What is special about the biceps (brachii) muscle?

The biceps is the two-headed muscle in the upper arm (also called the arm flexor) that is responsible for flexion of the forearm. Both tendons differ in length and originate at the elbow joint. If one of the tendons tears, it is called a biceps tendon tear or rupture.

What therapy is useful for a biceps rupture?

In the case of injuries to the biceps tendon, which is anchored in the shoulder joint at the so-called labrum, different therapies are possible depending on the type of injury. For younger patients who are active in sports overall, detachment from the biceps tendon anchor is recommended if a slap lesion is present accordingly. The detached biceps tendon is then refixed further out in the so-called sulcus bicipitalis and by means of a special anchor system, and in this way function is restored.

Due to the peculiarity that the biceps tendon muscle has two tendon attachments in the shoulder region, detachment of the long biceps tendon at the anchor without reattachment is recommended in older patients. The tendon then slips out of the joint and is no longer troublesome here or no longer causes discomfort due to instability. It then grows into the sulcus bicipitalis and the tensioning function is ensured by the short biceps tendon that is still present.

How to recognize instability of the shoulder?

Shoulder instability can be congenital (habitual) or caused by an accident with dislocation of the humeral head from the socket (traumatic). Injuries to the so-called labrum often occur.

What is important in the diagnosis?

In individual cases, the consequences of injuries must be objectified, for example by sonography (ultrasound) and magnetic resonance imaging.

Which therapeutic treatment approach is recommended?

In young athletically active patients, surgical stabilization is recommended if there is evidence of a labral injury or concomitant injuries to the rotator cuff. In older patients, initial traumatic dislocation can initially be treated conservatively without surgery. However, in the event of a recurrence of dislocation, surgical stabilization, performed arthroscopically, is also recommended in this case. In the case of habitual shoulder instability, appropriate therapy must be initiated on an individual basis depending on the severity of the findings.

What is a shoulder fracture?

The term fracture means a break in the bone. A distinction is made between different forms of fracture. The bone can be partially or completely broken. External influences are usually the cause, such as a fall or impact.

What are the conservative / surgical treatments?

In the case of fractures of the humeral head or clavicle, depending on the displacement of the bony parts, either a non-operative, i.e. conservative or operative therapy is initiated. For this purpose, in addition to the X-ray examination, a computed tomographic clarification of the situation is often necessary in order to offer the appropriate and individually tailored therapy to the patient.

What is a frozen shoulder?

Frozen shoulder is a disease that occurs in three stages: 1) First, inflammation occurs in the shoulder. 2) In the further course, the affected person notices an increasing restriction of movement (therefore also called “freezing”). 3) In the further course, appropriate therapy can help to reduce the inflammation and improve mobility (“onset of freezing”).

What are the symptoms of those affected?

Those affected often suffer from permanent pain, which also occurs at night and disturbs sleep. Accordingly, sufferers position themselves on one side, which places additional stress on the shoulder. Imaging procedures such as sonography (ultrasound), X-rays and magnetic resonance imaging are therefore necessary for clarification.

In addition, the patients hardly move the arm due to the severe pain, so that there is an increasing shrinkage of the capsule and a frozen shoulder sets in.

What are the treatment options?

Initial treatment with inflammation-reducing medication and often also with cortisone (in the form of an injection or medication) is necessary at an early stage. Only when the acute pain symptoms have subsided is physiotherapeutic exercise treatment advisable.

If necessary, surgery can also help with frozen shoulder. This involves arthroscopy to remove inflamed tissue and also to loosen adhesions. Each anesthesia is followed by anesthesia mobilization, which may be followed by intensive physiotherapy.

What does therapy depend on?

Um den Schweregrad der Schulterverletzung richtig zu bestimmen, wird eine Klassifikation (nach Tossy/ Rockwood) vorgenommen. Die Zuteilung bestimmt dann die entsprechend passende Therapie, die bei der Verletzung notwendig ist. Man unterscheidet in folgende drei Typen:

Tossy/ Rockwood I – The AC joint is compressed, the capsule overstretched. The bones and especially the clavicle do not shift under load. Conservative therapy is used in this case.

Tossy/ Rockwood II – Es handelt sich um eine Teilruptur der Gelenkkapsel und der akromioklavikularen Bänder. Auch in diesem Stadium kann konservativ behandelt werden.

Tossy/ Rockwood III – Complete rupture of capsule and ligaments with horizontal and vertical instability. Since the so-called coracoclavicular ligaments are completely torn, the clavicle is significantly higher compared to the acromion (shoulder roof). Successful treatment can only be achieved surgically.