Verletzungen der proximalen und distalen Bizepssehne

Zusammenfassung

Der M. biceps brachii besitzt 2 proximale Ursprünge und einen distalen Ansatz. Dabei kann die lange Bizepssehne (LBS) häufig als Ursache für den vorderen Schulterschmerz identifiziert werden. Zahlreiche Pathologien wie eine Tendinitis, (Partial-)Risse oder Subluxation der LBS sind dafür grundlegend. Rupturen der Rotatorenmanschette stellen dabei auch ursächliche Veränderungen für Beschwerden der LBS dar. Scheitert die konservative Therapie, kann entsprechend dem körperlichen Anspruch eine Tenotomie resp. Tenodese der LBS erfolgen. Sowohl supra- als auch subpektorale LBS-Tenodesen führen dabei zu guten funktionellen Ergebnissen. Die LBS-Tenotomie kann bei Patienten mit geringeren funktionellen Anforderungen angewandt werden, jedoch mit einem höheren Risiko für eine postoperative Distalisierung des Muskelbauchs des Biceps brachii.

Die distale Bizepssehne (DBS) ist der wichtigste Supinator des Unterarms und fungiert als sekundärer Flexor des Ellenbogens. Rupturen der DBS treten am häufigsten bei Männern mittleren Alters im Rahmen eines traumatischen Ereignisses auf. Bei körperlichem Anspruch mit relevantem Defizit von Supinationskraft und -ausdauer ist die chirurgische Versorgung indiziert. Verschiedene Operationstechniken sind zur Refixation der DBS beschrieben. In unserer Praxis hat sich die unikortikale Onlay-Refixation sowohl mit dem Kortikalis-Button als auch mit All-Suture-Ankern bewährt. Bei chronischen Rupturen der DBS kann eine Augmentation durch ein Transplantat durchgeführt werden.

Dieser Artikel bietet einen umfassenden Überblick über Therapie von proximalen und distalen Sehnenrupturen des Biceps brachii.

Pathologien sowohl von langer als auch distaler Bizepssehne stellen relevante Krankheitsbilder der oberen Extremität dar. Dabei kann die lange Bizepssehne eine häufige Ursache für den vorderen Schulterschmerz sein. Die distale Bizepssehne tritt vor allem als häufigste Sehnenruptur des Ellenbogens klinisch in Erscheinung. Dieser Artikel bietet einen umfassenden Überblick über Therapie von proximalen und distalen Sehnenrupturen des Biceps brachii.

Abstract

The biceps brachii possesses two proximal attachments and one singular distal. The long head of the biceps tendon is a well-known cause for anterior shoulder pain. Various pathologies, e.g. tendinitis, (partial-)tears, and (sub-)luxation of the long head of the biceps tendon can lead to these symptoms. Additionally, there is a high association of aforementioned pathologies with rotator cuff tears. If non-operative treatment fails, surgical intervention including either tenotomy or tenodesis of the long head of the biceps tendon is indicated depending on the physical demands of the patient. Both, supra- as well as subpectoral tenodesis of the long head of the biceps tendon lead to good to excellent outcomes. While tenotomy of the long head of the biceps tendon is applied for patients with lower functional demands, a higher risk of postoperative distalization of the biceps muscle may occur.

The distal biceps tendon is the major supinator of the forearm and serves as a secondary flexor of the elbow. Distal biceps tendon ruptures mostly occur in middle-aged men due to a trauma. Surgical repair of the distal biceps tendon is indicated to restore supination strength and endurance in patients with physical demands. A uni-cortical onlay fixation of the distal biceps tendon with cortical buttons or all-suture anchors is the standard procedure in our clinical practice. In cases of chronic distal biceps tendon ruptures a graft augmentation can be performed.

This article provides a comprehensive overview of both, proximal and distal biceps brachii tendon ruptures.

Schlüsselwörter

lange Bizepssehne - distale Bizepssehne - Musculus biceps brachii - Sehnenruptur - Therapie

Keywords

long head of the biceps tendon - distal biceps tendon - tendon rupture - treatment

Publication History

Article published online:
06 July 2023

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