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Foley RCA, Callaghan DH, Forman GN, Graham JD, Holmes MWR, La Delfa NJ. A comprehensive scoping review and meta-analysis of upper limb strength asymmetry. Sci Rep 2025; 15:4636. [PMID: 39920213 PMCID: PMC11806048 DOI: 10.1038/s41598-025-87413-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2024] [Accepted: 01/20/2025] [Indexed: 02/09/2025] Open
Abstract
The "10% rule" of handedness asserts the dominant hand is 10% stronger than the non-dominant hand. Primarily derived from handgrip data, it is unclear if a generalized asymmetry exists across the upper limb. Understanding how strength asymmetry may be affected by handedness, sex, and exertion type has important implications for ergonomics design, sports performance, and clinical rehabilitation. The purpose of this study was to systematically synthesize currently available evidence examining upper limb strength asymmetry. 10,061 results were retrieved, and 174 studies remained after title/abstract screening. 87 studies were synthesized. Results are compiled by exertion type and manner of asymmetry comparison (i.e. right/left, dominant/non-dominant). Asymmetry ratios were calculated to examine the effects of handedness, exertion side, arm region, and sex. Strength differences were most frequently reported for grip exertions (n = 49). 25 studies reported other joint strength asymmetries. Overall, the right limb was 6.7% stronger than the left limb (n = 9342) and the dominant limb was 11.6% stronger than the non-dominant limb (n = 9327), though strength asymmetry varied across joints and movements (2.1% to 19.5%). This research demonstrates that the 10% rule is a good approximation for upper limb strength asymmetry. However, several factors, including joint, movement type, and sex, can affect this relationship.
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Affiliation(s)
- Ryan C A Foley
- Department of Kinesiology, Faculty of Health Sciences, Ontario Tech University, Oshawa, ON, Canada
| | - Danny H Callaghan
- Department of Kinesiology, Faculty of Health Sciences, Ontario Tech University, Oshawa, ON, Canada
| | - Garrick N Forman
- Department of Kinesiology, Faculty of Applied Health Sciences, Brock University, St Catharine's, ON, Canada
| | - Jeffrey D Graham
- Department of Kinesiology, Faculty of Health Sciences, Ontario Tech University, Oshawa, ON, Canada
- Department of Kinesiology, Faculty of Applied Health Sciences, Brock University, St Catharine's, ON, Canada
| | - Michael W R Holmes
- Department of Kinesiology, Faculty of Applied Health Sciences, Brock University, St Catharine's, ON, Canada
| | - Nicholas J La Delfa
- Department of Kinesiology, Faculty of Health Sciences, Ontario Tech University, Oshawa, ON, Canada.
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Jokiel M, Kazmierczak K, Czarnecki P, Bartkowiak-Graczyk A, Madziewicz A, Breborowicz E, Miedzyblocka M, Adamski M, Kaczmarek K, Kaczmarek L, Romanowski L. Biomechanical Examination of Wrist Flexors and Extensors with Biodex System Dynamometer-Isometric, Isokinetic and Isotonic Protocol Options. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1184. [PMID: 39064613 PMCID: PMC11278849 DOI: 10.3390/medicina60071184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Revised: 07/03/2024] [Accepted: 07/11/2024] [Indexed: 07/28/2024]
Abstract
Background and Objectives: Biodex System® is an advanced dynamometer used for testing various biomechanical parameters of muscles. Test outcomes allow for the identification of muscle pathology and consequently lead to a clinical diagnosis. Despite being widely used for the testing and rehabilitation of the human musculoskeletal system, no universal and acceptable protocol for wrist examination has been proposed for patients with wrist pathology. In this study, the authors aim to identify the most appropriate protocol for testing the biomechanical parameters of flexors and extensors of the wrist. Materials and Methods: A group of 20 patients with symptomatic tennis elbow and 26 healthy volunteers were examined using three different protocols: isokinetic, isometric and isotonic. Protocol order for each study participant was assigned at random with a minimum of a 24 h break between protocols. All protocol parameters were set according to data obtained from a literature review and an earlier pilot study. Following completion of each protocol, participants filled out a questionnaire-based protocol, assessing pain intensity during the exam, difficulty with exam performance and post-exam muscle fatigue. Results: The isotonic protocol showed the best patient tolerance and the highest questionnaire score. There was a significant difference (p < 0.05) between the three protocols in average pain intensity reported by study participants. All participants completed the isotonic protocol, but not all patients with symptomatic tennis elbow were able to complete the isometric and isokinetic protocols. The isotonic protocol was deemed "difficult but possible to complete" by study participants. Conclusions: The isotonic protocol is most suitable for testing the flexors and extensors of the wrist. It gives the most biomechanical data of all protocols, is well tolerated by patients and rarely causes pain during examination even in symptomatic participants.
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Affiliation(s)
- Marta Jokiel
- Traumatology, Orthopedics and Hand Surgery Department, Poznan University of Medical Sciences, 61-701 Poznan, Poland
- Physiotherapy Department, Poznan University of Medical Sciences, 61-701 Poznan, Poland
| | - Katarzyna Kazmierczak
- Department of Rehabilitation, Poznan University of Medical Sciences, 61-701 Poznan, Poland
| | - Piotr Czarnecki
- Traumatology, Orthopedics and Hand Surgery Department, Poznan University of Medical Sciences, 61-701 Poznan, Poland
| | - Aleksandra Bartkowiak-Graczyk
- Traumatology, Orthopedics and Hand Surgery Department, Poznan University of Medical Sciences, 61-701 Poznan, Poland
- Physiotherapy Department, Poznan University of Medical Sciences, 61-701 Poznan, Poland
| | - Anna Madziewicz
- Traumatology, Orthopedics and Hand Surgery Department, Poznan University of Medical Sciences, 61-701 Poznan, Poland
- Physiotherapy Department, Poznan University of Medical Sciences, 61-701 Poznan, Poland
| | - Ewa Breborowicz
- Traumatology, Orthopedics and Hand Surgery Department, Poznan University of Medical Sciences, 61-701 Poznan, Poland
| | - Malgorzata Miedzyblocka
- Traumatology, Orthopedics and Hand Surgery Department, Poznan University of Medical Sciences, 61-701 Poznan, Poland
| | - Michal Adamski
- Traumatology, Orthopedics and Hand Surgery Student Scientific Group, Poznan University of Medical Sciences, 61-701 Poznan, Poland
| | - Krystian Kaczmarek
- Traumatology, Orthopedics and Hand Surgery Student Scientific Group, Poznan University of Medical Sciences, 61-701 Poznan, Poland
| | - Leszek Kaczmarek
- Traumatology, Orthopedics and Hand Surgery Department, Poznan University of Medical Sciences, 61-701 Poznan, Poland
| | - Leszek Romanowski
- Traumatology, Orthopedics and Hand Surgery Department, Poznan University of Medical Sciences, 61-701 Poznan, Poland
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Franceschetti E, Giovannetti de Sanctis E, Palumbo A, Paciotti M, La Verde L, Maffulli N, Franceschi F. The management of the long head of the biceps in rotator cuff repair: A comparative study of high vs. subpectoral tenodesis. JOURNAL OF SPORT AND HEALTH SCIENCE 2023; 12:613-618. [PMID: 32791203 PMCID: PMC10466182 DOI: 10.1016/j.jshs.2020.08.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 06/18/2020] [Accepted: 07/01/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Tenodesis of the long head of the biceps (LHB) is commonly undertaken during arthroscopic rotator cuff repair. We assessed the clinical and structural outcomes after high arthroscopic tenodesis (HAT) or mini-open subpectoral tenodesis (ST). We hypothesized that the clinical and structural results after HAT and ST are similar. METHODS We included 40 patients with rotator cuff tear and LHB tendinopathy. Twenty patients (7 women and 13 men; mean age: 57.9 years; range: 56-63 years) were treated using HAT, and 20 patients (8 women and 12 men; mean age: 58.5 years; range: 55-64 years) were treated using ST. Functional evaluation was performed preoperatively and at 6 weeks, 6 months, and 1 year after surgery, using the Constant Murley Score and Simple Shoulder Test scores; the LHB was evaluated using the LHB score. A Visual Analogue Scale was administered to all patients preoperatively and 2 days after surgery. RESULTS The postoperative total and pain subscale's Constant scores were significantly higher in the ST group. Moreover, 2 LHB score values were significantly different between the groups. The postoperative LHB total score in the ST and HAT groups averaged 86.9 ± 4.1 (mean ± SD) points and 73.3 ± 6.4 points, respectively. The Pain/Cramps subscale in the ST and HAT groups averaged 47.1 ± 5.9 and 33.2 ± 4.6 points, respectively. The 2 groups showed no difference in Visual Analogue Scale values (5.5 in the HAT group; 5.8 in the ST group) postoperatively. One patient in the HAT group reported a secondary onset of Popeye deformity. CONCLUSION Both high arthroscopic and mini-open ST of the LHB tendon produced reliably good functional results, but the ST group was associated with better postoperative clinical outcomes.
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Affiliation(s)
- Edoardo Franceschetti
- Department of Orthopaedic and Trauma Surgery, Campus Biomedico University of Rome, Via Alvaro del Portillo 200, 00100 Rome, Italy
| | | | - Alessio Palumbo
- Department of Orthopaedic and Trauma Surgery, Campus Biomedico University of Rome, Via Alvaro del Portillo 200, 00100 Rome, Italy
| | - Michele Paciotti
- Department of Orthopaedic and Trauma Surgery, Campus Biomedico University of Rome, Via Alvaro del Portillo 200, 00100 Rome, Italy
| | - Luca La Verde
- Anca Surgical Center, Via Francesco Maidalchini 20, Roma, 00152, Rome, Italy
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, Via Salvador Allende, 43, 84081 Baronissi, Salerno, Italy; Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, 275 Bancroft Road, London E1 4DG, England, UK; School of Pharmacy and Bioengineering, Keele University School of Medicine, Thornburrow Drive, Stoke on Trent ST4, England, UK.
| | - Francesco Franceschi
- Department of Orthopaedic and Trauma Surgery, Campus Biomedico University of Rome, Via Alvaro del Portillo 200, 00100 Rome, Italy
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Brassart F, Faupin A, Hays A, Bakatchina S, Alberca I, Watelain E, Weissland T. Upper limb cranking asymmetry during a Wingate anaerobic test in wheelchair basketball players. Scand J Med Sci Sports 2023. [PMID: 37186476 DOI: 10.1111/sms.14376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 04/05/2023] [Accepted: 04/07/2023] [Indexed: 05/17/2023]
Abstract
INTRODUCTION Interlimb asymmetry of strength and/or motor coordination could limit the performance of wheelchair athletes or increase their risk of injury. Studies of interlimb asymmetry in the lower limbs have shown high between-subject variability that does not depend on the side of dominance and that does not change with fatigue. Upper limb asymmetry is particularly large in manual wheelchair athletes with a lower degree of impairment. The aim of this study was to evaluate interlimb asymmetry of forces developed during an upper limb Wingate anaerobic test, the effects of fatigue on force, and differences between high- and low-point players. METHOD Twenty-five wheelchair basketball players (13 females and 12 males) of male and female national French teams performed a 30s anaerobic Wingate test on an arm ergometer. Participants were classified into two functional categories, high-point (classed from 3 to 4.5) and low-point (classed from 1 to 2.5), according to the International Wheelchair Basketball Federation classification. Left and right arm forces were measured during the pushing and pulling phases at peak power, 10s, and the end of the 30s test. RESULTS Upper limb asymmetry changed with fatigue during each phase. Force asymmetry differed between peak power, 10s and 30s, with no consistent increase or decrease. Asymmetry did not differ significantly between low- and high-point players but tended to be greater in high-point players. Asymmetry tended to be greater in the females, with significant differences between the males and females in the push phase. CONCLUSION Inter-subject variability was high, but forces were asymmetric for most participants, especially females. The Wingate anaerobic test could highlight problematic asymmetries that might impact daily life or sports performance.
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Affiliation(s)
- Florian Brassart
- Université de Toulon, La Garde, France
- Laboratoire IMS, Pessac, France
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van der Velden LL, Onneweer B, Haarman CJW, Benner JL, Roebroeck ME, Ribbers GM, Selles RW. Development of a single device to quantify motor impairments of the elbow: proof of concept. J Neuroeng Rehabil 2022; 19:77. [PMID: 35864498 PMCID: PMC9306071 DOI: 10.1186/s12984-022-01050-2] [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] [Received: 11/11/2020] [Accepted: 07/06/2022] [Indexed: 11/10/2022] Open
Abstract
Background For patients with post-stroke upper limb impairments, the currently available clinical measurement instruments are inadequate for reliable quantification of multiple impairments, such as muscle weakness, abnormal synergy, changes in elastic joint properties and spasticity. Robotic devices to date have successfully achieved precise and accurate quantification but are often limited to the measurement of one or two impairments. Our primary aim is to develop a robotic device that can effectively quantify four main motor impairments of the elbow. Methods The robotic device, Shoulder Elbow Perturbator, is a one-degree-of-freedom device that can simultaneously manipulate the elbow joint and support the (partial) weight of the human arm. Upper limb impairments of the elbow were quantified based on four experiments on the paretic arm in ten stroke patients (mean age 65 ± 10 yrs, 9 males, post-stroke) and the non-dominant arm in 20 healthy controls (mean age 65 ± 14 yrs, 6 males). The maximum strength of elbow flexor and elbow extensor muscles was measured isometrically at 90-degree elbow flexion. The maximal active extension angle of the elbow was measured under different arm weight support levels to assess abnormal synergy. Torque resistance was analyzed during a slow (6°/s) passive elbow rotation, where the elbow moved from the maximal flexion to maximal extension angle and back, to assess elastic joint properties. The torque profile was evaluated during fast (100°/s) passive extension rotation of the elbow to estimate spasticity. Results The ten chronic stroke patients successfully completed the measurement protocol. The results showed impairment values outside the 10th and 90th percentile reference intervals of healthy controls. Individual patient profiles were determined and illustrated in a radar figure, to support clinicians in developing targeted treatment plans. Conclusion The Shoulder Elbow Perturbator can effectively quantify the four most important impairments of the elbow in stroke patients and distinguish impairment scores of patients from healthy controls. These results are promising for objective and complete quantification of motor impairments of the elbow and monitoring patient prognosis. Our newly developed Shoulder Elbow Perturbator can therefore in the future be employed to evaluate treatment effects by comparing pre- and post-treatment assessments. Supplementary Information The online version contains supplementary material available at 10.1186/s12984-022-01050-2.
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Affiliation(s)
- Levinia Lara van der Velden
- Department of Rehabilitation Medicine, Erasmus MC University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands. .,Rijndam Rehabilitation, Westersingel 300, 3015 LJ, Rotterdam, The Netherlands.
| | - Bram Onneweer
- Department of Rehabilitation Medicine, Erasmus MC University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.,Rijndam Rehabilitation, Westersingel 300, 3015 LJ, Rotterdam, The Netherlands
| | | | - Joyce Lisanne Benner
- Department of Rehabilitation Medicine, Erasmus MC University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Marij Eugenie Roebroeck
- Department of Rehabilitation Medicine, Erasmus MC University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.,Rijndam Rehabilitation, Westersingel 300, 3015 LJ, Rotterdam, The Netherlands
| | - Gerard Maria Ribbers
- Department of Rehabilitation Medicine, Erasmus MC University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.,Rijndam Rehabilitation, Westersingel 300, 3015 LJ, Rotterdam, The Netherlands
| | - Ruud Willem Selles
- Department of Rehabilitation Medicine, Erasmus MC University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.,Rijndam Rehabilitation, Westersingel 300, 3015 LJ, Rotterdam, The Netherlands
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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.
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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
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Khwaja MK, Oliver E, Wilson H, Dhaliwal K, Choudhry B, Neen D. Outcomes of distal biceps tendon repair using a dual incision, cortical button technique: a single surgeon study. JSES Int 2021; 5:816-820. [PMID: 34223436 PMCID: PMC8245989 DOI: 10.1016/j.jseint.2021.03.001] [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: 11/30/2022] Open
Abstract
Background The purpose of this study was to evaluate patient-reported outcomes, function, complication rates, and radiographs in a series of patients with distal biceps tendon repair using the dual incision cortical button technique by a single surgeon. By having a single surgeon perform the surgery, the technique is standardized to all patients. Twenty-two patients consented to participate in the study. The average time from surgery to review was 2.2 years. Patient satisfaction was assessed using the DASH, Oxford, and Mayo Elbow Performance Scores. Methods Range of movement was assessed and compared to the unaffected limb using a goniometer. Isometric flexion and supination strength was tested using a standardized dynamometer—both measurements taken by a single physiotherapist. Radiographs were discussed at the time of the review by 2 orthopedic surgeons to check for heterotopic ossification. Results The mean DASH score was 6.3 postsurgery at the time of follow-up. There was no significant difference in active range of movement between the repaired and nonrepaired arm in flexion, extension, supination, or pronation. Four radiographs showed evidence of heterotopic ossification (HTO)—none showed synostosis. For patients with HTO, there was evidence that supination was inhibited compared to those patients who did not have HTO. Conclusion Our study found that at an average of 2 years of follow-up these patients had good outcomes clinically with no major complications. HTO was present in only 4 patients, and there was a significant difference in supination compared to those who did not have HTO. These patients had an average DASH of 14 compared to a score of 4.5 in those who did not have an HTO. The study showed that the dual incision cortical button repair remains a procedure with excellent patient outcomes at the risk of HTO.
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Affiliation(s)
- Murtaza K Khwaja
- Trauma & Orthopaedics Department, Maidstone & Tunbridge Wells NHS Trust, Pembury, United Kingdom
| | - Emile Oliver
- Trauma & Orthopaedics Department, Darent Valley Hospital, Dartford, Kent, United Kingdom
| | - Holly Wilson
- Kent Community Health NHS Foundation Trust, Kent, East Sussex and Newham, United Kingdom
| | - Kawaljit Dhaliwal
- Trauma & Orthopaedics Department, Maidstone & Tunbridge Wells NHS Trust, Pembury, United Kingdom
| | - Baseem Choudhry
- Trauma & Orthopaedics Department, Maidstone & Tunbridge Wells NHS Trust, Pembury, United Kingdom
| | - Daniel Neen
- Trauma & Orthopaedics Department, Darent Valley Hospital, Dartford, Kent, United Kingdom
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Goyal N, Wilson DJ, Salzano MB, Fernandez JJ, Cohen MS, Wysocki RW. Restoration of peak strength and endurance following distal biceps reconstruction with allograft for chronic ruptures. J Shoulder Elbow Surg 2020; 29:853-858. [PMID: 32197770 DOI: 10.1016/j.jse.2019.12.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 12/02/2019] [Accepted: 12/10/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Distal biceps reconstruction for chronic rupture often requires a graft to recover length and allow for distal tendon reattachment to bone. Our purpose was to assess peak strength and endurance recovery following biceps reconstruction with tendon grafts. HYPOTHESIS We hypothesized that allograft reconstruction would result in decreased flexion and supination peak strength and endurance. METHODS Consecutive distal biceps reconstructions with allograft, performed for chronic ruptures between January 2008 and March 2018 at a single institution, were reviewed. Isokinetic dynamometry for peak strength and endurance testing was performed on the operative and contralateral arms in flexion and supination. Functional outcomes and overall satisfaction with the operation were determined. RESULTS Eleven patients were available for a complete evaluation, including dynamometry, at a mean of 46 months postoperatively. Reconstructions demonstrated a nonsignificant trend toward decreased peak flexion strength (P = .06), and significantly decreased peak supination strength (P = .01) compared with the unaffected arm. There were no differences in flexion and supination endurance between the affected and unaffected arms. Using standardized outcome scales, patients reported excellent function. CONCLUSION Chronic biceps ruptures undergoing reconstruction are highly functional and patients are satisfied. Somewhat surprisingly, supination and flexion endurance were equal to the contralateral, uninvolved arm. However, this procedure does not restore peak supination strength.
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Affiliation(s)
- Nitin Goyal
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA.
| | - David J Wilson
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Michael B Salzano
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - John J Fernandez
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Mark S Cohen
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Robert W Wysocki
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
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Bellringer SF, Phadnis J, Human T, Redmond CL, Bain GI. Biomechanical comparison of transosseous cortical button and Footprint repair techniques for acute distal biceps tendon ruptures. Shoulder Elbow 2020; 12:54-62. [PMID: 32010234 PMCID: PMC6974884 DOI: 10.1177/1758573218815312] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 11/03/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND The biceps brachii is the main forearm supinator, which is a direct consequence of its anatomic arrangement. The primary aim of distal biceps rupture is to restore supination strength and function. Cadaveric studies demonstrate that anatomic repairs significantly improve the supination moment when compared to more anterior repairs; however, this has not been tested in the clinical setting. The aim of this study was to compare biomechanical and clinical outcomes of an anatomic repair (Footprint), with a widely used transosseous technique (Endobutton). METHODS Twenty-two patients were retrospectively identified from a clinical database (11 Footprint versus 11 Endobutton). Biomechanical performance of strength and endurance for flexion and supination was assessed using a validated isokinetic dynamometry protocol and clinical outcome scores (Quick Disabilities of the Arm, Shoulder and Hand Outcome Measure and the Mayo Elbow Performance Score) were collected for all patients. RESULTS For supination, the Footprint group demonstrated a superior trend for all biomechanical parameters tested. This was statistically significant for mean peak torque, total work of maximal repetition and work in the last third of repetitive testing (p = 0.031, p = 0.036 and p = 0.048). For flexion, the Footprint group demonstrated a superior trend for all biomechanical parameters tested but this was only statistically significant for work in the last third of repetitive testing (p = 0.039). The clinical outcomes were good or excellent for all patients in both groups. CONCLUSION This study is the first to demonstrate that an anatomic Footprint repair restores superior biomechanical supination strength and endurance compared to a conventional Endobutton technique in a clinical setting. Both techniques, however, provide good or excellent clinical outcomes.
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Affiliation(s)
- Simon F Bellringer
- Department of Trauma and Orthopaedics,
Brighton and Sussex University Hospitals, Brighton, UK,Simon F Bellringer, Brighton and Sussex
University Hospitals NHS Trust, Royal Sussex County Hospital, Eastern Road,
Brighton, BN2 5BE, UK.
| | - Joideep Phadnis
- Department of Trauma and Orthopaedics,
Brighton and Sussex University Hospitals, Brighton, UK
| | - Taaibos Human
- Department of Trauma and Orthopaedics,
Flinders University, Adelaide, Australia
| | - Christine L Redmond
- Discipline of Physiotherapy, School of
Medicine, Nursing and Health Sciences, Flinders University, Adelaide,
Australia
| | - Gregory I Bain
- Department of Trauma and Orthopaedics,
Flinders University, Adelaide, Australia
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10
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Liu X, Li P, Wang Z, Lu Y, Li N, Xiao L, Duan H, Wang Z, Li J, Shan C, Wu W. Evaluation of isokinetic muscle strength of upper limb and the relationship with pulmonary function and respiratory muscle strength in stable COPD patients. Int J Chron Obstruct Pulmon Dis 2019; 14:2027-2036. [PMID: 31564850 PMCID: PMC6733348 DOI: 10.2147/copd.s214737] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 08/15/2019] [Indexed: 11/23/2022] Open
Abstract
Background Upper limb muscle strength plays an important role in respiratory and pulmonary function, and limited research focuses on the role of strength and endurance of the elbow extensor and flexor. This study was conducted to accurately assess upper limb muscle function and quantified associations with pulmonary function and respiratory muscle strength in patients with stable chronic obstructive pulmonary disease (COPD). Methods In this cross-sectional study, patients with stable COPD treated in Yue-Yang Integrative Medicine Hospital from March 2014 to March 2016 were recruited. All participants underwent a pulmonary function test (forced expiratory volume in first second/forced vital capacity, FEV1/FVC; percentage value of predicted FEV1, FEV1%pred), a respiratory muscle strength test (maximal inspiratory pressure, MIP; maximal expiratory pressure, MEP), and an isokinetic test of dominant upper limb after a 24-hr interval (peak torque, PT; PT/body weight, PT/BW; total work, TW; endurance ratio, ER). Results A total of 88 patients with stable COPD (age: 65.5±8.7 years) were recruited, of which 73% (64 patients) were male. In the multiple stepwise regression analysis, sex remained as significant impactors in the final model for FEV1%pred (adjusted R2=0.243, P<0.001). Elbow flexor PT/BW and ER, sex, and BMI remained as significant impactors in the final model for FEV1/FVC (adjusted R2=0.255, P<0.01). Elbow flexor TW remained as significant impactors for MIP (adjusted R2=0.112, P=0.001), while elbow extensor PT and PT/BW and sex remained as significant impactors for MEP (adjusted R =0.385, P<0.01). Conclusion In stable COPD, pulmonary function and respiratory muscle strength are associated with upper limb muscle strength. In particular, elbow flexor endurance is likely an important impactor for pulmonary function and inspiratory muscle strength, while elbow extensor strength is of importance for expiratory muscle strength.
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Affiliation(s)
- Xiaodan Liu
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China.,Institute of Rehabilitation Medicine, Shanghai Academy of Traditional Chinese Medicine, Shanghai, People's Republic of China
| | - Peijun Li
- Department of Sports Medicine, Shanghai University of Sport, Shanghai, People's Republic of China
| | - Zhenwei Wang
- Department of Respiratory Medicine, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai, People's Republic of China
| | - Yufan Lu
- Department of Sports Medicine, Shanghai University of Sport, Shanghai, People's Republic of China
| | - Ning Li
- Department of Sports Medicine, Shanghai University of Sport, Shanghai, People's Republic of China
| | - Lu Xiao
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China
| | - Hongxia Duan
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China
| | - Zhengrong Wang
- Department of Sports Medicine, Shanghai University of Sport, Shanghai, People's Republic of China
| | - Jian Li
- Department of Sports Medicine, Shanghai University of Sport, Shanghai, People's Republic of China
| | - Chunlei Shan
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China.,Institute of Rehabilitation Medicine, Shanghai Academy of Traditional Chinese Medicine, Shanghai, People's Republic of China
| | - Weibing Wu
- Department of Sports Medicine, Shanghai University of Sport, Shanghai, People's Republic of China
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11
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Hassan S, Patel V. Biceps tenodesis versus biceps tenotomy for biceps tendinitis without rotator cuff tears. J Clin Orthop Trauma 2019; 10:248-256. [PMID: 30828187 PMCID: PMC6383069 DOI: 10.1016/j.jcot.2018.12.013] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 12/18/2018] [Accepted: 12/30/2018] [Indexed: 01/25/2023] Open
Abstract
Disorders of the long head of the biceps tendon (LHB) are a well-recognised cause of shoulder pain despite the function of the long head of the biceps remaining poorly understood. There has been a dramatic rise in the number of biceps tenodesis procedures being performed in the last decade. This may partly be attributed to concerns regarding residual cosmetic deformity and pain after biceps tenotomy though there is little evidence to suggest that functional outcomes of tenodesis are superior to biceps tenotomy. Current literature focuses on LHB disorders with concomitant rotator cuff tears. The aim of this review is to discuss the anatomy of the LHB, the pathogenesis of tendinopathy of the LHB, indications of biceps tenodesis and tenotomy and compare the current literature on the functional outcomes of these procedures for LHB disorders in the absence of rotator cuff tears.
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Affiliation(s)
| | - Vipul Patel
- Corresponding author. Department of Trauma and Orthopaedic Surgery, South West London Elective Orthopaedic Centre, Dorking Road, Epsom, KT18 7EG, United Kingdom
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12
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Arthroscopic Rotator Cuff Repair With Mini-open Subpectoral Biceps Tenodesis. Arthrosc Tech 2017; 6:e1667-e1674. [PMID: 29416964 PMCID: PMC5795267 DOI: 10.1016/j.eats.2017.06.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Accepted: 06/26/2017] [Indexed: 02/03/2023] Open
Abstract
With a range of tear characteristics such as chronicity, degree of fatty atrophy, and number of tendons involved as well as varying patient-specific characteristics including age, injury mechanism, and expectations after treatment to consider, proper and successful treatment of a rotator cuff tear is multifactorial and, consequently, challenging. Although conservative management of a rotator cuff tear may be successful, a more severe tear with involvement of more tendons may warrant surgical intervention. Furthermore, additional pathology including biceps tendinopathy may result in greater patient morbidity and an even more complex treatment decision-making process and surgical technique. The purpose of this Technical Note is to describe our preferred surgical technique for the treatment of a rotator cuff tear involving 2 rotator cuff tendons in conjunction with a lesion of the long head of the biceps tendon.
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Chen W, Wang W, Li Z, Qian Y, Song J, Liu J, Cheng Y, Fan CY. Effect on muscle strength of the upper extremities after open elbow arthrolysis. JSES OPEN ACCESS 2017; 1:63-71. [PMID: 30675542 PMCID: PMC6340865 DOI: 10.1016/j.jses.2017.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background Open elbow arthrolysis manipulates tendons and soft tissues surrounding the elbow and may lead to strength decline after the operation. We hypothesized that strength of elbow and wrist motions and handgrip could be compromised after the procedure and that the strength recovery pattern may differ between men and women and between the dominant and nondominant side. Methods This was a prospective cohort study. We monitored 32 patients with post-traumatic elbow stiffness who underwent open arthrolysis between June 2014 and December 2014. All patients underwent standardized postoperative physical therapy. Preoperative and postoperative isometric strength were measured by a handheld dynamometer. Mayo Elbow Performance Score (MEPS) and arc of motion (AOM) were also analyzed. Results Mean follow-up was 26.13 months. Significant improvement was noticed in mean AOM (from 46° to 127°) and MEPS (from 67.97 to 96.86). No significant decline was noted in isometric strength at the last follow-up day. The strength ratios between men and women showed no significant difference from postoperative day 7 to the last follow-up day. At all follow-up assessments, isometric strength showed no significant difference between the dominant and nondominant side. Conclusions AOM and MEPS achieved significant enhancement after open elbow arthrolysis. The procedure did not lead to isometric strength decline. Postoperative gain of strength was proportional to the baseline strength level of each muscle group, and men had a more prominent gain of strength than women during the entire follow-up. Dominance had no effect on postoperative strength recovery.
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Affiliation(s)
- Wei Chen
- Department of Orthopaedics, Shanghai Jiao Tong University, Affiliated Sixth People's Hospital, Shanghai, China
| | - Wei Wang
- Department of Orthopaedics, Shanghai Sixth People's Hospital East Branch, Shanghai, China
- Shanghai University of Medicine and Health Science, Shanghai, China
| | - Zhiwei Li
- Department of Orthopaedics, Shanghai Jiao Tong University, Affiliated Sixth People's Hospital, Shanghai, China
| | - Yun Qian
- Department of Orthopaedics, Shanghai Jiao Tong University, Affiliated Sixth People's Hospital, Shanghai, China
| | - Jialin Song
- Department of Orthopaedics, Shanghai Jiao Tong University, Affiliated Sixth People's Hospital, Shanghai, China
| | - Jiazhi Liu
- Department of Orthopaedics, Shanghai Sixth People's Hospital East Branch, Shanghai, China
| | - Yuan Cheng
- Department of Orthopaedics, Shanghai Jiao Tong University, Affiliated Sixth People's Hospital, Shanghai, China
| | - Cun-yi Fan
- Department of Orthopaedics, Shanghai Jiao Tong University, Affiliated Sixth People's Hospital, Shanghai, China
- Department of Orthopaedics, Shanghai Sixth People's Hospital East Branch, Shanghai, China
- Corresponding author: Cun-yi Fan, MD, PhD, Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Rd, Shanghai 200233, China. (C.-y. Fan).
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Kerschbaum M, Maziak N, Böhm E, Scheibel M. Elbow flexion and forearm supination strength in a healthy population. J Shoulder Elbow Surg 2017; 26:1616-1619. [PMID: 28734715 DOI: 10.1016/j.jse.2017.05.031] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 05/24/2017] [Accepted: 05/27/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND HYPOTHESIS Despite the lack of representative data of a healthy population, many clinical trials concerning the measurement of postoperative elbow flexion or forearm supination strength use the contralateral side as a control. We hypothesized that there are no differences in elbow flexion and supination strength between the dominant and nondominant sides in healthy volunteers. METHODS The study was performed on a cross-sectional cohort of healthy subjects without any prior injuries or surgical interventions of the upper extremities. Isometric elbow flexion strength and supination strength were measured on both the dominant and nondominant sides. The results were analyzed for the entire group and subanalyzed for female vs. male, for different age groups, and according to handedness and regular practice of overhead sports. RESULTS A total of 150 subjects (75 female and 75 male subjects; mean age, 44 ± 15 years [range, 18-72 years]) were included in this study. Within the entire collective, no significant differences concerning the elbow flexion strength between the dominant and nondominant sides could be detected, whereas the supination strength was 7% higher on the dominant side (P = .010). Women, right-hand-dominant subjects, and subjects who do not regularly practice overhead sports have a significant 8% higher supination strength on the dominant side compared with the nondominant side (P < .05). Left-hand-dominant subjects have an 8% higher elbow flexion strength on the nondominant right side (P < .05). CONCLUSION Elbow flexion strength and forearm supination strength differ between the dominant and nondominant sides. The contralateral upper extremity cannot be used as a matched control without some adjustments.
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Affiliation(s)
- Maximilian Kerschbaum
- Center for Musculoskeletal Surgery, Campus-Virchow/Campus-Mitte, Charité-Unversitätsmedizin Berlin, Berlin, Germany
| | - Nina Maziak
- Center for Musculoskeletal Surgery, Campus-Virchow/Campus-Mitte, Charité-Unversitätsmedizin Berlin, Berlin, Germany
| | - Elisabeth Böhm
- Center for Musculoskeletal Surgery, Campus-Virchow/Campus-Mitte, Charité-Unversitätsmedizin Berlin, Berlin, Germany
| | - Markus Scheibel
- Center for Musculoskeletal Surgery, Campus-Virchow/Campus-Mitte, Charité-Unversitätsmedizin Berlin, Berlin, Germany.
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15
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Good isometric and isokinetic power restoration after distal biceps tendon repair with anchors. Arch Orthop Trauma Surg 2017; 137:939-944. [PMID: 28577179 DOI: 10.1007/s00402-017-2724-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Distal biceps brachii tendon rupture can lead to 30-40% power loss of elbow flexion and up to 50% of forearm supination. Re-fixation of the distal biceps brachii tendon is recommended to warrant an adequate quality of the patient's life. This study reports the isometric and isokinetic results after anchor re-fixation 2.5 years after surgery. PATIENTS AND METHODS Between 2007 and 2010, 69 patients with distal biceps brachii tendon tear underwent a suture anchor reattachment. During the follow-up examination, a questionnaire and DASH score were filled in, the circumferences of the arm were measured, range of motion was collected, and different trials were conducted at the BTE Primus RS™ (Baltimore Therapeutic Equipment) on both arms. RESULTS 49 patients (71%) were reinvestigated with a follow-up of 32 months (11-58 months). A significant difference was found in the ability of elbow flexion between the affected arm and the opposite side as well as in pronation and supination. In elbow flexion and extension as well as in pronation and supination of the forearm, the strength was significantly diminished. CONCLUSIONS 32 months after surgical re-fixation of the distal biceps brachii tendon rupture, strength in all exercises is marginally reduced in comparison to the opposite arm. Re-fixation of the distal biceps brachii tendon is an adequate method to return the range of motion and the strength in the elbow joint to an almost normal level and that gives rise to a high level of patient satisfaction. LEVEL OF EVIDENCE Level III, case-control study.
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16
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Clinical outcomes of single-incision suture anchor repair of distal biceps tendon rupture. CURRENT ORTHOPAEDIC PRACTICE 2017. [DOI: 10.1097/bco.0000000000000529] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kerschbaum M, Scheuermann M, Gerhardt C, Scheibel M. Arthroscopic knotless suprapectoral tenodesis of the long head of biceps: clinical and structural results. Arch Orthop Trauma Surg 2016; 136:1135-42. [PMID: 27139186 DOI: 10.1007/s00402-016-2466-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Different techniques for tenodesis of the long head of biceps (LHB) have been described. Previous studies focused on intraosseously performed techniques while only little clinical data exists for epiosseously performed knotless LHB tenodesis. The hypothesis is that arthroscopic suprapectoral knotless epiosseous tenodesis of the LHB would have good clinical, cosmetic and structural results. METHODS Forty-nine patients [16 women, 33 men; mean age 58; mean follow-up 36.4 months (range 24-57 months)], in whom a tenodesis of the long biceps tendon (LHB) has been performed, were included into this study. The clinical evaluation included the Constant score as well as the LHB score. In addition elbow flexion and supination strength were assessed. The integrity of the tenodesis construct was evaluated indirectly by sonographic detection of the LHB in the bicipital groove. RESULTS The overall Constant score did not reveal any significant differences comparing both sides [mean, 86 ± 19 points vs. 89 ± 16 points (p > 0.05)]. The mean LHB score reached 88.3 points (range 54-100 points). Thirty-four patients (69 %) presented an examiner-dependent upper arm deformity although only three patients (6 %) confirmed a subjective cosmetic deformity. Both, flexion and supination strength were significantly decreased compared to the non-operated side (p < 0.05). In five patients (10 %) it was not possible to verify the LHB sonographically in the bicipital groove. Therefore the biceps tenodesis was classified as a failure. CONCLUSION The arthroscopic suprapectoral epiosseous knotless tenodesis of the LHB provides good functional results. The high rate of examiner-dependent upper arm deformities can be explained by a non-physiological situation of the primary length-tension relationship or an elongation of the tendon after fixation.
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Affiliation(s)
- Maximilian Kerschbaum
- Department of Shoulder and Elbow Surgery, Center for Musculoskeletal Surgery, Campus-Virchow/Campus-Mitte, Charité-Unversitaetsmedizin Berlin, Augustenburgerplatz 1, 13353, Berlin, Germany
| | - Mitja Scheuermann
- Department of Shoulder and Elbow Surgery, Center for Musculoskeletal Surgery, Campus-Virchow/Campus-Mitte, Charité-Unversitaetsmedizin Berlin, Augustenburgerplatz 1, 13353, Berlin, Germany
| | - Christian Gerhardt
- Department of Shoulder and Elbow Surgery, Center for Musculoskeletal Surgery, Campus-Virchow/Campus-Mitte, Charité-Unversitaetsmedizin Berlin, Augustenburgerplatz 1, 13353, Berlin, Germany
| | - Markus Scheibel
- Department of Shoulder and Elbow Surgery, Center for Musculoskeletal Surgery, Campus-Virchow/Campus-Mitte, Charité-Unversitaetsmedizin Berlin, Augustenburgerplatz 1, 13353, Berlin, Germany.
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Kerschbaum M, Arndt L, Bartsch M, Chen J, Gerhardt C, Scheibel M. Using the LHB score for assessment of LHB pathologies and LHB surgery: a prospective study. Arch Orthop Trauma Surg 2016; 136:469-75. [PMID: 26714473 DOI: 10.1007/s00402-015-2391-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The long head of biceps tendon (LHB) score was designed to clinically assess LHB pathologies. Purpose of this study was to prospectively assess patients with LHB pathologies preoperatively and after LHB surgery using the LHB score. MATERIALS AND METHODS Fifty-seven patients (29 f/28 m, Ø age 61.0 years), showing clinical signs of LHB pathologies, were prospectively included into this study. In 43 patients LHB pathologies could be confirmed intraoperatively. Among these, in 26 patients a biceps tenodesis (group I; 8 f/18 m, Ø age 61.2 years), and in 17 patients a biceps tenotomy was performed (group II; 12 f/5 m, Ø age 64.2 years). In 14 patients no intraoperative correlate concerning the biceps symptoms could be found (group III; 9 f/5m, Ø age 56.8 years). In these patients no further LHB treatment was carried out. The clinical evaluation contained the Constant score (CS) as well as the LHB score preoperatively and 2 years postoperatively. RESULTS The CS improved significantly in all the three groups [group I: 41.7 (20-70) to 81.3 (62-100); group II: 42.2 (18-66) to 75.3 (41-84); group III: 45.7 (22-77) to 72.9 (48-85)] (p < 0.05). Also the LHB score increased significantly in all three groups [group I: 74.3 (41-97) to 94.2 (80-100); group II: 73.4 (57-97) to 84.2 (49-100); group III: 71.1 (58-80) to 90.8 (70-100)] (p < 0.05). Compared to group II, group I showed significant better results in the total LHB score and in the cosmetic result (p < 0.05). CONCLUSIONS We recommend that patients with LHB pathologies are evaluated using the LHB score, since it provides LHB related information and is a proper tool to assess the clinical outcome after surgery. However, the score is not appropriate to detect LHB pathologies preoperatively. LEVEL OF EVIDENCE II.
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Affiliation(s)
- M Kerschbaum
- Center for Musculoskeletal Surgery, Campus Virchow, Charité, Universitaetsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - L Arndt
- Center for Musculoskeletal Surgery, Campus Virchow, Charité, Universitaetsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - M Bartsch
- Center for Musculoskeletal Surgery, Campus Virchow, Charité, Universitaetsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - J Chen
- Center for Musculoskeletal Surgery, Campus Virchow, Charité, Universitaetsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - C Gerhardt
- Center for Musculoskeletal Surgery, Campus Virchow, Charité, Universitaetsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - M Scheibel
- Center for Musculoskeletal Surgery, Campus Virchow, Charité, Universitaetsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
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Júnior JCG, de Castro Filho CDC, de Castro Mello TF, de Vasconcelos RA, Zabeu JLA, Garcia JPM. ISOKINETIC AND FUNCTIONAL EVALUATION OF DISTAL BICEPS RECONSTRUCTION USING THE MAYO MINI-DOUBLE ROUTE TECHNIQUE. Rev Bras Ortop 2015; 47:581-7. [PMID: 27047869 PMCID: PMC4799447 DOI: 10.1016/s2255-4971(15)30007-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Accepted: 03/15/2012] [Indexed: 11/02/2022] Open
Abstract
OBJECTIVE To evaluate the functional outcome among patients with distal biceps injuries who were operated using the Mayo mini-double route technique, with a minimum follow-up of six months after surgery, through digital isokinetic dynamometry, goniometry and subjective scores in order to establish objective and subjective improvement patterns and discuss the effectiveness of the procedure. METHODS Nine patients who underwent surgery to treat distal biceps injury were evaluated by means of Cybex digital dynamometry using an angular velocity of 30°/s with five repetitions and 120°/s with 15 repetitions, in comparison with the uninjured side. DASH (Disabilities of the arm, shoulder and hand), Mayo elbow score and conventional goniometry were also used. RESULTS Digital dynamometer showed that using the angular velocity of 30°/s with five repetitions, there was an average flexion deficit of 9.6% and an average supination deficit of -28.97%. Using an angular velocity of 120°/s with fifteen repetitions, the average flexion deficit was 4.43% and the average supination deficit was -24.1%. CONCLUSIONS The loss of flexion followed the pattern already shown in the literature. However, in our series, there were supination strength gains, possibly due to the strict rehabilitation protocol. The technique used in this study was safe and low-cost, with few complications and good functional results.
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Affiliation(s)
- José Carlos Garcia Júnior
- Shoulder and Elbow Surgeon in the Advanced Study Center for Orthopedics and Neurosurgery, São Paulo, SP, Brazil
| | | | - Tadeu Fujita de Castro Mello
- Resident in the Orthopedics and Traumatology Clinic, Celso Pierro Hospital and Maternity Hospital, PUC/Campinas, Campinas, SP, Brazil
| | | | - José Luís Amim Zabeu
- Physician in the Orthopedics and Traumatology Clinic, Celso Pierro Hospital and Maternity Hospital, PUC/Campinas, Campinas, SP, Brazil
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Abstract
Long head biceps tendon is a common cause of anterior shoulder pain. Failure of conservative treatment may warrant surgical intervention. Surgical treatment involves long head biceps tenotomy or tenodesis. Several different techniques have been described for biceps tenodesis, including arthroscopic versus open and suprapectoral versus subpectoral. Most studies comparing tenodesis to tenotomy are limited by the level of evidence and confounding factors, such as concomitant rotator cuff tear. Many studies demonstrate similar outcomes for both procedures. Surgeon preference is likely more influential in choosing between tenotomy and tenodesis. Higher-powered studies are necessary to elucidate any differences in outcomes if present.
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Affiliation(s)
- Kushal V Patel
- Baylor Scott and White Orthopaedics at Garland, 601 Clara Barton Boulevard, Plaza III, Suite 250, Garland, TX 75012, USA.
| | - Jonathan Bravman
- Department of Orthopaedics, Sports Medicine and Shoulder Surgery, CU Sports Medicine, University of Colorado Hospital, 311 Mapleton Avenue, Boulder, CO 80304, USA
| | - Armando Vidal
- Department of Orthopaedics, Sports Medicine and Shoulder Surgery, CU Sports Medicine, University of Colorado Hospital, 311 Mapleton Avenue, Boulder, CO 80304, USA
| | - Ashley Chrisman
- Department of Orthopaedics, CU Sports Medicine, University of Colorado Hospital, 311 Mapleton Avenue, Boulder, CO 80304, USA
| | - Eric McCarty
- Department of Orthopaedics, Sports Medicine and Shoulder Surgery, CU Sports Medicine, University of Colorado Hospital, 311 Mapleton Avenue, Boulder, CO 80304, USA
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Abstract
BACKGROUND People with multiple sclerosis (MS) are encouraged to engage in exercise programs but an increased experience of fatigue may impede sustained participation in training sessions. A high number of movements is, however, needed for obtaining optimal improvements after rehabilitation. METHODS This cross-sectional study investigated whether people with MS show abnormal fatigability during a robot-mediated upper limb movement trial. Sixteen people with MS and sixteen healthy controls performed five times three minutes of repetitive shoulder anteflexion movements. Movement performance, maximal strength, subjective upper limb fatigue and surface electromyography (median frequency and root mean square of the amplitude of the electromyography (EMG) signal of the anterior deltoid) were recorded during or in-between these exercises. After fifteen minutes of rest, one extra movement bout was performed to investigate how rest influences performance. RESULTS A fifteen minutes upper limb movement protocol increased the perceived upper limb fatigue and induced muscle fatigue, given a decline in maximal anteflexion strength and changes of both the amplitude and the median frequency of EMG the anterior deltoid. In contrast, performance during the 3 minutes of anteflexion movements did not decline. There was no relation between changes in subjective fatigue and the changes in the amplitude and the median frequency of the anterior deltoid muscle, however, there was a correlation between the changes in subjective fatigue and changes in strength in people with MS. People with MS with upper limb weakness report more fatigue due to the repetitive movements, than people with MS with normal upper limb strength, who are comparable to healthy controls. The weak group could, however, keep up performance during the 15 minutes of repetitive movements. DISCUSSION AND CONCLUSION Albeit a protocol of repetitive shoulder anteflexion movements did not elicit a performance decline, fatigue feelings clearly increased in both healthy controls and people with MS, with the largest increase in people with MS with upper limb weakness. Objective fatigability was present in both groups with a decline in the muscle strength and increase of muscle fatigue, shown by changes in the EMG parameters. However, although weak people with multiple sclerosis experienced more fatigue, the objective signs of fatigability were less obvious in weak people with MS, perhaps because this subgroup has central limiting factors, which influence performance from the start of the movements.
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Recordon JAF, Misur PN, Isaksson F, Poon PC. Endobutton versus transosseous suture repair of distal biceps rupture using the two-incision technique: a comparison series. J Shoulder Elbow Surg 2015; 24:928-33. [PMID: 25861852 DOI: 10.1016/j.jse.2014.12.032] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2014] [Revised: 12/10/2014] [Accepted: 12/23/2014] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to report the outcome of a large cohort of patients undergoing distal biceps tendon repair. We compared the endobutton and transosseous suture repair techniques, both performed through a 2-incision approach. METHOD At an average of 2.1 years after a distal biceps repair, 46 male patients (19 endobutton and 27 transosseous suture) were reviewed. The mean age of our patients was 50 years. RESULTS Forty-three patients (93%) were satisfied with the results of their distal biceps tendon repair. The average pain score was 1.3 of 10 at a mean 2.1 years after repair. More than 80% of patients had regained their premorbid function in both recreational and occupational activities. The mean Mayo Elbow Performance Score was 93 of 100. Biodex strength testing demonstrated restoration of 92% of low-velocity supination power, 102% of high-velocity supination power, and 104% endurance compared with the contralateral limb. There was no statistically significant difference in postoperative strength between the transosseous suture and endobutton groups. There were 3 complications in this series, 1 case of heterotopic ossification and 2 cases of injury to the lateral cutaneous nerve of the forearm. CONCLUSION In this large cohort of 2-incision distal biceps repairs, we found a high degree of patient satisfaction and a low complication rate. We did not find any difference in clinical outcome with regard to subjective patient rating, pain, range of motion, or supination strength when comparing the 2-incision endobutton and transosseous suture fixation techniques.
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Affiliation(s)
- James A F Recordon
- Orthopaedics, North Shore Hospital, Waitemata District Health Board, Auckland, New Zealand.
| | - Peter N Misur
- Orthopaedics, North Shore Hospital, Waitemata District Health Board, Auckland, New Zealand
| | - Fredrik Isaksson
- Orthopaedics, North Shore Hospital, Waitemata District Health Board, Auckland, New Zealand
| | - Peter C Poon
- Orthopaedics, North Shore Hospital, Waitemata District Health Board, Auckland, New Zealand
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Alemann G, Dietsch E, Gallinet D, Obert L, Kastler B, Aubry S. Repair of distal biceps brachii tendon assessed with 3-T magnetic resonance imaging and correlation with functional outcome. Skeletal Radiol 2015; 44:629-39. [PMID: 25503858 DOI: 10.1007/s00256-014-2079-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Revised: 10/24/2014] [Accepted: 12/04/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Objectives were to study the MRI appearance of the repaired distal biceps tendon (DBT), anatomically reinserted, and to search for a correlation between tendon measurements and functional results. MATERIALS AND METHODS Twenty-five patients (mean age, 49 ± 4.9 years old) who benefited from 3-T MRI follow-up of the elbow after surgical reinsertion of the DBT were retrospectively included and compared to a control group (n = 25; mean age, 48 ± 10 years old). MRI was performed during the month of clinical follow-up and on average 22 months after surgery. Delayed complications (secondary avulsion, new rupture), intratendinous osteoma, tendinous signal on T1-weighted (T1w) and fat-suppressed proton density-weighted (FS-PDw) images as well as DBT measurements were recorded. The maximum isometric elbow flexion strength (MEFS) and range of motion of the elbow were assessed. RESULTS Repaired DBT demonstrated a heterogeneous but normally fibrillar structure. Its low T1w signal was less pronounced than that of normal tendons, and the FS-PDW image signal was similar to that of T1w images. MRI detected seven osteomas (Se = 53 % vs. plain radiography), one textiloma and one secondary avulsion. Repaired DBT measurements were significantly correlated with MEFS (dominant arm R2: 0.38; nondominant arm R2: 0.54); this correlation involved the insertion surface (Δ = -75.7 mm(2), p = 0.046), transverse diameter (Δ = -2.6 mm, p = 0.018), anteroposterior diameter at the level of the radial head (Δ = -3.9 mm, p = 0.001) and DBT cross-sectional area (Δ = -50.2 mm(2), p = 0.003). CONCLUSION The quality of functional outcome after anatomical elbow rehabilitation of DBT correlates with the extent of tendinous hypertrophy during the healing process.
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Affiliation(s)
- Guillaume Alemann
- Department of Musculoskeletal Imaging, University Hospital of Besancon, 3 boulevard Fleming, 25000, Besancon, France,
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The B, Brutty M, Wang A, Campbell PT, Halliday MJC, Ackland TR. Long-term functional results and isokinetic strength evaluation after arthroscopic tenotomy of the long head of biceps tendon. INTERNATIONAL JOURNAL OF SHOULDER SURGERY 2014; 8:76-80. [PMID: 25258498 PMCID: PMC4168656 DOI: 10.4103/0973-6042.140114] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION The objective of this study is to evaluate the biomechanical function of the upper arm after arthroscopic long head of biceps (LHB) tenotomy at long-term follow-up. MATERIALS AND METHODS Twenty-five male subjects ranging from 30 to 63 years old were evaluated at a mean follow-up of 7.0 years after tenotomy. Bilateral isokinetic testing was performed to obtain peak torque values, as well as total work done throughout the full range of elbow flexion and supination. RESULTS Magnetic resonance imaging scans revealed nine unrecognized LHB ruptures in the contralateral arm, leaving 16 subjects to complete the testing protocol. The mean quickDASH score was 8.1 (standard error [SE] 2.5). The mean oxford elbow score was 97.9 (SE 1.6). The tenotomy arm recorded a decrease in peak flexion torque of 7.0% (confidence interval [CI] 1.2-12.8), and a decrease in the peak supination torque of 9.1% (CI 1.8-16.4) relative to the contralateral arm. The total work carried out through the full range of joint motion was reduced in elbow flexion by 5.1% (CI -1.3-11.4) and in forearm supination by 5.7% (CI-2.4-13.9). DISCUSSION Maximum strength in elbow flexion and forearm supination is significantly reduced compared with the contralateral arm. However, this impairment is partially compensated for by relatively greater strength sustained through the latter stages of joint motion. This results in comparable total work measurements between the tenotomised and contralateral side, potentially accounting for ongoing high levels of patient satisfaction and clinical function in the long term after LHB tenotomy. LEVEL OF EVIDENCE IV Case series without comparison group.
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Affiliation(s)
- Bertram The
- Department of Orthopaedic Surgery, Sir Charles Gairdner Hospital, Perth, Australia
| | - Mike Brutty
- School of Sport Science, Exercise and Health, University of Western Australia, Perth, Australia
| | - Allan Wang
- Department of Orthopaedic Surgery, Sir Charles Gairdner Hospital, Perth, Australia ; School of Sport Science, Exercise and Health, University of Western Australia, Perth, Australia ; Department of Orthopaedic Surgery, Saint John of God Hospitals, Perth, Australia
| | - Peter T Campbell
- Department of Orthopaedic Surgery, Saint John of God Hospitals, Perth, Australia
| | - Michael J C Halliday
- Department of Orthopaedic Surgery, Saint John of God Hospitals, Perth, Australia
| | - Timothy R Ackland
- School of Sport Science, Exercise and Health, University of Western Australia, Perth, Australia
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Lee HI, Shon MS, Koh KH, Lim TK, Heo J, Yoo JC. Clinical and radiologic results of arthroscopic biceps tenodesis with suture anchor in the setting of rotator cuff tear. J Shoulder Elbow Surg 2014; 23:e53-60. [PMID: 24021158 DOI: 10.1016/j.jse.2013.06.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Revised: 05/22/2013] [Accepted: 06/01/2013] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to report clinical and radiologic results of arthroscopic biceps tenodesis with 1 suture anchor in rotator cuff tear patients. METHODS During a 2-year period, 84 consecutive patients (45 men; 39 women) who underwent arthroscopic tenodesis were evaluated retrospectively. Mean age was 58 years. The primary indication for surgery was rotator cuff tear in 96.4%. Tenodesis was performed with 1 suture anchor placed in the bicipital groove with 2 knots, 1 lasso-type and 1 that pierced the tendon. At final follow-up at a mean of 33.2 months, visual analog scale pain (pain-VAS) score, shoulder scores (American Shoulder and Elbow Surgeons [ASES] and Constant score), Popeye deformity (PD), anterior arm pain, and elbow flexion power were evaluated. Postoperative magnetic resonance images were evaluated in 60 patients to determine the integrity of the tenodesis and the location of the suture anchor. RESULTS The average pain-VAS decreased from 5.3 to 1.4 (P < .001). ASES and Constant scores significantly increased, from 42.9 and 56.2 to 85.2 and 82.5, respectively. PD occurred in 11 patients (12.9%), and 2 (2.3%) had self-consciousness; however, no patients complained about the deformity and the PD did not correlate with poorer clinical scores. Six patients (7.1%) complained of anterior cramping pain. Elbow flexion power was similar compared with the contralateral side. In postoperative magnetic resonance imagine analysis, 15 patients (25%) showed distal migration of tenodesed biceps tendon, although only 6 (7.1%) had clinical PD. Postoperative clinical outcomes were not influenced by the location of the suture anchor within the bicipital groove. CONCLUSIONS Arthroscopic biceps tenodesis with 1 suture anchor resulted in good clinical outcomes at 2 years postoperatively. PD was seen in 12.9% of the patients.
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Affiliation(s)
- Hyun Il Lee
- Department of Orthopaedic Surgery, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, South Korea
| | - Min Soo Shon
- Department of Orthopaedic Surgery, National Medical Center, Seoul, South Korea
| | - Kyoung Hwan Koh
- Department of Orthopaedic Surgery, Seoul Medical Center, Seoul, South Korea
| | - Tae Kang Lim
- Department of Orthopedic Surgery, Wonkwang University Sanbon Hospital, Gunpo-si, South Korea
| | - Jaewon Heo
- Department of Orthopaedic Surgery, Samsung Medical Center, Sung Kyun Kwan University School of Medicine, Seoul, South Korea
| | - Jae Chul Yoo
- Department of Orthopaedic Surgery, Samsung Medical Center, Sung Kyun Kwan University School of Medicine, Seoul, South Korea.
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Arthroscopically Assisted Mini-Open Transdeltoid Biceps Tenodesis. TECHNIQUES IN SHOULDER AND ELBOW SURGERY 2013. [DOI: 10.1097/bte.0b013e318297c451] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
BACKGROUND Distal biceps tendon rupture is not a very common injury and the literature remains scarce, mainly limited to case series. While surgical repair has become popular, it is not universally accepted and there are insufficient data regarding patient satisfaction following repair. The purpose of this study was to assess the results of anatomical reinsertion according to objective muscle strength testing and patient-reported outcome measures. PATIENTS AND METHODS Twenty-four patients underwent surgical repair over the last 10 years. All patients underwent clinical assessment using the Mayo Elbow Performance Score (MEPS), Disabilities of the Arm, Shoulder and Hand (DASH) score and Oxford Elbow score. Measurement of range of motion, supination and flexion strength testing was done using a Biodex isokinetic dynamometer. RESULTS Ninety-five percent of the patients had good or excellent results following surgery as defined by Mayo and Oxford Elbow scores. The average DASH score following surgery was 7.1, nearly the same as the score of 6.2 in the normal population. The mean elbow flexion arc was 134° ± 10.8 (range, 125-150°; 95% confidence interval (CI) 129.6-137.8) with no flexion contractures in the operated side compared with the unaffected elbow. The range of pronation-supination was also comparable in both sides. The average torque in flexion improved by 19.8% (p = 0.25) while supination torque was reduced by 4% (p = 0.12) when compared to the uninjured side. There was 8% incidence of persistent neuropraxia of the antebrachial cutaneous nerve of the forearm and 4% incidence of asymptomatic heterotopic ossification. CONCLUSION Surgical repair of distal biceps ruptures provides consistently good results in terms of patient-scored outcomes. Objective muscle strength testing does not reveal statistical difference between the injured and the opposite side.
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Tanner C, Johnson T, Muradov P, Husak L. Single incision power optimizing cost-effective (SPOC) distal biceps repair. J Shoulder Elbow Surg 2013; 22:305-11. [PMID: 23352549 DOI: 10.1016/j.jse.2012.10.044] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Revised: 10/25/2012] [Accepted: 10/28/2012] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to review the results of a single anterior incision distal biceps tendon repair that reattaches the tendon to its posterior anatomic insertion site. We hypothesize this repair maximizes the supination torque of the biceps muscle throughout the full arc of forearm rotation. METHODS A consecutive series of patients with distal biceps tears were treated using a technique that reattaches the distal biceps tendon to the posterior radial surface similar to a 2-incision repair, which optimizes the biceps moment arm in all forearm positions including maximum supination. This method of distal biceps reattachment has been utilized in our practice since December 2008 on 40 distal biceps tendon repairs. Biodex testing was used to quantify the peak supination torque, the supination work, and the power of supination at each degree of forearm rotation and included on patients with a minimum clinical follow up of 12 months. Range of motion was also recorded. RESULTS Thirty patients met the inclusion criteria. Three patients, 2 of whom were lost to follow-up and 1 with bilateral repairs, were not included in this study. Seventeen of the remaining 27 patients completed strength testing using a Biodex Isokinetic Testing machine. Supination strength averaged 91% and 91% of the uninjured side at 60 and 120 deg/sec, respectively. Twenty-five (93%) patients reported no pain and had returned to work or normal activities. CONCLUSION A single anterior incision distal biceps tendon repair that maximizes supination torque throughout full forearm rotation has been utilized. No specialized anchors or equipment are required. LEVEL OF EVIDENCE Level IV, Case Series, Treatment Study.
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Affiliation(s)
- Cary Tanner
- Sierra Pacific Orthopedic Center, Fresno, CA, USA.
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Huh JK, Lim JY, Song CH, Baek GH, Lee YH, Gong HS. Isokinetic evaluation of pronation after volar plating of a distal radius fracture. Injury 2012; 43:200-4. [PMID: 21835404 DOI: 10.1016/j.injury.2011.07.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2011] [Revised: 06/28/2011] [Accepted: 07/11/2011] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Pronator quadratus (PQ) is an important contributor to forearm pronation, and there is concern that volar plating of a distal radius fracture (DRF) may damage the PQ function. The purpose of this study was to determine whether isokinetic pronation strength would decrease considerably after volar locking plating of a DRF, and whether clinical outcomes would be affected by any pronation strength decrease. MATERIALS AND METHODS Thirty-four patients of mean age of 55 years (range, 21-74 years) underwent bilateral isokinetic testing at 6 months and 1 year after open reduction and internal fixation using volar plating. Isokinetic pronation and supination strengths were compared between the operated and normal sides. Clinical outcomes such as grip strengths, range of motions and disabilities of the arm, shoulder and hand (DASH) scores were evaluated and analysed for any associations with isokinetic results. RESULTS At 6 months, peak torque and total work values for both pronation and supination were lower in the operated sides than in the normal sides (all p < 0.001). However, at 1 year postoperatively, the differences in pronation strength were not statistically significant (p = 0.188 for peak torque and p = 0.190 for total work), whilst supination torque and total work were still significantly lower in the operated sides (p = 0.015 and p = 0.029, respectively). Decreases in pronation strength were found to correlate significantly with decreases in supination strength and grip power. Wrist motion and DASH scores were not found to be correlated with decrease in pronation or supination strengths. CONCLUSIONS In patients with a DRF treated by volar plating, pronation strength was not significantly different between the operated and normal sides at 1 year postoperatively, and decreases in pronation or supination strengths were not found to affect clinical outcomes as assessed by DASH scores. This study suggests that dissection of the PQ may have minimal clinical impact on forearm pronation function.
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Affiliation(s)
- Jung Kyu Huh
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707, Republic of Korea
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Scheibel M, Schröder RJ, Chen J, Bartsch M. Arthroscopic soft tissue tenodesis versus bony fixation anchor tenodesis of the long head of the biceps tendon. Am J Sports Med 2011; 39:1046-52. [PMID: 21257843 DOI: 10.1177/0363546510390777] [Citation(s) in RCA: 107] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Currently there are no prospective data available that compare the different tenodesis techniques of the long head of the biceps tendon with regard to their clinical and structural results. HYPOTHESIS Soft tissue tenodesis provides clinical and structural results equivalent to those of bony fixation anchor tenodesis. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Fifty-seven patients with arthroscopically proven lesions of the long head of the biceps tendon (LHB) were prospectively included in this study. Thirty patients (7 women, 23 men; mean age, 57.9 years) were treated with an arthroscopic soft tissue tenodesis (STT) and 27 patients (8 women, 19 men; mean age, 61 years) with an arthroscopic bony fixation anchor tenodesis (BFAT). The clinical evaluation included the Constant score as well as a newly developed LHB score (maximum 100 points) that includes evaluation of pain and cramps (maximum 50 points), the patient- and examiner-dependent grading of the cosmetic result (maximum 30 points), and the measurement of elbow flexion strength (maximum 20 points). The integrity of the tenodesis construct was evaluated indirectly by detecting the position of the LHB using magnetic resonance imaging. A proximal intertubercular location of the tendon was judged as an intact tenodesis construct (3 points), a distal intertubercular location as a failure of tenodesis followed by autotenodesis in the sulcus (2 points), and an extratubercular location as a complete failure (1 point). RESULTS Twenty-four patients (5 women, 19 men; mean age, 58.6 years; mean follow-up, 19.6 months) in the STT group and 20 patients (5 women, 15 men; mean age, 59.1 years; mean follow-up, 22.4 months) in the BFAT group could be evaluated. The overall Constant score did not reveal any significant difference in the STT group (mean, 75.0 points) compared with the BFAT group (mean, 78.3 points) (P > .05). However, the BFAT group showed significantly better results in the LHB score (BFAT mean, 91.8 points vs STT mean, 80.9 points), the examiner-dependent evaluation of the cosmetic result (BFAT mean, 11.3 points vs STT mean, 8.0 points), as well as in the evaluation of the structural integrity of the tenodesis construct (BFAT mean, 2.7 points vs STT mean, 2.2 points) (P < .05). CONCLUSION When arthroscopic tenodesis of the LHB is indicated, the authors recommend a bony fixation over soft tissue fixation because anchor fixation provides significant advantages concerning the clinical and structural outcome.
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Affiliation(s)
- Markus Scheibel
- Center for Musculoskeletal Surgery, Charité-Universitaetsmedizin Berlin, Campus-Virchow, Berlin Germany.
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Wittstein JR, Queen R, Abbey A, Toth A, Moorman CT. Isokinetic strength, endurance, and subjective outcomes after biceps tenotomy versus tenodesis: a postoperative study. Am J Sports Med 2011; 39:857-65. [PMID: 21189355 DOI: 10.1177/0363546510387512] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Similar subjective outcomes have been reported for tenotomy or tenodesis of the long head of the biceps. Few studies have reported on postoperative strength and endurance. HYPOTHESIS Biceps tenodesis results in superior subjective outcomes, strength, and endurance compared with tenotomy. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Participants completed isokinetic strength and endurance testing for elbow flexion and supination on the operative and nonoperative sides a minimum of 2 years after biceps tenotomy or tenodesis. Modified American Shoulder and Elbow Surgeons (MASES) and Single Assessment Numeric Evaluation (SANE) scores were obtained. The operative/nonoperative strength and endurance scores were compared for the tenotomy and tenodesis groups, with the nonoperative shoulder serving as the control for each participant's operative shoulder. Change scores for strength and endurance were reported as percentage increase or decrease as compared with the nonoperative side. Change scores and MASES and SANE scores were compared between the 2 groups. The presence of a "popeye" deformity or pain at the tenodesis site was noted. RESULTS Thirty-five patients (19 tenotomy, 16 tenodesis) were studied. No significant difference was noted in postoperative MASES and SANE scores. Operative-side peak supination torque was significantly decreased relative to the nonoperative side in the tenotomy group, which had a significantly larger decrease in supination peak torque than did the tenodesis group on comparison of change scores. No significant difference was noted for peak flexion torque or flexion/supination endurance between operative and nonoperative sides in either group or between change scores for peak flexion torque or flexion/supination endurance in the tenotomy and tenodesis groups. Four tenotomy patients had a popeye deformity, 2 of whom reported painful cramping. Two patients had pain at the tenodesis site. CONCLUSION Subjective outcomes are similar for patients treated with tenotomy and tenodesis. Tenotomy decreases supination peak torque relative to the nonoperative side and tenodesis.
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Affiliation(s)
- Jocelyn R Wittstein
- Bassett Shoulder and Sports Medicine Research Institute, Division of Orthopaedics, Bassett Healthcare Network, Cooperstown, New York, USA.
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