Pulley lesion - ways out of the painful shoulder sling.

The shoulder is a complex joint that allows for a wide range of motion. The structures that stabilize the shoulder joint include bones, muscles, tendons, and ligaments.

One of the important structures supporting the shoulder joint is the pulley system. The pulley system consists of a series of ligaments and tendons that help guide the long biceps tendon in the shoulder joint.

A pulley lesion of the shoulder can cause pain and discomfort and, if left untreated, can lead to damage to the rotator cuff.

In this guide, we explain the clinical picture of a pulley lesion, including its definition, common symptoms, diagnosis, and treatment options.

In this article you will learn:

Definition of pulley lesion.
Typical symptoms of a pulley lesion.
This is how a pulley lesion is diagnosed.
This is the typical course of a pulley lesion.
These are the treatment options for pulley lesions.

Definition of the pulley lesion

A pulley lesion describes the condition of damage to the loop that guides the long biceps tendon in the shoulder joint.

The pulley system consists of several ligaments, including the coracohumeral ligament, the superior glenohumeral ligament, and rotator cuff tendons. These ligaments and tendons work together to stabilize the long biceps tendon in the shoulder joint and ensure pain-free weight-bearing function of the shoulder.

When a pulley injury occurs, the ligaments that comprise the pulley system are damaged or torn, which can cause the long biceps tendon in the shoulder joint to become unstable. This can lead to pain and discomfort and, if left untreated, damage to the rotator cuff or articular cartilage .

Typical symptoms of a pulley lesion

The symptoms of a pulley injury can vary depending on the severity of the injury. Some of the most common symptoms include:

Pains:

Pain is the most common symptom of a pulley injury. The pain can be sharp or dull and can occur when the shoulder is moving or at rest.

Shoulder instability:

This occurs when the ligaments and tendons that make up the pulley system are damaged or torn.

Weakness:

Shoulder weakness can be another symptom of a pulley injury. It occurs when the tendons that support the shoulder joint become damaged or torn, which can cause the muscles around the shoulder to become weak.

Limited range of motion:

A limited range of motion is a common symptom of a pulley injury. This occurs when the long biceps tendon is no longer stabilized in its guideway, causing reflex inflammation of the shoulder joint capsule .

A distinction is made between pain-related restricted movement and pain-free restricted movement. It is also important to distinguish between passive and active restricted movement.

How a pulley lesion is diagnosed

Diagnosis of a pulley lesion typically includes a physical examination, imaging, and other diagnostic tests.

During the physical examination, the shoulder is examined for signs of pain, weakness, and limited range of motion.

Specific tests indicate damage to the pulley loop, but it is important to consider the function of the long biceps tendon and the rotator cuff.

Imaging techniques such as an MRI scan or ultrasound can also be used to diagnose a pulley lesion. These tests can help detect damage or tears to the ligaments and tendons that make up the pulley apparatus.

In cases of unclear symptoms, despite imaging studies and conservative treatment, arthroscopy can help identify minor damage to the pulley system using a camera and, if necessary, repair it immediately. Arthroscopy is a minimally invasive procedure in which a small camera is inserted into the shoulder joint to examine the structures inside the joint.

This is the typical course of a pulley lesion

If you reduce the strain on the arm, especially overhead activities like throwing, swimming, playing tennis, etc., the symptoms often decrease. Activities below shoulder level are then usually possible without pain.

However, if you want to resume the strain and use your arm forcefully, for example for overhead activities, the pain caused by the damage to the sling often returns relatively quickly.

If left untreated, relatively small damage to the sling guide can increase over time and damage the tendons of the rotator cuff .

The most commonly affected tendons are the directly adjacent subscapularis and supraspinatus tendons.

These are the treatment options for pulley lesions

Treatment options for a pulley lesion depend on the severity of the injury .

In some cases, conservative treatments such as rest, cooling, weight-bearing capacity, non-steroidal anti-inflammatory drugs such as ibuprofen, and physical therapy such as physiotherapy can help reduce pain.

In more severe cases, especially if the rotator cuff tendons are already affected, it may be necessary to repair the damage and thus eliminate the cause of the pain.

The most effective procedure has proven to be a short keyhole procedure, in which the long biceps tendon is fixed in its natural course below the pulley loop.

If the rotator cuff is damaged, it may be necessary to repair the tendons in the same minimally invasive procedure. Depending on individual needs, the procedure can be performed on an outpatient or inpatient basis.