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Arthritis und Rheuma 2016; 36(05): 305-311
DOI: 10.1055/s-0037-1617745
Schulterschmerz
Schattauer GmbH

Die lange Bizepssehne als Schmerzgenerator der Schulter

The long head of biceps tendon as pain generator of the shoulder
T. Patzer
1   Orthopädische Klinik, Sektion für Schulter-Ellenbogen-Chirurgie, Arthroskopie, Sport-Orthopädie, Universitätsklinikum Düsseldorf
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Publication History

Publication Date:
20 December 2017 (online)

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Zusammenfassung

Der intraartikuläre Anteil der langen Bizepssehne läuft frei über die Humerusgelenkfläche. Dabei sorgen komplexe Weichteilstrukturen am Ursprung und im Verlauf für einen reibungslosen Verlauf bei der Bewegung. Bei Überlastung oder Läsionen der Bizeps-stabilisierenden Strukturen kann es zu Schmerzen und auch Reibungsschäden (chondral print) auf dem Oberarmkopf kommen. Durch die Einstrahlung in das glenoidale Labrum, den SLAP-Komplex, führen sogenannte SLAP-Läsionen zu einer erhöhten glenohumeralen Translation und erhöhtem Druck der Bizepssehne. Läsionen der stabilisierenden Schlinge vor Eintritt in den knöchernen Sulcus bicipitalis, sogenannte Bizeps-Pulley-Läsionen, führen zu einer Scheibenwischer-artigen Bizeps-instabilität, wodurch die Rotatorenmanschette oder der humerale Knorpel geschädigt werden können. Bei Patienten < 36 Lebensjahren ist ein SLAP-Repair mit Fadenankern erfolgversprechend, bei älteren Patienten sowie bei Pulley-Läsionen ist eine LBS-Tenotomie oder -Tenodese adäquat, um den störenden Teil der langen Bizepssehne aus dem Gelenk zu entfernen. Die Läsionen sind durch repetitive Mikro- und Makrotraumata bei Überkopf-Aktiven, aber nicht selten auch durch degenerative Veränderungen bedingt.

Summary

In the healthy pain-free glenohumeral joint complex soft tissue structures provide for smooth intra-articular gliding of the long head of the biceps tendon in all directions. Overuse or lesions of the biceps-stabilizing structures can cause pain and even chondral defects by friction on the humeral head surface. Due to the insertion at the glenoidal labrum, the so called SLAP complex, SLAP lesions lead to an increase of glenohumeral translation and pressure on the biceps tendon. Lesions of the stabilizing sling before entering the bony sulcus, so-called biceps Pulley lesions, lead to a windshield-wiper like biceps instability causing lesions of the rotator cuff or a humeral chondral print. In patients aged under 36 years arthroscopic SLAP repair with suture anchors can restore anatomy. In older patients and in biceps Pulley lesions, biceps tenotomy or tenodesis is appropiate to remove the disturbing part of the tendon from the joint cavity. Biceps lesions can occur by repetitive micro- or macrotraumata in overhead active patients but also by degenerative changes.

Schlüsselwörter

Bizepssehne - SLAP-Läsion - Bizeps-PulleyLäsion - Knorpelschaden

Keywords

Biceps tendon - SLAP lesion - biceps Pulley lesion - chondral print
 

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