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Moderne Behandlungsstrategien der langen Bizepssehne

Modern treatment strategies for the long head of the biceps tendon

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Zusammenfassung

Die lange Sehne des M. biceps und die Schlinge des Bizeps-Pulley-Systems sind anfällig für akute oder degenerative Läsionen. Da sie beide als wesentliche Schmerzursachen identifiziert wurden, sind eine entsprechende Diagnose und Behandlung für die erfolgreiche Therapie von Schulterschmerzen essenziell. Die grundlegenden Prinzipien zur Behandlung dieser beiden pathologischen Veränderungen haben sich zwar in den letzten Jahrzehnten nicht geändert, es wurden jedoch neue Ansätze für einfacher durchzuführende chirurgische Optionen entwickelt. Die Refixation von SLAP-Läsionen (SLAP: Superiores Labrum von anterior nach posterior) wird restriktiver gehandhabt und zumeist bei jungen Patienten durchgeführt, während eine Tenotomie oder Tenodese häufiger bei Patienten über 30 Jahren vorgenommen wird. Läsionen der langen Bizepssehne und des Pulley-Systems werden entweder mittels Tenotomie oder Tenodese behandelt. Insbesondere die chirurgischen Techniken bei der Tenodese sind bei Verwendung aktueller Implantate weniger invasiv. Dabei wird die Tenodese entweder intraartikulär, supra- oder subpektoral mit Tenodeseschrauben oder Fadenankern durchgeführt. Dagegen wurde in den letzten 10 Jahren das Verfahren der Weichteiltenodese immer seltener eingesetzt. Mit der chirurgischen Behandlung pathologischer Veränderungen der langen Bizepssehne sind hochgradig zufriedenstellende Ergebnisse möglich, wenn die Indikation sorgfältig gestellt wird.

Abstract

The long head of the biceps and the biceps pulley sling are prone to acute or degenerative injury. As they both were identified as major pain generators, adequate diagnosis and treatment is vital for successful treatment of shoulder pain. Although the basic principles to address either pathology have not changed over the last decades, new trends have evolved to simplify surgical options. SLAP (superior labral tear from anterior to posterior) repair is seen more restrictive and is mostly performed in young individuals, whereas tenotomy or tenodesis are more often used in patients over 30. The long head of the biceps and pulley lesions are treated with either tenotomy or tenodesis. Surgical techniques for tenodesis are especially less invasive using current implants. Tenodesis is performed either intraarticular, supra- or subpectoral with tenodesis screws or suture anchors. Soft tissue tenodesis has become unpopular over the last decade. Surgical treatment of the long head of the biceps pathologies allows highly satisfying results if the indication is chosen thoroughly.

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Abbreviations

CHL:

Ligamentum coracohumerale

LBS:

Lange Bizepssehne

MGHL:

Ligamentum glenohumerale mediale

PDS:

Poly-p-dioxanon

SGHL:

Ligamentum glenohumerale superius

SLAP:

Superiores Labrum von anterior nach posterior

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Authors and Affiliations

  1. Gelenkpunkt – Sport- und Gelenkchirurgie Innsbruck, Olympiastraße 39, 6020, Innsbruck, Österreich

    S. Braun

  2. Sportorthopädie, TU München, Ismaninger Str. 22, 81675, München, Deutschland

    S. Braun & A. B. Imhoff

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  2. A. B. Imhoff
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Correspondence to S. Braun.

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S. Braun und A. B. Imhoff sind Berater der Firma Arthrex, München.

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

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Braun, S., Imhoff, A.B. Moderne Behandlungsstrategien der langen Bizepssehne. Orthopäde 47, 113–120 (2018). https://doi.org/10.1007/s00132-017-3514-3

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