yogabook / pathology / pulley lesion

Definition of

The pulley complex is the structure that holds the long biceps tendon in its course before it enters the bicipital sulcus . This structure is formed by the supraspinatus, subscapularis, supperior coracohumerale ligament and superior glenohumeral ligament.

57% of pulley lesions are atraumatic, including overuse -related damage caused by excessive anteversion , adduction , and endorotation . A suitable traumatic trigger could be a catching procedure in which an attempt is made to catch an object falling from above with eccentric contraction of the arm flexors (including both heads of the biceps ) and simultaneous endorotation and adduction of the upper arm.
With the lack of fixation of the long biceps tendon before it enters the intertubercular sulcus, -centering effect of the biceps tendon is also reduced the humerus , resulting in anterosuperior internal impingement ( ASI , entrapment of the tendon between the anterosuperior glenoid edge and humeral head ) or posterosuperior internal impingement ( PSI , Entrapment of the tendon between the posterosuperior glenoid rim and the humeral head ).

There are two relevant classifications, Bennett differentiates according to instability of the biceps tendon and Habermeyer according to damaged structure.

Classification according to Habermayer

1. isolated rupture of the superior glenohumeral ligament
2. Rupture of the superior glenohumeral ligament plus partial rupture of the ventral tendon of the supraspinatus
3. Rupture of the superior glenohumeral ligament plus partial rupture of the superior tendon of the subscapularis
4. Damage to the superior glenohumeral ligament , joint-side partial rupture of the ventral tendon of the supraspinatus and the upper tendon of the subscapularis

All four types cause destabilization of the long biceps tendon and can lead to their subluxation in front of the subscapularis tendon , which in tendinopathy of the biceps and/or subscapularis tendon. can result

Bennett classification

1. tendon Injury to the subscapularis with the medial coracohumeral ligament intact
2. Injury to the medial tendon sheath (superior glenohumeral ligament and medial coracohumeral ligament tendon ) with intact subscapularis
3. Injury to the medial tendon sheath tendon and subscapularis
4. Injury to the supraspinatus tendon and the lateral coracohumeral ligament
5. tendon Injury to all involved structures ( subscapularis , medial tendon sheath tendon , supraspinatus , lateral coracohumeral ligament )

Causes

1. usually traumatic: fall on the outstretched arm, which endorotated or exorotated . can be
2. secondary to rotator cuff tears , especially those of the subscapularis
3. Overuse – caused by iterated microtraumas

Predisposing

1. Omarthrose

Diagnosis

1. MRT

Symptoms

1. ventral shoulder pain
2. painful restriction of movement

Therapy

1. Tenotomy of the long biceps tendon
2. surgical reconstruction

Complications

1. Biceps tendon tendinitis and tear of the long biceps tendon
2. Omarthrose

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