Skip to main content
SpringerLink
Log in

Diagnostik und Therapie der isolierten proximalen Bizepsläsion

Diagnostics and therapy of isolated proximal biceps lesions

  • Leitthema: Übersicht
  • Published:
Obere Extremität Aims and scope Submit manuscript

Zusammenfassung

Die Läsionen der proximalen Bizepssehne können den Bizepsanker, den intraartikulären Anteil der Sehne sowie den Pulley-Apparat betreffen. Eine genaue Differenzierung anhand der klinischen Untersuchung und Anamnese ist oftmals schwierig, da die klinischen Tests zur Evaluation einer Bizepspathologie zwar sensitiv, jedoch nicht spezifisch sind. Die Kombination verschiedener spezifischer Tests kann diese jedoch verbessern. Bildgebende Verfahren wie die Sonographie oder die Kernspintomographie bzw. die Magnetresonanz (MR)-Arthrographie geben wichtige Informationen bezüglich begleitender Pathologien. Darüber hinaus eignet sich insbesondere die MR-Arthrographie zur Erfassung einer Bizepssehnenpathologie hoher Sensitivität.

Zur Differenzierung einer intraartikulären von einer subakromialen Pathologie eignen sich „diagnostische“ Injektionen mit Lokalanästhetika.

Die Behandlung richtet sich nach der vorliegenden Erkrankung. Die operativen Verfahren nach frustraner konservativer Therapie beinhalten in erster Linie das Débridement bzw. die Refixation des SLAP („superior labrum anterior to posterior“)-Komplexes, die Tenotomie oder die Tenodese der langen Bizepssehne.

Die Entscheidung zur Tenotomie oder Tenodese wird individuell nach Alter, Konstitution und kosmetischem Anspruch getroffen. Die verwendete Technik der Tenodese kann sowohl arthroskopisch als auch „mini-open“ als suprapektorale oder subpektorale Tenodese durchgeführt werden. Das verwendete Verfahren richtet sich in erster Linie nach der Präferenz des Operateurs, da alle Verfahren mit guten klinischen Resultaten beschrieben wurden.

Abstract

Pathologies of the long head of the biceps tendon are a frequent cause of pain and restricted shoulder function. In most cases the anamnesis and clinical examination with a combination of specific tests for the biceps tendon lead to the diagnosis. Magnetic resonance imaging (MRI) especially with intraarticular contrast medium enables differentiation of the different biceps pathologies and additional disorders, such as rotator cuff tears. Radiological examination can rule out other bone pathologies. In cases of unclear persistent shoulder disability, diagnostic arthroscopy remains the gold standard which allows a precise diagnosis as well as direct operative treatment of the underlying pathologies. Conservative treatment consists of adaptation of physical activity, anti-inflammatory drugs as well as injections with local anesthetics. Physical therapy can further address concomitant contractures of the capsule or dyskinesia of the scapula. After failed conservative treatment, the surgical procedure depends on the underlying pathology including debridement or refixation of the biceps anchor, tenotomy or tenodesis of the biceps tendon as well as treatment of concomitant pathologies, such as rotator cuff tears.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2 Abb. 1
Abb. 3
Abb. 4

Literatur

  1. Amaravathi RS, Pankappilly B, Kany J (2011) Arthroscopic keyhole proximal biceps tenodesis: a technical note. J Orthop Surg (Hong Kong) 19:379–383

    Google Scholar 

  2. Armstrong A, Teefey SA, Wu T, Clark AM, Middleton WD, Yamaguchi K, Galatz LM (2006) The efficacy of ultrasound in the diagnosis of long head of the biceps tendon pathology. J Shoulder Elbow Surg 15:7–11

    Google Scholar 

  3. Barber FA, Byrd JW, Wolf EM, Burkhart SS (2001) How would you treat the partially torn biceps tendon? Arthroscopy 17:636–639

    Article  CAS  PubMed  Google Scholar 

  4. Beall DP, Williamson EE, Ly JQ, Adkins MC, Emery RL, Jones TP, Rowland CM (2003) Association of biceps tendon tears with rotator cuff abnormalities: degree of correlation with tears of the anterior and superior portions of the rotator cuff. AJR Am J Roentgenol 180:633–639

    Google Scholar 

  5. Becker DA, Cofield RH (1989) Tenodesis of the long head of the biceps brachii for chronic bicipital tendinitis. Long-term results. J Bone Joint Surg Am 71:376–381

    CAS  PubMed  Google Scholar 

  6. Bennett WF (1998) Specificity of the Speed’s test: arthroscopic technique for evaluating the biceps tendon at the level of the bicipital groove. Arthroscopy 14:789–796

    Article  CAS  PubMed  Google Scholar 

  7. Bennett WF (2004) Arthroscopic bicipital sheath repair: two-year follow-up with pulley lesions. Arthroscopy 20:964–973

    Article  PubMed  Google Scholar 

  8. Boileau P, Krishnan SG, Coste JS, Walch G (2002) Arthroscopic biceps tenodesis: a new technique using bioabsorbable interference screw fixation. Arthroscopy 18:1002–1012

    Article  PubMed  Google Scholar 

  9. Boileau P, Parratte S, Chuinard C, Roussanne Y, Shia D, Bicknell R (2009) Arthroscopic treatment of isolated type II SLAP lesions: biceps tenodesis as an alternative to reinsertion. Am J Sports Med 37:929–936

    Article  PubMed  Google Scholar 

  10. Bradbury T, Dunn WR, Kuhn JE (2008) Preventing the popeye deformity after release of the long head of the biceps tendon: an alternative technique and biomechanical evaluation. Arthroscopy 24:1099–1102

    Article  PubMed  Google Scholar 

  11. Braun S, Minzlaff P, Imhoff AB (2012) [Subpectoral tenodesis of the long head of the biceps tendon for pathologies of the long head of the biceps tendon and the biceps pulley]. Oper Orthop Traumatol 24:479–485

    Article  CAS  PubMed  Google Scholar 

  12. Brockmeier SF, Voos JE, Williams RJ III, Altchek DW, Cordasco FA, Allen AA, Hospital for Special Surgery Sports Medicine and Shoulder Service (2009) Outcomes after arthroscopic repair of type-II SLAP lesions. J Bone Joint Surg Am 91:1595–1603

    Article  PubMed Central  PubMed  Google Scholar 

  13. Burkhart SS, Brady PC (2006) A cowboy’s guide to advanced shoulder arthroscopy. Lippincott Williams & Wilkens, Philadelphia

  14. Burkhart SS, Morgan CD (1998) The peel-back mechanism: its role in producing and extending posterior type II SLAP lesions and its effect on SLAP repair rehabilitation. Arthroscopy 14:637–640

    Article  CAS  PubMed  Google Scholar 

  15. Burkhead W, Habermeyer P, Walch G, Lin K (2009) The biceps tendon. In: Rockwood C, Matsen F, Wirth M, Lipitt S (Hrsg) The shoulder, 4. Aufl. Saunders Elsevier, Philadelphia

    Google Scholar 

  16. Byram IR, Dunn WR, Kuhn JE (2011) Humeral head abrasion: an association with failed superior labrum anterior posterior repairs. J Shoulder Elbow Surg 20:92–97

    Article  PubMed  Google Scholar 

  17. Checchia SL, Doneux PS, Miyazaki AN, Silva LA, Fregoneze M, Ossada A, Tsutida CY, Masiole C (2005) Biceps tenodesis associated with arthroscopic repair of rotator cuff tears. J Shoulder Elbow Surg 14:138–144

    Article  PubMed  Google Scholar 

  18. Ciccotti MG, Kuri JA, Leland JM, Schwartz M, Becker C (2010) A cadaveric analysis of the arthroscopic fixation of anterior and posterior SLAP lesions through a novel lateral transmuscular portal. Arthroscopy 26:12–18

    Article  PubMed  Google Scholar 

  19. David TS, Schuldhorn JC (2012) Arthroscopic suprapectoral tenodesis of the long head biceps: reproducing an anatomic length-tension relationship. Arthroscopy Tech 1:e127–e132

    Google Scholar 

  20. Denard PJ, Ladermann A, Burkhart SS (2012) Long-term outcome after arthroscopic repair of type II SLAP lesions: results according to age and workers’ compensation status. Arthroscopy 28:451–457

    Article  PubMed  Google Scholar 

  21. Drakos MC, Verma NN, Gulotta LV, Potucek F, Taylor S, Fealy S, Selby RM, O’Brien SJ (2008) Arthroscopic transfer of the long head of the biceps tendon: functional outcome and clinical results. Arthroscopy 24:217–223

    Google Scholar 

  22. Ebinger N, Magosch P, Lichtenberg S, Habermeyer P (2008) A new SLAP test: the supine flexion resistance test. Arthroscopy 24:500–555

    Article  PubMed  Google Scholar 

  23. Ejnisman B, Monteiro GC, Andreoli CV, de Castro PA (2010) Disorder of the long head of the biceps tendon. Br J Sports Med 44:347–354

    Article  PubMed  Google Scholar 

  24. Frost A, Zafar MS, Maffulli N (2009) Tenotomy versus tenodesis in the management of pathologic lesions of the tendon of the long head of the biceps brachii. Am J Sports Med 37:828–833

    Article  PubMed  Google Scholar 

  25. Gartsman GM, Hammerman SM (2000) Arthroscopic biceps tenodesis: operative technique. Arthroscopy 16:550–552

    Article  CAS  PubMed  Google Scholar 

  26. Gaskill TR, Braun S, Millett PJ (2011) Multimedia article. The rotator interval: pathology and management. Arthroscopy 27:556–567

    Article  PubMed  Google Scholar 

  27. Gill TJ, McIrvin E, Mair SD, Hawkins RJ (2001) Results of biceps tenotomy for treatment of pathology of the long head of the biceps brachii. J Shoulder Elbow Surg 10:247–249

    Article  CAS  PubMed  Google Scholar 

  28. Holtby R, Razmjou H (2004) Accuracy of the Speed’s and Yergason’s tests in detecting biceps pathology and SLAP lesions: comparison with arthroscopic findings. Arthroscopy 20:231–236

    Article  PubMed  Google Scholar 

  29. Hsu AR, Ghodadra NS, Provencher MT, Lewis PB, Bach BR (2011) Biceps tenotomy versus tenodesis: a review of clinical outcomes and biomechanical results. J Shoulder Elbow Surg 20:326–332

    Article  PubMed  Google Scholar 

  30. Kelly AM, Drakos MC, Fealy S, Taylor SA, O’Brien SJ (2005) Arthroscopic release of the long head of the biceps tendon: functional outcome and clinical results. Am J Sports Med 33:208–213

    Article  PubMed  Google Scholar 

  31. Khazzam M, George MS, Churchill RS, Kuhn JE (2012) Disorders of the long head of biceps tendon. J Shoulder Elbow Surg 21:136–145

    Article  PubMed  Google Scholar 

  32. Kibler W, Sciascia AD, Hester P, Dome D, Jacobs C (2009) Clinical utility of traditional and new tests in the diagnosis of biceps tendon injuries and superior labrum anterior and posterior lesions in the shoulder. Am J Sports Med 37:1840–1847

    Article  PubMed  Google Scholar 

  33. Klepps S, Hazrati Y, Flatow E (2002) Arthroscopic biceps tenodesis. Arthroscopy 18:1040–1045

    Article  PubMed  Google Scholar 

  34. Lafosse L, Reiland Y, Baier GP, Toussaint B, Jost B (2007) Anterior and posterior instability of the long head of the biceps tendon in rotator cuff tears: a new classification based on arthroscopic observations. Arthroscopy 23:73–80

    Article  PubMed  Google Scholar 

  35. Levy JC (2012) Simultaneous rotator cuff repair and arthroscopic biceps tenodesis using lateral row anchor. Arthroscopy Tech 1:e1–e4

    Google Scholar 

  36. Liu SH, Henry MH, Nuccion SL (1996) A prospective evaluation of a new physical examination in predicting glenoid labral tears. Am J Sports Med 24:721–725

    Article  CAS  PubMed  Google Scholar 

  37. Lo IK, Burkhart SS (2004) Arthroscopic biceps tenodesis using a bioabsorbable interference screw. Arthroscopy 20:85–95

    Article  PubMed  Google Scholar 

  38. Lorbach O, Kieb M, Grim C, Engelhardt M (2010) [Proximal and distal rupture of the m. biceps brachii]. Orthopäde 39:1117–1122

    Article  CAS  PubMed  Google Scholar 

  39. Lutton DM, Gruson KI, Harrison AK, Gladstone JN, Flatow EL (2011) Where to tenodese the biceps: proximal or distal? Clin Orthop Relat Res 469:1050–1055

    Article  PubMed Central  PubMed  Google Scholar 

  40. Maier D, Jaeger M, Suedkamp NP, Koestler W (2007) Stabilization of the long head of the biceps tendon in the context of early repair of traumatic subscapularis tendon tears. J Bone Joint Surg Am 89:1763–1769

    Article  PubMed  Google Scholar 

  41. Mariani EM, Cofield RH, Askew LJ, Li GP, Chao EY (1988) Rupture of the tendon of the long head of the biceps brachii. Surgical versus nonsurgical treatment. Clin Orthop Relat Res 228:233–239

    PubMed  Google Scholar 

  42. Mazzocca AD, Rios CG, Romeo AA, Arciero RA (2005) Subpectoral biceps tenodesis with interference screw fixation. Arthroscopy 21:896

    PubMed  Google Scholar 

  43. Mazzocca AD, Cote MP, Arciero CL, Romeo AA, Arciero RA (2008) Clinical outcomes after subpectoral biceps tenodesis with an interference screw. Am J Sports Med 36:1922–1929

    Article  PubMed  Google Scholar 

  44. Morgan CD, Burkhart SS, Palmeri M, Gillespie M (1998) Type II SLAP lesions: three subtypes and their relationships to superior instability and rotator cuff tears. Arthroscopy 14:553–565

    Article  CAS  PubMed  Google Scholar 

  45. Nho SJ, Reiff SN, Verma NN, Slabaugh MA, Mazzocca AD, Romeo AA (2010) Complications associated with subpectoral biceps tenodesis: low rates of incidence following surgery. J Shoulder Elbow Surg 19:764–768

    Google Scholar 

  46. Nho SJ, Strauss EJ, Lenart BA, Provencher MT, Mazzocca AD, Verma NN, Romeo AA (2010) Long head of the biceps tendinopathy: diagnosis and management. J Am Acad Orthop Surg 18:645–656

    PubMed  Google Scholar 

  47. Nord KD, Masterson JP, Mauck BM (2004) Superior labrum anterior posterior (SLAP) repair using the Neviaser portal. Arthroscopy 20:129–133

    Article  PubMed  Google Scholar 

  48. O’Brien SJ, Pagnani MJ, Fealy S, McGlynn SR, Wilson JB (1998) The active compression test: a new and effective test for diagnosing labral tears and acromioclavicular joint abnormality. Am J Sports Med 26:610–613

    PubMed  Google Scholar 

  49. O’Brien SJ, Allen AA, Coleman SH, Drakos MC (2002) The trans-rotator cuff approach to SLAP lesions: technical aspects for repair and a clinical follow-up of 31 patients at a minimum of 2 years. Arthroscopy 18:372–377

    Article  PubMed  Google Scholar 

  50. Oh JH, Kim SH, Lee HK, Jo KH, Bae KJ (2008) Trans-rotator cuff portal is safe for arthroscopic superior labral anterior and posterior lesion repair: clinical and radiological analysis of 58 SLAP lesions. Am J Sports Med 36:1913–1921

    Article  PubMed  Google Scholar 

  51. Osbahr DC, Diamond AB, Speer KP (2002) The cosmetic appearance of the biceps muscle after long-head tenotomy versus tenodesis. Arthroscopy 18:483–487

    Article  PubMed  Google Scholar 

  52. Ozalay M, Akpinar S, Karaeminogullari O, Balcik C, Tasci A, Tandogan RN, Gecit R (2005) Mechanical strength of four different biceps tenodesis techniques. Arthroscopy 21:992–998

    Google Scholar 

  53. Pandya NK, Colton A, Webner D, Sennett B, Huffman GR (2008) Physical examination and magnetic resonance imaging in the diagnosis of superior labrum anterior-posterior lesions of the shoulder: a sensitivity analysis. Arthroscopy 24:311–317

    Article  PubMed  Google Scholar 

  54. Patzer T, Rundic JM, Bobrowitsch E, Olender GD, Hurschler C, Schofer MD (2011) Biomechanical comparison of arthroscopically performable techniques for suprapectoral biceps tenodesis. Arthroscopy 27:1036–1047

    Article  PubMed  Google Scholar 

  55. Patzer T, Kircher J, Krauspe R (2012) All-arthroscopic suprapectoral long head of biceps tendon tenodesis with interference screw-like tendon fixation after modified lasso-loop stitch tendon securing. Arthroscopy Tech 1:e53–e56

    Google Scholar 

  56. Patzer T, Santo G, Olender GD, Wellmann M, Hurschler C, Schofer MD (2012) Suprapectoral or subpectoral position for biceps tenodesis: biomechanical comparison of four different techniques in both positions. J Shoulder Elbow Surg 21:116–125

    Article  PubMed  Google Scholar 

  57. Provencher MT, McCormick F, Dewing C, McIntire S, Solomon D (2013) A prospective analysis of 179 type 2 superior labrum anterior and posterior repairs: outcomes and factors associated with success and failure. Am J Sports Med 41:880–886

    Article  PubMed  Google Scholar 

  58. Richards DP, Burkhart SS (2004) Arthroscopic-assisted biceps tenodesis for ruptures of the long head of biceps brachii: the cobra procedure. Arthroscopy 20:201–207

    Article  PubMed  Google Scholar 

  59. Schaeffeler C, Waldt S, Holzapfel K, Kirchhoff C, Jungmann PM, Wolf P, Stat D, Schröder M, Rummeny EJ, Imhoff AB, Woertler K (2012) Lesions of the biceps pulley: diagnostic accuracy of MR arthrography of the shoulder and evaluation of previously described and new diagnostic signs. Radiology 264:504–513

    Article  PubMed  Google Scholar 

  60. Scheibel M, Schroder RJ, Chen J, Bartsch M (2011) Arthroscopic soft tissue tenodesis versus bony fixation anchor tenodesis of the long head of the biceps tendon. Am J Sports Med 39:1046–1052

    Article  PubMed  Google Scholar 

  61. Sekiya JK, Elkousy HA, Rodosky MW (2003) Arthroscopic biceps tenodesis using the percutaneous intra-articular transtendon technique. Arthroscopy 19:1137–1141

    Article  PubMed  Google Scholar 

  62. Sethi PM, Kingston S, Elattrache N (2005) Accuracy of anterior intra-articular injection of the glenohumeral joint. Arthroscopy 21:77–80

    Article  PubMed  Google Scholar 

  63. Skendzel JG, Jacobson JA, Carpenter JE, Miller BS (2011) Long head of biceps brachii tendon evaluation: accuracy of preoperative ultrasound. AJR Am J Roentgenol 197:942–948

    Article  PubMed  Google Scholar 

  64. Slenker NR, Lawson K, Ciccotti MG, Dodson CC, Cohen SB (2012) Biceps tenotomy versus tenodesis: clinical outcomes. Arthroscopy 28:576–582

    Article  PubMed  Google Scholar 

  65. Stanish WD, Peterson DC (1995) Shoulder arthroscopy and nerve injury: pitfalls and prevention. Arthroscopy 11:458–466

    Article  CAS  PubMed  Google Scholar 

  66. Szabo I, Boileau P, Walch G (2008) The proximal biceps as a pain generator and results of tenotomy. Sports Med Arthrosc 16:180–186

    Article  PubMed  Google Scholar 

  67. Trusler ML, Bryan WJ, Ilahi OA (2002) Anatomic and radiographic analysis of arthroscopic tack placement into the superior glenoid. Arthroscopy 18:366–371

    Article  PubMed  Google Scholar 

  68. Verma NN, Drakos M, O’Brien SJ (2005) Arthroscopic transfer of the long head biceps to the conjoint tendon. Arthroscopy 21:764

    PubMed  Google Scholar 

  69. Walch G, Nove-Josserand L, Levigne C, Renaud E (1994) Tears of the supraspinatus tendon associated with „hidden“ lesions of the rotator interval. J Shoulder Elbow Surg 3:353–360

    Article  CAS  PubMed  Google Scholar 

  70. Walch G, Edwards TB, Boulahia A, Nové-Josserand L, Neyton L, Szabo I (2005) Arthroscopic tenotomy of the long head of the biceps in the treatment of rotator cuff tears: clinical and radiographic results of 307 cases. J Shoulder Elbow Surg 14:238–246

    Article  PubMed  Google Scholar 

  71. Wellmann M, Habermeyer P, Lichtenberg S (2010) [Arthroscopic biceps tenodesis with isometric tendon refixation]. Unfallchirurg 113:491–494

    Article  CAS  PubMed  Google Scholar 

  72. Zanetti M, Weishaupt D, Gerber C, Hodler J (1998) Tendinopathy and rupture of the tendon of the long head of the biceps brachii muscle: evaluation with MR arthrography. AJR Am J Roentgenol 170:1557–1561

    Article  CAS  PubMed  Google Scholar 

Download references

Einhaltung ethischer Richtlinien

Interessenkonflikt

O. Lorbach, C. Trennheuser und K. Anagnostakos geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

Author information

Authors and Affiliations

  1. Klinik für Orthopädie und orthopädische Chirurgie, Universität des Saarlandes, Kirrberger Str., Geb. 37, 66421, Homburg (Saar), Deutschland

    Olaf Lorbach, Christian Trennheuser & Konstantinos Anagnostakos

Authors
  1. Olaf Lorbach
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Christian Trennheuser
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Konstantinos Anagnostakos
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Olaf Lorbach.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lorbach, O., Trennheuser, C. & Anagnostakos, K. Diagnostik und Therapie der isolierten proximalen Bizepsläsion. Obere Extremität 9, 10–16 (2014). https://doi.org/10.1007/s11678-013-0243-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11678-013-0243-z

Schlüsselwörter

Keywords

Search

Navigation