|
1
|
Garg AK, Meena A, Farinelli L, D'Ambrosi R, Tapasvi S, Braun S. Partial subscapularis tear: State-of-the-art. J ISAKOS 2024; 9:100290. [PMID: 38909905 DOI: 10.1016/j.jisako.2024.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 06/06/2024] [Accepted: 06/17/2024] [Indexed: 06/25/2024]
Abstract
The subscapularis (SSC) muscle is a crucial anterior glenohumeral stabilizer and internal rotator of the shoulder joint. The partial tears of the SSC might result from traumatic injury or intrinsic degeneration. Partial SSC tears can range in severity and be classified into different categories based on the location of the tear, size of the lesion, and associated pathology. The tear usually begins from the superolateral margin in the first facet and propagates downwards. It is frequently associated with biceps pathology or anterosuperior lesions. These tears are now increasingly recognized as distinct pathology that requires specific diagnostic and management approaches. The current management approaches are shifting towards operative, as partial SSC tears are increasingly recognized as a distinct pathology. At present, there is no consensus regarding the timing of repair, but the relative tendency of the SSC to retract much faster than other rotator cuff muscles, and difficulty in mobilization, advocates an early repair for SSC irrespective of the lesion size. An associated biceps pathology can be treated with either tenotomy (biceps delamination/erosion) or tenodesis. The techniques of partial SSC repair are constantly improving. There is no reported difference in use of 2-anchor-based conventional single-row (SR), a 3-anchor-based interconnected double-row technique, or a 2-anchor-based interconnected hybrid double-row construct in the repair construct. However, the 2-anchor-based interconnected double-row provides an advantage of better superolateral coverage with leading-edge protection, as it helps in placing the superolateral anchor superior and lateral to the original footprint. A timely intervention and restoration of the footprint will help restore and rehabilitate the shoulder. Future directions should prioritise injury prevention, early diagnosis with clinic-radiological cues and targeted interventions to mitigate risk.
Collapse
Affiliation(s)
- Ankit Kumar Garg
- All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Amit Meena
- Division of Orthopedics, Shalby Multi-Specialty Hospital, Jaipur, India; Gelenkpunkt-Sports and Joint Surgery, FIFA Medical Centre of Excellence, Innsbruck, Austria; Research Unit for Orthopaedic Sports Medicine and Injury Prevention (OSMI), Private University for Health Sciences, Medical Informatics and Technology, Innsbruck, Austria.
| | - Luca Farinelli
- Clinical Orthopaedics, Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona, Italy
| | - Riccardo D'Ambrosi
- IRCCS Ospedale Galeazzi - Sant'Ambrogio, Milan, Italy; Università degli Studi di Milano, Dipartimento di Scienze Biomediche per la Salute, Milan, Italy
| | | | - Sepp Braun
- Gelenkpunkt-Sports and Joint Surgery, FIFA Medical Centre of Excellence, Innsbruck, Austria; Research Unit for Orthopaedic Sports Medicine and Injury Prevention (OSMI), Private University for Health Sciences, Medical Informatics and Technology, Innsbruck, Austria
| |
Collapse
|
|
2
|
Dale WW, Field LD. Arthroscopic Recognition and Treatment Options for Biceps Subluxation. Arthrosc Tech 2024; 13:103141. [PMID: 39780884 PMCID: PMC11704894 DOI: 10.1016/j.eats.2024.103141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Accepted: 05/24/2024] [Indexed: 01/11/2025] Open
Abstract
Instability of the long head of the biceps tendon is a common pathologic condition that may be difficult to identify using history, physical examination, advanced diagnostic imaging, and even arthroscopic diagnostic inspection. The goal of this technical article is to showcase important anatomic features, intra-articular arthroscopic assessment, and commonly associated pathologies that should raise concern for biceps instability. Techniques to address concurrent biceps and subscapularis lesions are also described.
Collapse
Affiliation(s)
- Wood W. Dale
- Mississippi Sports Medicine and Orthopaedic Center, Jackson, Mississippi, U.S.A
| | - Larry D. Field
- Mississippi Sports Medicine and Orthopaedic Center, Jackson, Mississippi, U.S.A
| |
Collapse
|
|
3
|
Kamal Eldin M, Alieldin E, Ashour A, Ismail A, Ashour AT, Shekedaf S. Arthroscopic Assessment of the Incidence of Biceps Pulley Lesions Associated With Rotator Cuff Tears: An Observational Study. Cureus 2024; 16:e66593. [PMID: 39252729 PMCID: PMC11383426 DOI: 10.7759/cureus.66593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2024] [Indexed: 09/11/2024] Open
Abstract
The shoulder joint houses a stabilizing structure called the biceps pulley. Biceps pulley lesions can trigger anterior shoulder pain and frequently coincide with rotator cuff tears, whose prevalence rises with age. In our study, we aim to assess the incidence of biceps pulley lesions associated with rotator cuff tears in patients undergoing arthroscopic repair, the possible associated factors, and whether MRI findings were correlated with them. This study was a prospective observational one conducted at Al-Hadra University Hospital. The patients aged 40 to 65 years were indicated for arthroscopic repair of a rotator cuff tear. We used IBM Corp. Released 2011. IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp. to conduct the analysis. A total of 60 patients were enrolled in the study. The mean age was 50.97 ± 6.90. The overall incidence of biceps pulley lesions was 85%. Older age was found to be significantly associated with increased incidence. On the other hand, gender, and the mode of injury (cuff tear) had no significant associations with the incidence. Also, formal MR had no significance in diagnosing biceps pulley lesions. The overall incidence of biceps pulley lesions in the current study was 85%. The older the patient with a cuff tear, the greater the incidence of finding a pulley lesion arthroscopically. Moreover, MRI did not have a significant role in diagnosing the biceps pulley lesions.
Collapse
Affiliation(s)
| | - Ehab Alieldin
- Trauma and Orthopedic, Barts Health Trust, London, GBR
| | - Ahmed Ashour
- Trauma and Orthopedic, Queen Elizabeth Hospital Birmingham, Birmingham, GBR
| | - Ahmed Ismail
- Trauma and Orthopedic, Bradford Royal Infirmary, London, GBR
| | - Ahmed T Ashour
- Trauma and Orthopedic, Elhadara University Hospital, Alexandria, EGY
| | - Saeed Shekedaf
- Trauma and Orthopedic, Elhadara University Hospital, Alexandria, EGY
| |
Collapse
|
|
4
|
Ebrahimi Ardjomand S, Meurer F, Ehmann Y, Pogorzelski J, Waschulzik B, Makowski MR, Siebenlist S, Heuck A, Woertler K, Neumann J. Evaluation of Conventional MR Imaging of the Shoulder in the Diagnosis of Lesions of the Biceps Pulley. Acad Radiol 2024; 31:3327-3335. [PMID: 38448326 DOI: 10.1016/j.acra.2024.01.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 01/20/2024] [Accepted: 01/29/2024] [Indexed: 03/08/2024]
Abstract
RATIONALE AND OBJECTIVES To determine the diagnostic accuracy and reproducibility of conventional MR imaging (MRI) of the shoulder in evaluating biceps pulley lesions using arthroscopy as the standard of reference. METHODS In a retrospective study, MR examinations of 68 patients with arthroscopically proven torn or intact biceps pulley were assessed for the presence of pulley lesions by three radiologists. The following criteria were evaluated: displacement of the long head of the biceps tendon (LHBT) relative to the subscapularis tendon (displacement sign), subluxation/dislocation of the LHBT, the integrity of the superior glenohumeral ligament (SGHL) and the coracohumeral ligament (CHL), lesions of the supraspinatus (SSP) and subscapularis (SSC) tendons adjacent to the rotator interval, presence of biceps tendinopathy and subacromial bursitis. RESULTS There were 42 patients with pulley lesions in the study group. Conventional MR imaging showed an overall sensitivity of 95.2%, 88.1% and 92.9%, a specificity of 61.5%, 73.1%, and 80.8% and an accuracy of 82.4%, 82.4% and 88.2% in the diagnosis of pulley lesions. Interobserver agreement was substantial (multirater k = 0.75). Biceps tendinopathy (97.6%, 95.2%, 97.6%), defects of the SGHL (86.3%, 81.0%, 88.1%) and the displacement sign (88.1%, 81.0%, 85.7%) were the most sensitive diagnostic criteria. Subluxation/dislocation of the LHBT was insensitive (78.6%, 42.9%, 33.3%), but specific (69.2%, 100,0%, 96.2%). CONCLUSION In the diagnosis of pulley lesions, conventional MR imaging is reproducible and shows high sensitivity and accuracy but moderate specificity.
Collapse
Affiliation(s)
- Saba Ebrahimi Ardjomand
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Strasse 22, 81675 Munich, Germany.
| | - Felix Meurer
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Strasse 22, 81675 Munich, Germany; Musculoskeletal Radiology Section, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Strasse 22, 81675 Munich, Germany
| | - Yannick Ehmann
- Department of Orthopaedic Sports Medicine, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Strasse 22, 81675 Munich, Germany
| | - Jonas Pogorzelski
- Department of Orthopaedic Sports Medicine, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Strasse 22, 81675 Munich, Germany
| | - Birgit Waschulzik
- Institute for AI and Informatics in Medicine, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Strasse 22, 81675 Munich, Germany
| | - Marcus R Makowski
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Strasse 22, 81675 Munich, Germany
| | - Sebastian Siebenlist
- Department of Orthopaedic Sports Medicine, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Strasse 22, 81675 Munich, Germany
| | - Andreas Heuck
- Clinic and Polyclinic of Radiology, Ludwig-Maximilian-University Hospital, Marchioninistraße 15, 81377 Munich, Germany
| | - Klaus Woertler
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Strasse 22, 81675 Munich, Germany; Musculoskeletal Radiology Section, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Strasse 22, 81675 Munich, Germany
| | - Jan Neumann
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Strasse 22, 81675 Munich, Germany; Musculoskeletal Radiology Section, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Strasse 22, 81675 Munich, Germany
| |
Collapse
|
|
5
|
Gerhardinger K, Klute L, Pfeifer C, Straub J, Hechinger L, Riedl M, Alt V, Kerschbaum M, Henssler L. Is the Tendon-to-Groove Ratio Associated with Elevated Risk for LHB Tendon Disorders?-A New Approach of Preoperative MR-Graphic Analysis for Targeted Diagnosis of Tendinopathy of the Long Head of Biceps. J Clin Med 2024; 13:2860. [PMID: 38792401 PMCID: PMC11121934 DOI: 10.3390/jcm13102860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 05/03/2024] [Accepted: 05/11/2024] [Indexed: 05/26/2024] Open
Abstract
Background: Pathologies of the long head of the biceps (LHB) tendon are a common cause of anterior shoulder pain. While the influence of the anatomical morphology of the intertubercular groove (ITG) on the development of LHB tendon instability has been investigated with ambiguous results, the relationship of the LHB to ITG anatomy has not yet been considered in this context. The objective of this study was to reliably extract the tendon-to-groove ratio from MRI scans of symptomatic patients and examine its potential influence on the occurrence of certain causes for LHB-associated symptoms. Methods: In this retrospective study, preoperative MRI scans of 35 patients (mean age of 46 ± 14 years) presenting with anterior shoulder pain and clinical indications of LHB tendinopathy were analyzed in transversal planes. Long and short diameters of the LHB tendon and ITG were measured, cross-sectional areas of the LHB tendon and ITG were calculated from these measurements, and the ratio of cross-sectional areas (LHB/ITG) was introduced. All measurements were repeated independently by three investigators and inter-rater reliability was assessed using intraclass correlation coefficient (ICC). Thereafter, tendon-to-groove ratios were compared in patients with and without intraoperative signs of LHB tendon instability. Results: All patients exhibited intraoperative signs of LHB tendinitis, with additional findings including pulley lesions and SLAP lesions. Analysis revealed variations in the dimensions of the LHB tendon and ITG cross sections, with the tendon-to-groove ratio decreasing from 37% at the pulley to 31% at the deepest point of the sulcus. Very good inter-rater reliability was observed for all measurements. The tendon-to-groove ratio did not significantly differ (p > 0.05) in patients with or without pulley lesions or SLAP lesions. Conclusions: Our study introduced the novel parameter of the tendon-to-groove ratio of cross-sectional areas as a reproducible parameter for the description of local anatomy in the field of targeted diagnosis of LHB tendon disorders. While our findings do not yet support the predictive value of the tendon-to-groove ratio, they underscore the importance of further research with larger cohorts and control groups to validate these observations.
Collapse
Affiliation(s)
- Kristina Gerhardinger
- Department of Trauma Surgery, Orthopaedics and Sports Medicine, Hospital Barmherzige Brueder, 93049 Regensburg, Germany
| | - Lisa Klute
- Department of Trauma Surgery, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Christian Pfeifer
- Department of Trauma Surgery, University Hospital Regensburg, 93053 Regensburg, Germany
- Department of Trauma and Hand Surgery, Innklinikum Altötting, 84503 Altötting, Germany
| | - Josina Straub
- Department of Trauma Surgery, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Laura Hechinger
- Department of Trauma Surgery, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Moritz Riedl
- Department of Trauma Surgery, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Volker Alt
- Department of Trauma Surgery, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Maximilian Kerschbaum
- Department of Trauma Surgery, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Leopold Henssler
- Department of Trauma Surgery, University Hospital Regensburg, 93053 Regensburg, Germany
| |
Collapse
|
|
6
|
Nada MG, Almalki YE, Basha MAA, Libda YI, Zaitoun MMA, M Abdalla AAEH, Almolla RM, Hassan HA, Dawoud TM, Eissa AHZ, Alduraibi SK, Eldib DB, Ziada YMAA. Biceps Pulley Lesions: Diagnostic Accuracy of Nonarthrographic Shoulder MRI and the Value of Various Diagnostic Signs. J Magn Reson Imaging 2024; 59:1299-1311. [PMID: 37675811 DOI: 10.1002/jmri.29004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 07/07/2023] [Accepted: 07/07/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND There is limited data in the literature regarding the role of nonarthrographic MRI for detecting biceps pulley (BP) lesions. PURPOSE To assess the accuracy of nonarthrographic MRI for detecting BP lesions, and to evaluate the diagnostic value of various MRI signs (superior glenohumeral ligament discontinuity/nonvisibility, long head of biceps (LHB) displacement sign or subluxation/dislocation, LHB tendinopathy, and supraspinatus and subscapularis tendon lesions) in detecting such lesions. STUDY TYPE Retrospective. POPULATION 84 patients (32 in BP-lesion group and 52 in BP-intact group-as confirmed by arthroscopy). FIELD STRENGTH/SEQUENCE 1.5-T, T1-weighted turbo spin echo (TSE), T2-weighted TSE, and proton density-weighted TSE spectral attenuated inversion recovery (SPAIR) sequences. ASSESSMENT Three radiologists independently reviewed all MRI data for the presence of BP lesions and various MRI signs. The MRI signs and final MRI diagnoses were tested for accuracy regarding detecting BP lesions using arthroscopy results as the reference standard. Furthermore, the inter-reader agreement (IRA) between radiologists was determined. STATISTICAL TESTS Student's t-tests, Chi-squared, and Fisher's exact tests, and 4-fold table test were used. The IRA was calculated using Kappa statistics. A P-value <0.05 was considered statistically significant. RESULTS The sensitivity, specificity, and accuracy of nonarthrographic MRI for detecting BP lesions were 65.6%-78.1%, 90.4%-92.3%, and 81%-86.9%, respectively. The highest accuracy was noticed for the LHB displacement sign (84.5%-86.9%), and the highest sensitivity was registered for the LHB tendinopathy sign (87.5%). Furthermore, the highest specificity was observed for the LHB displacement sign and LHB subluxation/dislocation sign (98.1%-100%). The IRA regarding final MRI diagnosis and MRI signs of BP lesions was good to very good (κ = 0.76-0.98). DATA CONCLUSION Nonarthrographic shoulder MRI may show good diagnostic accuracy for detecting BP lesions. The LHB displacement sign could serve as the most accurate and specific sign for diagnosis of BP lesions. LEVEL OF EVIDENCE 3 TECHNICAL EFFICACY: Stage 2.
Collapse
Affiliation(s)
- Mohamad Gamal Nada
- Department of Radiology, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Yassir Edrees Almalki
- Division of Radiology, Medical College, Najran University, Najran, Kingdom of Saudi Arabia
- Department of Internal Medicine, Medical College, Najran University, Najran, Kingdom of Saudi Arabia
| | | | - Yasmin Ibrahim Libda
- Department of Radiology, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Mohamed M A Zaitoun
- Department of Radiology, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | | | - Rania Mostafa Almolla
- Department of Radiology, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Hanan A Hassan
- Department of Radiology, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Tamer Mahmoud Dawoud
- Department of Diagnostic Radiology, Faculty of Human Medicine, Tanta University, Tanta, Egypt
| | - Ahmad Hassan Zaki Eissa
- Department of Orthopedic Surgery and Traumatology, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Sharifa Khalid Alduraibi
- Department of Radiology, College of Medicine, Qassim University, Buraidah, Kingdom of Saudi Arabia
| | - Diaa Bakry Eldib
- Department of Radiology, Faculty of Human Medicine, Benha University, Benha, Egypt
| | - Yara Mohammed Ahmad Ali Ziada
- Department of Radiology, General Organization for Teaching Hospitals and Medical Institutes (GOTHI), Al-Ahrar Teaching Hospital, Zagazig, Egypt
| |
Collapse
|
|
7
|
Winkler S, Herbst B, Kafchitsas K, Wohlmuth P, Hoffstetter P, Rueth MJ. Pre-operative Assessment of Shoulder Pathologies on MRI by a Radiologist and an Orthopaedic Surgeon. Malays Orthop J 2024; 18:42-50. [PMID: 38638663 PMCID: PMC11023335 DOI: 10.5704/moj.2403.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 05/03/2023] [Indexed: 04/20/2024] Open
Abstract
Introduction Pathologies of the shoulder, i.e. rotator cuff tears and labral injuries are very common. Most patients receive MRI examination prior to surgery. A correct assessment of pathologies is significant for a detailed patient education and planning of surgery. Materials and methods Sixty-nine patients were identified, who underwent both, a standardised shoulder MRI and following arthroscopic shoulder surgery in our hospital. For this retrospective comparative study, the MRIs were pseudonymised and evaluated separately by an orthopaedic surgeon and a radiologist. A third rater evaluated images and reports of shoulder surgery, which served as positive control. Results of all raters were then compared. The aim was an analysis of agreement rates of diagnostic accuracy of preoperative MRI by a radiologist and an orthopaedic surgeon. Results The overall agreement with positive control of detecting transmural cuff tears was high (84% and 89%) and lower for partial tears (70-80%). Subscapularis tears were assessed with moderate rates of agreement (60 - 70%) compared to intra-operative findings. Labral pathologies were detected mostly correctly. SLAP lesions and pulley lesions of the LHB were identified with only moderate agreement (66.4% and 57.2%) and had a high inter-rater disagreement. Conclusion This study demonstrated that tears of the rotator cuff (supraspinatus, infraspinatus) and labral pathologies can be assessed in non-contrast pre-operative shoulder MRI images with a high accuracy. This allows a detailed planning of surgery and aftercare. Pathologies of the subscapularis tendon, SLAP lesions and biceps instabilities are more challenging to detect correctly. There were only small differences between a radiologic and orthopaedic interpretation of the images.
Collapse
Affiliation(s)
- S Winkler
- Department of Orthopaedic Surgery, Asklepios Hospital Lindenlohe, Schwandorf, Germany
| | - B Herbst
- Department of Orthopaedic Surgery, Asklepios Hospital Lindenlohe, Schwandorf, Germany
| | - K Kafchitsas
- Department of Orthopaedic Surgery, Asklepios Hospital Lindenlohe, Schwandorf, Germany
| | - P Wohlmuth
- Department of Research, ASKLEPIOS Proresearch, Hamburg, Germany
| | - P Hoffstetter
- Department of Radiology, University of Regensburg, Regensburg, Germany
| | - M J Rueth
- Department Sports Clinic, Sportklinik Fichtelgebirge, Markredwitz, Germany
| |
Collapse
|
|
8
|
Kirchner F, Ono Y, Albers S, Junker M, Fal MF, Kircher J. Arthroscopic subscapularis repair using the subscapularis interlocking (SICK)-stitch technique leads to restoration of clinical function with low complication and revision rates. JSES Int 2024; 8:67-74. [PMID: 38312275 PMCID: PMC10837738 DOI: 10.1016/j.jseint.2023.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2024] Open
Abstract
Background The purpose of this study is to determine the mid-term outcome after arthroscopic subscapularis tendon (SCP) reconstruction using the subscapularis interlocking (SICK)-stitch technique. The hypotheses are that arthroscopically repaired SCP lesions using the SICK-stitch show a good restoration of shoulder function with low complication and failure rates. Methods This is a retrospective monocentric study of n = 199 patients (n = 106 female) with arthroscopically treated SCP tears with the interlocking (SICK) stitch technique from July 2013 to October 2018. Inclusion criteria: minimum follow-up of 2 years. Exclusion criteria: irreparable and massive cuff tears, osteoarthritis, and fractures. The postoperative assessment consisted of the range of motion, constant score, simple shoulder test, simple shoulder value, disability of the shoulder and arm score, short form 12, and patient satisfaction. Results Mean age was 61 years (25-83); n = 4 (2%) patients were lost to follow-up with mean follow-up time of 63.6 months (36-96). Additional supraspinatus tendon lesions (n = 147) were repaired in n = 101 cases. SCP grading (n = 69) (35% traumatic) (Fox/Romeo): n = 113 grade II, n = 71 grade III, n = 11 grade IV. A positive preoperative lift-off test (n = 132, 68%) was corrected in n = 124 (94%) of cases. Ninety seven percent of patients would undergo surgery again with a mean satisfaction score of 14.4/15. Results at final follow-up (data: mean pre; post; P value): lexion (130; 166; .001), abduction (123;159; .001), external rotation (35;82; .001), internal rotation (52; 68; .07), constant score (50; 82; .001), disability of the shoulder and arm score (40; 19; .001), simple shoulder test (5; 10; .001), and simple shoulder value (44; 83; .001) significantly improved. The mean physical health scale short form 12 was 46 (24-63) and 51 (15-66) for mental health. Age, body mass index, SCP-grading, and supraspinatus tendon repair did not significantly affect any outcome parameter. Three (1.5%) patients underwent revision surgery, of which 1 (0.5%) had an infection. Conclusion Two years after arthroscopic SCP repair using the SICK-stitch technique, we observed excellent restoration of clinical function with low complication and revision rates. The SICK-stitch technique thus represents a good and reliable therapeutic option for the arthroscopic repair of SCP lesions.
Collapse
Affiliation(s)
- Florian Kirchner
- Department of Shoulder and Elbow Surgery, ATOS Klinik Fleetinsel Hamburg, Hamburg, Germany
| | - Yohei Ono
- Hokkaido Shoulder Clinic, Obihiro, Hokkaido, Japan
| | - Sebastian Albers
- Department of Shoulder and Elbow Surgery, ATOS Klinik Fleetinsel Hamburg, Hamburg, Germany
| | - Marius Junker
- Department of Shoulder and Elbow Surgery, ATOS Klinik Fleetinsel Hamburg, Hamburg, Germany
| | - Milad Farkhondeh Fal
- Department of Trauma and Orthopaedic Surgery, University Hospital Hamburg Eppendorf, Hamburg, Germany
| | - Jörn Kircher
- Department of Shoulder and Elbow Surgery, ATOS Klinik Fleetinsel Hamburg, Hamburg, Germany
- Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| |
Collapse
|
|
9
|
Feuerriegel GC, Weiss K, Tu Van A, Leonhardt Y, Neumann J, Gassert FT, Haas Y, Schwarz M, Makowski MR, Woertler K, Karampinos DC, Gersing AS. Deep-learning-based image quality enhancement of CT-like MR imaging in patients with suspected traumatic shoulder injury. Eur J Radiol 2024; 170:111246. [PMID: 38056345 DOI: 10.1016/j.ejrad.2023.111246] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 11/21/2023] [Accepted: 11/29/2023] [Indexed: 12/08/2023]
Abstract
PURPOSE To evaluate the diagnostic performance of CT-like MR images reconstructed with an algorithm combining compressed sense (CS) with deep learning (DL) in patients with suspected osseous shoulder injury compared to conventional CS-reconstructed images. METHODS Thirty-two patients (12 women, mean age 46 ± 14.9 years) with suspected traumatic shoulder injury were prospectively enrolled into the study. All patients received MR imaging of the shoulder, including a CT-like 3D T1-weighted gradient-echo (T1 GRE) sequence and in case of suspected fracture a conventional CT. An automated DL-based algorithm, combining CS and DL (CS DL) was used to reconstruct images of the same k-space data as used for CS reconstructions. Two musculoskeletal radiologists assessed the images for osseous pathologies, image quality and visibility of anatomical landmarks using a 5-point Likert scale. Moreover, signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were calculated. RESULTS Compared to CT, all acute fractures (n = 23) and osseous pathologies were detected accurately on the CS only and CS DL images with almost perfect agreement between the CS DL and CS only images (κ 0.95 (95 %confidence interval 0.82-1.00). Image quality as well as the visibility of the fracture lines, bone fragments and glenoid borders were overall rated significantly higher for the CS DL reconstructions than the CS only images (CS DL range 3.7-4.9 and CS only range 3.2-3.8, P = 0.01-0.04). Significantly higher SNR and CNR values were observed for the CS DL reconstructions (P = 0.02-0.03). CONCLUSION Evaluation of traumatic shoulder pathologies is feasible using a DL-based algorithm for reconstruction of high-resolution CT-like MR imaging.
Collapse
Affiliation(s)
- Georg C Feuerriegel
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany.
| | | | - Anh Tu Van
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany.
| | - Yannik Leonhardt
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany.
| | - Jan Neumann
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany; Musculoskeletal Radiology Section, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany.
| | - Florian T Gassert
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany.
| | - Yannick Haas
- Department of Trauma Surgery, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany.
| | - Markus Schwarz
- Department of Trauma Surgery, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany.
| | - Marcus R Makowski
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany.
| | - Klaus Woertler
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany; Musculoskeletal Radiology Section, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany.
| | - Dimitrios C Karampinos
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany.
| | - Alexandra S Gersing
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany; Department of Neuroradiology, University Hospital of Munich, LMU Munich, Munich, Germany.
| |
Collapse
|
|
10
|
Gadéa F, Dordain F, Merbah J, Charousset C, Berhouet J. Methods to analyse the long head of the biceps in the management of distal ruptures of the supraspinatus tendon. Part 1: the concept of the "biceps box": dynamic rotator interval approach. Incidence of lesions of the long head of the biceps tendon. Orthop Traumatol Surg Res 2023; 109:103669. [PMID: 37517471 DOI: 10.1016/j.otsr.2023.103669] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/25/2023] [Accepted: 05/31/2023] [Indexed: 08/01/2023]
Abstract
INTRODUCTION The area encompassing the long head of the biceps (LHB) can be represented as a rectangular parallelepiped. This geometric view can be likened to a box, the "biceps box", where the sides are the extrinsic structures and the LHB is the intrinsic structure. Since these structures are mobile in relation to each other, a dynamic "biceps box" model can modify assessments of the LHB, in its healthy or pathological state, and make the therapeutic approach to treating LHB lesions less arbitrary. MATERIAL AND METHOD In order to describe the different sides of the "biceps box", and to understand their possible physiological and pathological consequences, a literature review using PRISMA methodology was used. RESULTS The supraspinatus (SSP) has expansions on its anterior aspect that project anteriorly and cross the coracohumeral ligament (CHL). The most functionally important expansion is the fasciculus obliquus, which extends perpendicular to the axis of the tendon fibers of the SSP, divides the CHL into a deep and a superficial layer, and terminates on the superficial aspect of the subscapularis. The humeral insertion of the SSP may be binary, making a bridge over the LHB, with a posterior branch inserting on the greater tuberosity and an anterior branch on the lesser tuberosity. The superior glenohumeral ligament (SGHL) has a twisted course, downward and forward, and ends at the proximal opening of the bicipital groove with a flap on which the LHB rests. The bicipital pulley is not an independent structure but an arciform structure resulting from the fusion of several tissues. DISCUSSION The presence of structures linked together by common expansions in the 3 planes of space validates the relevance of a "biceps box" as a functional geometric model. The structure that acts as a crossroads through which all expansions pass is the CHL. An extrinsic SSP lesion can be compensated for by other "biceps box" structures, whereas an extrinsic SGHL lesion rarely exists without the presence of an intrinsic LHB lesion. The CHL constitutes a connective tissue crossed by a vasculonervous pedicle from the lateral pectoral nerve, which may explain some anterior shoulder pain attributed to the biceps. CONCLUSION The LHB can be likened to an intrinsic structure contained in a box whose sides are made up of different interconnected stabilizing structures defining the extrinsic structures. The concept of a dynamic "biceps box" allows LHB lesions to be accurately classified, separating extrinsic and intrinsic lesions, and thus potentially modifying therapeutic approaches to the LHB. LEVEL OF EVIDENCE IV; systematic review.
Collapse
Affiliation(s)
- François Gadéa
- Centre Ortho-Globe, place du Globe, 83000 Toulon, France.
| | - Franck Dordain
- Hôpital privé Saint-Martin, 18, rue des Roquemonts, 14000 Caen, France
| | - Johan Merbah
- Centre Ortho-Globe, place du Globe, 83000 Toulon, France
| | | | - Julien Berhouet
- Service de chirurgie orthopédique, hôpital Trousseau, CHRU de Tours, faculté de médecine, université de Tours Centre-Val de Loire, Tours, France
| |
Collapse
|
|
11
|
Takeshima M, Morihara T, Furukawa R, Ito H, Kida Y, Sukenari T, Takahashi K. Efficacy of biceps-radial-slice magnetic resonance images for the diagnosis of biceps and pulley lesions. J Shoulder Elbow Surg 2023; 32:2436-2444. [PMID: 37543281 DOI: 10.1016/j.jse.2023.06.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 06/26/2023] [Accepted: 06/27/2023] [Indexed: 08/07/2023]
Abstract
BACKGROUND Injuries to the biceps reflection pulley lead to instability of the long head of the biceps tendon (LHBT). However, conventional magnetic resonance (MR) imaging (MRI) has low diagnostic accuracy for LHBT and pulley lesions. Here, we investigated the usefulness of novel biceps-radial MRI for evaluating LHBT and pulley lesions. METHODS Biceps-radial MR images of 84 patients (84 shoulders) were prospectively analyzed. The biceps-radial MRI protocol includes sequences acquired in radial planes perpendicular to the LHBT in the shoulder joint. All patients underwent shoulder arthroscopy, and the intraoperative LHBT and pulley lesion findings were compared to the preoperative evaluations. The diagnostic accuracies of the biceps-radial MR images and conventional MR images were determined. RESULTS A normal LHBT was observed in 30 (31.6%) patients, partial tears in 43 (52.6%), and complete tears in 11 (15.8%). Normal LHBT stability was present in 54 (61.4%) patients, subluxation in 24 (31.6%), and dislocation in 6 (7.0%). The biceps-radial MR (kappa coefficient: 0.94) and conventional MR (kappa coefficient: 0.68) images accurately identified LHBT tears. The biceps-radial MR images excellently agreed with the arthroscopic findings (kappa coefficient: 0.91), whereas the conventional MR images poorly agreed (kappa coefficient: 0.17) regarding LHBT instability. A normal medial wall of the pulley was observed in 26 (31.0%) patients, partial tears in 30 (35.7%), and complete tears in 28 (33.3%). A normal lateral wall of the pulley was observed in 30 (35.7%) patients, partial tears in 21 (25.0%), and complete tears in 33 (39.3%). The biceps-radial MR images excellently agreed with the arthroscopic findings (kappa coefficient: 0.89), whereas the conventional MR images moderately agreed (kappa coefficient: 0.50) regarding medial pulley lesions. The biceps-radial MR images excellently agreed with the arthroscopic findings (kappa coefficient: 0.95) and the conventional MR images moderately agreed (kappa coefficient: 0.56) regarding lateral pulley lesions. CONCLUSION Biceps-radial MRI allows for tracking of the LHBT and pulley from the supraglenoid tuberosity to the bicipital groove in the glenohumeral joint and accurate evaluations of LHBT and pulley lesions.
Collapse
Affiliation(s)
- Minoru Takeshima
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
| | - Toru Morihara
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Ryuhei Furukawa
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hirotoshi Ito
- Department of Radiology, Kajiicho Medical Imaging Center, Kyoto, Japan
| | - Yoshikazu Kida
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Tsuyoshi Sukenari
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kenji Takahashi
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| |
Collapse
|
|
12
|
Sethi P, Fares MY, Murthi A, Tokish JM, Abboud JA. The long head of the biceps tendon: a valuable tool in shoulder surgery. J Shoulder Elbow Surg 2023; 32:1801-1811. [PMID: 37245621 DOI: 10.1016/j.jse.2023.04.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 03/28/2023] [Accepted: 04/05/2023] [Indexed: 05/30/2023]
Abstract
ANATOMY AND FUNCTION The long head of the biceps tendon (LHBT) has different properties and characteristics that render it a valuable tool in the hands of shoulder surgeons. Its accessibility, biomechanical strength, regenerative capabilities, and biocompatibility allow it to be a valuable autologous graft for repairing and augmenting ligamentous and muscular structures in the glenohumeral joint. SHOULDER SURGERY APPLICATIONS Numerous applications of the LHBT have been described in the shoulder surgery literature, including augmentation of posterior-superior rotator cuff repair, augmentation of subscapularis peel repair, dynamic anterior stabilization, anterior capsule reconstruction, post-stroke stabilization, and superior capsular reconstruction. Some of these applications have been described meticulously in technical notes and case reports, whereas others may require additional research to confirm clinical benefit and efficacy. CONCLUSION This review examines the role of the LHBT as a source of local autograft, with biological and biomechanical properties, in aiding outcomes of complex primary and revision shoulder surgery procedures.
Collapse
Affiliation(s)
- Paul Sethi
- Orthopedic and Neurosurgical Specialists, ONS Foundation, Greenwich, CT, USA
| | - Mohamad Y Fares
- Division of Shoulder and Elbow Surgery, Rothman Orthopaedic Institute, Philadelphia, PA, USA
| | - Anand Murthi
- Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD, USA
| | - John M Tokish
- Department of Orthopedic Surgery, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - Joseph A Abboud
- Division of Shoulder and Elbow Surgery, Rothman Orthopaedic Institute, Philadelphia, PA, USA.
| |
Collapse
|
|
13
|
Forsythe B, Patel HH, Berlinberg EJ, Forlenza EM, Okoroha KR, Williams BT, Yanke AB, Cole BJ, Verma NN. A Radiostereometric Analysis of Tendon Migration After Arthroscopic and Mini-Open Biceps Tenodesis: Interference Screw Versus Single Suture Anchor Fixation. Am J Sports Med 2023; 51:2869-2880. [PMID: 37548005 DOI: 10.1177/03635465231187030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
BACKGROUND Studies suggest that similar clinical results are achieved via arthroscopic and open biceps tenodesis (BT) techniques. PURPOSE To quantify the postoperative migration of the BT construct between arthroscopic suprapectoral BT (ASPBT) and open subpectoral BT (OSPBT) techniques via interference screw (IS) or single-suture suture anchor (SSSA) fixation using radiostereometric analysis. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS Distal migration of the biceps tendon after OSPBT with a polyetheretherketone IS, OSPBT with 1 SSSA, ASPBT with polyetheretherketone IS, and ASPBT with 2 SSSAs was measured prospectively. Patients with symptomatic biceps tendinopathy and preoperative patient-reported outcome measures (PROMs) including Constant-Murley subjective, Single Assessment Numeric Evaluation, or Patient-Reported Outcomes Measurement Information System-Upper Extremity scores were included. A tantalum bead was sutured on the proximal end of the long head of the biceps tendon before fixation of tendon tissue. Anteroposterior radiographs were performed immediately postoperatively, at 1 week, and at 3 months. Bead migration was measured, and preoperative PROMs were compared with those at latest follow-up. RESULTS Of 115 patients, 94 (82%) were available for final follow-up. IS fixation yielded the least tendon migration with no difference between the open and arthroscopic approaches (4.31 vs 5.04 mm; P = .70). Fixation with 1 suture anchor demonstrated significantly greater migration than that achieved with an IS at both 1 week (6.47 vs 0.1 mm, 6.47 vs 1.75 mm, P < .001;) and 3 months (14.76 vs 4.31 mm, 14.76 vs 5.04 mm, P < .001) postoperatively. Two-suture anchor fixation yielded significantly greater migration than IS fixation at 1 week (7.02 vs 0.1 mm, P < .001; 7.02 vs 1.75 mm, P = .003) but not 3 months postoperatively (8.06 vs 4.31 mm, P = .10; 8.06 vs 5.04 mm, P = .07). Four patients with suture anchor fixation (3 patients in the OSPBT 1 SSSA group, 9.4%, and 1 patient in the ASPBT 2 SSSAs group, 3.8%) developed a Popeye deformity, whereas no Popeye deformities occurred in the IS groups. Mean 3-month bead migration in patients with and without a Popeye deformity was 60.8 and 11.2 mm, respectively (P < .0001). PROMs did not differ among groups at final follow-up. CONCLUSION Interference screw fixation yielded the least tendon migration whether achieved arthroscopically or open. The available data indicated that fixation with 1 SSSA but not 2 SSSAs resulted in significantly greater migration than that achieved with an IS. Despite variations in tendon migration, PROMs were similar among all groups. When SSSAs are used, tendon migration may be minimized by using ≥2 anchors.
Collapse
Affiliation(s)
| | - Harsh H Patel
- Midwest Orthopaedics at Rush, Chicago, Illinois, USA
| | | | | | - Kelechi R Okoroha
- Mayo Clinic Orthopedics and Sports Medicine, Minneapolis, Minnesota, USA
| | - Brady T Williams
- University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Adam B Yanke
- Midwest Orthopaedics at Rush, Chicago, Illinois, USA
| | - Brian J Cole
- Midwest Orthopaedics at Rush, Chicago, Illinois, USA
| | | |
Collapse
|
|
14
|
Diplock B, Hing W, Marks D. The long head of biceps at the shoulder: a scoping review. BMC Musculoskelet Disord 2023; 24:232. [PMID: 36978047 PMCID: PMC10044783 DOI: 10.1186/s12891-023-06346-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 03/20/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND This review aimed to explore the available literature to update our understanding of the long head of biceps (LHB) at the shoulder. Synthesise our findings to identify emergent themes and knowledge gaps to inform future research and management directions. METHODS PubMed, Embase, Cinahl, SportDiscus, CENTRAL, and Web of Science were searched from inception to 31st December 2021. Articles were included if they referenced adult participants > 18 years of age and were written in English. RESULTS 214 articles were included in the final analysis, and results were categorised into six emergent themes: (1) Anatomy - Normal anatomical variation of the biceps from aberrant origins, third and fourth accessory heads, and an absence of the LHB tendon (LHBT) are not necessarily benign, with shoulder pain and instability a commonly reported theme. (2) Function - Bicep's role in glenohumeral elevation and stability in healthy shoulders is minimal. In contrast, LHB has a more significant role in shoulder stability and humeral head depression in subjects with rotator cuff failure or an absent LHBT. (3) Pathology - There is an association between LHB tendinopathy, rotator cuff disease, LHBT instability and occult rotator cuff tears. Early recruitment and hyperactivity of the LHB in subjects with symptomatic rotator cuff tears and instability suggest a potential compensatory role. (4) Assessment - The limited diagnostic utility of special orthopaedic tests in assessing LHBT pathology was a consistent theme. The utility of magnetic resonance imaging and ultrasound to identify full-thickness tendon tears and instability of the LHBT was moderate to high. However, the utility of clinical tests and imaging may be underestimated due to arthroscopy's limitations in fully visualising the proximal LHBT. (5) Non-Surgical Management - Ultrasound-guided injections into the biceps sheath show greater accuracy and patient outcomes than blinded injections; however, the entry of injectate into the intraarticular glenohumeral joint may have unwanted complications. (6) Surgical management - For the surgical management of biceps pathology with or without rotator cuff pathology, both biceps tenodesis and tenotomy report similar improvements in pain without any significant adverse effect on strength or function. Tenodesis favoured higher overall constant scores and a lower incidence of Popeye deformity and cramping arm pain, with tenotomy trending to be more cost and time effective. For patients with a healthy LHBT, rotator cuff repair with adjunctive tenodesis or tenotomy fails to provide additional clinical improvements compared to rotator cuff repair in isolation. CONCLUSIONS The scoping review highlights the variability of biceps anatomy, which is not necessarily benign and suggests a minimal role of the LHB in shoulder elevation and stability in healthy individuals. In contrast, individuals with rotator cuff tears experience proximal humeral migration and demonstrate hyperactivity of the LHB, suggesting a potential compensation role. The observed prevalence of LHBT pathology with rotator cuff tears is well established; however, the cause-and-effect relationship between LHBT pathology and rotator cuff disease is undetermined. The diagnostic utility of clinical tests and imaging to exclude LHBT pathology may be understated due to the limitations of arthroscopy to visualise the proximal LHBT fully. Rehabilitation programs for the LHB are understudied. Similar post-surgical clinical outcomes are observed for tenodesis and tenotomy for biceps and rotator cuff-related shoulder pain. Subjects undergoing biceps tenodesis are less likely to have cramping arm pain and a Popeye deformity than patients undergoing biceps tenotomy. The significance of routine surgical removal of the LHBT and sequelae on rotator cuff tear progression to failure and long-term shoulder function is unknown, and further research is required. PRE-REGISTRATION OSF: https://osf.io/erh9m.
Collapse
Affiliation(s)
- Brendan Diplock
- Faculty of Health Sciences & Medicine, Bond University, Gold Coast, Australia.
| | - Wayne Hing
- Faculty of Health Sciences & Medicine, Bond University, Gold Coast, Australia
| | - Darryn Marks
- Faculty of Health Sciences & Medicine, Bond University, Gold Coast, Australia
| |
Collapse
|
|
15
|
Sudah SY, Menendez ME, Garrigues GE. Nonoperative Treatment of the Biceps-Labral Complex. Phys Med Rehabil Clin N Am 2023; 34:365-375. [PMID: 37003658 DOI: 10.1016/j.pmr.2022.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
The long head of the biceps and superior labrum should be evaluated as an interdependent functional unit. A focused patient history and physical examination including multiple provocative tests should be performed alongside advanced imaging studies to obtain an accurate diagnosis. Nonoperative treatment modalities including nonsteroidal anti-inflammatory drugs, glucocorticoid injections, and a standardized physical therapy regimen should be exhausted before operative intervention. Significant improvements in pain, functional outcomes, and quality of life are achieved in patients treated nonoperatively. Although these outcomes are less consistent for overhead athletes, return to play and performance metrics seem comparable to those who undergo surgery.
Collapse
Affiliation(s)
- Suleiman Y Sudah
- Department of Orthopedics, Monmouth Medical Center, 300 2nd Avenue, Long Branch, NJ 07740, USA
| | - Mariano E Menendez
- Oregon Shoulder Institute at Southern Oregon Orthopedics, 2780 East Barnett Road, 200, Medford, OR 97504, USA
| | - Grant E Garrigues
- Department of Orthopaedic Surgery, Rush University Medical Center, Midwest Orthopaedics at Rush, 1611 West Harrison Street, Orthopedic Building, Suite 400, Chicago, IL 60612, USA.
| |
Collapse
|
|
16
|
Kleim BD, Carbonel JFS, Hinz M, Rupp MC, Scheiderer B, Imhoff AB, Siebenlist S. A shallow morphology of the intertubercular groove is associated with medial and bilateral but not lateral pulley lesions. Knee Surg Sports Traumatol Arthrosc 2023:10.1007/s00167-023-07350-x. [PMID: 36820903 DOI: 10.1007/s00167-023-07350-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 02/10/2023] [Indexed: 02/24/2023]
Abstract
PURPOSE To investigate the influence of intertubercular groove (IG) morphology on the development of different types of biceps reflection pulley (BRP) injuries. METHODS A consecutive cohort of 221 patients with ventral shoulder pain and a preoperative diagnosis suspecting BRP injury, who underwent arthroscopy, was retrospectively reviewed. The presence or absence as well as type of pulley injury (medial, lateral or bilateral) was confirmed arthroscopically. The intertubercular groove was evaluated on MRIs after triplanar reconstruction of the axial plane. IG depth, width, medial wall angle (MWA), lateral wall angle (LWA) and total opening angle (TOA) were measured. IG depth and width were expressed in relation to the humeral head diameter. Measurements were performed by two clinicians independently and averaged. RESULTS Of 166 included patients 43 had bilateral, 65 medial and 38 lateral BRP lesions. 20 patients had intact BRPs and represented the control group. The intra-class correlation coefficient of measurements was 0.843-0.955. Patients with a medial or bilateral BRP injury had a flatter MWA (38.8° or 40.0° vs. 47.9°, p < 0.001), wider TOA (96.1° or 96.6° vs. 82.6°, p < 0.001), greater width (12.5 or 12.3 vs. 10.8 mm, p = 0.013) and shallower depth (5.5 or 5.4 vs. 6.2 mm, p < 0.001) than the control group. Conversely, the IG morphology of those with lateral BRP injuries did not differ significantly from the control group. The odds ratio for a medial or bilateral BRP injury when the TOA exceeded 95° was 6.8 (95% confidence interval 3.04-15.2). CONCLUSION A dysplastic type of IG morphology with a wide TOA, flat MWA, decreased depth and increased width is associated with the presence of medial and bilateral BRP injuries. A TOA of > 95° increases the likelihood of a medial or bilateral BRP injury 6.8-fold. Lateral BRP injuries are not associated with dysplastic IG morphology. Concomitant LHBT surgery may, therefore, not always be necessary during isolated supraspinatus tendon repair. LEVEL OF EVIDENCE Level III.
Collapse
Affiliation(s)
- Benjamin Daniel Kleim
- Department of Sports Orthopedics, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
| | | | - Maximilian Hinz
- Department of Sports Orthopedics, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Marco-Christopher Rupp
- Department of Sports Orthopedics, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Bastian Scheiderer
- Department of Sports Orthopedics, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Andreas Balthasar Imhoff
- Department of Sports Orthopedics, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Sebastian Siebenlist
- Department of Sports Orthopedics, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| |
Collapse
|
|
17
|
Kao JT, Chiu CH, Hsu KY, Chang SS, Chan YS, Chen ACY. Arthroscopic diagnosis of long head of biceps tendon instability in refractory anterior shoulder pain: A comparison study between pulley tear and non-tear lesions. Biomed J 2023; 46:163-169. [PMID: 35065282 PMCID: PMC10104962 DOI: 10.1016/j.bj.2022.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 12/23/2021] [Accepted: 01/10/2022] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Long head of the biceps tendon (LHBT) instability and biceps reflection pulley (BRP) lesions are common cause of refractory anterior shoulder pain. We described a technique using dynamic arthroscopy to determine associated intraarticular pathologies. METHODS Patients with refractory anterior shoulder pain and arthroscopically-diagnosed LHBT instability were enrolled. LHBT instability and the integrity of BRP and concomitant intra-articular lesions were investigated by ramp test. Demographics and arthroscopic findings were compared between patients with and without BRP tear. RESULTS Forty patients were enrolled. BRP tear was noted in 25 patients (group A) and superior glenohumeral ligament (SGHL) insufficiency through ramp test in 15 patients (group B). Concomitant intraarticular pathologies were noted in 27 patients, including 19 in group A (76%) and eight in group B (53%), without significant group-wise difference (p = 0.138). The incidence of articular-side subscapularis tear was significantly higher in group A (p = 0.021), and those of the other intraarticular pathologies were similar between groups A and B. Fraying at the articular side of the subscapularis and supraspinatus tendons was frequent in group B, without difference of incidence as compared to group A (p = 0.5 and p = 0.084, respectively). CONCLUSIONS LHBT instability was a common disorder in patients with refractory shoulder pain. In those patients, dynamic assessment of BRP lesions and SGHL insufficiency and meticulous survey of associated intra-articular pathologies, including subscapularis tear are necessary for making accurate diagnosis and treatment decision.
Collapse
Affiliation(s)
- Jo-Ting Kao
- Bone and Joint Research Center, Department of Orthopaedic Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Chih-Hao Chiu
- Bone and Joint Research Center, Department of Orthopaedic Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan; Comprehensive Sports Medicine Center, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Kuo-Yau Hsu
- Bone and Joint Research Center, Department of Orthopaedic Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan; Comprehensive Sports Medicine Center, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Shih-Sheng Chang
- Bone and Joint Research Center, Department of Orthopaedic Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan; Comprehensive Sports Medicine Center, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Yi-Sheng Chan
- Bone and Joint Research Center, Department of Orthopaedic Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan; Comprehensive Sports Medicine Center, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Alvin Chao-Yu Chen
- Bone and Joint Research Center, Department of Orthopaedic Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan; Comprehensive Sports Medicine Center, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.
| |
Collapse
|
|
18
|
Comment on Feuerriegel et al. Assessment of Acute Lesions of the Biceps Pulley in Patients with Traumatic Shoulder Dislocation Using MR Imaging. Diagnostics 2022, 12, 2345. Diagnostics (Basel) 2022; 13:diagnostics13010025. [PMID: 36611317 PMCID: PMC9818658 DOI: 10.3390/diagnostics13010025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022] Open
Abstract
We wish to congratulate the authors for the successful publication of the article titled 'Assessment of Acute Lesions of the Biceps Pulley in Patients with Traumatic Shoulder Dislocation Using MR Imaging' [...].
Collapse
|
|
19
|
Jain A, Aniq H, Mistry A. SLAP Injury and the Superior Labrum. Semin Musculoskelet Radiol 2022; 26:577-584. [DOI: 10.1055/s-0042-1758840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
AbstractInjuries around the superior labrum are a common cause of shoulder dysfunction and pain. The injuries sustained result mainly from repetitive microtrauma but can also occur following a fall on outstretched hand. Both athletic and general populations can be affected. Injuries to the superior labrum are called superior labrum anterior and posterior (SLAP) tears. Based on cross-sectional imaging findings, the literature defines four main SLAP tears (I–IV) and six extended types (V–X). An accurate description of imaging findings of the SLAP tear type, along with concomitant findings, aids clinicians in treatment planning. We also briefly discuss management options, postoperative appearance of superior labral repair, and the diagnosis of a retear.
Collapse
Affiliation(s)
- Abhishek Jain
- Liverpool University Hospitals, Royal Liverpool University Hospital, Liverpool, United Kingdom
| | - Hifz Aniq
- Liverpool University Hospitals, Royal Liverpool University Hospital, Liverpool, United Kingdom
| | - Alpesh Mistry
- Liverpool University Hospitals, Royal Liverpool University Hospital, Liverpool, United Kingdom
| |
Collapse
|
|
20
|
McKean D, Teh J. Imaging of the Long Head of Biceps Tendon and Rotator Interval. Semin Musculoskelet Radiol 2022; 26:566-576. [DOI: 10.1055/s-0042-1758850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
AbstractThis article reviews the imaging and common pathology of the long head of biceps tendon and rotator interval (RI). This area of complex anatomy plays a crucial role in normal shoulder function. Injury or abnormality of the RI may contribute to a range of shoulder pathology, such as biceps instability, tendinopathy, and frozen shoulder. Understanding the normal and pathologic appearances of the RI structures is crucial for a correct diagnosis and directing treatment.
Collapse
Affiliation(s)
- David McKean
- Stoke Mandeville Hospital, Buckinghamshire Healthcare NHS Trust, Aylesbury, United Kingdom
- Cleveland Clinic London, London, United Kingdom
| | - James Teh
- The Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, United Kingdom
| |
Collapse
|
|
21
|
Assessment of Acute Lesions of the Biceps Pulley in Patients with Traumatic Shoulder Dislocation Using MR Imaging. Diagnostics (Basel) 2022; 12:diagnostics12102345. [PMID: 36292035 PMCID: PMC9600602 DOI: 10.3390/diagnostics12102345] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 09/19/2022] [Accepted: 09/25/2022] [Indexed: 11/25/2022] Open
Abstract
Background: Shoulder dislocations represent common injuries and are often combined with rotator cuff tears and potentially damage to the biceps pulley. Purpose: To assess the occurrence and type of biceps pulley lesions in patients after traumatic anterior shoulder dislocation using 3T MRI. Methods: Thirty-three consecutive patients were enrolled between June 2021 and March 2022 (14 women, mean age 48.0 ± 19 years). All patients underwent MR imaging at 3 T within one week. Images were analyzed for the presence and type of pulley tears, subluxation/dislocation of the LHBT, rotator cuff lesions, joint effusion, labral lesions, and osseous defects. Results: Seventeen patients (52%) with traumatic anterior shoulder dislocation demonstrated biceps pulley lesions. Of those, eleven patients (33%) showed a combined tear of the sGHL and CHL. All seventeen patients with lesions of the biceps pulley showed associated partial tearing of the rotator cuff, whereas three patients showed an additional subluxation of the LHBT. Patients with pulley lesions after dislocations were significantly older than those without (mean age 52 ± 12 years vs. 44 ± 14 years, p = 0.023). Conclusion: Our results suggest an increased awareness for lesions of the biceps pulley in acute traumatic shoulder dislocation, particularly in patients over 45 years.
Collapse
|
|
22
|
Two-Year Clinical Outcomes and Survivorship After Isolated Biceps Tenodesis. Arthroscopy 2022; 38:1834-1842. [PMID: 34923105 DOI: 10.1016/j.arthro.2021.12.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 11/04/2021] [Accepted: 12/09/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to evaluate clinical outcomes and survivorship of isolated biceps tenodesis (BT) at a minimum of 2 years and to identify patient-specific factors associated with these outcomes in patients undergoing BT without concomitant rotator cuff repair (RCR). We hypothesized that patient-reported outcomes would be significantly improved on American Shoulder and Elbow Surgeons Survey (ASES) and Single Assessment Numeric Evaluation (SANE), with a high rate of survivorship (>90%) at 2-year follow-up. METHODS A retrospective review of an institutional registry was performed to identify patients who underwent BT from July 2016 to December 2017. Patients >18 years old who underwent an open or arthroscopic BT procedure using an interference screw, button, or anchor for underlying bicipital pathology, without a concomitant RCR or shoulder arthroplasty, and were a minimum of 2 years postoperative were included. Patients were administered ASES and SANE questionnaires preoperatively and at final follow-up. Survivorship was evaluated using Kaplan-Meier analysis. Failure was defined as any patient who underwent reoperation related to the index surgery. RESULTS A total of 110 patients (mean ± standard deviation age, 48.60 ± 12.14 years) who underwent isolated BT with a follow-up of 24.90 ± 3.95 months were included in analysis. There was a significant improvement in ASES and SANE at final follow-up (P < .001), with 81% to 84% of patients achieving minimal clinically important difference (MCID), 72% to 82% achieving substantial clinical benefit (SCB), and 72% to 80% achieving patient-acceptable symptom state (PASS). Worker's Compensation (WC) patients had a decreased likelihood of achieving PASS on ASES (P = .015) and SANE (P = .012). Four cases were deemed failures (3 revision BTs and 1 capsular debridement) at 15.09 ± 9.57 months. WC did not have a significant effect on likelihood of BT failure. CONCLUSION Biceps tenodesis provided significant clinical improvement and high rates of survivorship 2 years postoperatively. WC was associated with a decreased likelihood of achieving PASS. These results support the continued use of isolated BT for treating biceps pathology. LEVEL OF EVIDENCE IV, case series.
Collapse
|
|
23
|
Chellamuthu G, Sundar S, Rajan DV. Current concepts review in the management of subscapularis tears. J Clin Orthop Trauma 2022; 28:101867. [PMID: 35494488 PMCID: PMC9043658 DOI: 10.1016/j.jcot.2022.101867] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 04/08/2022] [Indexed: 11/24/2022] Open
Abstract
Subscapularis (SSc) is the prime internal rotator of shoulder. It is the most powerful rotator cuff muscle, maintaining the anterior force couple of shoulder. The tears in SSc as any other rotator cuff muscles might result from a traumatic event or more commonly from intrinsic degeneration. With the advent and widespread use of shoulder arthroscopy, SSc tears, which were once considered as "forgotten or hidden lesions" are now being increasingly recognized. Isolated SSc tears are relatively rare. They occur in combinations. Clinically internal rotation can be near normal because of the compensation provided by other internal rotators. It is not uncommon for patients with SSc tear to be normal on routine physical examination. The Bear Hug test (BHT) has high sensitivity and accuracy in the diagnosis of SSc tear. The combined use of BHT with Belly Press Test has been found optimal for diagnosis. US is an accurate and reliable method for diagnosing SSc tears and outperformed MRI in diagnosing partial-thickness SSc tears. The MRI is currently the most advanced imaging available for diagnosis. The specificity is up to 100%. However, the sensitivity is between 36 and 40%. The earliest classification system for SSc tears was by Fox et al. The commonly used classification is by Lafosse et al. The recent system by Yoo et al. is based on the insertion of SSc. The comma sign is gaining importance not only in arthroscopic diagnosis but also in MRI identification and repair of SSc. The mode of management is mainly arthroscopic. The techniques of repair of SSc are continuously progressing. However, there is no clear consensus on the double vs single-row repairs, biceps tendon management, and the role of coracoplasty. Future research must focus on these areas. Reserve shoulder arthroplasty is reserved for salvage in older age groups. Tendon transfers are performed in young active individuals with irreparable tears.
Collapse
Affiliation(s)
- Girinivasan Chellamuthu
- Corresponding author. Ortho One Orthopaedic Speciality Centre, Singanallur, Coimbatore, 641005, Tamil Nadu, India.
| | | | | |
Collapse
|
|
24
|
Shibayama Y, Hirose T, Sugi A, Mizushima E, Watanabe Y, Tomii R, Iba K, Yamashita T. Diagnostic accuracy of magnetic resonance imaging for partial tears of the long head of the biceps tendon in patients with rotator cuff tears. JSES Int 2022; 6:638-642. [PMID: 35813151 PMCID: PMC9264005 DOI: 10.1016/j.jseint.2022.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background Magnetic resonance imaging (MRI) is useful for diagnosing shoulder diseases preoperatively. However, detection of partial tears of the long head of the biceps tendon (LHBT) using current clinical tests and imaging modalities is difficult. We aimed to evaluate the accuracy of radial-slice MRI for diagnosing partial tears of the LHBT. We hypothesized that radial-slice MRI may be a valuable diagnostic tool for assessing diagnosing tears of the LHBT. Methods We retrospectively investigated 118 patients who underwent shoulder arthroscopy for rotator cuff tears. Intraoperative LHBT findings were compared with the identification of partial tears of the LHBT on conventional-slice MRI and radial-slice MRI, using a 3.0-T system. We calculated sensitivity, specificity, accuracy, and positive and negative predictive values for the detection of LHBT tears. Inter- and intraobserver reliability for radial-slice MRI was calculated using kappa statistics. Results We diagnosed 69 patients (58%) without any LHBT tears and 49 with partial tears (42%), arthroscopically. Sensitivity, specificity, accuracy, and positive and negative predictive values of conventional-slice MRI for detection of partial tears of the LHBT were 52%, 94%, 78%, 92%, and 58%, respectively. Radial-slice MRI had 84% sensitivity, 90% specificity, 86% accuracy, and 92% positive and 80% negative predictive values for partial tears of the LHBT. Inter- and intraobserver reliability for radial-slice MRI was 0.69 and 0.74, respectively, corresponding to high reproducibility and defined as good. Conclusion Radial-slice MRI demonstrated significantly higher sensitivity than conventional-slice MRI. These results indicate that radial-slice MRI is useful for diagnosing LHBT partial tears.
Collapse
Affiliation(s)
- Yuji Shibayama
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
- Corresponding author: Yuji Shibayama, MD, PhD, Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, South 1 West 16, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan.
| | | | - Akira Sugi
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Emi Mizushima
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Yuto Watanabe
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Rira Tomii
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Kousuke Iba
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Toshihiko Yamashita
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| |
Collapse
|
|
25
|
Association of damage to the coracohumeral ligament with anterosuperior rotator cuff degeneration revealed by anatomical dissection. Sci Rep 2022; 12:4238. [PMID: 35273287 PMCID: PMC8913693 DOI: 10.1038/s41598-022-08070-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 03/02/2022] [Indexed: 11/08/2022] Open
Abstract
The coracohumeral ligament (CHL) is an important structure of the biceps pulley which also merges with the rotator cuff. Which role it actually plays in the pathogenesis of rotator cuff degeneration (RCD) and rotator cuff tears (RCT) is still a point of discussion. The hypothesis of this study was, that macroscopic injury to the anterosuperior part of the rotator cuff also includes parts of or the whole CHL. Forty fresh-frozen shoulders were dissected and examined, the morphology of the rotator cuff and the coracohumeral ligament were evaluated and existing lesions documented. 27.5% of the shoulder joints showed an anterosuperior full-thickness RCT. 57.5% of all examined shoulder girdles showed at least a partial rupture of the CHL. A highly significant correlation (p < 0.001, rho = 0.529) between the presence of rotator cuff tears and ruptures of the CHL was found. Cartilage damage within the anterosuperior section of the humeral head was observed in 20% cases. In rotator cuff degeneration and atraumatic rotator cuff tears of the elderly population, the pathomechanism of full-thickness RCT is based on repetitive anterosuperior glenoid impingement. This is especially supported by the identification of a higher frequency of CHL lesions compared to RCT reported in this study. No intact CHL was identified in shoulders with damaged rotator cuff tendons.
Collapse
|
|
26
|
Lalehzarian SP, Agarwalla A, Liu JN. Management of proximal biceps tendon pathology. World J Orthop 2022; 13:36-57. [PMID: 35096535 PMCID: PMC8771414 DOI: 10.5312/wjo.v13.i1.36] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 08/10/2021] [Accepted: 12/25/2021] [Indexed: 02/06/2023] Open
Abstract
The long head of the biceps tendon is widely recognized as an important pain generator, especially in anterior shoulder pain and dysfunction with athletes and working individuals. The purpose of this review is to provide a current understanding of the long head of the biceps tendon anatomy and its surrounding structures, function, and relevant clinical information such as evaluation, treatment options, and complications in hopes of helping orthopaedic surgeons counsel their patients. An understanding of the long head of the biceps tendon anatomy and its surrounding structures is helpful to determine normal function as well as pathologic injuries that stem proximally. The biceps-labral complex has been identified and broken down into different regions that can further enhance a physician's knowledge of common anterior shoulder pain etiologies. Although various physical examination maneuvers exist meant to localize the anterior shoulder pain, the lack of specificity requires orthopaedic surgeons to rely on patient history, advanced imaging, and diagnostic injections in order to determine the patient's next steps. Nonsurgical treatment options such as anti-inflammatory medications, physical therapy, and ultrasound-guided corticosteroid injections should be utilized before entertaining surgical treatment options. If surgery is needed, the three options include biceps tenotomy, biceps tenodesis, or superior labrum anterior to posterior repair. Specifically for biceps tenodesis, recent studies have analyzed open vs arthroscopic techniques, the ideal location of tenodesis with intra-articular, suprapectoral, subpectoral, extra-articular top of groove, and extra-articular bottom of groove approaches, and the best method of fixation using interference screws, suture anchors, or cortical buttons. Orthopaedic surgeons should be aware of the complications of each procedure and respond accordingly for each patient. Once treated, patients often have good to excellent clinical outcomes and low rates of complications.
Collapse
Affiliation(s)
- Simon P Lalehzarian
- The Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL 60064, United States
| | - Avinesh Agarwalla
- Department of Orthopedic Surgery, Westchester Medical Center, Valhalla, NY 10595, United States
| | - Joseph N Liu
- USC Epstein Family Center for Sports Medicine, Keck Medicine of USC, Los Angeles, CA 90033, United States
| |
Collapse
|
|
27
|
MRI morphological evaluation of humeral head bone profile inside region of the biceps pulley reflection. Skeletal Radiol 2022; 51:2017-2025. [PMID: 35460041 PMCID: PMC9381443 DOI: 10.1007/s00256-022-04056-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 04/04/2022] [Accepted: 04/04/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Evaluating humeral head bone profile inside biceps reflection pulley area in order to identify possible anatomical variants and any causes predisposing to tendon's instability of the long head of the biceps. MATERIALS AND METHODS This retrospective study analyzed 326 patients, 183 males and 143 females (age 15-88 years; average 51.5 years), who underwent MRI examination between 2013 and 2019. Biceps pulley reflection area morphology of 192 right shoulders and 134 left shoulders was assessed analyzing 309 MRI and 17 MR arthrography (MRA) shoulder exams. We investigated age and gender and the frequency of morphological variants among the patient groups. RESULTS Four possible morphological variants were identified: 95 with convex shape; 127 with flat shape; 77 with spiculated shape; and 12 with mixed morphology. Fifteen humeral bone profiles were not classifiable. CONCLUSIONS MRI was effective in defining humeral head anatomic variants inside the biceps pulley reflection area. The most frequent variants were flat or convex types.
Collapse
|
|
28
|
Candela V, Preziosi Standoli J, Carbone S, Rionero M, Gumina S. Shoulder Long Head Biceps Tendon Pathology Is Associated With Increasing Rotator Cuff Tear Size. Arthrosc Sports Med Rehabil 2021; 3:e1517-e1523. [PMID: 34712989 PMCID: PMC8527326 DOI: 10.1016/j.asmr.2021.07.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 07/18/2021] [Indexed: 11/01/2022] Open
Abstract
Purpose To evaluate the association between rotator cuff tear (RCT) size and long head biceps tendon (LHBT) pathology. Methods We retrospectively enrolled 202 consecutive patients (114 women and 88 men with mean age at surgery of 62.14 years [SD, 7.73]) who underwent arthroscopic rotator cuff repair for different sized full-thickness RCTs. LHBT pathology was evaluated considering the presence of inflammation, section alteration, loss of integrity, dislocation, dynamic instability, and absence. The site of LHBT pathology was evaluated considering 3 portions: (1) the insertional element; (2) the free intra-articular portion; (3) the part that enters the intertubercular groove. Statistics were evluated. Results The LHBT was absent in 22 cases (10.9%): 2, 4, 15, and 1 patients with small, large, massive, and subscapularis RCTs, respectively. A significant correlation was found between the prevalence of LHBT absence and massive RCTs (P < .001). In 53 patients (26%), there was a healthy LHBT; a healthy LHBT was present in 47%, 20% and 8% of small, large and massive RCTs, respectively. A significant correlation between LHBT inflammation, section alteration, loss of integrity, and RCT severity was found (P < .001, P < .001, and ). The insertional portion was the most involved (57% of cases); RCT severity was significantly associated with the number of involved portions (P < .001). Conclusions Shoulder LHBT pathology is associated with increasing rotator cuff tear size. Clinical Relevance Surgeons should be aware that biceps pathology is particularly prevalent in patients with larger RTCs.
Collapse
Affiliation(s)
- Vittorio Candela
- Department of Anatomical, Histological, Forensic Medicine and Orthopaedics Sciences, Sapienza University of Rome, Rome, Italy.,Istituto Clinico Ortopedico Traumatologico, Latina, Italy
| | | | - Stefano Carbone
- Sapienza Univerisity, Sant'Andrea Hospital (X.X.X. ), Rome, Italy
| | - Marco Rionero
- Department of Anatomical, Histological, Forensic Medicine and Orthopaedics Sciences, Sapienza University of Rome, Rome, Italy.,Istituto Clinico Ortopedico Traumatologico, Latina, Italy
| | - Stefano Gumina
- Shoulder Unit, San Feliciano Clinic, Rome, Italy.,Istituto Clinico Ortopedico Traumatologico, Latina, Italy
| |
Collapse
|
|
29
|
Dhanaraj D, Cable B, Hoge CG, Kelly JD. The Comma Sign: An Anatomic Study. Orthopedics 2021; 44:e546-e548. [PMID: 34292811 DOI: 10.3928/01477447-20210618-15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The "comma sign" is a comma-shaped arc of tissue located at the superolateral edge of the subscapularis at its insertion on the humeral head. It consists of the coracohumeral ligament (CHL) and the superior glenohumeral ligament (SGHL). It was recently recognized as an important landmark to aid surgeons in identifying the edge of a torn subscapularis tendon. The exact proportion of CHL and SGHL has not been precisely defined. The goal of this study was to dissect and more accurately define the composition of the comma tissue and its exact relationship to the subscapularis tendon. A total of 8 fresh frozen cadaveric shoulder specimens (mean age, 74 years; 5 male, 3 female) were dissected via a wide deltopectoral approach. Anatomic landmarks were identified, and measurements were taken with a digital caliper. The midpoint width of the SGHL and CHL and the composite insertion width of the subscapularis were measured. Measurements were taken 3 times each and averaged to calculate mean width. Mean midpoint width of the SGHL, CHL, and composite insertion was 5.99 mm (range, 5.25-6.91 mm), 5.13 mm (range, 4.28-5.72 mm), and 9.93 mm (range, 6.69-12.05 mm), respectively. The comma sign consists of approximately half SGHL (54%) and half CHL (46%) at its insertion to the subscapularis tendon, with an approximate width of 1 cm. With the increase in arthroscopic subscapularis repairs, knowledge of these dimensions will aid surgeons in discerning the comma tissue from other capsular elements and ultimately help in surgical restoration of native anatomy. [Orthopedics. 2021;44(4):e546-e548.].
Collapse
|
|
30
|
Lee JH, Rhyou IH, Ahn KB. Prediction of the anterior shoulder pain source by detecting indirect signs for partial articular subscapularis tendon tears through conventional magnetic resonance imaging. Knee Surg Sports Traumatol Arthrosc 2021; 29:2297-2304. [PMID: 32897409 DOI: 10.1007/s00167-020-06259-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 08/28/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To evaluate the diagnostic efficacy of indirect signs for proximal articular-positioned, partial (< 50%), subscapularis tendon tears (facet 1 tears) via conventional magnetic resonance imaging (MRI). METHODS A retrospective study was conducted on 67 patients of Yoo's type 1 or 2A tears. Forty-five arthroscopic subacromial decompression and acromioclavicular resection cases served as controls. Indirect signs indicating a facet 1 tear included small defects, superior subscapularis recess (SSR), long head of the biceps (LHBT) configurations, bone edema or cyst formation on lesser tuberosity (LTBEC), and fatty infiltration of subscapularis muscle. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were checked. RESULTS SSR was the most sensitive sign (90%). The sensitivities and NPV of LHBT configurations and LTBEC were low (sensitivity: 42.9% and 17.9%, NPV: 56.4% and 44.4%, respectively). The specificities of all indirect signs were relatively high (> 90%). The Chi-squared test and multinomial logistic regression confirmed the significance of small defects, SSRs, and fatty infiltrations for facet 1 tears (p ≤ 0.014). The combined sensitivity and specificity were up to 97.7% and 92.3%, respectively, in the presence of either a small defect or an SSR. CONCLUSIONS Conventional MRI alone can detect facet 1 tears through indirect signs (small defects, SSR, and fatty infiltrations of the subscapularis muscle), predicting unspecified anterior shoulder pain due to concealed biceps instability, and facilitating preoperative diagnosis for a facet 1 tear. LEVEL OF EVIDENCE III.
Collapse
Affiliation(s)
- Ji Ho Lee
- Department of Orthopedic Surgery, Pohang Semyeong Christianity Hospital, 351, Poscodaero, NamKu, Pohang, Gyungbuk, South Korea
| | - In Hyeok Rhyou
- Department of Orthopedic Surgery, Pohang Semyeong Christianity Hospital, 351, Poscodaero, NamKu, Pohang, Gyungbuk, South Korea.
| | - Kee Baek Ahn
- Department of Orthopedic Surgery, Pohang Semyeong Christianity Hospital, 351, Poscodaero, NamKu, Pohang, Gyungbuk, South Korea
| |
Collapse
|
|
31
|
Knapik DM, Bach BR. Diagnosis of Biceps Incarceration: Observations on the Biceps Incarceration Maneuver. Arthrosc Tech 2021; 10:e1369-e1372. [PMID: 34141555 PMCID: PMC8185888 DOI: 10.1016/j.eats.2021.01.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 01/31/2021] [Indexed: 02/03/2023] Open
Abstract
Instability of the long head of the biceps brachii tendon is a recognized source of shoulder pain. However, this diagnosis is usually associated with concomitant pathology including subscapularis tendon tears. The appropriate diagnosis of biceps incarceration or instability remains challenging, with failure to address instability being likely to result in persistent pain and disability despite arthroscopic management of concomitant shoulder pathology. The objective of this article is to (1) describe a dynamic test performed both preoperatively and intraoperatively, termed the "biceps incarceration maneuver," to help identify biceps instability; (2) reinforce the concept that biceps instability must be ruled out in young patients presenting with anterior shoulder pain; and (3) report that with proper diagnosis and treatment, patients with biceps instability will experience rapid symptomatic resolution after management.
Collapse
Affiliation(s)
- Derrick M. Knapik
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Bernard R. Bach
- Midwest Orthopaedics at Rush University, Chicago, Illinois, U.S.A.,Address correspondence to Bernard R. Bach Jr, M.D., Midwest Orthopaedics at Rush, 1611 W Harrison St, Ste 300, Chicago, IL 60612, U.S.A.
| |
Collapse
|
|
32
|
Roache PB. Anterior Cable Tears in Arthroscopic Rotator Cuff Repairs. Arthrosc Sports Med Rehabil 2021; 3:e695-e705. [PMID: 34195634 PMCID: PMC8220606 DOI: 10.1016/j.asmr.2021.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 01/12/2021] [Indexed: 11/15/2022] Open
Abstract
Purpose To determine whether anterior cable tears could be identified at the time of arthroscopic rotator cuff repair and determine the characteristics of the anterior cable tears identified. Methods From 2016 to 2017 all shoulder arthroscopies had data collected prospectively at the time of surgery, specifically including injury to the capsular and tendon zones of insertion on the greater tuberosity. Anterior cable position and degree of injury and medialization were recorded, as well as complete findings of the diagnostic arthroscopy. The inclusion criterion was primary shoulder arthroscopy. The exclusion criterion was any revision shoulder arthroscopy. All arthroscopic rotator cuff repairs (ARCR) were grouped together and all other nonarthroscopic rotator cuff repair surgeries (non-ARCR) were grouped together. Results In total, 118 shoulder arthroscopies had data collected prospectively at the time of surgery: 90 primary shoulder arthroscopies met the inclusion criteria; 28 were excluded because they were revision surgeries. There were 42 patients in the ARCR group (Group 1). Six of these were partial tears, and 36 were full-thickness tears. There were 48 patients in the non-ARCR group (Group 2). The non-ARCR Group 2 served as an anatomic baseline for ARCR Group 1. In all 90 shoulders, the rotator cable and anterior cable were identified. Group 1 (ARCR) incidence of anterior cable tears with abnormal position was 71.4% compared to 2.1% in group 2 (non-ARCR) (P < .001) Group 1 (ARCR) incidence of anterior cable tears with normal anterior cable position (n = 12) was compared to abnormal anterior cable position (n = 30). Injury to the anterior footprint capsular and tendon zones were compared. Normal anterior cable position correlated with no or low-grade injury to anterior footprint capsular zone. (Nimura zone C1). Abnormal anterior cable displacement graded as moderate (n = 20) and severe (n = 10) were compared for injury to the anterior footprint. Moderate displacement correlated with complete or high grade injury to C1 in 85% and complete injury to R1 in 45% (P < .001 and .049). In severe displacement complete C1 injury was 100%, and complete R1 injury was 100% (P < .001 and .001). Conclusions Anterior cable tears are universally identified in ARCR. Three patterns of medial displacement severity correlated with injury to a crucial insertion zone (C1) at the anterior footprint. The degree of anterior cable disruption at the anterior footprint and displacement was commonly disproportionately greater than the injury to the supraspinatus. Level of Evidence Level III, diagnostic study.
Collapse
Affiliation(s)
- Paul B Roache
- Department of Orthopedic Surgery, California Pacific Medical Center, San Francisco, California, U.S.A
| |
Collapse
|
|
33
|
Phornphutkul C, Tahwang S, Settakorn J. Effects of type II SLAP lesion repair techniques on the vascular supply of the long head of the biceps tendon: a cadaveric injection study. J Shoulder Elbow Surg 2021; 30:772-778. [PMID: 32711104 DOI: 10.1016/j.jse.2020.07.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 07/06/2020] [Accepted: 07/07/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND One option for the treatment of type 2 superior labral anterior to posterior (SLAP) lesions is arthroscopic repair. However, the fact that the vascular supply of the proximal long head of the biceps tendon (LHBT) arises from the soft tissue near the SLAP repair site must also be considered. The aims of this study were to evaluate the vascular channel of the proximal long head biceps tendon and to compare potential damage to the vascular supply with alternative SLAP techniques. METHODS Forty-five fresh cadaveric shoulders were divided into 3 groups: 9 shoulders each for the normal group and the created SLAP group, and 27 shoulders for the repaired SLAP group. SLAP group shoulders were repaired using one of 3 techniques: 2 anchors with simple sutures, 1 anchor with double sutures, or 1 anchor with a horizontal mattress suture. India ink was then injected into the acromial branch of the thoracoacromial artery. The proximal LHBT was resected for a histologic cross-sectional study. The intratendinous vascular distance was measured and compared among the groups. RESULTS The vascular supply of the proximal LHBT arises from soft tissue lying anterior and dorsal to the tendon origin. In the normal shoulders, the average intratendinous vascular distance was 16.9 ± 1.5 mm (95% confidence interval: 15.8-18.1). A comparison of nonrepaired SLAPs with each of the repair techniques found that using 2 anchors with simple sutures showed no significant difference in vascular distance (P = .716), whereas the other techniques showed a significant disruption of the blood supply. The differences in vascular distance among the 3 repair techniques were statistically significant (P = .0001). CONCLUSIONS The main vascular supply of the proximal LHBT comes from the anterior-dorsal direction. Some SLAP repair techniques can disrupt vascularization; however, the technique using 2 anchors with simple sutures, 1 anchor 3 mm anterior to the anterior border and 1 at the posterior border of the tendon, can preserve the vascularization of the LHBT.
Collapse
Affiliation(s)
- Chanakarn Phornphutkul
- Department of Orthopedics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
| | - Siripong Tahwang
- Department of Orthopedics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Jongkolnee Settakorn
- Department of Pathology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| |
Collapse
|
|
34
|
Martetschläger F, Zampeli F, Tauber M, Habermeyer P, Leibe M. A classification for partial subscapularis tendon tears. Knee Surg Sports Traumatol Arthrosc 2021; 29:275-283. [PMID: 32285157 PMCID: PMC7862509 DOI: 10.1007/s00167-020-05989-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 04/07/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of the study was to analyze partial subscapularis tendon (SSC) tears and provide a descriptive classification. METHODS The retrospective study included 50 patients with arthroscopically confirmed partial SSC tears. Internal rotation (IR) force measurements and IR ROM have been made and compared to the healthy contralateral side. Then the footprint of the SSC was routinely investigated by arthroscopy with standardized measurement of the bony footprint lesion. The partial tears were classified according to the mediolateral and craniocaudal extension of the rupture in the transverse and coronal plane, respectively. RESULTS Partial SSC tears could be classified into split lesions (type 1, n = 11) and 3 further groups depending on the mediolateral peeled-off length of the bony footprint (type 2: < 10 mm, n = 20; type 3: 10-15 mm, n = 10; type 4: > 15 mm, n = 9). Type 2-4 could be further divided depending on the craniocaudal peeled-off length of the bony footprint (group A: < 10 mm, group B: 10-15 mm, group C: > 15 mm). Significantly decreased IR strength was shown for types 2-4 (p < 0.05) but not for split lesions as compared to healthy side. Types 1-4 showed significant decreased active IR ROM and all except type 3 (n.s.) which showed decreased passive IR ROM compared to the healthy side (p < 0.05). CONCLUSION We present a novel classification for partial SSC tears for a more detailed and reproducible description. This can help to improve the current knowledge about the appropriate treatment. It could be shown that partial tears of the subscapularis can have an impact on IR strength and motion. LEVEL OF EVIDENCE III.
Collapse
Affiliation(s)
- Frank Martetschläger
- Department of Shoulder and Elbow Surgery, ATOS Clinic Munich, Effnerstraße 38, 81925, Munich, Germany.
- Department for Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany.
| | - Frantzeska Zampeli
- Department of Shoulder and Elbow Surgery, ATOS Clinic Munich, Effnerstraße 38, 81925, Munich, Germany
| | - Mark Tauber
- Department of Shoulder and Elbow Surgery, ATOS Clinic Munich, Effnerstraße 38, 81925, Munich, Germany
- Department of Traumatology and Sports Injuries, Paracelsus Medical University, Salzburg, Austria
| | - Peter Habermeyer
- Department of Shoulder and Elbow Surgery, ATOS Clinic Munich, Effnerstraße 38, 81925, Munich, Germany
| | - Markus Leibe
- Helios Clinic Munich West, Department of Orthopedic Sports Medicine, Trauma Surgery and Hand Surgery, Munich, Germany
| |
Collapse
|
|
35
|
[Injuries of the biceps-labrum complex : Principles, pathologies and treatment concepts]. Unfallchirurg 2020; 124:96-107. [PMID: 33301084 DOI: 10.1007/s00113-020-00927-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND The biceps-labrum complex is prone to acute lesions and degenerative changes due to its anatomical structure and the high load it has to endure. Pathological changes of these structures are common pain generators and can significantly impair shoulder function. Anatomically, the biceps-labrum complex can be divided into three zones: inside, junction and bicipital tunnel. DIAGNOSTIC PROCEDURE Despite the focused physical examination and advancements in imaging techniques, the exact localization of pathologies remains challenging. Arthroscopy can be used to accurately diagnose inside and junctional pathologies but extra-articular changes in the region of the bicipital tunnel can only be partially visualized. TREATMENT In cases of unsuccessful conservative treatment and correct indications, a high level of patient satisfaction can be surgically achieved. In young patients an anatomical reconstruction of inside lesions or tenodesis of the long head of the biceps tendon is performed; however, even tenotomy is a valuable option and can achieve equally satisfactory results. Unaddressed pathological changes of the bicipital tunnel can lead to persistence of pain. In clinical procedures performing tenodesis, both the different techniques and the implants used have been found to show similar results. This article describes the anatomical principles, pathological changes, the focused clinical instrumental diagnostics and discusses the different treatment philosophies as well as the outcome according to the recent literature.
Collapse
|
|
36
|
A new significance of an old structure: Aponeurotic expansion of supraspinatus tendon and its relationships with biceps brachii long head and rotator cuff tendons. Eur J Radiol 2020; 133:109374. [PMID: 33130358 DOI: 10.1016/j.ejrad.2020.109374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 08/14/2020] [Accepted: 10/20/2020] [Indexed: 11/22/2022]
Abstract
PURPOSE To investigate the relationship between aponeurotic expansion of supraspinatus tendon and disorders of biceps brachii long head (LHB), supraspinatus and subscapularis tendons. METHODS Images of 3.0 T shoulder magnetic resonance images (MRI) of a total of 154 patients and 157 shoulders (3 cases with bilateral imaging) between the ages of 18-45 were retrospectively evaluated for the presence of aponeurotic expansion. When identified it was further categorized according to its thickness. Tendinopathy and tears of LHB, supraspinatus and subscapularis tendons and LHB subluxations were evaluated individually. Statistical analyses were performed using Chi-square, Fisher's exact, Mann-Whitney U and Kruskall-Wallis tests. Odds ratio and multiple logistic regression analyses were performed when applicable. p < 0.05 was considered as statistically significant. RESULTS A total of 82 male and 72 female cases with a mean age of 34 (±8.2) were included. Aponeurotic expansion could be identified in 31 cases (19.8 %). MRI findings for LHB disorders in this group was significantly higher (p = 0.01). The adjusted odds ratio of having LHB tendinopathy in the presence of aponeurotic expansion was 3.25 (% 95 CI:1.29-8.19). No significant correlation was found between presence of aponeurotic expansion and subscapularis or supraspinatus tendon disorders (p = 0.66 and p = 0.792 respectively). Age was a significant variable for disorders of all three tendons (p < 0.001). CONCLUSION On 3.0 T MRI, findings of LHB tendon disorders were significantly more common in cases with aponeurotic expansion of supraspinatus tendon. This anatomical variation may have an unrecognized clinical significance.
Collapse
|
|
37
|
Rosenthal J, Nguyen ML, Karas S, Gottschalk M, Daly C, Wagner E, Singer AD. A comprehensive review of the normal, abnormal, and post-operative MRI appearance of the proximal biceps brachii. Skeletal Radiol 2020; 49:1333-1344. [PMID: 32219466 DOI: 10.1007/s00256-020-03415-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 02/26/2020] [Accepted: 03/08/2020] [Indexed: 02/02/2023]
Abstract
The biceps brachii myotendinous unit, particularly the long head of the biceps tendon and its labral attachment, is a common cause of shoulder and arm pain. Its complex anatomy and normal variations can present a challenge when interpreting MR images. The purpose of this manuscript is to review the proximal biceps anatomy, variants, pathology, and post-operative appearance as seen on MRI. Recent data regarding the accuracy of clinical examination and MRI will be summarized.
Collapse
Affiliation(s)
| | - My-Linh Nguyen
- Department of Radiology and Imaging Sciences, Section of Musculoskeletal Imaging, Emory University Hospital, 59 Executive Park South, 4th Floor Suite 4009, Atlanta, GA, 30329, USA
| | - Spero Karas
- Department of Orthopaedics, Emory University Hospital, Atlanta, GA, USA
| | | | - Charles Daly
- Department of Orthopaedics, Emory University Hospital, Atlanta, GA, USA
| | - Eric Wagner
- Department of Orthopaedics, Emory University Hospital, Atlanta, GA, USA
| | - Adam D Singer
- Department of Radiology and Imaging Sciences, Section of Musculoskeletal Imaging, Emory University Hospital, 59 Executive Park South, 4th Floor Suite 4009, Atlanta, GA, 30329, USA.
| |
Collapse
|
|
38
|
Arthroskopische Therapie der glenohumeralen Arthrose. ARTHROSKOPIE 2020. [DOI: 10.1007/s00142-020-00393-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
|
39
|
Can subcoracoid cyst formation be a sign of anterosuperior rotator cuff tears and biceps pulley lesions? A prospective radiologic and arthroscopic correlation study. J Shoulder Elbow Surg 2020; 29:1665-1670. [PMID: 32192879 DOI: 10.1016/j.jse.2019.11.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 11/21/2019] [Accepted: 11/23/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND The aim of this study was to investigate the pathologies associated with subcoracoid cysts (ScCs) in patients with rotator cuff (RC) tears and the postoperative appearance of ScCs after arthroscopic repair. METHODS A total of 114 patients who underwent arthroscopic RC repair were prospectively evaluated. The inclusion criteria were as follows: patients with or without ScCs, patients with Patte class 1 or 2 tears, and patients who were 40-65 years of age. Forty-four patients with ScCs (group 1) were evaluated during the 12-month study period. Fifty-two patients who had no ScCs (group 2) were evaluated as a control group. Preoperative and postoperative cyst volumes were measured on magnetic resonance imaging (MRI), and arthroscopic findings were noted. RESULTS Thirty-one patients (70%) in group 1 had a subscapularis tear vs. 10 patients (19%) in group 2 (P < .001). Biceps lesions were encountered in 32 patients (72%) in group 1, whereas 12 patients (23%) had a biceps lesion in group 2 (P < .001). Cyst volume was significantly higher in the following situations: (1) patients who had a subscapularis tear compared with patients without a subscapularis tear, (2) patients who had biceps pulley lesions compared with patients without pulley lesions, and (3) patients who had both pathologies (P = .047, P = .01, and P = .002, respectively). Cyst volumes significantly decreased following RC repair in group 1 (P < .001). CONCLUSION Among patients with small- to medium-sized, full-thickness supraspinatus tears, the prevalence of biceps pulley lesions and/or subscapularis tears is higher in patients with ScCs.
Collapse
|
|
40
|
Chae SH, Jung TW, Lee SH, Kim MJ, Park SM, Jung JY, Yoo JC. Hidden Long Head of the Biceps Tendon Instability and Concealed Intratendinous Subscapularis Tears. Orthop J Sports Med 2020; 8:2325967119898123. [PMID: 32656285 PMCID: PMC7333499 DOI: 10.1177/2325967119898123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Accepted: 09/03/2019] [Indexed: 11/26/2022] Open
Abstract
Background: Few studies have described the characteristics of a concealed intratendinous subscapularis tear (CIST), and there is a lack of research on the preoperative predictability of such lesions. Purpose: To describe the characteristics of a CIST as seen on magnetic resonance imaging (MRI) and intraoperatively and to develop a scoring system for predicting such lesions. Study Design: Case series; Level of evidence, 4. Methods: Retrospectively, we identified 43 patients with CISTs among 442 consecutive patients who had undergone rotator cuff repair from July 2014 to June 2016. Range of motion, visual analog scale results for pain and function, and patient-reported outcome scores were evaluated preoperatively and at 1 and 2 years postoperatively. CISTs were classified arthroscopically as small (<5 mm), medium (5-10 mm), and large (>10 mm). We performed repair (≥50%) or debridement (<50%) depending on the total subscapularis tendon tear size including the CIST. Preoperative MRI findings were analyzed by 2 observers and were correlated with the arthroscopic findings. A 10-point scoring system was developed based on characteristics during the physical examination (anterior tenderness, bear hug sign), MRI (biceps tendon displacement and subluxation, subscapularis signal change just lateral to the lesser tuberosity), and arthroscopic surgery (medial biceps tendon lesion, combined subscapularis tendon tear), with a cutoff value of ≥7 predicting a CIST. After the retrospective study, we prospectively enrolled 95 patients to validate the 10-point CIST scoring system. Results: All 43 patients diagnosed with a CIST during the retrospective study improved both range of motion and functional scores at 1 year postoperatively. The interrater agreement of the 2 observers was substantial for the evaluation of all parameters except for subscapularis tear classification, which was moderate. On arthroscopic surgery, 11 small, 19 medium, and 13 large CISTs were detected. The preliminary prospective study showed a sensitivity of 61.9%, specificity of 94.3%, positive predictive value of 89.0%, negative predictive value of 75.7%, and accuracy of 80.0% when the cutoff value was set at ≥7 on the CIST scoring system. Conclusion: A CIST can be suspected using a combination of preoperative MRI and intra-articular diagnostic arthroscopic findings, but a definitive diagnosis requires an arthroscopic view. On the 10-point CIST scoring system, a score of ≥5 can be suggestive of a CIST, and a score of ≥7 is most likely to predict a CIST.
Collapse
Affiliation(s)
- Sang Hoon Chae
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Tae Wan Jung
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sang Hyeon Lee
- Department of Orthopaedics, Graduate School, Kyung Hee University, Seoul, Republic of Korea
| | - Myo Jong Kim
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Seung Min Park
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jeung Yeol Jung
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jae Chul Yoo
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| |
Collapse
|
|
41
|
Dekker TJ, Aman ZS, Peebles LA, Storaci HW, Chahla J, Millett PJ, Provencher MT. Quantitative and Qualitative Analyses of the Glenohumeral Ligaments: An Anatomic Study. Am J Sports Med 2020; 48:1837-1845. [PMID: 32441993 DOI: 10.1177/0363546520917665] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND While several studies have qualitatively described the anatomy of the glenohumeral ligaments, there remains a lack of consensus regarding their quantitative humeral and glenoid attachment sites. PURPOSE To quantitatively and qualitatively describe the anatomic humeral and glenoid attachment sites of the glenohumeral ligaments and their relationship to well-established anatomic landmarks. STUDY DESIGN Descriptive laboratory study. METHODS A total of 10 nonpaired, fresh-frozen human cadaveric shoulders were included in this study. A 3-dimensional coordinate measuring device was used to quantify the location of pertinent bony landmarks and soft tissue attachment areas. All subcutaneous tissues and musculature were removed, with the exception of the rotator cuff (respective muscle bellies cut at their musculotendinous junctions) and the long head of the biceps tendon. The superior glenohumeral ligament (SGHL), middle glenohumeral ligament (MGHL), anteroinferior glenohumeral ligament (AIGHL), posteroinferior glenohumeral ligament (PIGHL), and coracohumeral ligament (CHL) were then transected. Coordinates of points along the perimeters of attachment sites were used to calculate areas, while coordinates of center points were used to determine distances between surgically relevant attachment sites and pertinent bony landmarks. RESULTS The mean length of the SGHL humeral attachment along the intra-articular cartilage margin was 9.5 ± 3.2 mm, spanning from 12:55 to 1:40, while the SGHL glenoid attachment to the labrum was 1.9 ± 1.2 mm medial to the most lateral extent of the labral rim, spanning from 12:30 to 12:45. The mean length of the MGHL attachment along the intra-articular cartilage margin was 16.4 ± 3.0 mm, equating to 2:10 to 3:35 on the humeral head clockface, and the glenoid attachment was confluent with the labrum, attaching 1.5 ± 1.0 mm medial to the most lateral extent of the labral rim and thus extending from 1:50 to 2:35 on the glenoid clockface. The mean length of the AIGHL attachment along the intra-articular cartilage margin was 12.0 ± 3.0 mm, spanning from 4:05 to 5:10 on the humeral head clockface. The AIGHL bony footprint on the glenoid neck was 48.4 ± 24.5 mm2. The confluent attachment of the AIGHL to the labrum was 1.2 ± 0.9 mm medial to the most lateral extent of the labral rim, corresponding to 3:30 to 4:05 on the glenoid clockface. The mean length of the PIGHL attachment along the intra-articular cartilage margin was 12.0 ± 1.4 mm, spanning from 7:40 to 8:50 on the humeral head clockface. The PIGHL attachment to the labrum was 1.2 ± 0.5 mm medial to the most lateral extent of the labral rim. This attachment to the labrum was calculated to span from 7:35 to 8:50 on the glenoid clockface. The mean length of the CHL origin from the coracoid was 12.9 mm, with its most anterior point located a mean of 14.1 mm from the tip of the coracoid. The mean length of the CHL attachment along the intra-articular cartilage margin was 10.0 ± 4.0 mm, spanning from 11:55 to 12:40 on the humeral head clockface. CONCLUSION Glenohumeral ligaments were consistently identified in all specimens with minor anatomic variability for the SGHL, MGHL, AIGHL, and PIGHL. Important landmarks including the cartilage surface of the humerus, the bicipital groove, and the clockface can be utilized intraoperatively when attempting anatomic repair of these structures. CLINICAL RELEVANCE There are multiple open and arthroscopic shoulder procedures that rely on anatomic restoration of these static stabilizers to provide optimal shoulder function and prevent recurrent instability. The qualitative descriptions are comparable with current literature; however, this study is the first to quantify the glenohumeral capsular and ligamentous attachments. The data provided allow for reliable landmarks to be established from known bony and soft tissue structures.
Collapse
Affiliation(s)
- Travis J Dekker
- Steadman Philippon Research Institute, Vail, Colorado, USA.,The Steadman Clinic, Vail, Colorado, USA
| | - Zachary S Aman
- Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Liam A Peebles
- Steadman Philippon Research Institute, Vail, Colorado, USA
| | | | - Jorge Chahla
- Rush University Medical Center, Chicago, Illinois, USA
| | - Peter J Millett
- Steadman Philippon Research Institute, Vail, Colorado, USA.,The Steadman Clinic, Vail, Colorado, USA
| | - Matthew T Provencher
- Steadman Philippon Research Institute, Vail, Colorado, USA.,The Steadman Clinic, Vail, Colorado, USA
| |
Collapse
|
|
42
|
Kim J, Nam JH, Kim Y, Kim JS, Kim SH. Long Head of the Biceps Tendon Tenotomy versus Subpectoral Tenodesis in Rotator Cuff Repair. Clin Orthop Surg 2020; 12:371-378. [PMID: 32904028 PMCID: PMC7449864 DOI: 10.4055/cios19168] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 12/26/2019] [Indexed: 11/08/2022] Open
Abstract
Backgroud Lesions of the long head of the biceps tendon (LHBT) are one of the most common pathologies in patients with a rotator cuff tear. Although various procedures have been shown to be effective for treating LHBT lesions during rotator cuff repair, no consensus has been reached regarding the most effective treatment. The purpose of this study was to compare the outcomes of tenotomy vs subpectoral tenodesis of the LHBT in arthroscopic rotator cuff repair. Methods The records of 135 patients who underwent arthroscopic rotator cuff repair with biceps tenotomy or subpectoral tenodesis for a partial LHBT tear of > 50% were initially reviewed. Finally, 77 patients (38 patients with tenotomy and 39 patients with subpectoral tenodesis) with an intact rotator cuff, who underwent a functional evaluation at 1 year postoperatively, were enrolled in this retrospective study. Results The average follow-up was 13.3 ± 4.36 months (13.2 ± 1.4 months in the tenotomy group and 13.6 ± 2.7 months in the subpectoral tenodesis group; p = 0.416). Demographic and surgical data were not significantly different between the 2 groups. Preoperatively, biceps groove tenderness, Speed's test, and Yergason test results were positive in 27.3%, 27.3%, and 10.4% of the study subjects, respectively. Compared with preoperative values, all functional scores including shoulder muscle power were significantly improved postoperatively, and no significant intergroup difference was observed (all p > 0.05). A visible Popeye deformity was not encountered in either group at the final follow-up. Eight patients in the tenotomy group and 7 patients in the subpectoral tenodesis group complained of mild anterior shoulder pain (p = 0.731), and 4 patients in each group complained of groove tenderness (p = 0.969). No surgical or postoperative complication occurred in either group. Conclusions Both biceps tenotomy and subpectoral tenodesis performed during rotator cuff repair improved pain and function and resulted in comparable clinical outcomes. Residual symptoms associated with the remnant LHBT in the groove may not be a problem after adhesion of LHBT.
Collapse
Affiliation(s)
- Jangwoo Kim
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Ji Hoon Nam
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Yuna Kim
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jong Seop Kim
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Sae Hoon Kim
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| |
Collapse
|
|
43
|
Martetschläger F, Zampeli F, Tauber M, Habermeyer P. Lesions of the biceps pulley: a prospective study and classification update. JSES Int 2020; 4:318-323. [PMID: 32490420 PMCID: PMC7256895 DOI: 10.1016/j.jseint.2020.02.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Hypothesis The purpose of the study was to investigate which anatomic structures are affected in a series of patients with pulley lesions and whether all lesions can be classified according to the Habermeyer classification. Methods One hundred consecutive patients with pulley lesions were prospectively studied. During arthroscopy, lesions of the superior glenohumeral ligament (SGHL), medial coracohumeral ligament (MCHL) and/or lateral coracohumeral ligament (LCHL), adjacent rotator cuff, and biceps (long head of the biceps) were recorded. All lesions were then classified according to the Habermeyer classification. The χ2 test was used for statistical analysis. Results There were 3 lesions in group 1, 20 in group 2, 6 in group 3, and 35 in group 4 according to the Habermeyer classification. Thirty-six lesions were not classifiable because of an intact SGHL. A lateral pulley sling (LCHL) lesion was found in 95% of the patients, and a medial pulley sling (MCHL-SGHL) lesion was noted 64%. An isolated lesion of the MCHL and/or SGHL was present in 5%, and an isolated lesion of the LCHL was found in 36%. Combined medial-lateral sling lesions were correlated with complete subscapularis tears and biceps fraying. Conclusion The lateral pulley sling is more often affected than the medial sling. The SGHL is not always affected, and isolated lesions of the medial sling are rare. Lesions of both slings correlated with complete subscapularis tears and fraying of the long head of the biceps. An updated classification of direct pulley lesions is proposed: type 1, lesion of the medial pulley (MCHL and/or SGHL); type 2, lesion of the lateral pulley (LCHL); and type 3, lesion of the medial and lateral pulley slings. Concomitant lesions of the indirect pulley stabilizers can be mentioned additionally according to the well-known classifications.
Collapse
Affiliation(s)
- Frank Martetschläger
- Department of Shoulder and Elbow Surgery, ATOS Clinic Munich, Munich, Germany.,Department for Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Frantzeska Zampeli
- Department of Shoulder and Elbow Surgery, ATOS Clinic Munich, Munich, Germany
| | - Mark Tauber
- Department of Shoulder and Elbow Surgery, ATOS Clinic Munich, Munich, Germany.,Department of Traumatology and Sports Injuries, Paracelsus Medical University, Salzburg, Austria
| | - Peter Habermeyer
- Department of Shoulder and Elbow Surgery, ATOS Clinic Munich, Munich, Germany
| |
Collapse
|
|
44
|
Schmalzl J, Plumhoff P, Gilbert F, Gohlke F, Konrads C, Brunner U, Jakob F, Ebert R, Steinert AF. The inflamed biceps tendon as a pain generator in the shoulder: A histological and biomolecular analysis. J Orthop Surg (Hong Kong) 2020; 27:2309499018820349. [PMID: 30739571 DOI: 10.1177/2309499018820349] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION The long head of the biceps (LHB) is often resected in shoulder surgery. However, its contribution to inflammatory processes in the shoulder remains unclear. In the present study, inflamed and noninflamed human LHBs were comparatively characterized for features of inflammation. MATERIALS AND METHODS Twenty-two resected LHB tendons were classified into inflamed ( n = 11) and noninflamed ( n = 11) samples. For histological examination, samples were stained with hematoxylin eosin, Azan, van Gieson, and Masson Goldner trichrome. Neuronal tissue was immunohistochemically visualized. In addition, specific inflammatory marker gene expression of primary LHB-derived cell cultures were analyzed. RESULTS Features of tendinopathy, such as collagen disorganization, infiltration by inflammatory cells, neovascularization, and extensive neuronal innervation were found in the tendinitis group. Compared to noninflamed samples, inflamed LHBs showed a significantly increased inflammatory marker gene expression. CONCLUSION Structural and biomolecular differences of both groups suggest that the LHB tendon acts as an important pain generator in the shoulder joint. These findings can, on the one hand, contribute to the understanding of the biomolecular genesis of LHB tendinitis and, on the other hand, provide possibilities for new therapeutic approaches.
Collapse
Affiliation(s)
- J Schmalzl
- 1 Department of Orthopaedic Surgery, Julius Maximilians University of Wuerzburg, Wuerzburg, Germany.,2 Department of Traumatology and Hand Surgery, St. Vincentius Clinic, Suedendstraße Karlsruhe, Germany
| | - P Plumhoff
- 1 Department of Orthopaedic Surgery, Julius Maximilians University of Wuerzburg, Wuerzburg, Germany
| | - F Gilbert
- 1 Department of Orthopaedic Surgery, Julius Maximilians University of Wuerzburg, Wuerzburg, Germany.,3 Department of Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital of Wuerzburg, Wuerzburg, Germany
| | - F Gohlke
- 1 Department of Orthopaedic Surgery, Julius Maximilians University of Wuerzburg, Wuerzburg, Germany.,4 Clinic for Shoulder Surgery, Rhoen Klinikum AG, Bad Neustadt/Saale, Germany
| | - C Konrads
- 1 Department of Orthopaedic Surgery, Julius Maximilians University of Wuerzburg, Wuerzburg, Germany
| | - U Brunner
- 5 Department of Orthopaedic and Trauma Surgery, Norbert-Kerkel-Platz, Krankenhaus Agatharied GmbH, Hausham, Germany
| | - F Jakob
- 1 Department of Orthopaedic Surgery, Julius Maximilians University of Wuerzburg, Wuerzburg, Germany
| | - R Ebert
- 1 Department of Orthopaedic Surgery, Julius Maximilians University of Wuerzburg, Wuerzburg, Germany
| | - A F Steinert
- 1 Department of Orthopaedic Surgery, Julius Maximilians University of Wuerzburg, Wuerzburg, Germany.,5 Department of Orthopaedic and Trauma Surgery, Norbert-Kerkel-Platz, Krankenhaus Agatharied GmbH, Hausham, Germany
| |
Collapse
|
|
45
|
Li D, Wang W, Liu Y, Ma X, Huang S, Qu Z. The backward traction test: a new and effective test for diagnosis of biceps and pulley lesions. J Shoulder Elbow Surg 2020; 29:e37-e44. [PMID: 31526561 DOI: 10.1016/j.jse.2019.07.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Revised: 06/25/2019] [Accepted: 07/01/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND The value of physical examination for diagnosis of lesions of the long head of the biceps (LHB) and the pulley remains unsatisfactory. The purpose of this study was to describe a new diagnostic test, the backward traction (BT) test, to detect lesions of the LHB and the biceps pulley. METHODS A prospective study of 143 patients was performed to evaluate the diagnostic value of the BT test and 2 traditional clinical tests (Speed and Yergason tests). Shoulder arthroscopy was used as the "gold standard." RESULTS For the detection of LHB injury, the BT test was the most sensitive (74%) and accurate (68%). The BT test had a higher diagnostic value for pulley lesions, with a high sensitivity of 81% and an accuracy of 71%. No significant differences in terms of specificity for LHB and pulley lesions were observed between tests. Regarding pulley lesions, the internally rotated and externally rotated BT test positions had high specificity for the diagnosis of specific anteromedial and posterolateral pulley lesions (79% and 73%, respectively). The BT test had a high κ coefficient of 0.768-0.811. CONCLUSION The BT test is more sensitive and accurate as a new test for LHB and pulley lesions and also specific to distinguish the medial sling and lateral sling lesions of the pulley.
Collapse
Affiliation(s)
- Danmei Li
- Department of Sports Medicine, The Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Weiming Wang
- Department of Sports Medicine, The Affiliated Zhongshan Hospital of Dalian University, Dalian, China.
| | - Yupeng Liu
- Department of Sports Medicine, The Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Xiaojun Ma
- Department of Sports Medicine, The Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Shibo Huang
- Department of Sports Medicine, The Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Zhenan Qu
- Department of Sports Medicine, The Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| |
Collapse
|
|
46
|
Loock E, Michelet A, D'Utruy A, Molinazzi P, Hannink G, Bertiaux S, Courage O. Magnetic resonance arthrography is insufficiently accurate to diagnose biceps lesions prior to rotator cuff repair. Knee Surg Sports Traumatol Arthrosc 2019; 27:3970-3978. [PMID: 31346668 DOI: 10.1007/s00167-019-05633-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 07/15/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate the diagnostic accuracy between magnetic resonance arthrography (MRA) and arthroscopic examination for the assessment of pathologies of the long head of the biceps (LHB) prior to rotator cuff (RC) repair. The hypothesis was that MRA is suitable to identify biceps instabilities, due to improved visibility of the biceps pulley. METHODS Sixty-six patients aged 58.5 ± 17.6 (range, 46-71) scheduled to have RC repair between 2016 and 2017 were prospectively enrolled. MRA images of the LHB were interpreted by one radiologist and two surgeons, then compared to arthroscopic findings. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated by comparing MRA axial readings to arthroscopic assessment in the neutral position (static instability), MRA sagittal readings to arthroscopic assessment in external rotation (dynamic s instability), MRA coronal and axial readings to arthroscopic assessment in the neutral position (tendinopathy). RESULTS Among the three observers, the radiologist obtained the highest sensitivity and specificity for MRA, which were respectively: (1) for static instability, 62% (C.I. 35-85) and 77% (C.I. 63-88); (2) for dynamic instability, 50% (C.I. 29-71) and 62% (C.I. 46-77), and (3) for tendinopathy, 49% (C.I. 36-62) and 100% (C.I. 3-100). CONCLUSIONS MRA is not suitable for the diagnosis of LHB lesions prior to arthroscopic rotator cuff repair. LEVEL OF EVIDENCE Diagnostic study, Level I.
Collapse
Affiliation(s)
- Elise Loock
- Service de chirurgie orthopédique et traumatologique, CHRU de Lille, avenue du professeur Emile Laine, Lille, France
| | - Aude Michelet
- ReSurg SA, Chemin de Vuarpilliere 35, 1260, Nyon, Switzerland.
| | - Amaury D'Utruy
- Hopital Privé de Versailles, Clinique des Franciscaines, Versailles, France.,Hôpital Européen Georges-Pompidou, Paris, France
| | - Pierre Molinazzi
- Ramsay Générale de Santé, Hôpital Privé de l'Estuaire, Le Havre, France
| | - Gerjon Hannink
- Orthopaedic Research Laboratory, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Simon Bertiaux
- Ramsay Générale de Santé, Hôpital Privé de l'Estuaire, Le Havre, France
| | - Olivier Courage
- Ramsay Générale de Santé, Hôpital Privé de l'Estuaire, Le Havre, France
| |
Collapse
|
|
47
|
Cardoso A, Amaro P, Barbosa L, Coelho AM, Alonso R, Pires L. Diagnostic accuracy of clinical tests directed to the long head of biceps tendon in a surgical population: a combination of old and new tests. J Shoulder Elbow Surg 2019; 28:2272-2278. [PMID: 31500987 DOI: 10.1016/j.jse.2019.07.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 06/25/2019] [Accepted: 07/01/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Our objective was to examine the clinical utility of old and new clinical tests directed to the long head of the biceps tendon (LHBT) and to quantify the importance of proper test interpretation. METHODS A consecutive 65 patients scheduled to undergo arthroscopic surgery were selected. Before surgery, 5 clinical tests were performed: Speed, Yergason, upper cut, biceps resisted flexion (BRF), and modified BRF (mBRF) using a dumbbell. Pain in an area other than the bicipital groove was noted. The presence of LHBT disease was assessed at arthroscopy, and the clinical utility of the tests was calculated. RESULTS The upper cut test was the most sensitive test and the one with the lowest negative likelihood ratio (0.90 and 0.26, respectively); the Yergason test was the most specific and the one with the highest positive likelihood ratio (0.83 and 2.20, respectively). BRF strength did not correlate with an LHBT lesion. The mBRF test has a sensitivity of 0.34 and a specificity of 0.75. Higher age predicted an increased risk of an LHBT lesion (1.2 times). Different interpretations of the tests can result in a difference of up to 29 percentage points in performance (ie, sensitivity). CONCLUSION Our results suggest that the upper cut test should be used as a screening test and that after a positive result, the Speed and the Yergason tests should be used as confirmatory tests.
Collapse
Affiliation(s)
- Afonso Cardoso
- Department of Orthopaedics, Hospital Beatriz Ângelo, Loures, Portugal.
| | - Pedro Amaro
- Department of Orthopaedics, Hospital Beatriz Ângelo, Loures, Portugal
| | - Luís Barbosa
- Department of Orthopaedics, Hospital Beatriz Ângelo, Loures, Portugal
| | - Ana M Coelho
- Department of Orthopaedics, Hospital Beatriz Ângelo, Loures, Portugal
| | - Raul Alonso
- Department of Orthopaedics, Hospital Beatriz Ângelo, Loures, Portugal
| | - Luís Pires
- Department of Orthopaedics, Hospital Beatriz Ângelo, Loures, Portugal
| |
Collapse
|
|
48
|
Wirth B, Kunz S, Schwyzer HK, Flury M, Lenz M, Audigé L. Repair of Lafosse I subscapularis lesions brings no benefit in anterosuperior rotator cuff reconstruction. Knee Surg Sports Traumatol Arthrosc 2019; 27:4021-4031. [PMID: 31482182 DOI: 10.1007/s00167-019-05681-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 08/19/2019] [Indexed: 01/22/2023]
Abstract
PURPOSE Optimal management of partial anterosuperior rotator cuff tears is unknown. Our aim was to compare clinical and subjective outcomes of supraspinatus (SSP) repair patients treated with or without repair of an associated superior subscapularis (SSC) partial tear. METHODS SSP repair patients with an associated partial (Lafosse I) tear of the superior SSC tendon were retrospectively examined. Baseline and operative data and the outcomes of shoulder range of motion (ROM), pain level, strength, Constant-Murley Score, complications at 6 months as well as patient-reported Oxford Shoulder Score, Subjective Shoulder Value, and satisfaction at 6- and 24-month post-surgery were compared between patients with and without a repaired SSC tear. Mixed models and propensity-score matching were used to adjust baseline group differences. RESULTS Of 75 eligible patients, 34 had an SSC repair and were younger with better baseline function. Non-repair surgeries were significantly shorter by 34 min (95% CI 23-45; p < 0.001). There were no group differences in the clinical and patient-rated outcome scores at both follow-ups (n.s.) as well as in pain, muscle strength in abduction, ROM, the 6-month complication risk (risk difference - 1.9%), and satisfaction with postoperative shoulder condition (n.s.). CONCLUSION We could not show a functional or subjective benefit of repairing cranial partial tears of the SSC tendon over debridement only in the setting of an SSP reconstruction with 24 months of follow-up. A longer operative duration is expected if a partial SSC tear repair is performed. LEVEL OF EVIDENCE III.
Collapse
Affiliation(s)
- Barbara Wirth
- Shoulder and Elbow Surgery Department, Schulthess Clinic, Zurich, Switzerland
| | - Sebastian Kunz
- Research and Development Department, Schulthess Clinic, Lengghalde 2, 8008, Zurich, Switzerland.,Department of Orthopaedic Surgery and Traumatology, University Hospital of Basel, Basel, Switzerland
| | | | - Matthias Flury
- Shoulder and Elbow Surgery Department, Schulthess Clinic, Zurich, Switzerland.,Center for Orthopaedics and Neurosurgery, In-Motion, Wallisellen, Switzerland
| | - Maximilian Lenz
- Shoulder and Elbow Surgery Department, Schulthess Clinic, Zurich, Switzerland.,Department of Orthopaedic and Trauma Surgery, University Hospital of Cologne, Cologne, Germany
| | - Laurent Audigé
- Shoulder and Elbow Surgery Department, Schulthess Clinic, Zurich, Switzerland. .,Research and Development Department, Schulthess Clinic, Lengghalde 2, 8008, Zurich, Switzerland.
| |
Collapse
|
|
49
|
[Painful shoulder: Frequent shoulder diseases, diagnosis and therapy]. MMW Fortschr Med 2019; 161:62-73. [PMID: 31587241 DOI: 10.1007/s15006-019-0027-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
|
50
|
Schmalzl J, Plumhoff P, Gilbert F, Gohlke F, Konrads C, Brunner U, Jakob F, Ebert R, Steinert AF. Tendon-derived stem cells from the long head of the biceps tendon: Inflammation does not affect the regenerative potential. Bone Joint Res 2019; 8:414-424. [PMID: 31588358 PMCID: PMC6775540 DOI: 10.1302/2046-3758.89.bjr-2018-0214.r2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Objectives The long head of the biceps (LHB) is often resected in shoulder surgery and could therefore serve as a cell source for tissue engineering approaches in the shoulder. However, whether it represents a suitable cell source for regenerative approaches, both in the inflamed and non-inflamed states, remains unclear. In the present study, inflamed and native human LHBs were comparatively characterized for features of regeneration. Methods In total, 22 resected LHB tendons were classified into inflamed samples (n = 11) and non-inflamed samples (n = 11). Proliferation potential and specific marker gene expression of primary LHB-derived cell cultures were analyzed. Multipotentiality, including osteogenic, adipogenic, chondrogenic, and tenogenic differentiation potential of both groups were compared under respective lineage-specific culture conditions. Results Inflammation does not seem to affect the proliferation rate of the isolated tendon-derived stem cells (TDSCs) and the tenogenic marker gene expression. Cells from both groups showed an equivalent osteogenic, adipogenic, chondrogenic and tenogenic differentiation potential in histology and real-time polymerase chain reaction (RT-PCR) analysis. Conclusion These results suggest that the LHB tendon might be a suitable cell source for regenerative approaches, both in inflamed and non-inflamed states. The LHB with and without tendinitis has been characterized as a novel source of TDSCs, which might facilitate treatment of degeneration and induction of regeneration in shoulder surgery. Cite this article: J. Schmalzl, P. Plumhoff, F. Gilbert, F. Gohlke, C. Konrads, U. Brunner, F. Jakob, R. Ebert, A. F. Steinert. Tendon-derived stem cells from the long head of the biceps tendon: Inflammation does not affect the regenerative potential. Bone Joint Res 2019;8:414–424. DOI: 10.1302/2046-3758.89.BJR-2018-0214.R2.
Collapse
Affiliation(s)
- Jonas Schmalzl
- Department of Orthopaedic Surgery, Julius-Maximilians-University, Wuerzburg, Germany; Department of Traumatology and Hand Surgery, St. Vincentius Clinic, ViDia Clinis, Teaching Hospital Albert-Ludwigs University Freiburg, Karlsruhe, Germany
| | - Piet Plumhoff
- Department of Orthopaedic Surgery, Julius-Maximilians-University, Wuerzburg, Germany
| | - Fabian Gilbert
- Department of Orthopaedic Surgery, Julius-Maximilians-University, Wuerzburg, Germany; Department of Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital, Wuerzburg, Germany
| | - Frank Gohlke
- Department of Orthopaedic Surgery, Julius-Maximilians-University, Wuerzburg, Germany; Clinic for Shoulder Surgery, Rhoen Klinikum AG, Bad Neustadt an der Saale, Germany
| | - Christian Konrads
- Department of Orthopaedic Surgery, Julius-Maximilians-University, Wuerzburg, Germany
| | - Ulrich Brunner
- Department of Orthopaedic and Trauma Surgery, Krankenhaus Agatharied GmbH, Hausham, Germany
| | - Franz Jakob
- Department of Orthopaedic Surgery, Julius-Maximilians-University, Wuerzburg, Germany
| | - Regina Ebert
- Department of Orthopaedic Surgery, Julius-Maximilians-University, Wuerzburg, Germany
| | - Andre F Steinert
- Department of Orthopaedic Surgery, Julius-Maximilians-University, Wuerzburg, Germany; Department of Orthopaedic and Trauma Surgery, Krankenhaus Agatharied GmbH, Hausham, Germany
| |
Collapse
|