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Proximale und distale Ruptur des M. biceps brachii

Proximal and distal rupture of the m. biceps brachii

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Zusammenfassung

Rupturen der Bizepssehne stellen einen nicht unerheblichen Anteil der Sehnenrupturen dar. Proximale Rupturen der langen Bizepssehne sind eher degenerativen Ursprungs und treten häufig in Assoziation mit Rotatorenmanschettenläsionen auf. Die Beschwerden sind unspezifisch, nicht selten bestehen die Schulterbeschwerden schon länger. Die distale Bizepssehnenruptur wird dagegen fast immer durch eine plötzlich auf den angespannten Muskel einwirkende Kraft verursacht.

Klinisch imponiert die Distalisierung oder Proximalisierung des Muskelbauchs mit Hämatombildung. In Kombination mit klinisch spezifischen Tests und der weiterführenden Diagnostik gelingt in der Regel die Diagnose. Die Behandlungsoptionen sind sowohl konservativ, als auch operativ. Da die Ergebnisse der Tenotomie und Tenodese zur Therapie der proximalen Bizepssehnenruptur vergleichbar sind, ist die Therapie insbesondere bei älteren Patienten eher konservativ. Distale Rupturen dagegen werden in der Regel operativ versorgt. Die Ergebnisse der operativen Refixation sind sowohl für die proximale, als auch für die distale Bizepssehne vielversprechend. Chronische distale Rupturen werden aufgrund der Retraktion der Sehne mittels Auto- oder Allografts versorgt.

Abstract

Ruptures of the biceps tendon account for a high percentage of tendon ruptures. The aetiology of proximal ruptures of the long head of the biceps tendon is often degenerative and they are frequently associated with lesions of the rotator cuff. The clinical findings are often not specific and long lasting. Distal ruptures of the biceps tendon mostly occur during eccentric contraction of the biceps muscle.

Clinical tests, the associated haematoma and a distalisation or proximalisation of the muscle belly in combination with ultrasound or MRI to rule out combined diseases lead to the diagnosis. The possible options include conservative and operative treatment. Tenotomy and tenodesis lead to comparable results in the literature. Therefore, conservative treatment is mostly recommended in proximal ruptures. Operative treatment is preferred in distal ruptures of the biceps tendon in order to achieve an anatomical reconstruction of the muscle function. Chronic ruptures of the distal biceps tendon can be successfully treated with free autografts or allografts.

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  1. Klinik für Unfall-, Hand- und orthopädische Chirurgie, Klinikum Osnabrück, Am Finkenhügel 1–3, 49076, Osnabrück, Deutschland

    O. Lorbach, M. Kieb, C. Grim & M. Engelhardt

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  1. O. Lorbach
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  2. M. Kieb
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  3. C. Grim
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Correspondence to O. Lorbach.

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Lorbach, O., Kieb, M., Grim, C. et al. Proximale und distale Ruptur des M. biceps brachii. Orthopäde 39, 1117–1122 (2010). https://doi.org/10.1007/s00132-010-1687-0

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