achieved. In young patients an anatomical reconstruction of inside lesions or tenodesis of the long head of the biceps tendon is performed; however, even tenotomy is a valuable option and can achieve equally satisfactory results. Unaddressed pathological changes of the bicipital tunnel can lead to persistence of pain. In clinical procedures performing tenodesis, both the different techniques and the implants used have been found to show similar results.

Summary

This article describes the anatomical principles, pathological changes, the focused clinical instrumental diagnostics and discusses the different treatment philosophies as well as the outcome according to the recent literature.

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Authors and Affiliations

  1. Unfallchirurgische Klinik, Medizinische Hochschule Hannover (MHH), Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland

    N. Hawi MBA, S. Razaeian &  C. Krettek

  2. Schulterzentrum Prof. Habermeyer, Törringstr. 6, 81675, München, Deutschland

    P. Habermeyer

  3. Klinikum Dritter Orden, Menzinger Str. 44, 80638, München, Deutschland

    R. Meller

  4. Institut für Diagnostische und Interventionelle Radiologie, Medizinische Hochschule Hannover (MHH), Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland

    C. von Falck

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  1. N. Hawi MBA
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Correspondence to N. Hawi MBA.

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N. Hawi, P. Habermeyer, R. Meller, S. Razaeian, C. von Falck und C. Krettek geben an, dass kein Interessenkonflikt besteht.

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Hawi, N., Habermeyer, P., Meller, R. et al. Verletzungen des Bizeps-Labrum-Komplexes. Unfallchirurg 124, 96–107 (2021). https://doi.org/10.1007/s00113-020-00927-y

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