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Scapular fractures are a rare injury entity accounting for 0,4-1 % of all fractures and 3-5 % of fractures involving the shoulder girdle. This study focuses on a 29-year-old male patient who sustained an intraarticular scapular fracture during a "Rugby Bundesliga" match after direct impact with another player. The clinical and radiological examinations showed a dislocated multifragmentary transverse scapular fracture involving the superior border, the medial border and the glenoid (Euler and Rüedi D2b/AO 14 F1.3e). The patient was subjected to arthroscopic surgery and underwent early postoperative functional rehabilitation without weight-bearing and with a limited range of motion of 90° abduction/anteversion. In the first match of the second half of the season (5 months post-operatively), the patient was available to play, and in the clinical follow-up 6 months post-operatively, he was pain-free with excellent clinical results (CS 100 pt, SSV 98 %, OSS 12 pt, ASES 100 pt). No pain or restrictions in the range of motion were reported. In conclusion, the arthroscopic-assisted management of intra-articular scapular fractures is a safe and effective choice of treatment in young and active patients.Bei Skapulafrakturen handelt es sich um eine seltene Verletzungsentität mit einer Inzidenz von 0,4–1 % aller Frakturen und 3–5 % der Frakturen des Schultergürtels. Im vorliegenden Fall handelt es sich um einen 29-jährigen männlichen Patienten, der im Rahmen eines Punktspiels der Rugby-Bundesliga die o. g. Verletzung nach einem direkten Anpralltrauma erlitt. Nach der klinischen sowie radiologischen Untersuchung zeigten sich eine mehrfragmentäre, dislozierte Skapulablattfraktur unter mehrfragmentärer Beteiligung der Margo superior, Frakturausläufer in die Margo medialis und V. a. Stufenbildung im Glenoid bei äquatorialer Transversalfraktur (Euler und Rüedi D2b/nach AO 14 F1.3e). Die operative Versorgung erfolgte in minimalinvasiver arthroskopischer Technik, und postoperativ wurde eine frühfunktionelle Nachbehandlung ohne Belastung und mit einer Bewegungslimitierung von 90° Abduktion/Anteversion durchgeführt. Bereits am 1. Spieltag der Rückrunde (5 Monate postoperativ) war der Patient wieder vollständig einsatzfähig und 6 Monate postoperativ präsentierte sich der Patient beschwerdefrei mit einem exzellenten klinischen Resultat (CS 100 Punkte, SSV 98 %, OSS 12 Punkte, ASES-Score 100 Punkte). Zusammenfassend ist die arthroskopisch assistierte Versorgung einer intraartikulären Skapulafraktur beim sportlich aktiven Patienten mit einem entsprechend hohen körperlichen Anspruch eine suffiziente Therapieoption.

The suprascapular nerve can be compromised as a result of a compression syndrome in different locations. A (proximal) compression within the scapular notch can lead to dorsal shoulder pain and simultaneous weakness of the infraspinatus and supraspinatus muscles. By transection of the lig. transversum this compression syndrome can be treated. By means of a systematic review, the present work analyzes the motor recovery potential after arthroscopic decompression.A systematic review of the U. S. National Library of Medicine/National Institutes of Health (PubMed) database and the Cochrane Library was performed using the PRISMA checklist. The search words used were "suprascapular" and "arthroscopic"; "suprascapular" and "arthroscopy". Based on the evaluated literature, articles in English with at least a partial arthroscopic case series from 4 cases on and a compression syndrome of the suprascapular nerve treated with arthroscopic decompression in the scapular notch were identified. Motor recovery was described by means of EMG, clinical strength and MRI.Primarily 408 hits were generated. Six articles met the inclusion criteria and were further analyzed. The number of arthroscopic cases was between 4 and a maximum of 27. The level of evidence was between III and IV. The majority of the reported clinical results were good. Motor recovery as measured by EMG was observed, recovery of full strength was not achieved in the majority of reported cases (60%), neither was regression of structural (fatty) degeneration of the muscle bellies.Arthroscopic decompression of the suprascapular nerve in the scapular notch provides good clinical results and considerable pain relief. However, in the majority of cases it does not lead to a complete recovery of the strength of the supra- and infraspinatus muscles. Patients should be informed about this. An early decompression after diagnosis in the event of proximal compression within the suprascapular notch combined with beginning EMG or MRI changes appears reasonable. These beginning changes should be further defined. Future studies should develop prognostic criteria for motor recovery. Awareness regarding the diagnosis needs to be improved due to the probably time-dependent irreversibility of resulting muscular weakness.Der N. suprascapularis kann in seinem Verlauf an verschiedenen Stellen komprimiert werden. Ein (proximales) Kompressionssyndrom spezifisch in der Incisura scapulae führt häufig zu dorsalen Schulterschmerzen und zu einer simultanen Kraftabschwächung des Infraspinatus- und Supraspinatusmuskels. Durch Durchtrennung des Lig. transversum kann dieses Kompressionssyndrom behandelt werden. Die vorliegende Arbeit analysiert durch einen systematischen Review das motorische Erholungspotenzial nach arthroskopischer Dekompression.Es wurde eine systematische Durchsicht der Datenbank der U. S. National Library of Medicine/National Institutes of Health (PubMed) und der Cochrane Library unter Anwendung der PRISMA-Checkliste durchgeführt. Als Suchwörter dienten „suprascapular“ und „arthroscopic“; „suprascapular“ und „arthroscopy“. Anhand der evaluierten Literatur wurden Artikel mit zumindest anteiligen arthroskopischen Fallserien ab 4 Fällen bei Kompressionssyndrom mit einer arthroskopischen Dekompression des N. suprascapularis in der Incisura scapulae in englischer Sprache identifiziert. Eine motorische Erholung des Nervs wurde beschrieben anhand von EMG, klinischem Kraftgrad und MRT.Es wurden primär 408 Treffer generiert. Sechs Artikel entsprachen den Einschlusskriterien und wurden weitergehend inhaltlich analysiert. Die arthroskopische Fallzahl lag zwischen 4 und maximal 27. Der Evidenzlevel lag zwischen III und IV. Die berichteten klinischen Ergebnisse waren mehrheitlich gut. Eine motorische Erholung, gemessen mittels EMG, wurde beobachtet, eine Wiedererlangung des vollständigen Kraftgrades in der Mehrzahl der berichteten Fälle nicht (60%), eine Rückbildung von strukturellen (fettigen) Degenerationen der Muskelbäuche ebenso wenig.Die arthroskopische Dekompression des N. suprascapularis in der Incisura scapulae sorgt für klinisch gute Ergebnisse und erhebliche Schmerzerleichterung. Sie führt in der Mehrzahl der Fälle aber nicht zu einer kompletten Erholung des Kraftgrades der Supra- und Infraspinatusmuskulatur. Hierüber sollten Patienten aufgeklärt werden. Eine frühe Dekompression bei klinischer Diagnose bei proximaler Kompression in der Incisura scapulae und leichten Veränderungen im EMG oder MRT erscheint sinnvoll. Diese beginnenden Veränderungen sollten weiter definiert werden. Zukünftige Studien sollten zudem prognostische Kriterien für das Erholungspotenzial des N. suprascapularis entwickeln. Die Awareness hinsichtlich der Diagnose muss wegen der wahrscheinlich zeitabhängigen Irreversibilität der Muskelschwäche erhöht werden.

The shoulder girdle is a chain of bones and joints which connect the upper extremity to the axial skeleton. The shoulder as a biomechanical unit has a remarkable range of motion and is therefore frequently prone to injuries of the three major joints (sternoclavicular joint, acromioclavicular joint, glenohumeral joint) and the bony elements (clavicle, scapula, humerus). Projection radiography is still the first imaging modality for injuries of the shoulder and usually sufficient for initial diagnosis and injury classification. Computed tomography (including 3D reconstructions) and magnetic resonance imaging provide additional useful information for the detection of accompanying soft-tissue injury, for surgical planning and in cases of complex anatomy (e.g., scapular fractures).We aim to describe the fundamentals of injuries of the shoulder girdle and the proximal humerus with special emphasis on radiological diagnostics.A selective PubMed literature search was performed using the following terms: "sternoclavicular joint dislocation", "clavicle fracture", "acromioclavicular joint injury", "scapular fracture", "shoulder dislocation", "proximal humerus fracture", and "shoulder girdle injuries".The article describes the basics of the anatomy, the trauma mechanism and the epidemiology of the most common injuries of the shoulder girdle and the proximal humerus. Special emphasis is given to radiological diagnostics, including basic projection radiography and advanced cross-sectional imaging.

The combination of glenoid destruction with cuff arthropathy remains a challenge. A 75-year old woman presented with a post-traumatic loss of the glenoid and concomitant cuff arthropathy. Using CT-data a custom-made glenoid component was created by 3D printing. 6 months after reverse shoulder arthroplasty, the patient was free of pain with acceptable ROM. An individual glenoid component created by 3D printing is a feasible therapeutic option in patients with loss of the glenoid and concomitant cuff arthropathy.

Fragestellung: In unserer Sprechstunde stellte sich eine 15-jährige Patientin mit einem schmerzhaften Knarren der rechten Scapula vor. Ein auslösendes Trauma war nicht erinnerlich. In der weitergehenden Diagnostik wurde unter anderem eine CT-Bildgebung der Scapula angefertigt, in welcher ein[zum vollständigen Text gelangen Sie über die oben angegebene URL], Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2018)

Isolated fractures of the coracoid process during sporting activities are very rare. There are a few case studies and retrospective studies with low numbers of cases.Presentation of an initially neglected fracture and conservative treatment.Case study of a 14-year-old national water polo player with a non-dislocated fracture of the coracoid process and conservative therapy using focused shockwave therapy.Return to sports after conservative therapy was after 13 weeks and return to competitive sport after 14 weeks.In cases with therapy refractory shoulder pain after trauma and unremarkable native X‑ray, extended 3D imaging by magnetic resonance imaging (MRI) or computed tomography (CT) should be done early. Conservative therapy of a non-dislocated fracture in this case showed a good outcome.

The aim of the surgical technique is the stable fixation of a glenoid baseplate and reconstruction of bone loss with correction of version, inclination, and medialization of the joint line.Significant glenoid bone loss due to glenoid loosening or wear in revision shoulder arthroplasty.Active infection, inoperability due to poor health condition.Reconstruction of advanced glenoid bone stock in case of glenoid loosening of total shoulder arthroplasty can be performed either with autografts and allografts or metallic augmentation together with reverse baseplates in a one- or two-stage procedure. The preferred fixation mode was a transfixation technique using autograft and baseplates with extra-long coated or threaded post with 2-4 locking screws. Baseplates with an extended post and locking screws adjustable in various inclination are required to achieve fixation along the "3-column concept" which is used by the authors based on a recently introduced classification algorithm, which is based on the remaining bone stock available for fixation of the post in native bone stock.The standard protocol with an abduction brace for 6 weeks and passive exercises is modified, depending on the extent of reconstruction on the humeral and glenoid side, and the type of implant.In all, 145 cases of revision total shoulder arthroplasty suffering from moderate or advanced bone loss were retrospectively evaluated and 95 followed up for a mean of 2.7 years (range 1-7 years). We classified the remaining bone stock as grade 4 or 5 in 61 patients and grade 2 and 3 in 84 patients. Our preferred surgical technique was cementless fixation of structural bone grafts using a reverse baseplate in transfixation technique. In all, 56 cases required substantial iliac crest bone grafts, of which 36 patients were operated on in a 2-stage procedure. In 20 patients the bone defect in the iliac crest was secured by a locking plate in order to avoid a fatigue fracture of the anterior iliac spine. Only in 5 cases with intact rotator cuff was an anatomical "platform" component used; the remaining cases were converted to reverse shoulder arthroplasty. A success rate of more than 90% for both one- and two-stage reconstructions, which is mainly related to the high rate of incorporation of autografts taken from the iliac crest, is comparable to the majority of data published in the literature.

Fractures of the scapula are rare and have an incidence of 1% of all fractures. Publications highlight glenoid rim fractures. Classification by Ideberg and Euler and Rüdi are accepted. Euler and Rüdi describe three extra-articular and two intra-articular fracture patterns. The indications for surgery are displaced glenoid fractures, scapula tilt of more than 40° and injuries to the superior shoulder suspensory complex. We describe a case of a 22 year old man, who while cycling collided with a moving car due to wet roads. After his admission to hospital as a polytraumatised patient, the trauma CT-Scan showed haemothorax with several associated rip fractures, displaced humeral shaft fracture and fractures of the acromion and glenoid, classified as type D2c according to Euler and Rüdi. Following damage control principles, drainage of the haemothorax was already performed in the ER and surgical treatment of the displaced humeral shaft fracture was performed on the day of admission. No peripheral neurological deficits were evident. After pulmonary stabilisation, surgery was performed 6 days later on the glenoid and acromion fracture, which in conjunction may be regarded as an injury to the superior shoulder suspensory complex. We performed an arthroscopically-assisted screw fixation of the glenoid fracture (type D2c according to Euler and Rüdi) and an ORIF procedure at the acromion. Postoperative rehabilitation was performed with passive abduction and elevation up to 90° for the first two weeks and active abduction an elevation up to 90° for weeks 3 to 6. Full ROM was allowed at week 7.Articular fractures of the glenoid are rare and mainly seen as rim fractures. The indications for surgery are displaced articular fractures and injury to the superior shoulder suspensory complex. As demonstrated by this article, type D2c fractures according to Euler and Rüdi can be treated effectively as an arthroscopically-assisted screw fixation procedure.Skapulafrakturen sind selten und machen 1% aller Frakturen aus. Klassifiziert werden Skapulafrakturen nach Ideberg oder Euler und Rüdi, wobei hier 3 extraartikuläre und 2 intraartikuläre Frakturformen unterschieden werden. Eine OP-Indikation besteht bei dislozierten intraartikulären Frakturen und Schädigung des „superior shoulder suspensory complex“. Wir berichten über den Fall eines 22-jährigen Mannes, der als Fahrradfahrer mit einem Pkw kollidierte und als polytraumatisierter Patient notarztbegleitet über den Schockraum vorgestellt wurde. Dem Damage-Control-Prinzip entsprechend erfolgte noch am Aufnahmetag die Anlage einer Thoraxsaugdrainage bei Hämatopneumothorax und Rippenserienfraktur sowie die Osteosynthese einer Humerusschaftfraktur mittels eines Humerusmarknagels. Die periphere Sensibilität und Durchblutung waren zu jeder Zeit intakt. Nach Stabilisierung des Patienten schloss sich 6 Tage später die Versorgung der Skapulafraktur (Typ D2c nach Euler und Rüdi) und Akromionfraktur an. Die Skapulafraktur wurde arthroskopisch unterstützt als minimalinvasive Schraubenosteosynthese und die zusätzlich bestehende Akromionfraktur mittels Plattenosteosynthese versorgt. Die Nachbehandlung bestand in einer passiven Beübung bis 90° für Anteversion und Abduktion innerhalb der ersten 2 Wochen mit aktiver Beübung bis 90° für die 3. – 6. Woche. Freigabe ab der 6. Woche.Gelenkbeteiligende Skapulafrakturen sind seltene Frakturen und betreffen meist den Glenoidrand. OP-Indikationen bestehen bei dislozierten intraartikulären Frakturen sowie Verletzungen des „superior shoulder suspensory complex“. Intraartikuläre Frakturen Typ D2c nach Euler und Rüdi können erfolgreich arthroskopisch gestützt als minimalinvasive Schraubenosteosynthesen durchgeführt werden.

Anatomic shoulder arthroplasty in osteoarthritis with biconcave glenoid wear results in decreased functional results and a higher rate of early glenoid loosening.The aim of the data analysis of the German shoulder arthroplasty register was to clarify whether reverse shoulder arthroplasty can provide better functional results and a lower complication rate than anatomic arthroplasty in osteoarthritis with biconcave glenoid wear.The analysis included 1052 completely documented primary implanted arthroplasties with a minimum follow-up of 2 years. In 119 cases, a B2-type glenoid was present. Out of these cases, 86 were treated with an anatomic shoulder arthroplasty, and in 33 cases a reverse shoulder arthroplasty was implanted. The mean follow-up was 47.6 months.The Constant score with its subcategories, as well as the active range of movement improved significantly after anatomic and after reverse shoulder arthroplasty.We observed no difference in functional results between both types of arthroplasty; however, reverse arthroplasty showed a significant higher revision rate (21.2%) (3% glenoid loosening, 6% prosthetic instability) than anatomic shoulder arthroplasty (12.8%) (11.6% glenoid loosening, 1.2% prosthetic instability), whereas anatomic shoulder arthroplasty showed a higher rate of glenoid loosening. Functional and radiographic results of both types of arthroplasty are comparable with the results reported in the literature, although our analysis represents results from an implant registry (data pertaining to medical care quality).

Here we present the case of a young patient with one-sided winged scapula and lyme borreliosis. This disease can be very delimitating in daily life. If non-operative treatment fails, dynamic or static stabilization of the scapula can be a therapeutic option.

The aim of this comparative study was to evaluate the clinical radiological outcome after open treatment of acute anterior glenoid rim fractures and to analyze the influencing factors and complications.The study included 26 patients with an average age of 51.6 years (range 27-71 years) at surgery. The mean period of follow-up was 5.1 years (range 2.0-11.1 years). The average extent of glenoid fracture involvement was 25.5 % (range 18-35%) and three fixation techniques were applied: 1) bioresorbable pins (n = 16), 2) small fragment screws (n = 5) and 3) bioresorbable suture anchors (n = 5).The mean score values were 80.3 points for the absolute Constant score, 87.6 points for the normalized Constant score, 88.7 points for the Rowe score, 17.4 points for the Oxford shoulder score, 10.3 points for the simple shoulder test, 13.0 points for the shoulder pain and disability index and 81.5 % for the subjective shoulder value. The fixation technique did not show a significant influence; however, multi-fragment fractures were associated with a significantly inferior absolute (73 vs. 87 points, p = 0.022) and normalized Constant scores (81 vs. 94 points, p = 0.019). Subscapularis insufficiency with internal rotation deficit was found in 10 (39 %) patients and posttraumatic osteoarthritis occurred in 6 (23 %) patients.Open fixation yielded good or excellent shoulder function in 20 out of the 26 (77 %) patients and the clinical outcome primarily depended on the underlying type of fracture. Significantly inferior outcomes should be expected in patients with multi-fragment fractures. The main complications were subscapularis insufficiency and posttraumatic osteoarthritis.

A key element for movement of the arm is the position and motion of the scapula. A stable basis for efficient arm function is only possible if the scapula makes three dimensional movements coordinated with the upper arm.This article presents a discussion of causes, diagnosis and therapy options for scapular dyskinesis.The article is based on a literature search in the PubMed database and taking own experience into account.Soft tissue and bony injuries, muscle insufficiency and dysbalance can alter the position and function of the scapula. This pathological position and motion is called scapular dyskinesis. This clinically presents as a prominent medial border and malrotation (lacking external rotation and posterior tilt) of the scapula when raising the arm. The clinical examination includes a visual inspection followed by clinical tests of the scapula at rest and during movement. Specific exercises of the musculature surrounding the scapula and specific techniques for schooling the senses for positioning and movement can harmonize the sequence of movements and restore the dynamic scapular stability.A conservative stepwise and stage-adapted exercise program can be used to treat scapular dyskinesis with good results.

During sports the shoulder complex is exposed to considerable load especially where throwing is important and various pathological changes can occur. In the last two decades the shoulder in athletes has become a special term in clinical sports medicineSelective literature review in PubMed and consideration of personal experience, research results as well as national and international recommendationsIn general acute lesions of the shoulder caused by sudden sport injuries, such as traumatic luxation, acromioclavicular (AC) joint disruption, traumatic tendon ruptures, labral lesions, cartilage defects and fractures have to be distinguished from chronic or long-standing pathologies due to recurrent microtrauma, such as overuse bursitis and tendinitis, as well as secondary forms of impingement along with rotator cuff tears and labral lesions. Besides common pathological changes that can be observed in almost all overhead-sports, there are also injuries that are more sport-specific due to the particular load profile in each sport. These injuries are especially common in racquet and throwing sports (e.g. golf, tennis, handball and volleyball) as well as in individual and artistic sports (e.g. swimming, gymnastics, dancing and rowing), contact and extreme sports (e.g. judo, mixed martial arts, bodybuilding, weightlifting, motocross and downhill mountain biking).Knowledge about sport-specific load profiles as well as about the variety of treatment options is crucial for successful treatment of these injuries.

The fracture of the clavicle is the second most common fracture in snowboarding after the distal radius fracture. Nonsurgical treatment is frequently the treatment of first choice. For displaced fractures, surgical treatment is recommended.In general, internal fixation can be performed with a plate osteosynthesis or an intramedullary nail. Clinical studies were able to show similar and even slightly better functional results of the intramedullary nail in comparison to plate osteosynthesis. Because of less surgical trauma and better cosmetic results, intramedullary systems are increasingly preferred.Lateral clavicular fractures are more complex regarding surgical treatment due to their potential for concomitant ligamentous injuries. The hooked plate shows good clinical results with the advantage of addressing the fracture as well as the ligament injury in one step. The limitation of mobility during the first few postoperative weeks is the technique's main disadvantage.Ligament reconstruction with suture pulley systems as a stand-alone treatment or in combination with a locking plate osteosythesis are increasingly used due to their excellent clinical results with early postoperative mobilization.

Full arthroscopic treatment of severe anterior shoulder instability due to glenoid bone loss, Hill-Sachs lesion and irreparable ligament damage.Recurrent anterior dislocations or subluxations, previously failed Bankart repairs; patients with anterior glenoid bone loss, Hill-Sachs defect; patients with irreparable damage to soft tissues of labrum, capsule and ligaments; patients with chronic humeral avulsion of glenohumeral ligament (HAGL lesion); combinations of lesions above; young contact sport athletes, where Bankart repairs have high failure rates.Presence of (arthroscopically confirmed) good preconditions for Bankart repair: good quality of labrum, capsule and ligament, labrum still present, no or minimal bone loss of glenoid, no engaging Hill-Sachs. Lack of requirements for complex arthroscopic procedure (e.g., special instruments and skills).Diagnostic arthroscopy. Removal of anterosuperior and superior capsule, middle glenohumeral ligament, anterior labrum. Preparation of glenoid neck, debridement. Opening of rotator interval. Preparation of coracoid process and conjoint tendons. Subdeltoid preparation of anterior coracoid with arthroscope moved to anterolateral portal. Tenotomy of pectoralis minor. Arthroscopic split of subscapularis tendon via deep anteromedial portal. Predrilling of 2 holes through coracoid, insertion of 2 special washers into predrilled holes ("top hats"). Arthroscopic osteotomy of coracoid at base. Mounting of coracoid to special coracoid cannula. Manipulation of coracoid/conjoint tendon through subscapularis to glenoid neck, prefixation with wires. Fixation of coracoid after drilling with cannulated special screws.Immobilization in a sling on postoperative day 1; pain-controlled active range of motion without limit starting postoperative day 2. Sling during the night for 4 weeks.Between 2007 and June 2013, 210 operations were performed. No intraoperative conversion to open operative technique. Revision required in 10 patients with postoperative complications. No intraoperative or neurovascular complications.

In addition to prosthetic rehabilitation, maxillary defects can also be surgically reconstructed. Soft-tissue reconstruction employs a radial forearm or latissimus dorsi muscle flap, while bony reconstruction can be achieved using a fibula, iliac crest, or scapular flap. Reconstruction using a scapular flap is further divided into two subgroups: the traditional scapular flap with the circumflex scapular artery as the donor vessel and the scapular angle flap with the angular artery originating from the thoracodorsal artery as the donor vessel.We report on four patients who underwent successful reconstruction with a free scapular angle flap between 2009 and 2011, following maxillary resection due to malignancy.Vertical positioning of the scapular angle flap enables reconstruction of the facial contour, whereas its horizontal alignment and microvascular anastomosis makes a bony reconstruction of the hard palate possible.The versatility, low rate of donor site morbidity and shape of the scapular angle flap--which resembles that of the hard palate--render it ideal for plastic reconstruction. The suitability of bone quality for dental rehabilitation with implants is a topic of controversial discussion. The scapular angle flap represents an alternative to obturator prosthesis for the reconstruction of maxillary defects ≥ grade I according to Okay et al.

Arthroscopic or open reconstruction of isolated subscapularis tendon tears with the use of suture anchors to restore the glenohumeral function and joint biomechanics.Traumatic full-thickness tears, chronic tears with a functional deficit or decentration of the humerus head, anterosuperior rotator cuff insufficiency, symptomatic reruptures after prior arthroscopic or open surgical procedures.Frozen shoulder, atrophygrade II (Thomazeau) or fatty infiltrationgrade III (Goutallier/Fox) of the muscle, high-grade omarthrosis.Diagnostic arthroscopy and careful tendon release. If the inferior edge of the rupture is reliable visible and the tendon-mobilisation works proper, the repair is performed arthroscopically. The footprint is decorticated lightly and 1-4 suture anchors (depending on the lesion-size) are placed from inferior to superior. Knots are tied starting from caudal in a modified Mason-Allen technique (alternative: single or double mattress stitches) with a slipknot and three half hitches in opposite directions. In case of larger tears, a double-row technique for better reconstruction of the trapezoidal footprint is performed. For open reconstruction, a deltopectoral approach is used to reattache the tendon in an analogous fashion.Arthroscopic or open repair of isolated subscapularis tendon tears (Fox type II-IV) was performed in 35 patients. The Constant score increased significantly after 36 m, with no difference between these two groups. The majority of subscapularis tests were postoperatively negative, 6% in both groups showed a rerupture. A symptomatic period of 6 m prior to the operation and a high grade atrophy and fatty infiltration of the muscle was correlated with poorer results.

The subscapularis tendon is involved in up to 43% of arthroscopically treated rotator cuff lesions. Due to the close anatomic relationship, participation of the long head of the biceps and supraspinatus tendon is common. Subscapularis tendon lesions are often not primary diagnosed correctly. Using specific clinical tests and modern sectional imaging, the percentage of correct diagnoses can be increased. Convincing clinical results, advantages of minimally invasive surgery, and superior visualization compared to the open approach argue for arthroscopic treatment of subscapularis lesions. Awareness of the footprint allows anatomic reconstruction. In case of planned open treatment, arthroscopy should precede as particularly articular-sided lesions might be missed otherwise.

Bei Sportlern, die vorzugsweise Überkopf-Wurfbewegungen ausüben, werden Dysfunktionen des distalen Astes des N. suprascapularis beschrieben. Die dazu verfügbaren Publikationen suchen eine Beziehung zu dem als inkonstant angesehenen Lig. spinoglenoidale. Dabei wird eine große Variabilität des Bandes mit teils widersprüchlichen Aussagen beschrieben. Das Ziel der vorliegenden Untersuchung war die Einordnung einer Metaanalyse der gegebenen Informationen über die Beziehung von Nerv und Band anhand eigener Untersuchungen an 36 Präparaten. Darüber hinaus wurden Korrelationen mit morphometrischen, mithin radiologisch erfassbaren Parametern der Scapula gesucht. Die Studie zeigt, dass die Geometrie der Scapula wesentlichen Einfluss auf die Ausprägung des Bandes hat. Je stärker die Längen-Breiten-Relation zu Gunsten der Länge verschoben ist, desto ungünstiger wird die Situation für den Nerv.

Eccentric training (ET) has been shown to be an effective conservative treatment option for chronic patellar and Achilles tendinopathies. As part of the four-muscle-tendon-complex of the rotator cuff, the supraspinatus is involved most commonly in shoulder disorders. Histopathologic alterations of the supraspinatus tendon are comparable to findings in lower extremity tendinopathies. Hence, the question arises whether the concept of eccentric training can be successfully transferred to the upper extremity. Yet, no randomised controlled trials have been published to support this theory. This problem emerges from the fact that the supraspinatus is part of a complex functional unit. Consequently, surrounding soft tissues are frequently concomitantly affected. The inherent etiology and genesis of pathologic alterations in the supraspinatus tendon and its influence on shoulder disorders is not clear to date. However, the apparent success of ET in managing tendinopathies of the lower extremity urges further scientific work for developing evidence-based guidelines for the conservative treatment of tendinopathies in the shoulder region. Taking into account this lack of data as well as the anatomical and functional constraints, the aim of this work is to review the current state of the literature.