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Erschienen in: Obere Extremität 1/2014

01.03.2014 | Leitthema: Übersicht

Diagnostik und Therapie der isolierten proximalen Bizepsläsion

verfasst von: PD Dr. Olaf Lorbach, Christian Trennheuser, Konstantinos Anagnostakos

Erschienen in: Obere Extremität | Ausgabe 1/2014

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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.
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Metadaten
Titel
Diagnostik und Therapie der isolierten proximalen Bizepsläsion
verfasst von
PD Dr. Olaf Lorbach
Christian Trennheuser
Konstantinos Anagnostakos
Publikationsdatum
01.03.2014
Verlag
Springer Berlin Heidelberg
Erschienen in
Obere Extremität / Ausgabe 1/2014
Print ISSN: 1862-6599
Elektronische ISSN: 1862-6602
DOI
https://doi.org/10.1007/s11678-013-0243-z

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