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Erschienen in: Die Unfallchirurgie 8/2022

11.07.2022 | Arthroskopie | CME

Anatomie und Diagnostik von Subskapularissehnenrupturen

verfasst von: David Endell, Christopher Child, Florian Freislederer, Philipp Moroder, Markus Scheibel

Erschienen in: Die Unfallchirurgie | Ausgabe 8/2022

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Zusammenfassung

Innerhalb der Rotatorenmanschettenläsionen gehören Subskapularissehnenrupturen zu den selteneren Verletzungen und treten meist in Kombination mit zusätzlichen Läsionen der posterosuperioren Rotatorenmanschette und der langen Bizepssehne auf. Die primäre Diagnostik sollte bereits bei initialem klinischem Verdacht mithilfe der modernen Schnittbildgebung um die Magnetresonanztomographie erweitert werden, um eine Sehnenverletzung und pathologische Begleiterscheinungen zu erfassen. Dennoch werden Subskapularissehnenrupturen häufig initial übersehen und erst während der Schulterarthroskopie korrekt diagnostiziert.
Literatur
1.
Zurück zum Zitat Ward SR et al (2006) Rotator cuff muscle architecture: implications for glenohumeral stability. Clin Orthop Relat Res 448:157–163PubMed Ward SR et al (2006) Rotator cuff muscle architecture: implications for glenohumeral stability. Clin Orthop Relat Res 448:157–163PubMed
2.
Zurück zum Zitat Burkhart SS (1992) Fluoroscopic comparison of kinematic patterns in massive rotator cuff tears. A suspension bridge model. Clin Orthop Relat Res 284:144–152CrossRef Burkhart SS (1992) Fluoroscopic comparison of kinematic patterns in massive rotator cuff tears. A suspension bridge model. Clin Orthop Relat Res 284:144–152CrossRef
3.
Zurück zum Zitat Aluisio FV, Osbahr DC, Speer KP (2003) Analysis of rotator cuff muscles in adult human cadaveric specimens. Am J Orthop (Belle Mead NJ) 32(3):124–129 Aluisio FV, Osbahr DC, Speer KP (2003) Analysis of rotator cuff muscles in adult human cadaveric specimens. Am J Orthop (Belle Mead NJ) 32(3):124–129
4.
Zurück zum Zitat Su WR, Budoff JE, Luo ZP (2009) The effect of anterosuperior rotator cuff tears on glenohumeral translation. Arthroscopy 25(3):282–289PubMedCrossRef Su WR, Budoff JE, Luo ZP (2009) The effect of anterosuperior rotator cuff tears on glenohumeral translation. Arthroscopy 25(3):282–289PubMedCrossRef
5.
Zurück zum Zitat O’Connell NE, Cowan J, Christopher T (2006) An investigation into EMG activity in the upper and lower portions of the subscapularis muscle during normal shoulder motion. Physiother Res Int 11(3):148–151PubMedCrossRef O’Connell NE, Cowan J, Christopher T (2006) An investigation into EMG activity in the upper and lower portions of the subscapularis muscle during normal shoulder motion. Physiother Res Int 11(3):148–151PubMedCrossRef
6.
Zurück zum Zitat Plachel F et al (2018) Arthroskopische Doppelreihenrekonstruktion hochgradiger Rupturen der Subskapularissehne. Oper Orthop Traumatol 30(2):111–129PubMedCrossRef Plachel F et al (2018) Arthroskopische Doppelreihenrekonstruktion hochgradiger Rupturen der Subskapularissehne. Oper Orthop Traumatol 30(2):111–129PubMedCrossRef
7.
Zurück zum Zitat D’Addesi LL et al (2006) The subscapularis footprint: an anatomic study of the subscapularis tendon insertion. Arthroscopy 22(9):937–940PubMedCrossRef D’Addesi LL et al (2006) The subscapularis footprint: an anatomic study of the subscapularis tendon insertion. Arthroscopy 22(9):937–940PubMedCrossRef
8.
Zurück zum Zitat Richards DP et al (2007) The subscapularis footprint: an anatomic description of its insertion site. Arthroscopy 23(3):251–254PubMedCrossRef Richards DP et al (2007) The subscapularis footprint: an anatomic description of its insertion site. Arthroscopy 23(3):251–254PubMedCrossRef
9.
Zurück zum Zitat Ide J et al (2008) An anatomic study of the subscapularis insertion to the humerus: the subscapularis footprint. Arthroscopy 24(7):749–753PubMedCrossRef Ide J et al (2008) An anatomic study of the subscapularis insertion to the humerus: the subscapularis footprint. Arthroscopy 24(7):749–753PubMedCrossRef
10.
Zurück zum Zitat Jost B, Koch PP, Gerber C (2000) Anatomy and functional aspects of the rotator interval. J Shoulder Elbow Surg 9(4):336–341PubMedCrossRef Jost B, Koch PP, Gerber C (2000) Anatomy and functional aspects of the rotator interval. J Shoulder Elbow Surg 9(4):336–341PubMedCrossRef
11.
Zurück zum Zitat Flury MP et al (2006) Rupture of the subscapularis tendon (isolated or in combination with supraspinatus tear): when is a repair indicated? J Shoulder Elbow Surg 15(6):659–664PubMedCrossRef Flury MP et al (2006) Rupture of the subscapularis tendon (isolated or in combination with supraspinatus tear): when is a repair indicated? J Shoulder Elbow Surg 15(6):659–664PubMedCrossRef
12.
Zurück zum Zitat Bennett WF (2001) Subscapularis, medial, and lateral head coracohumeral ligament insertion anatomy: arthroscopic appearance and incidence of “hidden” rotator interval lesions. Arthroscopy 17(2):173–180PubMedCrossRef Bennett WF (2001) Subscapularis, medial, and lateral head coracohumeral ligament insertion anatomy: arthroscopic appearance and incidence of “hidden” rotator interval lesions. Arthroscopy 17(2):173–180PubMedCrossRef
13.
Zurück zum Zitat Morag Y et al (2011) The subscapularis: anatomy, injury, and imaging. Skelet Radiol 40(3):255–269CrossRef Morag Y et al (2011) The subscapularis: anatomy, injury, and imaging. Skelet Radiol 40(3):255–269CrossRef
14.
Zurück zum Zitat Bartl C et al (2011) Open repair of isolated traumatic subscapularis tendon tears. Am J Sports Med 39(3):490–496PubMedCrossRef Bartl C et al (2011) Open repair of isolated traumatic subscapularis tendon tears. Am J Sports Med 39(3):490–496PubMedCrossRef
15.
Zurück zum Zitat Deutsch A et al (1997) Traumatic tears of the subscapularis tendon. Clinical diagnosis, magnetic resonance imaging findings, and operative treatment. Am J Sports Med 25(1):13–22PubMedCrossRef Deutsch A et al (1997) Traumatic tears of the subscapularis tendon. Clinical diagnosis, magnetic resonance imaging findings, and operative treatment. Am J Sports Med 25(1):13–22PubMedCrossRef
16.
Zurück zum Zitat Bokor DJ, Conboy VB, Olson C (1999) Anterior instability of the glenohumeral joint with humeral avulsion of the glenohumeral ligament. A review of 41 cases. J Bone Joint Surg Br 81(1):93–96PubMedCrossRef Bokor DJ, Conboy VB, Olson C (1999) Anterior instability of the glenohumeral joint with humeral avulsion of the glenohumeral ligament. A review of 41 cases. J Bone Joint Surg Br 81(1):93–96PubMedCrossRef
17.
Zurück zum Zitat Gerber C, Wirth SH, Farshad M (2011) Treatment options for massive rotator cuff tears. J Shoulder Elbow Surg 20(2):S20–9PubMedCrossRef Gerber C, Wirth SH, Farshad M (2011) Treatment options for massive rotator cuff tears. J Shoulder Elbow Surg 20(2):S20–9PubMedCrossRef
18.
Zurück zum Zitat Collin P et al (2014) Relationship between massive chronic rotator cuff tear pattern and loss of active shoulder range of motion. J Shoulder Elbow Surg 23(8):1195–1202PubMedCrossRef Collin P et al (2014) Relationship between massive chronic rotator cuff tear pattern and loss of active shoulder range of motion. J Shoulder Elbow Surg 23(8):1195–1202PubMedCrossRef
19.
Zurück zum Zitat Lädermann A et al (2021) Diagnostic accuracy of clinical tests for subscapularis tears: a systematic review and meta-analysis. Orthop J Sports Med 9(9):23259671211042011PubMedPubMedCentralCrossRef Lädermann A et al (2021) Diagnostic accuracy of clinical tests for subscapularis tears: a systematic review and meta-analysis. Orthop J Sports Med 9(9):23259671211042011PubMedPubMedCentralCrossRef
20.
Zurück zum Zitat Barth JRH, Burkhart SS, De Beer JF (2006) The bear-hug test: a new and sensitive test for diagnosing a subscapularis tear. Arthroscopy 22(10):1076–1084PubMedCrossRef Barth JRH, Burkhart SS, De Beer JF (2006) The bear-hug test: a new and sensitive test for diagnosing a subscapularis tear. Arthroscopy 22(10):1076–1084PubMedCrossRef
21.
Zurück zum Zitat Kim S‑H et al (2005) Intra-articular repair of an isolated partial articular-surface tear of the subscapularis tendon. Am J Sports Med 33(12):1825–1830PubMedCrossRef Kim S‑H et al (2005) Intra-articular repair of an isolated partial articular-surface tear of the subscapularis tendon. Am J Sports Med 33(12):1825–1830PubMedCrossRef
22.
Zurück zum Zitat Scheibel M et al (2005) The belly-off sign: a new clinical diagnostic sign for subscapularis lesions. Arthroscopy 21(10):1229–1235PubMedCrossRef Scheibel M et al (2005) The belly-off sign: a new clinical diagnostic sign for subscapularis lesions. Arthroscopy 21(10):1229–1235PubMedCrossRef
23.
Zurück zum Zitat Hertel R et al (1996) Lag signs in the diagnosis of rotator cuff rupture. J Shoulder Elbow Surg 5(4):307–313PubMedCrossRef Hertel R et al (1996) Lag signs in the diagnosis of rotator cuff rupture. J Shoulder Elbow Surg 5(4):307–313PubMedCrossRef
24.
Zurück zum Zitat Chao S et al (2008) An electromyographic assessment of the “bear hug”: an examination for the evaluation of the subscapularis muscle. Arthroscopy 24(11):1265–1270PubMedCrossRef Chao S et al (2008) An electromyographic assessment of the “bear hug”: an examination for the evaluation of the subscapularis muscle. Arthroscopy 24(11):1265–1270PubMedCrossRef
25.
Zurück zum Zitat Walch G et al (1994) Tears of the supraspinatus tendon associated with “hidden” lesions of the rotator interval. J Shoulder Elbow Surg 3(6):353–360PubMedCrossRef Walch G et al (1994) Tears of the supraspinatus tendon associated with “hidden” lesions of the rotator interval. J Shoulder Elbow Surg 3(6):353–360PubMedCrossRef
26.
Zurück zum Zitat Narasimhan R et al (2016) Prevalence of subscapularis tears and accuracy of shoulder ultrasound in pre-operative diagnosis. Int Orthop 40(5):975–979PubMedCrossRef Narasimhan R et al (2016) Prevalence of subscapularis tears and accuracy of shoulder ultrasound in pre-operative diagnosis. Int Orthop 40(5):975–979PubMedCrossRef
27.
Zurück zum Zitat Malavolta EA et al (2019) Accuracy of magnetic resonance imaging (MRI) for subscapularis tear: a systematic review and meta-analysis of diagnostic studies. Arch Orthop Trauma Surg 139(5):659–667PubMedCrossRef Malavolta EA et al (2019) Accuracy of magnetic resonance imaging (MRI) for subscapularis tear: a systematic review and meta-analysis of diagnostic studies. Arch Orthop Trauma Surg 139(5):659–667PubMedCrossRef
28.
Zurück zum Zitat Roy J‑S et al (2015) Diagnostic accuracy of ultrasonography, MRI and MR arthrography in the characterisation of rotator cuff disorders: a systematic review and meta-analysis. Br J Sports Med 49(20):1316PubMedCrossRef Roy J‑S et al (2015) Diagnostic accuracy of ultrasonography, MRI and MR arthrography in the characterisation of rotator cuff disorders: a systematic review and meta-analysis. Br J Sports Med 49(20):1316PubMedCrossRef
29.
Zurück zum Zitat Waldt S et al (2007) Rotator cuff tears: assessment with MR arthrography in 275 patients with arthroscopic correlation. Eur Radiol 17(2):491–498PubMedCrossRef Waldt S et al (2007) Rotator cuff tears: assessment with MR arthrography in 275 patients with arthroscopic correlation. Eur Radiol 17(2):491–498PubMedCrossRef
30.
Zurück zum Zitat Pfirrmann CWA et al (1999) Subscapularis tendon tears: detection and grading at MR arthrography. Radiology 213(3):709–714PubMedCrossRef Pfirrmann CWA et al (1999) Subscapularis tendon tears: detection and grading at MR arthrography. Radiology 213(3):709–714PubMedCrossRef
31.
Zurück zum Zitat Reichel T et al (2021) Less than 9.5-mm coracohumeral distance on axial magnetic resonance imaging scans predicts for subscapularis tear. JSES Int 5(3):424–429PubMedPubMedCentralCrossRef Reichel T et al (2021) Less than 9.5-mm coracohumeral distance on axial magnetic resonance imaging scans predicts for subscapularis tear. JSES Int 5(3):424–429PubMedPubMedCentralCrossRef
32.
Zurück zum Zitat Meyer DC et al (2016) Lengthening of the subscapularis tendon as a sign of partial tearing in continuity. J Shoulder Elbow Surg 25(1):31–37PubMedCrossRef Meyer DC et al (2016) Lengthening of the subscapularis tendon as a sign of partial tearing in continuity. J Shoulder Elbow Surg 25(1):31–37PubMedCrossRef
33.
Zurück zum Zitat Adams CR et al (2012) A systematic approach for diagnosing subscapularis tendon tears with preoperative magnetic resonance imaging scans. Arthroscopy 28(11):1592–1600PubMedCrossRef Adams CR et al (2012) A systematic approach for diagnosing subscapularis tendon tears with preoperative magnetic resonance imaging scans. Arthroscopy 28(11):1592–1600PubMedCrossRef
34.
Zurück zum Zitat Wagner ER et al (2019) A prospective, blinded, clinical trial comparing the efficacy and accuracy of needle diagnostic arthroscopy with magnetic resonance imaging in diagnosing shoulder pathology. JSES Open Access 3(4):237CrossRef Wagner ER et al (2019) A prospective, blinded, clinical trial comparing the efficacy and accuracy of needle diagnostic arthroscopy with magnetic resonance imaging in diagnosing shoulder pathology. JSES Open Access 3(4):237CrossRef
35.
Zurück zum Zitat Sahu D et al (2016) Sentinel sign: a sign of biceps tendon which indicates the presence of subscapularis tendon rupture. Knee Surg Sports Traumatol Arthrosc 24(12):3745–3749PubMedCrossRef Sahu D et al (2016) Sentinel sign: a sign of biceps tendon which indicates the presence of subscapularis tendon rupture. Knee Surg Sports Traumatol Arthrosc 24(12):3745–3749PubMedCrossRef
36.
Zurück zum Zitat Lo IKY, Burkhart SS (2003) The comma sign: an arthroscopic guide to the torn subscapularis tendon. Arthroscopy 19(3):334–337PubMedCrossRef Lo IKY, Burkhart SS (2003) The comma sign: an arthroscopic guide to the torn subscapularis tendon. Arthroscopy 19(3):334–337PubMedCrossRef
37.
Zurück zum Zitat Wright JM et al (2001) Arthroscopic visualization of the subscapularis tendon. Arthroscopy 17(7):677–684PubMedCrossRef Wright JM et al (2001) Arthroscopic visualization of the subscapularis tendon. Arthroscopy 17(7):677–684PubMedCrossRef
38.
Zurück zum Zitat Adams CR, Schoolfield JD, Burkhart SS (2010) Accuracy of preoperative magnetic resonance imaging in predicting a subscapularis tendon tear based on arthroscopy. Arthroscopy 26(11):1427–1433PubMedCrossRef Adams CR, Schoolfield JD, Burkhart SS (2010) Accuracy of preoperative magnetic resonance imaging in predicting a subscapularis tendon tear based on arthroscopy. Arthroscopy 26(11):1427–1433PubMedCrossRef
39.
Zurück zum Zitat Foad A, Wijdicks CA (2012) The accuracy of magnetic resonance imaging and magnetic resonance arthrogram versus arthroscopy in the diagnosis of subscapularis tendon injury. Arthroscopy 28(5):636–641PubMedCrossRef Foad A, Wijdicks CA (2012) The accuracy of magnetic resonance imaging and magnetic resonance arthrogram versus arthroscopy in the diagnosis of subscapularis tendon injury. Arthroscopy 28(5):636–641PubMedCrossRef
40.
Zurück zum Zitat Toussaint B et al (2012) New endoscopic classification for subscapularis lesions. Orthop Traumatol Surg Res 98(8):S186–S192PubMedCrossRef Toussaint B et al (2012) New endoscopic classification for subscapularis lesions. Orthop Traumatol Surg Res 98(8):S186–S192PubMedCrossRef
42.
Zurück zum Zitat Lafosse L et al (2010) Arthroscopic repair of subscapularis tear: surgical technique and results. Orthop Traumatol Surg Res 96(8):S99–108PubMedCrossRef Lafosse L et al (2010) Arthroscopic repair of subscapularis tear: surgical technique and results. Orthop Traumatol Surg Res 96(8):S99–108PubMedCrossRef
44.
Zurück zum Zitat Martetschläger F et al (2021) A classification for partial subscapularis tendon tears. Knee Surg Sports Traumatol Arthrosc 29(1):275–283PubMedCrossRef Martetschläger F et al (2021) A classification for partial subscapularis tendon tears. Knee Surg Sports Traumatol Arthrosc 29(1):275–283PubMedCrossRef
Metadaten
Titel
Anatomie und Diagnostik von Subskapularissehnenrupturen
verfasst von
David Endell
Christopher Child
Florian Freislederer
Philipp Moroder
Markus Scheibel
Publikationsdatum
11.07.2022
Verlag
Springer Medizin
Erschienen in
Die Unfallchirurgie / Ausgabe 8/2022
Print ISSN: 2731-7021
Elektronische ISSN: 2731-703X
DOI
https://doi.org/10.1007/s00113-022-01207-7

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