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Diagnostik und Therapie anterosuperiorer Rotatorenmanschettenläsionen

Diagnostics and treatment of anterosuperior rotator cuff tears

Der Orthopäde volume 45, pages 130–135 (2016)Cite this article

Zusammenfassung

Einleitung

Anterosuperiore Läsionen der Rotatorenmanschette beinhalten eine Verletzung der Subscapularissehne, der Supraspinatussehne und fast immer auch eine Verletzung des Rotatorenintervalls. Grundsätzlich lassen sich drei Typen unterscheiden: Erweiterte Pulley-Läsionen der langen Bizepssehne, transmurale Supraspinatussehnenläsionen kombiniert mit einer Partialläsion der Subscapularissehne und anterosuperiore Massenrupturen.

Therapie

Allen drei Typen gemeinsam ist das schlechte Ansprechen auf physiotherapeutische Maßnahmen, bedingt durch die Instabilität der langen Bizepssehne. Die operative Therapie beinhaltet daher neben der Refixation der Rotatorenmanschette jeweils eine Tenodese oder Tenotomie der langen Bizepssehne. Auch isolierte tiefreichende Partialläsionen (≥ 6 mm), sowohl der Subscapularissehne als auch der Supraspinatussehne, sollten refixiert werden. Bei den anterosuperioren Massenrupturen ist die Refixation zeitkritisch aufgrund der hohen Retraktionstendenz der Subscapularissehne.

Abstract

Introduction

Anterosuperior rotator cuff lesions are defined as combined tears of the subscapularis and the supraspinatus tendon and are usually accompanied by an associated lesion of the rotator interval. There are three different types of lesion: extended lesions of the biceps pulley, transmural tears of the supraspinatus with an associated partial lesion of the subscapularis tendon, and massive anterosuperior rotator cuff tears.

None of these lesions responds well to physiotherapy because of biceps tendon instability. Therefore, surgical treatment is required, including tenodesis or tenotomy of the biceps tendon and additional repair of the rotator cuff. Deep partial tears of the subscapularis or the supraspinatus tendon (≥ 6 mm) should be refixed as well. Massive anterosuperior rotator cuff tears should be treated immediately because of the high retraction tendency of the subscapularis tendon.

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  1. Klinik für Orthopädie, Medizinische Hochschule Hannover (im Annastift), Anna von Borries Str. 1–6, 30625, Hannover, Deutschland

    M. Wellmann

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Wellmann, M. Diagnostik und Therapie anterosuperiorer Rotatorenmanschettenläsionen. Orthopäde 45, 130–135 (2016). https://doi.org/10.1007/s00132-015-3215-8

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  • DOI: https://doi.org/10.1007/s00132-015-3215-8

Schlüsselwörter

  • Rotatorenmanschette
  • Sehnenverletzung
  • Supraspinatussehne
  • Subcapularissehne
  • Bizeps Tenodese

Keywords

  • Rotator cuff
  • Tendon rupture
  • Supraspinatus tendon
  • Subcapularis tendon
  • Biceps tenodesis