Distale Bizepssehnen- und Trizepssehnenrupturen

Zusammenfassung

Rupturen der distalen Bizeps- und Trizepssehne sind selten, treten jedoch gehäuft bei männlichen, sportlichen und körperlich schwer arbeitenden Patienten auf. Dieser Übersichtsartikel beschreibt Ätiologie und Pathogenese sowie Diagnostik, Behandlungsmöglichkeiten, das zu erwartende Outcome dieser Verletzungen und gibt Einblicke in das eigene Vorgehen.

Abstract

Ruptures of the distal biceps and triceps tendon are rare. Most frequently these injuries occur in men, athletes and patients with physically demanding work activities. This review article describes aetiology and pathogenesis as well as diagnostics, treatment options, the expected outcome and provides insights in our own approach.

Kernaussagen

• Die Ruptur der distalen Bizeps- und Trizepssehne kann oft klinisch diagnostiziert werden und tritt hauptsächlich bei körperlich tätigen Männern und Kraftsportlern auf.

• Distale Trizepssehnenrupturen sind ein seltenes Verletzungsbild und werden häufig verpasst, daher ist eine sorgfältige klinische Untersuchung unabdingbar.

• Goldstandard für die Bildgebung distaler Bizeps- und Trizepssehnenrupturen ist das MRT

• In der Regel wird eine operative Versorgung empfohlen. Zur Gewährleistung eines guten Outcomes sollte diese in den ersten 2 – 3 Wochen erfolgen.

• Konservatives Management ist eine Option bei Partialrupturen und bei Patienten mit geringem funktionellem Anspruch und/oder höherem Alter.

• Die Ultraschall- und MRT Untersuchung ist besonders hilfreich bei Partialrupturen und Rerupturen.

• Rekonstruktionen der distalen Bizepssehne in Single- und Double-Inzisions-Technik ergeben unabhängig von der Fixationstechnik vergleichbar gute Ergebnisse.

• Die klinische Relevanz der anatomischen Rekonstruktion der distalen Bizepssehne muss noch definiert werden.

• Minor-Komplikationen bei distaler Bizepssehnenrefixation sind häufig und betreffen vor allem den N. cutaneus antebrachii lateralis in Form von transienten Neurapraxien.

• Eine Blutsperre kann eine Reposition der Sehne erschweren.

• Chronische und retrahierte Rupturen, welche mit einem Interponat operativ versorgt werden, weisen schlechtere Ergebnisse auf als direkt refixierte Sehnen, jedoch bessere Resultate als konservativ behandelte Rupturen.

• Ob die vielversprechenden Ansätze endoskopischer Techniken für eine komplikationsärmere und anatomische Rekonstruktion der Standard der Zukunft sind, wird sich zeigen.

Schlüsselwörter

Orthopädie - Traumatologie - obere Extremität - Sehnenruptur

Key words

orthopaedics - tendon rupture - elbow - biceps - triceps

Publication History

Article published online:
09 July 2020

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