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Canavan K, Zai Q, Bruni D, Alexander J, Oude Nijhuis KD, Ring D. Long Head of Biceps Tendinopathy Is Associated With Age and Cuff Tendinopathy on MRI Obtained for Evaluation of Shoulder Pain. Clin Orthop Relat Res 2025; 483:869-877. [PMID: 39679662 PMCID: PMC12014050 DOI: 10.1097/corr.0000000000003342] [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] [Received: 07/05/2024] [Accepted: 11/19/2024] [Indexed: 12/17/2024]
Abstract
BACKGROUND Shoulder pain-mostly related to rotator cuff tendinopathy-is the most common reason adults seek upper limb specialty care. Tendinopathy of the long head of the biceps may be part of rotator cuff tendinopathy, which most of us develop as we age. Evidence that these processes are related and that both are part of human shoulder senescence could contribute to a reconceptualization of shoulder tendinopathy as a single set of age-related changes, which are often well-accommodated, sometimes misinterpreted as an injury, and associated with notable nonspecific treatment effects, thus meriting caution regarding the potential for overtreatment. QUESTIONS/PURPOSES This study reviewed a consecutive series of MRI scans ordered for the evaluation of shoulder pain and asked: (1) Is long head of the biceps tendinopathy associated with advancing age? (2) Is long head of the biceps tendinopathy associated with concomitant degeneration of the rotator cuff tendons? METHODS Five hundred consecutive radiologist interpretations of MRIs of the shoulder obtained between May 2016 and June 2017 for assessment of shoulder pain in adults at a radiology group that provides approximately 80% of the imaging in all practices in our region were reviewed. Patients with bilateral MRIs had one MRI included at random. Patients with fractures, dislocations, previous surgery, and soft tissue masses seen on MRI were excluded, leaving 406 shoulder MRI interpretations for review. The radiology reports were used to identify the presence and severity of rotator cuff and long head of the biceps tendinopathy. Forty-nine percent (197 of 406) were men with a mean ± SD age of 55 ± 14 years, and 54% (220 of 406) were right shoulders. Multivariable analyses accounting for age and gender evaluated the association of long head of the biceps tendinopathy with age and tendinopathy of the rotator cuff tendons. RESULTS After controlling for tendinopathy of the other rotator cuff tendons, long head of the biceps tendinopathy was more common with advancing age (OR 1.04 [95% CI 1.02 to 1.06] per year; p < 0.001), meaning the prevalence increases by approximately 4% per year. Among people who were imaged for shoulder pain, everyone 85 years or older had both long head of the biceps and rotator cuff tendinopathy. Any rotator cuff pathophysiology was also notably associated with any long head of the biceps pathophysiology (OR 6.9 [95% CI 2.4 to 20]; p < 0.001). About half (49% [162 of 328]) of long head of the biceps tendons were normal in the presence of any supraspinatus tendinopathy, and 5% (9 of 175) of supraspinatus tendons were normal in the presence of any long head of the biceps tendinopathy. CONCLUSION The finding that among people seeking care for shoulder pain, long head of the biceps tendinopathy and rotator cuff tendinopathy occur together and are more common with increasing age (and ubiquitous by the latter half of the ninth decade) suggests that most shoulder pain in adults is associated with expected aging of the shoulder tendons inclusive. In this light, clinicians can guide patients to an understanding of shoulder pain as age-appropriate, safe and sound, and accommodated by a large percentage of people as they age, all of which may be unexpected and counterintuitive. Effective assimilation of this knowledge-which may take time and merits patience-has the potential to both put people at ease and open up possibilities for fewer visits, tests, and treatments addressing tendinopathy, allowing patients to manage on their own (agency) with a set of simple exercises and perhaps occasional use of over-the-counter analgesics. LEVEL OF EVIDENCE Level III, prognostic study.
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Affiliation(s)
- Kathryn Canavan
- Dell Medical School at The University of Texas at Austin, Austin, TX, USA
| | - Qais Zai
- Dell Medical School at The University of Texas at Austin, Austin, TX, USA
| | - David Bruni
- Dell Medical School at The University of Texas at Austin, Austin, TX, USA
| | - Jeremiah Alexander
- Dell Medical School at The University of Texas at Austin, Austin, TX, USA
| | | | - David Ring
- Dell Medical School at The University of Texas at Austin, Austin, TX, USA
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Worden JA, Kopriva JM, Gass HM, Hussain ZB, Karzon AL, Chopra KN, Gottschalk MB, Wagner ER. Surgical treatment of long head of biceps pathology: analyzing trends in the United States from 2010 to 2019. JSES REVIEWS, REPORTS, AND TECHNIQUES 2025; 5:160-169. [PMID: 40321877 PMCID: PMC12047552 DOI: 10.1016/j.xrrt.2024.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/08/2025]
Abstract
Background The long head of the biceps tendon (LHBT) is a common cause of anterior shoulder pain. A symptomatic LHBT is commonly encountered in the setting of a rotator cuff tear. The purpose of this study was to determine trends in the incidence of isolated tenotomy and tenodesis procedures for symptomatic LHBT in the setting of rotator cuff repairs (RCR). Methods The MarketScan database was queried from 2010 to 2019 for biceps tenotomy (open) and tenodesis (open and arthroscopic) in the United States. Annual procedure volumes and incidences were calculated using discharge weights and U.S. Census Bureau data, respectively. Further subgroup analysis included age, gender, and region. Results Open tenodesis remained the most common procedure in the United States for isolated LHBT management. Its incidence increased by 180% from 2010 to 2019, accounting for 49% of isolated LHBT procedures by 2019. In the setting of RCR, arthroscopic tenodesis was most common, and its incidence grew by 138%. By 2019, arthroscopic tenodesis accounted for 58% of procedures in the setting of RCR, while tenotomy claimed only 2%. The incidence of all procedures increased for the age ≥65 cohort, with a notable 828% increase in the incidence of open tenodesis as an isolated procedure, accounting for 76% of procedures by 2019. Conclusion Volumes of procedures aimed to ameliorate LHBT pathology increased from 2010 to 2019. Open tenodesis remained the preferred procedure for isolated LHBT pathology, while arthroscopic tenodesis was preferred in the setting of concomitant RCR. Future research can develop algorithmic approaches to treating biceps pathology.
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Affiliation(s)
- Jacob A. Worden
- Department of Orthopaedic Surgery, Medical College of Georgia, Augusta, GA, USA
| | - John M. Kopriva
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Henry M. Gass
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Zaamin B. Hussain
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Anthony L. Karzon
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Krishna N. Chopra
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Michael B. Gottschalk
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Eric R. Wagner
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, GA, USA
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Ode G. CORR Insights®: Long Head of Biceps Tendinopathy Is Associated With Age and Cuff Tendinopathy on MRI Obtained for Evaluation of Shoulder Pain. Clin Orthop Relat Res 2025; 483:878-880. [PMID: 39937471 PMCID: PMC12014101 DOI: 10.1097/corr.0000000000003411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2025] [Accepted: 01/21/2025] [Indexed: 02/13/2025]
Affiliation(s)
- Gabriella Ode
- Orthopaedic Surgeon and Assistant Professor, Sports Medicine Institute, Hospital for Special Surgery, New York, NY, USA
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Witten A, Clausen MB, Thorborg K, Hölmich P, Barfod KW. The Challenge of Diagnosing Patients Presenting With Signs and Symptoms of Subacromial Pain Syndrome: A Descriptive Study of 741 Patients Seen in a Secondary Care Setting. Orthop J Sports Med 2025; 13:23259671251332942. [PMID: 40303319 PMCID: PMC12038213 DOI: 10.1177/23259671251332942] [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: 11/28/2024] [Accepted: 12/30/2024] [Indexed: 05/02/2025] Open
Abstract
Background Subacromial pain syndrome has no universally accepted definition. Patients with shoulder pain are often diagnosed with subacromial pain syndrome without consideration of conflicting or concomitant diagnoses. Purpose To investigate the prevalence of conflicting and concomitant diagnoses in patients with signs and symptoms of subacromial pain syndrome. Study Design Cross-sectional study; Level of evidence, 3. Methods Using standardized diagnostic criteria, a prospective cohort of patients with signs and symptoms of subacromial pain syndrome was divided into 2 mutually exclusive groups: (1) patients with conflicting diagnoses-e.g., frozen shoulder or glenohumeral osteoarthritis (OA); (2) patients with subacromial pain syndrome. Patients with subacromial pain syndrome were further divided into 2 groups: (1) isolated subacromial pain syndrome; (2) subacromial pain syndrome with concomitant diagnoses-e.g., acromioclavicular OA, full-thickness rotator cuff tears, shoulder instability, long head biceps tendon pathology, labral lesions, and calcified tendinopathy. Standardized physical examination tests, radiographs, ultrasound, and magnetic resonance imaging scans were utilized. Tests were performed by experienced orthopaedic specialists in accordance with predefined standardized protocols. Results We systematically screened 3321 patients, of whom 576 had signs and symptoms of subacromial pain syndrome (mean age, 56 years; 57% women). Of these, 168 (29%) patients had conflicting diagnoses, with frozen shoulder accounting for the majority of these diagnoses. The remaining 408 patients were diagnosed with subacromial pain syndrome. Of these, 172 (42%) had at least 1 concomitant diagnosis, and 55 (13%) had multiple concomitant diagnoses. In total, 22 different combinations of concomitant diagnoses were observed across the 172 patients. Acromioclavicular OA and full-thickness rotator cuff tears, particularly of the supraspinatus, were the most common concomitant diagnoses. Biceps tendon pathology, calcified tendinopathy, minor shoulder instability, and superior labrum anterior to posterior (SLAP) lesions were less common. Conclusion Patients presenting with signs and symptoms of subacromial pain syndrome have a high prevalence of conflicting and concomitant diagnoses. This heterogeneity is a clinical challenge that necessitates a systematic and transparent diagnostic approach in patients presenting with signs and symptoms of subacromial pain syndrome.ClinicalTrials.gov: NCT05549674.
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Affiliation(s)
- Adam Witten
- Sports Orthopedic Research Center – Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Denmark
| | - Mikkel Bek Clausen
- Department of Midwifery, Physiotherapy, Occupational Therapy and Psychomotor Therapy, Faculty of Health, University College Copenhagen, Copenhagen, Denmark
| | - Kristian Thorborg
- Sports Orthopedic Research Center – Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Denmark
| | - Per Hölmich
- Sports Orthopedic Research Center – Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Denmark
| | - Kristoffer Weisskirchner Barfod
- Sports Orthopedic Research Center – Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Denmark
- Section for Sports Traumatology, Department of Orthopedic Surgery, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
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Gahlot N, Kumar Rajnish R, Rathore K. Higher complication rate is associated with suprapectoral biceps tenodesis as compared to subpectoral tenodesis: a systematic review and meta-analysis of comparative studies. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2025; 35:75. [PMID: 39998641 DOI: 10.1007/s00590-025-04196-6] [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: 11/05/2024] [Accepted: 02/09/2025] [Indexed: 02/27/2025]
Abstract
INTRODUCTION Biceps tenodesis techniques can be grouped into open or arthroscopic according to surgical approach, and into subpectoral or suprapectoral according to location of fixation. The purpose of this meta-analysis is to critically analyse the current evidence with regard to comparing two methods of biceps tenodesis, viz subpectoral vs supratenodesis. METHODS Primary electronic search was conducted on MEDLINE (PubMed), Embase, Scopus, and Cochrane Library databases for published literature from year of inception to August 2024. The current review included any prospective or retrospective English studies that evaluated the outcomes of suprapectoral versus subpectoral. Primary outcomes of interest were American shoulder and elbow society (ASES) score, constant score (CS), UCLA score, SST score, VAS, and complications. The secondary outcomes of interest was range of movements. RESULTS Thirteen studies were included in our quantitative analysis, comprising three RCTs and ten non-randomized comparative studies. ASES score was slightly higher in most of studies in favour of subpectoral tenodesis [95% CI (- 1.35, 0.10); I2 = 43%] (P > 0.05). We found no statistically significant difference between the two groups (P = 0.81), although the subpectoral tenodesis group had slightly higher mean CS 95% CI (- 0.95, 0.85), p = 0.81, I2 = 0%]. Our meta-analysis found a slightly higher SST in suprapectoral tenodesis group [95% CI (- 0.18, 0.49); I2 = 0%], while higher UCLA scores [P = 0.98; 95% CI (- 0.52, 0.50); I2 = 45%] in the subpectoral group (P > 0.05). Higher overall complication rate was noted with suprapectoral tenodesis group [OR 2.65; 95% CI (1.57, 4.45), I2 = 49%] (P = 0.0002). CONCLUSION Both the techniques of biceps tenodesis have shown comparable functional outcomes in most of the trials. On performing meta-analysis, suprapectoral tenodesis was associated with higher rate postoperative complications. Hence, it is advisable to choose subpectoral tenodesis, as and when possible.
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Affiliation(s)
- Nitesh Gahlot
- All India Institute of Medical Sciences Jodhpur, Jodhpur, India.
| | | | - Kuldeep Rathore
- All India Institute of Medical Sciences Jodhpur, Jodhpur, India
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Chen IW, Liao YT, Tseng H, Lin HC, Chou LW. Pain, function and peritendinous effusion improvement after dry needling in patients with long head of biceps brachii tendinopathy: a single-blind randomized clinical trial. Ann Med 2024; 56:2391528. [PMID: 39140690 PMCID: PMC11328602 DOI: 10.1080/07853890.2024.2391528] [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] [Received: 01/17/2024] [Revised: 06/20/2024] [Accepted: 07/02/2024] [Indexed: 08/15/2024] Open
Abstract
INTRODUCTION Long head of biceps brachii tendinopathy, a frequent source of anterior shoulder pain, may lead to discomfort and diminished function. The objective of this study is to assess the efficacy of dry needling and transcutaneous electrical nerve stimulation in these patients. PATIENTS AND METHODS Thirty patients were randomized into dry needling and transcutaneous electrical nerve stimulation groups and assessed before treatment, 8 and 15 days after treatment using a visual analogue scale, shoulder pain and disability index, pressure pain threshold, tissue hardness, and biceps peritendinous effusion. RESULTS Both treatments significantly reduced the visual analogue scale in immediate (p < 0.001), short-term (p < 0.01), and medium-term effects (p < 0.01). Dry needling outperformed transcutaneous electrical nerve stimulation for the pain (p < 0.01) and disability (p < 0.03) subscales of the shoulder pain and disability index in the short-term and medium-term effects, respectively. Pressure pain threshold increased after both treatments but didn't last beyond 8 days. Neither treatment showed any improvements in tissue hardness of the long head of biceps brachii muscle. Notably, only the dry needling group significantly reduced biceps peritendinous effusion in both short-term and medium-term effects (p < 0.01). CONCLUSIONS Dry needling showed non-inferior results to transcutaneous electrical nerve stimulation in reducing pain and disability and demonstrated even superior results in reducing biceps peritendinous effusion (see Graphical Abstract). TRIAL REGISTRATION The Institutional Review Board of the China Medical University Hospital (CMUH107-REC2-101) approved this study, and it was registered with Identifier NCT03639454 on ClinicalTrials.gov.
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Affiliation(s)
- I-Wei Chen
- Department of Physical Medicine and Rehabilitation, China Medical University Hospital, Taichung, Taiwan
- Department of Physical Medicine and Rehabilitation, Asia University Hospital, Asia University, Taichung, Taiwan
| | - Ying-Tzu Liao
- School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan
- Le Yang Chinese Medicine Clinic, Taipei, Taiwan
| | - Hsin Tseng
- Department of Ophthalmology, China Medical University Hospital, Taichung, Taiwan
| | - Hsiao-Che Lin
- Hsiao-Che Lin Chinese Medicine Clinic, Kaohsiung, Taiwan
- Graduate Institute of Acupuncture Science, China Medical University, Taichung, Taiwan
| | - Li-Wei Chou
- Department of Physical Medicine and Rehabilitation, China Medical University Hospital, Taichung, Taiwan
- Department of Physical Medicine and Rehabilitation, Asia University Hospital, Asia University, Taichung, Taiwan
- Department of Physical Therapy and Graduate Institute of Rehabilitation Science, China Medical University, Taichung, Taiwan
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Hespanhol BP, Secundino A, Baracho F, Cohen C, Piva F, Machado P. Outcomes of Subpectoral Tenodesis in the Treatment of Proximal Biceps Pathologies. Cureus 2024; 16:e76360. [PMID: 39867040 PMCID: PMC11758591 DOI: 10.7759/cureus.76360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/24/2024] [Indexed: 01/28/2025] Open
Abstract
Introduction The aim of this article is to evaluate the clinical and functional outcomes of subpectoral tenodesis of the long head of the biceps (LHB) in the treatment of proximal biceps pathologies. Methods A retrospective, cross-sectional study was conducted through the analysis of medical records from 24 patients and 26 shoulders who underwent the subpectoral tenodesis technique using bone tunnels. Three patients were excluded due to insufficient data to calculate the functional scores. The final study sample comprised 21 patients and 23 shoulders. Clinical and functional outcomes were evaluated based on the American Shoulder and Elbow Surgeons (ASES) Score and the Long Head of Biceps (LHB) Score. Additionally, the main indications for the procedure and potential complications were thoroughly assessed. Results The average follow-up time was four years and, of the 21 patients (23 shoulders), 19 (82.6%) were male and 4 (17.4%) were female shoulders, with a mean age of 41.6 years. The main indication for surgery was superior labral anterior to posterior injury in 12 (52.2%) cases, followed by subluxation and tenosynovitis. No case presented aesthetic deformity or pain on palpation at the LHB. Patients showed significant improvement in the ASES score (average from 75.13 to 98.52) and LHB score (average from 68.82 to 98.34). Conclusion The subpectoral tenodesis technique is a safe procedure, with good clinical and functional outcomes for the treatment of proximal biceps pathologies.
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Affiliation(s)
| | | | - Filipe Baracho
- Shoulder Surgery, Hospital do Trabalhador, Curitiba, BRA
| | - Carina Cohen
- Shoulder Surgery, Hospital do Trabalhador, Curitiba, BRA
| | - Fernanda Piva
- Shoulder Surgery, Hospital do Trabalhador, Curitiba, BRA
| | - Pedro Machado
- Shoulder Surgery, Hospital do Trabalhador, Curitiba, BRA
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Song HS, Kim H. Anatomical Analysis of Bicipital Groove and Its Spur Formation Using 3D-CT: A Retrospective Observational Study. Life (Basel) 2024; 14:1529. [PMID: 39768237 PMCID: PMC11676633 DOI: 10.3390/life14121529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2024] [Revised: 11/14/2024] [Accepted: 11/20/2024] [Indexed: 01/11/2025] Open
Abstract
Concomitant long head of biceps (LHB) pathologies commonly occur with rotator cuff tears, but LHB problems are often underestimated. There is a lack of studies on the correlation between bicipital groove morphology and biceps pathology, as well as the significance of bony spurs around the groove. This study analyzed the anatomical parameters of the bicipital groove and spur formation using 3D-CT in 111 patients. Biceps spurs were evaluated using 3D and 2D-CT images, and patients were grouped by age (below and above 55 years). The detection rate of biceps spur was higher with 3D-CT (54.0%) than with 2D-CT (42.3%). Spur incidence was significantly greater in older patients (60.3% vs. 45.8%). The average groove width was narrower in older adults (p = 0.006) and larger in men compared to women (p = 0.000). The average spur height was also greater in men (p = 0.039). Lateral spurs were the most common type that was observed. This study highlights the differences in bicipital groove morphology and spur formation by age and gender, with 3D-CT being more effective in detecting biceps spurs.
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Affiliation(s)
| | - Hyungsuk Kim
- Department of Orthopedic Surgery, Eunpyeong St Mary’s Hospital, School of Medicine, The Catholic University of Korea, Seoul 03312, Republic of Korea;
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McDevitt A, Cleland J, Hiefield P, Bravman J, Snodgrass S. Physical Therapy Utilization Prior to Biceps Tenodesis or Tenotomy for Biceps Tendinopathy. Int J Sports Phys Ther 2024; 19:1477-1489. [PMID: 39502549 PMCID: PMC11534157 DOI: 10.26603/001c.123950] [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: 05/02/2024] [Accepted: 09/06/2024] [Indexed: 11/08/2024] Open
Abstract
Introduction Surgery for the management of individuals with long head of the biceps tendon (LHBT) tendinopathy is common. Little is known about physical therapy (PT) utilization prior to surgery. The purpose of this review was to investigate the use of PT prior to biceps tenodesis and tenotomy surgeries by assessing the number of visits and the types of interventions. A secondary objective was to report on themes of PT interventions. Methods A retrospective observational cohort study design was used to analyze medical records and report on patient visits, procedure codes based on active or passive interventions, and themes of interventions utilized by PT. Results Patient records (n=308) were screened for eligibility, n=62 (20.1%) patients attended PT prior to surgery. The median number of PT visits was four (IQR=3.5), and 39/62 (63%) patients had four or more visits to PT. Active interventions were used in 54.5% (533/978) of the codes billed; passive interventions were used in 45.5% (445/978) of the codes. There was high utilization of therapeutic exercise [93.4% (498/533) of active procedure codes] including muscle performance/resistance, functional activity, motor control and stretching. Manual therapy [84.3% (375/445) of passive procedure codes] included soft tissue mobilization, non-thrust manipulation (glenohumeral joint and cervical spine) and thrust manipulation (thoracic spine). Conclusions PT was not commonly utilized prior to undergoing biceps tenodesis and tenotomy surgery. Further research is needed to understand the reasons for low utilization. Level of Evidence 3b.
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Affiliation(s)
- Amy McDevitt
- Physical Medicine and RehabilitationUniversity of Colorado Denver
| | - Joshua Cleland
- Department of Public Health and Community MedicineTufts University School of Medicine
| | - Paisley Hiefield
- Physical Medicine and RehabilitationUniversity of Colorado Denver
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Kim S, Deivert KT, Goodeill T, Firoved AB, Morgan CN, Worcester KS, Kim W, Bonner KF. Concomitant Biceps Tenodesis Does Not Compromise Arthroscopic Rotator Cuff Repair Outcomes. Arthroscopy 2024; 40:2556-2562.e1. [PMID: 38479637 DOI: 10.1016/j.arthro.2024.02.035] [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] [Received: 08/30/2023] [Revised: 02/20/2024] [Accepted: 02/24/2024] [Indexed: 04/20/2024]
Abstract
PURPOSE To compare outcomes of patients who underwent rotator cuff repair (RCR) with concomitant biceps tenodesis with those who underwent an isolated RCR. METHODS Exclusion criteria included previous ipsilateral shoulder surgery, irreparable rotator cuff tears, rotator cuff arthropathy, calcific tendinitis, adhesive capsulitis requiring a capsular release, or advanced osteoarthritis of the glenohumeral joint. Patients were indicated for biceps tenodesis if they had any degree of tendon tearing, moderate-to-severe tenosynovitis, instability, or a significant degenerative SLAP tear. Primary outcome measures included American Shoulder and Elbow Surgeons score, Simple Shoulder Test, EuroQoL 5-Dimension 5-Level visual analog scale, EuroQoL 5-Dimension 5-Level, and a site-specific questionnaire, which focused on surgical expectations, satisfaction, and complications. Multivariate analysis of variance to analyze descriptive statistics and determine significant differences between the patient groups for subjective and objective outcome measures were performed. RESULTS There were no significant differences for pain/visual analog scale (0.34 ± 0.09 vs 0.47 ± 0.09, P = .31), American Shoulder and Elbow Surgeons score (96.69 ± 0.87 vs 94.44 ± 0.91, P = .07), and Simple Shoulder Test (11.42 ± 0.17 vs 10.95 ± 0.18, P = .06) between the RCR with concomitant biceps tenodesis and isolated RCR at a minimum of 2 years' postoperatively. This is despite the RCR with concomitant biceps tenodesis group having significantly larger rotator cuff tears (4.25 ± 0.30 cm2 vs 2.80 ± 0.32 cm2, P = .001) than the isolated RCR group. CONCLUSIONS This study revealed that concomitant biceps tenodesis does not compromise outcomes when compared with an isolated RCR at 2-year follow-up, despite this group having larger rotator cuff tears. LEVEL OF EVIDENCE Level III, retrospective case study.
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Affiliation(s)
- Samuel Kim
- Eastern Virginia Medical School, Norfolk, Virginia, U.S.A..
| | - Kyle T Deivert
- Eastern Virginia Medical School, Norfolk, Virginia, U.S.A
| | | | - Amanda B Firoved
- Jordan-Young Institute for Orthopedic Surgery and Sports Medicine, Virginia Beach, Virginia, U.S.A
| | - Caleb N Morgan
- Eastern Virginia Medical School, Norfolk, Virginia, U.S.A
| | - Katherine S Worcester
- Jordan-Young Institute for Orthopedic Surgery and Sports Medicine, Virginia Beach, Virginia, U.S.A
| | - William Kim
- Eastern Virginia Medical School, Norfolk, Virginia, U.S.A
| | - Kevin F Bonner
- Eastern Virginia Medical School, Norfolk, Virginia, U.S.A.; Jordan-Young Institute for Orthopedic Surgery and Sports Medicine, Virginia Beach, Virginia, U.S.A
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Agrawal N, Shirodkar K, Mettu S, Shah AB, Shah BR, Iyengar KP, Botchu R. BAASIK technique: an innovative single needle technique of performing shoulder corticosteroid injections. J Ultrasound 2024:10.1007/s40477-024-00948-y. [PMID: 39174809 DOI: 10.1007/s40477-024-00948-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] [Received: 07/07/2024] [Accepted: 07/24/2024] [Indexed: 08/24/2024] Open
Abstract
The novel BAASIK (B-Botchu,Bipin, A-Agrawal, A-Ankit, S- Sindhura, I-Iyengar, K- Kapil) technique is a combined ultrasound-guided injection into the subacromial-subdeltoid (SASD) bursa and the biceps tendon sheath to treat shoulder pain associated with biceps tendonitis/tendinopathy, subacromial bursitis, rotator cuff impingement or to determine the source of shoulder pain. This technique aims in reducing shoulder pain, improving functional activities and enhancing treatment delivery. A single-entry supine ultrasound-guided injection of the subacromial-subdeltoid (SASD) bursa and biceps tendon sheath involves using a single needle insertion point to access both structures for therapeutic injection. This technique could become a favoured alternative technique, rather than subjecting patients to two needlesticks and preparing two separate injections to address often concomitant pathologies.
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Affiliation(s)
- Nidhi Agrawal
- Department of Radiology, South Warwickshire NHS Foundation Trust, West Midlands, UK
| | - Kapil Shirodkar
- Department of Musculoskeletal Radiology, Royal Orthopedic Hospital, Bristol Road South, Northfield, Birmingham, UK
| | - Sindhura Mettu
- Department of Radiology, Himagiri Hospitals, Hyderabad, India
| | | | | | - Karthikeyan P Iyengar
- Department of Orthopaedics, Southport and Ormskirk Hospital, West Lancashire Hospital NHS Trust, Southport, UK
| | - Rajesh Botchu
- Department of Musculoskeletal Radiology, Royal Orthopedic Hospital, Bristol Road South, Northfield, Birmingham, UK.
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Pianka MA, Sundaram V, Wolfe I, Lezak B, Moore MR, Alaia MJ, Feldman AJ, Jazrawi LM. Long-term patient-reported outcomes of open subpectoral biceps tenodesis with cortical button fixation. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:3201-3206. [PMID: 39060553 DOI: 10.1007/s00590-024-04036-z] [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: 04/21/2024] [Accepted: 06/24/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND Open subpectoral biceps tenodesis (OSBT) with cortical button fixation has been shown to deliver acceptable results in the short and intermediate term for long head of the biceps (LHB) pathology with the benefit of smaller bone tunnel diameter and a reduced risk of postoperative humeral shaft fracture. The primary purpose of this study was to determine whether OSBT with cortical button fixation results in significant improvements in patient reported outcomes (PROs) from pre-operative to long-term final follow-up. METHODS A retrospective analysis of patients who underwent OSBT with cortical button fixation at a single institution between the years of 2012 and 2014 was conducted and PROs were collected in the intermediate (> 2 years follow-up) and long term (> 9 years follow-up). PROs were measured pre-operatively, at intermediate follow-up, and at long-term follow-up using three validated questionnaires: American Shoulder and Elbow Surgeons (ASES) score, Disabilities of the Arm, Shoulder, and Hand (DASH) score, and Oxford Shoulder Score (OSS). Patients were additionally asked at final follow-up if they would undergo the same procedure again if they needed it. RESULTS Twenty-nine (29) patients with a mean age of 51.16 ± 9.06 years at the time of surgery were included in the study at final follow-up. Mean final follow-up time was 10.2 ± 0.5 years (range: 9.2-11.1 years). All PROs (ASES, OSS, and DASH) demonstrated statistically significant improvements from pre-operative to final follow-up with p < 0.01 for each. The proportions of patients exceeding established values for minimum clinically important difference (MCID) were 96.55%, 93.10%, and 75.86% for ASES, OSS, and DASH respectively. Only one patient had required re-operation as of final follow-up. None experienced humeral fractures post-operatively. A significant majority (89.66%; p < 0.01) of patients reported that they would undergo the same procedure again if they needed it. Fifty-three (53) patients were included in the study at intermediate follow-up with a mean follow-up time of 3.5 ± 1.4 years (range: 2-5.3 years). There were no statistically significant differences in any of the PRO measures from intermediate to long-term follow-up. CONCLUSION This study reported a minimum 9-year follow-up of patients undergoing OSBT with cortical button fixation for the management of LHBT pathology in the setting of concomitant shoulder procedures. All patients had significantly improved functional outcomes assessed with ASES, OSS, and DASH and no obvious differences in median group scores were found between patients assessed at intermediate (mean 3.5 years) and final (mean 10.2 years) follow-up. No infections, fractures, or fixation failures were reported.
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Affiliation(s)
- Mark A Pianka
- Department of Orthopedic Surgery, NYU Langone Health, 333 East 38th St, New York, NY, 10016, USA
| | - Vishal Sundaram
- Department of Orthopedic Surgery, NYU Langone Health, 333 East 38th St, New York, NY, 10016, USA.
| | - Isabel Wolfe
- Department of Orthopedic Surgery, NYU Langone Health, 333 East 38th St, New York, NY, 10016, USA
| | - Bradley Lezak
- Department of Orthopedic Surgery, NYU Langone Health, 333 East 38th St, New York, NY, 10016, USA
| | - Michael R Moore
- Department of Orthopedic Surgery, NYU Langone Health, 333 East 38th St, New York, NY, 10016, USA
| | - Michael J Alaia
- Department of Orthopedic Surgery, NYU Langone Health, 333 East 38th St, New York, NY, 10016, USA
| | - Andrew J Feldman
- Department of Orthopedic Surgery, NYU Langone Health, 333 East 38th St, New York, NY, 10016, USA
| | - Laith M Jazrawi
- Department of Orthopedic Surgery, NYU Langone Health, 333 East 38th St, New York, NY, 10016, USA
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Kent RN, Jewett ME, Buck TP, Said M, Hold LA, Crawford EA, Killian ML, Abraham AC, Huang AH, Baker BM. Engineered Microenvironmental Cues from Fiber-Reinforced Hydrogel Composites Drive Tenogenesis and Aligned Collagen Deposition. Adv Healthc Mater 2024; 13:e2400529. [PMID: 38441411 PMCID: PMC11281874 DOI: 10.1002/adhm.202400529] [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: 02/10/2024] [Indexed: 03/25/2024]
Abstract
Effective tendon regeneration following injury is contingent on appropriate differentiation of recruited cells and deposition of mature, aligned, collagenous extracellular matrix that can withstand the extreme mechanical demands placed on the tissue. As such, myriad biomaterial approaches have been explored to provide biochemical and physical cues that encourage tenogenesis and template aligned matrix deposition in lieu of dysfunctional scar tissue formation. Fiber-reinforced hydrogels present an ideal biomaterial system toward this end given their transdermal injectability, tunable stiffness over a range amenable to tenogenic differentiation of progenitors, and capacity for modular inclusion of biochemical cues. Here, tunable and modular, fiber-reinforced, synthetic hydrogels are employed to elucidate salient microenvironmental determinants of tenogenesis and aligned collagen deposition by tendon progenitor cells. Transforming growth factor β3 drives a cell fate switch toward pro-regenerative or pro-fibrotic phenotypes, which can be biased toward the former by culture in softer microenvironments or inhibition of the RhoA/ROCK activity. Furthermore, studies demonstrate that topographical anisotropy in fiber-reinforced hydrogels critically mediates the alignment of de novo collagen fibrils, reflecting native tendon architecture. These findings inform the design of cell-free, injectable, synthetic hydrogels for tendon tissue regeneration and, likely, that of a range of load-bearing connective tissues.
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Affiliation(s)
- Robert N. Kent
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI 48109
| | - Maggie E. Jewett
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI 48109
| | - Trevor P. Buck
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI 48109
| | - Mohamed Said
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI 48109
| | - LeeAnn A. Hold
- Department of Orthopedic Surgery, University of Michigan, Ann Arbor, MI 48109
| | - Eileen A. Crawford
- Department of Orthopedic Surgery, University of Michigan, Ann Arbor, MI 48109
| | - Megan L. Killian
- Department of Orthopedic Surgery, University of Michigan, Ann Arbor, MI 48109
| | - Adam C. Abraham
- Department of Orthopedic Surgery, University of Michigan, Ann Arbor, MI 48109
| | - Alice H. Huang
- Department of Orthopedic Surgery, Columbia University, New York, NY 10027
| | - Brendon M. Baker
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI 48109
- Department of Chemical Engineering, University of Michigan, Ann Arbor, MI 48109
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Lee HJ. Long head biceps tendon as a graft material. Clin Shoulder Elb 2024; 27:138-140. [PMID: 38863403 PMCID: PMC11181072 DOI: 10.5397/cise.2024.00325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 04/22/2024] [Accepted: 04/24/2024] [Indexed: 06/13/2024] Open
Affiliation(s)
- Hyo-Jin Lee
- Department of Orthopedic Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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15
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Lee DH, Lee GM, Park HB. Factors associated with long head of the biceps tendon tear severity and predictive insights for grade II tears in rotator cuff surgery. Clin Shoulder Elb 2024; 27:149-159. [PMID: 38738324 PMCID: PMC11181059 DOI: 10.5397/cise.2023.01053] [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: 11/23/2023] [Revised: 02/13/2024] [Accepted: 03/05/2024] [Indexed: 05/14/2024] Open
Abstract
BACKGROUND In rotator cuff repair, the long head of the biceps tendon (LHB) is commonly used as graft material. However, factors influencing LHB tear severity are poorly understood, and predicting grade II LHB tears is challenging. This study aimed to identify these factors preoperatively. METHODS The demographics, medical parameters, and pain severity of 750 patients who underwent arthroscopic surgery from January 2010 to February 2021 were evaluated to determine the factors associated with LHB tear severity and grade II tears. Both overall and largeto-massive rotator cuff tear (RCT) cohorts underwent ordinal and binary logistic regression analyses. Predictive accuracy for grade II LHB tears was determined using the area under the receiver operating characteristic curve (AUC). RESULTS In the overall cohort, high-sensitivity C-reactive protein (hs-CRP) >1 mg/L (P<0.001), subscapularis tear (P<0.001), hypothyroidism (P=0.031), and the tangent sign (P=0.003) were significantly associated with LHB tear severity, and hs-CRP>1 mg/L, subscapularis tear, and Patte retraction degree were significantly associated with grade II LHB tears (P<0.001). In the large-to-massive RCT cohort, hs-CRP>1 mg/L, hypertension, and age ≥50 years (P<0.05) were significantly associated with LHB tear severity, and hs-CRP>1 mg/L (P<0.001) and hypertension (P=0.026) were significantly associated with grade II LHB tears. In both cohorts, hs-CRP >1 mg/L demonstrated good predictive accuracy for grade II LHB tears (AUCs: 0.72 and 0.70). CONCLUSIONS Serum hs-CRP >1 mg/L is associated with LHB tear severity and serves as a reliable predictor of grade II LHB tears, facilitating preoperative assessment of the LHB as potential graft material in arthroscopic rotator cuff repair. Level of evidence: III.
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Affiliation(s)
- Dong-Hyun Lee
- Department of Orthopedic Surgery, Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Gyu-Min Lee
- Department of Orthopedic Surgery, Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Hyung Bin Park
- Department of Orthopedic Surgery, Gyeongsang National University Changwon Hospital, Changwon, Korea
- Department of Orthopedic Surgery, College of Medicine, Gyeongsang National University, Jinju, Korea
- Gyeongsang Institute of Health Sciences, Gyeongsang National University, Jinju, Korea
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Whitaker S, Cole S, Peri M, Satalich J, O’Neill C, Vap A. Open Biceps Tenodesis and Tenotomy Have Low 30-Day Postoperative Complication Rates. Arthrosc Sports Med Rehabil 2024; 6:100928. [PMID: 39006780 PMCID: PMC11240023 DOI: 10.1016/j.asmr.2024.100928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 03/12/2024] [Indexed: 07/16/2024] Open
Abstract
Purpose To compare 30-day postoperative rates of adverse events, particularly infection rates, between open biceps tenodesis and biceps tenotomy. Methods The American College of Surgeons National Surgical Quality Improvement Program was filtered using Current Procedural Terminology codes to identify patients undergoing open biceps tenodesis and tenotomy from 2010 to 2021. Patients were divided into cohorts based on procedure type. Propensity score matching was used to account for confounding variables. Statistical analyses were conducted to compare 30-day postoperative outcomes between cohorts, as well as to evaluate secondary risk factors for complications. Results Overall, 12,367 patients were included in the study with 11,417 undergoing open biceps tenodesis and 950 undergoing biceps tenotomy. After matching, 1,900 patients were included in the final analysis. The rate of outpatient procedures in the tenodesis cohort was significantly higher than in the tenotomy cohort. Rates of any adverse event (AAE), sepsis, pneumonia, reoperation, and extended length of stay (LOS) were significantly higher in the tenotomy cohort compared with the tenodesis cohort. There was no difference in infection rates or wound dehiscence between the 2 groups. After multivariable analysis, increasing age, longer operative time, and history of bleeding disorders were associated with significantly higher odds of developing AAE. Conclusions In this study, we found that tenotomy and open tenodesis are both safe options for treatment of biceps pathology. The overall rate of developing AAE and the rate of postoperative sepsis were higher in the tenotomy cohort. In addition, rates of postoperative infection and wound dehiscence did not vary between the 2 groups. Small differences were additionally observed in rates of pneumonia, return to the operating room, and extended LOS, and these rates were higher in the tenotomy cohort. Level of Evidence Level III, retrospective comparative study.
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Affiliation(s)
- Sarah Whitaker
- Virginia Commonwealth University School of Medicine, Richmond, Virginia, U.S.A
| | - Sarah Cole
- Virginia Commonwealth University School of Medicine, Richmond, Virginia, U.S.A
| | - Maria Peri
- Virginia Commonwealth University School of Medicine, Richmond, Virginia, U.S.A
| | - James Satalich
- Department of Orthopaedic Surgery, Virginia Commonwealth University Health System, Richmond, Virginia, U.S.A
| | - Conor O’Neill
- Department of Orthopaedic Surgery, Duke University Health System, Durham, North Carolina, U.S.A
| | - Alexander Vap
- Department of Orthopaedic Surgery, Virginia Commonwealth University Health System, Richmond, Virginia, U.S.A
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Alraddadi A, Aldebasi B, Alnufaie B, Almuhanna M, Alkhalifah M, Aleidan M, Murad Y, Almuklass AM, Ahmed AA. The association between a rotator cuff tendon tear and a tear of the long head of the biceps tendon: Chart review study. PLoS One 2024; 19:e0300265. [PMID: 38466684 PMCID: PMC10927094 DOI: 10.1371/journal.pone.0300265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 02/24/2024] [Indexed: 03/13/2024] Open
Abstract
Rotator cuff (RC) and long head of the biceps tendon (LHBT) tears are common shoulder problems presented to the orthopedic clinic. The aim of this study was to assess the association between RC and LHBT tears among a Saudi population sample. A total of 243 patients who were diagnosed with shoulder pain due to RC or LHBT tear between 2016 and 2018 using a magnetic resonance imaging scan were included in this study. Females comprised 66% of the sample, and 59% (n = 143) of the shoulders were on the right side. The mean age of the patients was 58 ± 11 years, ranging from 23 to 88 years. A significant association was detected between the LHBT and RC tears (P < 0.001). Out of 26 cases showing RC and LHBT tears, 81% had a full thickness tear, whereas 19% had a partial tear. The LHBT tears were presented significantly in 48% of cases with at least two completely torn RC compared to 10% in cases with one completely torn RC (P < 0.001). The LHBT tear was significantly observed in shoulders with RC tears including the tendons of subscapularis, supraspinatus, and infraspinatus, but not the teres minor (P < 0.001). Both types of tears were presented significantly in senior patients aged more than 65 years compared to younger patients (P < 0.01). Thus, the LHBT should be assessed carefully in shoulders with more than one RC tear or in chronic cases.
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Affiliation(s)
- Abdulrahman Alraddadi
- Department of Basic Medical Sciences, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center (KAIMRC), Ministry of National Guard – Health Affairs, Riyadh, Saudi Arabia
| | - Bader Aldebasi
- King Abdullah International Medical Research Center (KAIMRC), Ministry of National Guard – Health Affairs, Riyadh, Saudi Arabia
| | - Bander Alnufaie
- Department of Basic Medical Sciences, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Mohammed Almuhanna
- Department of Basic Medical Sciences, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Mohammed Alkhalifah
- Department of Basic Medical Sciences, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Motaz Aleidan
- Department of Basic Medical Sciences, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Yousef Murad
- Department of Basic Medical Sciences, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Awad M. Almuklass
- Department of Basic Medical Sciences, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center (KAIMRC), Ministry of National Guard – Health Affairs, Riyadh, Saudi Arabia
| | - Altayeb A. Ahmed
- Department of Basic Medical Sciences, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center (KAIMRC), Ministry of National Guard – Health Affairs, Riyadh, Saudi Arabia
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18
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Makovicka JL, Brinkman JC, Benner N, Tokish AJ, Moore ML, Tokish JM. All-Arthroscopic Falciform Portal Biceps Tenodesis. Arthrosc Tech 2024; 13:102842. [PMID: 38435253 PMCID: PMC10907896 DOI: 10.1016/j.eats.2023.09.017] [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: 07/25/2023] [Accepted: 09/20/2023] [Indexed: 03/05/2024] Open
Abstract
Biceps tenodesis has been proven to be an effective treatment for biceps tendon and superior labral pathology. Many techniques including both open and arthroscopic approaches have been reported. Open techniques afford management of the entire proximal biceps tendon but are limited by wound healing issues, increased bleeding, and increased surgical time. Arthroscopic tenodesis offers benefits in terms of surgical efficiency, cosmesis, and bleeding risk. However, standard arthroscopic tenodesis only addresses intra-articular biceps pathology. In this report we describe an all-arthroscopic biceps tenodesis technique at the suprapectoral region of the humerus using knotless suture anchor fixation.
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Affiliation(s)
| | | | - Nathan Benner
- Department of Orthopedic Surgery, University of Washington, Seattle, Washington
| | - Aiden J. Tokish
- Mayo Clinic Arizona Department of Orthopedic Surgery, Phoenix, Arizona
| | - M. Lane Moore
- Mayo Clinic Arizona Department of Orthopedic Surgery, Phoenix, Arizona
| | - John M. Tokish
- Mayo Clinic Arizona Department of Orthopedic Surgery, Phoenix, Arizona
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Liu K, Yin L, Zhang Y, Huang L, Liu G, Zhu R, Fang P, Ma Y, Ma Z. Effect of extracorporeal shock wave combined with Kinesio taping on upper limb function during individuals with biceps brachii tendinopathy：protocol for a double-blind, randomised controlled trial. BMJ Open 2024; 14:e071967. [PMID: 38191256 PMCID: PMC10806750 DOI: 10.1136/bmjopen-2023-071967] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 12/06/2023] [Indexed: 01/10/2024] Open
Abstract
INTRODUCTION Long head of biceps brachii tendinopathy (LHBT) is characterised by persistent pain and disability of shoulder joint, impairing patients' quality of life. Extracorporeal shock wave therapy (ESWT) is a non-invasive treatment, which promotes tissue regeneration and repair. However, ESWT has a side effect that often causes short-term pain and swelling in the treatment area. It is known that the effects of Kinesio taping (KT) on relieving swelling and pain. Due to insufficient clinical evidence from current limited studies, this randomised controlled study aims to explore the effects of ESWT combined with KT on upper limb function during individuals with LHBT. METHODS AND ANALYSIS A 2×2 factorial design, double-blind, randomised controlled trial will be conducted. A total of 144 participants will be randomly allocated into one of four groups (KT+ESWT, KT+sham ESWT, sham KT+ESWT or sham KT+sham ESWT) to participate in a 4-week treatment programme. Measurements will be taken at pretreatment (baseline), immediately after treatment and 6 weeks after treatment. The primary endpoint will be the Constant-Murley score (CMS), the secondary endpoints will include the pain Numerical Rating Scale, range of motion, pressure pain threshold and soft tissue hardness of biceps, speed test and global rating of change. Repeated measures analysis of variance will be used to compare differences among the effects of different interventions. ETHICS AND DISSEMINATION Ethics approval was obtained from the Ethics Committee of the Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine. In addition to international conference reports, findings will be disseminated through international publications in peer-reviewed journals. TRIAL REGISTRATION NUMBER ChiCTR2100051324.
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Affiliation(s)
- Kun Liu
- Department of Rehabilitation Medicine, Shanghai Sixth People's Hospital, Shanghai, China
| | - Lulu Yin
- Key Laboratory of Exercise and Health Sciences, Shanghai University of Sport, Shanghai, China
| | - Ye Zhang
- Department of Rehabilitation Medicine, Shanghai Sixth People's Hospital, Shanghai, China
| | - Lihua Huang
- Department of Rehabilitation Medicine, Shanghai Sixth People's Hospital, Shanghai, China
| | - Gongliang Liu
- Department of Rehabilitation Medicine, Shanghai Sixth People's Hospital, Shanghai, China
| | - Ran Zhu
- Department of Rehabilitation Medicine, Shanghai Sixth People's Hospital, Shanghai, China
| | - Ping Fang
- Department of Rehabilitation Medicine, Shanghai Sixth People's Hospital, Shanghai, China
| | - Yanhong Ma
- Department of Rehabilitation Medicine, Shanghai Sixth People's Hospital, Shanghai, China
| | - Zheng Ma
- Department of Rehabilitation Medicine, Shanghai Sixth People's Hospital, Shanghai, China
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Uehara H, Itoigawa Y, Wada T, Morikawa D, Koga A, Maruyama Y, Ishijima M. Shear wave elastography correlates to degeneration and stiffness of the long head of the biceps tendon in patients undergoing tenodesis with arthroscopic shoulder surgery. J Shoulder Elbow Surg 2024; 33:e31-e41. [PMID: 37327988 DOI: 10.1016/j.jse.2023.05.014] [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] [Received: 11/22/2022] [Revised: 04/11/2023] [Accepted: 05/06/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Tendinopathy of the long head of the biceps (LHB) tendon causes degeneration and changes its stiffness. However, a reliable means of diagnosis has not been established. Shear wave elastography (SWE) provides quantitative tissue elasticity measurements. In this study, the relationship of preoperative SWE values with biomechanically measured stiffness and degeneration of the LHB tendon tissue was investigated. METHODS LHB tendons were obtained from 18 patients who underwent arthroscopic tenodesis. SWE values were measured preoperatively at 2 sites, proximal to and within the bicipital groove of the LHB tendon. The LHB tendons were detached immediately proximal to the fixed sites and at their superior labrum insertion. Tissue degeneration was histologically quantified using the modified Bonar score. Tendon stiffness was determined using a tensile testing machine. RESULTS The SWE values of the LHB tendon were 502.1 ± 113.6 kPa proximal to the groove and 439.4 ± 123.3 kPa within the groove. The stiffness was 39.3 ± 19.2 N/mm. The SWE values displayed a moderate positive correlation with the stiffness proximal to the groove (r = 0.80) and within it (r = 0.72). The SWE value of the LHB tendon within the groove showed a moderate negative correlation with the modified Bonar score (r = -0.74). CONCLUSIONS These findings suggest that preoperative SWE values of the LHB tendon correlate moderately positively with stiffness and moderately negatively with tissue degeneration. Therefore, SWE may predict LHB tendon tissue degeneration and changes in stiffness caused by tendinopathy.
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Affiliation(s)
- Hirohisa Uehara
- Department of Orthopaedic Surgery, Juntendo University Urayasu Hospital, Chiba, Japan; Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yoshiaki Itoigawa
- Department of Orthopaedic Surgery, Juntendo University Urayasu Hospital, Chiba, Japan; Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo, Japan.
| | - Tomoki Wada
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Daichi Morikawa
- Department of Orthopaedic Surgery, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Akihisa Koga
- Department of Orthopaedic Surgery, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Yuichiro Maruyama
- Department of Orthopaedic Surgery, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Muneaki Ishijima
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo, Japan
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21
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Benhenneda R, Brouard T, Dordain F, Gadéa F, Charousset C, Berhouet J. Can artificial intelligence help decision-making in arthroscopy? Part 1: Use of a standardized analysis protocol improves inter-observer agreement of arthroscopic diagnostic assessments of the long head of biceps tendon in small rotator cuff tears. Orthop Traumatol Surg Res 2023; 109:103648. [PMID: 37356800 DOI: 10.1016/j.otsr.2023.103648] [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] [Received: 03/17/2023] [Revised: 05/09/2023] [Accepted: 05/17/2023] [Indexed: 06/27/2023]
Abstract
INTRODUCTION Injuries of the long head of biceps (LHB) tendon are common but difficult to diagnose clinically or using imaging. Arthroscopy is the preferred means of diagnostic assessment of the LHB, but it often proves challenging. Its reliability and reproducibility have not yet been assessed. Artificial intelligence (AI) could assist in the arthroscopic analysis of the LHB. The main objective of this study was to evaluate the inter-observer agreement for the specific LHB assessment, according to an analysis protocol based on images of interest. The secondary objective was to define a video database, called "ground truth", intended to create and train AI for the LHB assessment. HYPOTHESIS The hypothesis was that the inter-observer agreement analysis, on standardized images, was strong enough to allow the "ground truth" videos to be used as an input database for an AI solution to be used in making arthroscopic LHB diagnoses. MATERIALS AND METHOD One hundred and ninety-nine sets of standardized arthroscopic images of LHB exploration were evaluated by 3 independent observers. Each had to characterize the healthy or pathological state of the tendon, specifying the type of lesion: partial tear, hourglass hypertrophy, instability, fissure, superior labral anterior posterior lesion (SLAP 2), chondral print and pathological pulley without instability. Inter-observer agreement levels were measured using Cohen's Kappa (K) coefficient and Kappa Accuracy. RESULTS The strength of agreement was moderate to strong according to the observers (Kappa 0.54 to 0.7 and KappaAcc from 86 to 92%), when determining the healthy or pathological state of the LHB. When the tendon was pathological, the strength of agreement was moderate to strong when it came to a partial tear (Kappa 0.49 to 0.71 and KappaAcc from 85 to 92%), fissure (Kappa -0.5 to 0.7 and KappaAcc from 36 to 93%) or a SLAP tear (0.54 to 0.88 and KappaAcc from 90 to 97%). It was low for unstable lesion (Kappa 0.04 to 0.25 and KappaAcc from 36 to 88%). CONCLUSION The analysis of the LHB, from arthroscopic images, had a high level of agreement for the diagnosis of its healthy or pathological nature. However, the agreement rate decreased for the diagnosis of rare or dynamic tendon lesions. Thus, AI engineered from human analysis would have the same difficulties if it was limited only to an arthroscopic analysis. The integration of clinical and paraclinical data is necessary to improve the arthroscopic diagnosis of LHB injuries. It also seems to be an essential prerequisite for making a so-called "ground truth" database for building a high-performance AI solution. LEVEL OF EVIDENCE III; inter-observer prospective series.
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Affiliation(s)
- Rayane Benhenneda
- Service de Chirurgie Orthopédique, Hôpital Trousseau, Faculté de Médecine, Université de Tours Centre-Val de Loire, CHRU de Tours, Tours, France.
| | - Thierry Brouard
- LIFAT (EA6300), École Polytechnique Universitaire de Tours, 64, avenue Jean-Portalis, 37200 Tours, France
| | - Franck Dordain
- Hôpital Privé Saint-Martin, 18, rue des Roquemonts, 14000 Caen, France
| | - François Gadéa
- Centre Ortho-Globe, place du Globe, 83000 Toulon, France
| | | | - Julien Berhouet
- Service de Chirurgie Orthopédique, Hôpital Trousseau, Faculté de Médecine, Université de Tours Centre-Val de Loire, CHRU de Tours, Tours, France; LIFAT (EA6300), École Polytechnique Universitaire de Tours, 64, avenue Jean-Portalis, 37200 Tours, France
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Hagan DP, Hao KA, King JJ, Srinivasan RC, Wright TW, Moser MW, Farmer KW, Wright JO, Pazik M, Roach RP. Outcomes of Biceps Tenodesis Variations With Concomitant Rotator Cuff Repair: A Multicenter Database Analysis. Orthop J Sports Med 2023; 11:23259671231180173. [PMID: 37359975 PMCID: PMC10288396 DOI: 10.1177/23259671231180173] [Citation(s) in RCA: 4] [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] [Received: 02/02/2023] [Accepted: 03/09/2023] [Indexed: 06/28/2023] Open
Abstract
Background Studies to date comparing biceps tenodesis methods in the setting of concomitant rotator cuff repair (RCR) have demonstrated relatively equivalent pain and functional outcomes. Purpose To compare biceps tenodesis constructs, locations, and techniques in patients who underwent RCR using a large multicenter database. Study Design Cohort study; Level of evidence, 3. Methods A global outcome database was queried for patients with medium- and large-sized tears who underwent biceps tenodesis with RCR between 2015 and 2021. Patients ≥18 years of age with a minimum follow-up of 1 year were included. The American Shoulder and Elbow Surgeons, Single Assessment Numeric Evaluation, visual analog scale for pain, and Veterans RAND 12-Item Health Survey (VR-12) scores were compared at 1 and 2 years of follow-up based on construct (anchor, screw, or suture), location (subpectoral, suprapectoral, or top of groove), and technique (inlay or onlay). Nonparametric hypothesis testing was used to compare continuous outcomes at each time point. The proportion of patients achieving the minimal clinically important difference (MCID) at the 1- and 2-year follow-ups were compared between groups using chi-square tests. Results A total of 1903 unique shoulder entries were analyzed. Improvement in VR-12 Mental score favored anchor and suture fixations at 1 year of follow-up (P = .042) and the onlay tenodesis technique at 2 years of follow-up (P = .029). No additional tenodesis comparisons demonstrated statistical significance. The proportion of patients with improvement exceeding the MCID did not differ based on tenodesis methods for any outcome score assessed at the 1- or 2-year follow-up. Conclusion Biceps tenodesis with concomitant RCR led to improved outcomes regardless of tenodesis fixation construct, location, or technique. A clear optimal tenodesis method with RCR remains to be determined. Surgeon preference and experience with various tenodesis methods as well as patient clinical presentation should continue to guide surgical decision-making.
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Affiliation(s)
- David P Hagan
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, Florida, USA
| | - Kevin A Hao
- College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Joseph J King
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, Florida, USA
| | - Ramesh C Srinivasan
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, Florida, USA
| | - Thomas W Wright
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, Florida, USA
| | - Michael W Moser
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, Florida, USA
| | - Kevin W Farmer
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, Florida, USA
| | - Jonathan O Wright
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, Florida, USA
| | - Marissa Pazik
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, Florida, USA
| | - Ryan P Roach
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, Florida, USA
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Guerra JJ, Curran GC, Guerra LM. Subpectoral, Suprapectoral, and Top-of-Groove Biceps Tenodesis Procedures Lead to Similar Good Clinical Outcomes: Comparison of Biceps Tenodesis Procedures. Arthrosc Sports Med Rehabil 2023; 5:e663-e670. [PMID: 37388890 PMCID: PMC10300542 DOI: 10.1016/j.asmr.2023.03.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 03/23/2023] [Indexed: 07/01/2023] Open
Abstract
Purpose To determine whether there is a difference in clinical results among open subpectoral (SB), arthroscopic low-in-groove suprapectoral (SP), and arthroscopic top-of-groove (TOG) locations in terms of patient-reported outcome measures for biceps tenodesis (BT) procedures using a global, self-reporting registry. Methods We identified patients who underwent BT surgery in the Surgical Outcomes System registry. The inclusion criteria were isolated primary surgical procedures for BT, excluding patients with rotator cuff and labral repairs. Additional search requirements included repair location and 100% compliance with pretreatment and 2-year follow-up surveys. This study measured clinical outcomes comparing the 3 aforementioned techniques using the American Shoulder and Elbow Surgeons (ASES) score, visual analog scale (VAS) pain score, and Single Assessment Numeric Evaluation (SANE) score before treatment and at 3 months, 6 months, 1 year, and 2 years postoperatively. In addition, postoperative VAS pain scores were collected at 2 and 6 weeks. Statistical analysis was conducted using analysis of variance (Kruskal-Wallis test) and the Wilcoxon test. Results A total of 1,923 patients from the Surgical Outcomes System registry qualified for the study; of these, 879 underwent the SB technique, 354 underwent the SP technique, and 690 underwent the TOG technique. There was no statistically significant difference in the demographic characteristics among the groups except that the TOG group was older: 60.76 years versus 54.56 years in the SB group and 54.90 years in the SP group (P < .001). In all groups, the ASES score statistically improved from before treatment (mean, 49.29 ± 0.63) to 2 years postoperatively (mean, 86.82 ± 0.80; P < .05). There were no statistically significant differences among the 3 groups in the VAS, ASES, and SANE scores at all time points (P > .12) except for the VAS score at 1 year (P = .032) and the ASES score at 3 months (P = .0159). At 1 year, the mean VAS score in the SB group versus the TOG group was 1.146 ± 1.27 versus 1.481 ± 1.62 (P = .032), but the minimal clinically important difference (MCID) was not met. The 3-month ASES Index scores in the SB, SP, and TOG groups were 68.991 ± 18.64, 66.499 ± 17.89, and 67.274 ± 16.9, respectively (P = .0159), and similarly, the MCID was not met. At 2 years, the ASES scores in the SB, SP, and TOG groups improved from 49.986 ± 18.68, 49.54 ± 16.86, and 49.697 ± 7.84, respectively, preoperatively to 86.00 ± 18.09, 87.60 ± 17.69, and 86.86 ± 16.36, respectively, postoperatively (P > .12). Conclusions The SB, SP, and TOG BT procedures each resulted in excellent clinical improvement based on patient-reported outcome measures from a global registry. On the basis of the MCID, no technique was clinically superior to the other techniques in terms of VAS, ASES, or SANE scores at any time point up to 2 years. Level of Evidence Level III, retrospective comparative study.
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Bruni DF, Pierson SR, Sarwar F, Ring D, Ramtin S. Are the Pathologic Features of Enthesopathy, Tendinopathy, and Labral and Articular Disc Disease Related to Mucoid Degeneration? A Systematic Review. Clin Orthop Relat Res 2023; 481:641-650. [PMID: 36563131 PMCID: PMC10013668 DOI: 10.1097/corr.0000000000002499] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 10/31/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Tendinopathy, enthesopathy, labral degeneration, and pathologic conditions of the articular disc (knee meniscus and ulnocarpal) are sometimes described in terms of inflammation or damage, while the histopathologic findings are often consistent with mucoid degeneration. A systematic review of the histopathology of these structures at diverse locations might reconceptualize these diseases as expected aspects of human aging. The potential benefits of this evolution might include healthier patient and clinician mindsets as well as a reduced likelihood of overdiagnosis and overtreatment resulting from greater awareness of base rates of pathology. QUESTION/PURPOSE In this systematic review of studies of surgical specimens, we asked: Are there are any differences in the histopathologic findings of structural soft tissue conditions (mucoid degeneration, inflammation, and vascularity) by anatomic site (foot, elbow, or knee) or structure (tendon body, muscle or tendon origin or insertion [enthesis], labrum, or articular disc)? METHODS Studies between 1980 and 2021 investigating the histopathologic findings of specimens from surgery for trigger digit, de Quervain tendinopathy, plantar fasciitis, lateral and medial elbow enthesopathy, rotator cuff tendinopathy, posterior tibial tendinopathy, patellar tendinopathy, Achilles tendinopathy, or disease of the hip labrum, ulnocarpal articular disc, or knee meniscus were searched for in the PubMed, EMBASE, and CINAHL databases. Inclusion criteria were the prespecified anatomic location or structure being analyzed histologically and any findings described with respect to inflammation, vascularity, or mucoid degeneration. Studies were excluded if they were nonhuman studies or review articles. Search terms included "anatomy," "pathology," and "histopathology." These terms were coupled with anatomic structures or disorders and included "trigger finger," "de Quervain," "fasciitis, plantar," "tennis elbow," "rotator cuff tendinopathy," "elbow tendinopathy," "patellar tendonitis," "posterior tibial tendon," and "triangular fibrocartilage." This resulted in 3196 studies. After applying the inclusion criteria, 559 articles were then assessed for eligibility according to our exclusion criteria, with 52 eventually included. We recorded whether the study identified the following histopathologic findings: inflammatory cells or molecular markers, greater than expected vascularity (categorized as quantitative count, with or without controls; molecular markers; or qualitative judgments), and features of mucoid degeneration (disorganized collagen, increased extracellular matrix, or chondroid metaplasia). In the absence of methods for systematically evaluating the pathophysiology of structural (collagenous) soft tissue structures and rating histopathologic study quality, all studies that interpreted histopathology results were included. The original authors' judgment regarding the presence or absence of inflammation, greater than expected vascularity, and elements of mucoid degeneration was recorded along with the type of data used to reach that conclusion. RESULTS Regarding differences in the histopathology of surgical specimens of structural soft tissue conditions by anatomic site, there were no differences in inflammation or mucoid degeneration, and the knee meniscus was less often described as having greater than normal vascularity. There were no differences by anatomic structure. Overall, 20% (10 of 51) of the studies that investigated for inflammation reported it (nine inflammatory cells and one inflammatory marker). Eighty-three percent (43 of 52) interpreted increased vascularity: 40% (17 of 43) using quantitative methods (14 with controls and three without) and 60% (26 of 43) using imprecise criteria. Additionally, 100% (all 52 studies) identified at least one element of mucoid degeneration: 69% (36 of 52) reported an increased extracellular matrix, 71% (37 of 52) reported disorganized collagen, and 33% (17 of 52) reported chondroid metaplasia. CONCLUSION Our systematic review of the histopathology of diseases of soft tissue structures (enthesopathy, tendinopathy, and labral and articular disc) identified consistent mucoid degeneration, minimal inflammation, and imprecise assessment of relative vascularity; these findings were consistent across anatomic sites and structures, supporting a reconceptualization of these diseases as related to aging (senescence or degeneration) rather than injury or activity. CLINICAL RELEVANCE This reconceptualization supports accommodative mindsets known to be associated with greater comfort and capability. In addition, awareness of the notable base rates of structural soft tissue changes as people age might reduce overdiagnosis and overtreatment of incidental, benign, or inconsequential signal changes and pathophysiology.
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Affiliation(s)
- David F. Bruni
- Department of Surgery and Perioperative Care, Dell Medical School, the University of Texas at Austin, Austin, TX, USA
| | - S. Ryan Pierson
- Department of Surgery and Perioperative Care, Dell Medical School, the University of Texas at Austin, Austin, TX, USA
| | - Faiza Sarwar
- Department of Surgery and Perioperative Care, Dell Medical School, the University of Texas at Austin, Austin, TX, USA
| | - David Ring
- Department of Surgery and Perioperative Care, Dell Medical School, the University of Texas at Austin, Austin, TX, USA
| | - Sina Ramtin
- Department of Surgery and Perioperative Care, Dell Medical School, the University of Texas at Austin, Austin, TX, USA
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25
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Pujalte G, Hudspeth LJ, Troyer WD, Shapiro SA. Ultrasound-guided injection of the long head of the biceps tendon sheath with concomitant subacromial bursa injection through the same needlestick. Clin Anat 2023; 36:400-405. [PMID: 36210353 DOI: 10.1002/ca.23961] [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: 06/20/2022] [Revised: 09/30/2022] [Accepted: 10/02/2022] [Indexed: 11/09/2022]
Abstract
Sonography and specific shoulder positions allow for injections into both the long head of the biceps tendon sheath (LHBTS) and the subacromial space (SS) with one needlestick. We validated this technique using cadavers. An experienced proceduralist injected latex solution into 12 unembalmed cadaveric shoulders, aiming for the LHBTS and SS, using an ultrasound-guided injection technique that employs a single-needle entry point. An experienced surgeon dissected each specimen and graded latex location as: (1) completely accurate (in both the SS and LHBTS); (2) partially accurate (in either the SS or LHBTS); (3) accurate with overflow (in both locations, but also elsewhere); (4) partially accurate with overflow (in either location, but also somewhere else); or (5) completely inaccurate (no latex in either location). All 12 ultrasound-guided injections using the technique accurately placed latex into both LHBTS and SS (100% accuracy). Latex was also found in adjacent regions after two (17%) injections: one within the shoulder joint and one within the deltoid musculature. This newly described technique allows highly accurate access to the LHBTS and SS with single-needle entry. This technique could become a favored alternative to subjecting patients to two needlesticks and preparing separate injections to address often concomitant pathologies.
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Affiliation(s)
- George Pujalte
- Department of Family Medicine, Mayo Clinic, Jacksonville, Florida, USA.,Division of Sports Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Loren J Hudspeth
- Orthopedic Surgery, Piedmont Atlanta Hospital, Macon, Georgia, USA
| | - Wesley D Troyer
- Division of Sports Medicine, Mayo Clinic, Jacksonville, Florida, USA.,Department of Physical Medicine and Rehabilitation, Mayo Clinic, Jacksonville, Florida, USA
| | - Shane A Shapiro
- Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, Florida, USA
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26
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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.
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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
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27
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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.
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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.
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Zhang C, Yang G, Li T, Pang L, Li Y, Yao L, Li R, Tang X. Biceps Tenodesis Better Improves the Shoulder Function Compared with Tenotomy for Long Head of the Biceps Tendon Lesions: A Meta-Analysis of Randomised Controlled Trials. J Clin Med 2023; 12:1754. [PMID: 36902540 PMCID: PMC10003204 DOI: 10.3390/jcm12051754] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 02/09/2023] [Accepted: 02/14/2023] [Indexed: 02/25/2023] Open
Abstract
PURPOSE Surgical options for long head of the biceps tendon (LHBT) lesions include tenotomy and tenodesis. This study aims to determine the optimal surgical strategy for LHBT lesions with updated evidence from randomised controlled trials (RCTs). METHODS Literature was retrieved from PubMed, Cochrane Library, Embase and Web of Science on 12 January 2022. Randomised controlled trials (RCTs) comparing the clinical outcomes of tenotomy and tenodesis were pooled in the meta-analyses. RESULTS Ten RCTs with 787 cases met the inclusion criteria, and were included in the meta-analysis. Constant scores (MD, -1.24; p = 0.001), improvement of Constant scores (MD, -1.54; p = 0.04), Simple Shoulder Test (SST) scores (MD, -0.73; p = 0.03) and improvement of SST (p < 0.05) were significantly better in patients with tenodesis. Tenotomy was associated with higher rates of Popeye deformity (OR, 3.34; p < 0.001) and cramping pain (OR, 3.36; p = 0.008]. No significant differences were noticed between tenotomy and tenodesis regarding pain (p = 0.59), American Shoulder and Elbow Surgeons (ASES) score (p = 0.42) and its improvement (p = 0.91), elbow flexion strength (p = 0.38), forearm supination strength (p = 0.68) and range of motion of shoulder external rotation (p = 0.62). Subgroup analyses showed higher Constant scores in all tenodesis types and significantly larger improvement of Constant scores regarding intracuff tenodesis (MD, -5.87; p = 0.001). CONCLUSIONS According to the analyses of RCTs, tenodesis better improves shoulder function in terms of Constant scores and SST scores, and reduces the risk of Popeye deformity and cramping bicipital pain. Intracuff tenodesis might offer the best shoulder function as measured with Constant scores. However, tenotomy and tenodesis provide similar satisfactory results for pain relief, ASES score, biceps strength and shoulder range of motion.
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Affiliation(s)
- Chunsen Zhang
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
- Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Guang Yang
- Operating Room of Anesthesia Surgery Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Tao Li
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
- Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Long Pang
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
- Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Yinghao Li
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
- Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Lei Yao
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
- Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Ran Li
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
- Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Xin Tang
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
- Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu 610041, China
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Pratte T, Smith T, Arevalo A, Wazen J, Rubenstein D. Arthroscopic Suprapectoral Biceps Tenodesis: The Best of Both Worlds. Arthrosc Tech 2022; 11:e1619-e1623. [PMID: 36185115 PMCID: PMC9520008 DOI: 10.1016/j.eats.2022.05.008] [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: 03/08/2022] [Accepted: 05/18/2022] [Indexed: 02/03/2023] Open
Abstract
Biceps tendinopathy and superior labrum anterior posterior lesions are a common source of shoulder pain and disability and can be effectively treated with biceps tenodesis. There are a variety of open and arthroscopic tenodesis techniques, but no one technique has demonstrated superiority. Arthroscopic techniques often disregard the extra-articular portions of the biceps tendon as a potential source of pain. Open techniques address this concern; however, they can be associated with wound complications, increased blood loss, nerve injury, and disruptions to surgical workflow. Here, we describe an all arthroscopic tenodesis technique at the suprapectoral zone of the tendon. This method addresses extra-articular sources of pain, while limiting the potential pitfalls of open surgery.
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Affiliation(s)
- Tyler Pratte
- PCOM Orthopedic Residency Program, Philadelphia, Pennsylvania
- Address correspondence to Tyler Pratte, D.O., PCOM Orthopedic Residency Program, 4190 City Ave., Suite 409, Philadelphia, PA, 19131, U.S.A.
| | - Tyler Smith
- University of Massachusetts Medical Center Orthopedic Sports Medicine Fellowship, Worchester, Massachusetts
| | - Alfonso Arevalo
- PCOM Orthopedic Residency Program, Philadelphia, Pennsylvania
| | - Joseph Wazen
- PCOM Orthopedic Residency Program, Philadelphia, Pennsylvania
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30
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Meldau JE, Farooq H, Garbis NG, Schoenfeldt TL, Salazar DH. The Long Head of the Biceps Myotendinous Junction Is Located 1.14 Centimeters Distal to the Proximal Border of the Pectoralis Major Tendon: An Anatomic Study. Arthrosc Sports Med Rehabil 2022; 4:e1373-e1376. [PMID: 36033203 PMCID: PMC9402465 DOI: 10.1016/j.asmr.2022.04.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 04/26/2022] [Indexed: 11/27/2022] Open
Affiliation(s)
| | - Hassan Farooq
- Address correspondence to Hassan Farooq, M.D., Department of Orthopaedic Surgery and Rehabilitation, Loyola University Health System, 2160 S. First Ave. Maguire Center, Suite 1700 Maywood, IL 60153.
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31
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Kim BK, Lee HJ, Jung SH, Dan J. Flexion-extension-supination test compared to arthroscopic findings of biceps long head pathology: A physical examination that reflect anatomical evolution of human shoulder girdle. Medicine (Baltimore) 2022; 101:e29755. [PMID: 35839003 PMCID: PMC11132406 DOI: 10.1097/md.0000000000029755] [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] [Received: 07/19/2021] [Accepted: 05/21/2022] [Indexed: 11/25/2022] Open
Abstract
The accuracy of physical examination for diagnosing lesions of the long head of the biceps tendon (LHBT) remains unsatisfactory. The purpose of this study was to describe a new diagnostic test, the Flexion-Extension-Supination (FES) test for diagnosing lesions of the long head of biceps tendon. A prospective study of 162 patients was performed to evaluate the diagnostic value of FES test. All the participants were evaluated on the basis of their clinical presentation, physical examination (FES test), radiologic findings and arthroscopic examination. Shoulder arthroscopy findings were used as the gold standard. To reduce the omission of the hidden lesion, LHBT was checked at the intra- and the extraarticular side via arthroscopic examination. Surgical findings related to biceps pathology were as follows: rotator cuff tears, 89.5% (145/162); subacromial impingement, 8.6% (14/162); and biceps tendinitis, 1.9% (3/162). The prevalence of biceps pathology was 77.2% (125/162) of all arthroscopic procedures. No significant differences for LHBT lesions were observed between the FES test and the arthroscopic findings (P = .850). The interrater reliability of the FES test was 0.747. After excluding inconclusive results between examiners, the sensitivity, specificity, positive predictive value, and negative predictive value of the FES test were 87.9%, 66.7%, 82.9%, and 63.2%, respectively. Positive and negative likelihood ratios were 2.67 and 0.18, respectively. The maneuvers of the FES test irritate intra- and extraarticular lesion of LHBT. The FES test is a reproducible and reliable test that can be used during physical examinations to evaluate patients with LHBT lesions.
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Affiliation(s)
- Byung-Kook Kim
- Department of Orthopaedic Surgery, Gumi CHA Medical Center, School of Medicine, CHA University, Republic of Korea
| | - Ho-Jae Lee
- Department of Orthopaedic Surgery, Gumi CHA Medical Center, School of Medicine, CHA University, Republic of Korea
| | - Suk-Han Jung
- Department of Orthopaedic Surgery, Gumi CHA Medical Center, School of Medicine, CHA University, Republic of Korea
| | - Jinmyoung Dan
- Department of Orthopaedic Surgery, Gumi CHA Medical Center, School of Medicine, CHA University, Republic of Korea
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Lalevée M, van Rooij F, Nover L, Kumble A, Saffarini M, Courage O. 3D imaging has good specificity but poor sensitivity for the diagnosis of pathologies of the long head of the biceps: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2022; 30:2510-2520. [PMID: 35094096 DOI: 10.1007/s00167-022-06873-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 01/05/2022] [Indexed: 10/19/2022]
Abstract
PURPOSE To systematically review and meta-analyse the literature to determine which three-dimensional (3D) imaging modality provides the best diagnostic accuracy to detect pathologies of the long head of the biceps tendon (LHBT). MATERIALS AND METHODS A search was performed on PubMed, Embase®, and Cochrane. Studies that compared the diagnostic accuracy of 3D imaging modalities versus arthroscopy for the assessment of LHBT pathologies were included. Studies assessing superior labral anterior posterior (SLAP) lesions were excluded. RESULTS Fifteen studies were included; nine were eligible for meta-analysis. Six studies on instability indicated a sensitivity of 0.68 (CI 0.46-0.84) and specificity of 0.76 (CI 0.68-0.82). Four studies on full-thickness tears indicated a sensitivity of 0.56 (CI 0.28-0.81) and specificity of 0.97 (CI 0.93-0.99). Four studies on partial-thickness tears indicated a sensitivity of 0.52 (CI 0.20-0.82) and specificity of 0.64 (CI 0.25-0.91). Two studies on any tear indicated a sensitivity of 0.58 (CI 0.28-0.83) and specificity of 0.99 (CI 0.93-1.00). Only one study on other pathologies indicated a sensitivity of 0.61 and specificity of 0.84. CONCLUSION To diagnose LHBT pathologies, 3D imaging modalities overall have low-to-moderate sensitivity, but high-to-excellent specificity. The consistency in reported sensitivity is generally poor, while the consistency and reported specificity is good for the detection of instability, full-thickness tears and any tear, but poor for the detection of partial-thickness tears. 3D imaging may be adequate to rule out LHBT pathologies, but are not sufficiently reliable to confirm the presence of such pathologies. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Matthieu Lalevée
- Hopital Prive de l'Estuaire, Ramsay Santé, Le Havre, France.,Hôpital Charles Nicolle, CHU de Rouen, Rouen, France
| | | | - Luca Nover
- ReSurg SA, Rue Saint Jean 22, 1260, Nyon, Switzerland
| | | | - Mo Saffarini
- ReSurg SA, Rue Saint Jean 22, 1260, Nyon, Switzerland
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Ren YM, Duan YH, Sun YB, Yang T, Hou WY, Liu C, Tian MQ. mRNA and long non-coding RNA expression profiles of rotator cuff tear patients reveal inflammatory features in long head of biceps tendon. BMC Med Genomics 2022; 15:140. [PMID: 35725478 PMCID: PMC9210618 DOI: 10.1186/s12920-022-01292-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 06/15/2022] [Indexed: 02/06/2024] Open
Abstract
Background This study aimed to identify the differentially expressed mRNAs and lncRNAs in inflammatory long head of biceps tendon (LHBT) of rotator cuff tear (RCT) patients and further explore the function and potential targets of differentially expressed lncRNAs in biceps tendon pathology. Methods Human gene expression microarray was made between 3 inflammatory LHBT samples and 3 normal LHBT samples from RCT patients. GO analysis and KEGG pathway analysis were performed to annotate the function of differentially expressed mRNAs. The real-time quantitative reverse transcription-polymerase chain reaction (qRT-PCR) was admitted to verify their expression. LncRNA-mRNA co-expression network, cis-acting element, trans-acting element and transcription factor (TF) regulation analysis were constructed to predict the potential molecular regulatory mechanisms and targets for LHB tendinitis. Results 103 differentially expressed lncRNAs and mRNAs, of which 75 were up-regulated and 28 were down-regulated, were detected to be differentially expressed in LHBT. The expressions of 4 most differentially expressed lncRNAs (A2MP1, LOC100996671, COL6A4P, lnc-LRCH1-5) were confirmed by qRT-PCR. GO functional analysis indicated that related lncRNAs and mRNAs were involved in the biological processes of regulation of innate immune response, neutrophil chemotaxis, interleukin-1 cell response and others. KEGG pathway analysis indicated that related lncRNAs and mRNAs were involved in MAPK signaling pathway, NF-kappa B signaling pathway, cAMP signaling pathway and others. TF regulation analysis revealed that COL6A4P2, A2MP1 and LOC100996671 target NFKB2. Conclusions LlncRNA-COL6A4P2, A2MP1 and LOC100996671 may regulate the inflammation of LHBT in RCT patients through NFKB2/NF-kappa B signaling pathway, and preliminarily revealed the pathological molecular mechanism of tendinitis of LHBT. Supplementary Information The online version contains supplementary material available at 10.1186/s12920-022-01292-y.
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Affiliation(s)
- Yi-Ming Ren
- Department of Joint and Sport Medicine, Tianjin Union Medical Center, Nankai University Affiliated People's Hospital, Jieyuan Road 190, Hongqiao District, Tianjin, 300121, People's Republic of China
| | - Yuan-Hui Duan
- Department of Joint and Sport Medicine, Tianjin Union Medical Center, Nankai University Affiliated People's Hospital, Jieyuan Road 190, Hongqiao District, Tianjin, 300121, People's Republic of China
| | - Yun-Bo Sun
- Department of Joint and Sport Medicine, Tianjin Union Medical Center, Nankai University Affiliated People's Hospital, Jieyuan Road 190, Hongqiao District, Tianjin, 300121, People's Republic of China
| | - Tao Yang
- Department of Joint and Sport Medicine, Tianjin Union Medical Center, Nankai University Affiliated People's Hospital, Jieyuan Road 190, Hongqiao District, Tianjin, 300121, People's Republic of China
| | - Wei-Yu Hou
- Department of Joint and Sport Medicine, Tianjin Union Medical Center, Nankai University Affiliated People's Hospital, Jieyuan Road 190, Hongqiao District, Tianjin, 300121, People's Republic of China
| | - Chang Liu
- Schoole of Medicine, Nankai University, Tianjin, People's Republic of China
| | - Meng-Qiang Tian
- Department of Joint and Sport Medicine, Tianjin Union Medical Center, Nankai University Affiliated People's Hospital, Jieyuan Road 190, Hongqiao District, Tianjin, 300121, People's Republic of China.
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McDevitt AW, Cleland JA, Addison S, Calderon L, Snodgrass S. Physical Therapy Interventions for the Management of Biceps Tendinopathy: An International Delphi Study. Int J Sports Phys Ther 2022; 17:677-694. [PMID: 35693861 PMCID: PMC9159730 DOI: 10.26603/001c.35256] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 03/24/2022] [Indexed: 11/18/2022] Open
Abstract
Background Shoulder pain related to the long head of the biceps tendon (LHBT) tendinopathy can be debilitating and difficult to treat especially in athletes who often elect for surgical intervention. Conservative management is recommended but there are limited established guidelines on the physical therapy (PT) management of the condition. Hypothesis/Purpose The purpose of this study was to establish consensus on conservative, non-surgical physical therapy interventions for individuals with LHBT tendinopathy using the Delphi method approach. Study Design Delphi Study. Methods Through an iterative process, experts in the PT field rated their agreement with a list of proposed treatment interventions and suggested additional interventions during each round. Agreement was measured using a four-point Likert scale. Descriptive statistics including median and percentage agreement were used to measure agreement. Data analysis at the end of Round III produced, by consensus, a list of PT interventions recommended for the management of individuals with LHBT tendinopathy. Consensus was defined as an a priori cutoff of ≥75% agreement. Results The respondent group included 29 international experts in the PT management of individuals with shoulder pain. At the conclusion of the study 61 interventions were designated as recommended based on consensus amongst experts and 9 interventions were not recommended based on the same criteria, 15 interventions did not achieve consensus. Conclusion There is a lack of well-defined, PT interventions used to treat LHBT tendinopathy. Expert respondents reached consensus on multimodal interventions including exercise, manual therapy and patient education to manage LHBT tendinopathy. Level of Evidence 5.
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Affiliation(s)
- Amy W McDevitt
- Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus; The University of Newcastle
| | - Joshua A Cleland
- Department of Public Health and Community Medicine, Doctor of Physical Therapy Program, Tufts University School of Medicine
| | - Simone Addison
- Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus
| | - Leah Calderon
- Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus
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Gwark JY, Park HB. Prediction of Bilaterality in Patients With 1 Posterosuperior Rotator Cuff Tear. Am J Sports Med 2022; 50:1928-1937. [PMID: 35532963 DOI: 10.1177/03635465221094816] [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: 01/31/2023]
Abstract
BACKGROUND In patients with a known unilateral posterosuperior rotator cuff tear (PSRCT), the ability to predict a contralateral PSRCT may assist in earlier diagnosis and improved patient outcomes. PURPOSE To determine factors associated with bilateral PSRCT and their most predictive combinations using a nonhospitalized general population. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS This study involved 736 individuals (n = 1472 shoulders) drawn from a rural cohort. PSRCT was diagnosed using magnetic resonance imaging. Symptoms of the contralateral shoulder were not considered. The demographic, physical, social, metabolic, and imaging factors, as well as comorbidities, were evaluated using logistic regression analysis. Cutoff values for the significantly associated variables obtained from multivariable logistic regression analysis were calculated using the receiver operating characteristic (ROC) curve. The areas under the ROC curve (AUCs) of the combinations of significantly associated variables were compared using the DeLong method to determine the combination most predictive of bilateral PSRCT. The likelihood ratio and the posttest probability for each of the combinations were assessed. RESULTS Age ≥61 years, manual labor, critical shoulder angle (CSA) ≥35°, retraction degree of Patte ≥ grade 2, biceps tendon injury, and metabolic syndrome were significantly associated with bilateral PSRCT in multivariable analysis (P < .001). The 1-by-1 combination of any 4 of the 6 associated factors significantly increased the AUC of any smaller combinations of those 6 factors (P < .001). The AUCs of the 4-somes were all similar (P ≥ .383) and were not significantly increased by further addition of identified associated factors (P ≥ .422). Any combination of 4 of the 6 associated factors was highly predictive of bilateral PSRCT, each having a minimum AUC of 0.70, a likelihood ratio of >10, and a minimum posttest probability of 80%. CONCLUSION Unilateral PSRCT, accompanied by any 4 of the variables of age ≥61 years, manual labor, CSA ≥35°, retraction degree of Patte ≥ grade 2, biceps tendon injury, and metabolic syndrome, is highly predictive of PSRCT in the other shoulder.
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Affiliation(s)
- Ji-Yong Gwark
- Department of Orthopaedic Surgery, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
- Gyeongsang Institute of Health Sciences, Gyeongsang National University, Jinju, Republic of Korea
| | - Hyung Bin Park
- Department of Orthopaedic Surgery, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
- Gyeongsang Institute of Health Sciences, Gyeongsang National University, Jinju, Republic of Korea
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Shavana G, Cronjé JY, Mcduling C, Verbeek RB, Nkwenika T, Hohmann E, Natalie K. A biomechanical study on the effect of long head of biceps tenotomy on supraspinatus load and humeral head position during shoulder abduction. J Shoulder Elbow Surg 2022; 31:1294-1299. [PMID: 35051540 DOI: 10.1016/j.jse.2021.12.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 12/07/2021] [Accepted: 12/12/2021] [Indexed: 02/01/2023]
Abstract
INTRODUCTION The purpose of this study was to determine the effect of biceps tendon tenotomy on the load of the supraspinatus tendon/muscle complex during abduction of the arm from 0° to 15°. METHODS Eleven fresh frozen human cadaver shoulders (6 males, 5 females, age ranged 44-88 years, mean upper extremity weight 2.96 ± 0.56 kg) were included. The specimens were sequentially mounted onto a custom-made fixture attached to a pulley system and load cell. The pulley system was used to pull the supraspinatus tendon/muscle complex along its fiber directions to abduct the arm to 15°. Abduction angles were recorded with a digital inclinometer. Two conditions were tested: (1) long head biceps tendon (LHBT) intact and in normal anatomical position; (2) LHBT cut within the bicipital groove. Qualitative visual inspection of humeral head displacement during abduction was also included. Descriptive statistics were calculated. The Shapiro-Wilk test was used to establish normal data distribution, and the paired t-test was used to compare the 2 conditions. RESULTS For the intact condition (LHBT intact), the mean load was 45.71 ± 21.04 N. For the biceps tenotomy test, the load measured 41.37 ± 23.43 N. These differences were not significant (P = .1480). In the tenotomy condition, the humeral head initially displaced inferior, and with initiation of abduction, the humeral head translated superior to its normal position. CONCLUSION The results suggest that the LHBT has no critical role with initial abduction of the arm. Furthermore, the LHBT does not appear to increase loads required for the supraspinatus muscle/tendon complex to perform the same action of abduction.
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Affiliation(s)
- Govender Shavana
- Department of Anatomy, University of Pretoria, Pretoria, South Africa
| | - Jessica Y Cronjé
- Department of Anatomy, University of Pretoria, Pretoria, South Africa
| | - Chris Mcduling
- Materials Science and Manufacturing, Council for Scientific and Industrial Research, Pretoria, South Africa
| | | | - Tshifhiwa Nkwenika
- Biostatistics Unit, South Africa Medical Research Council, Pretoria, South Africa
| | - Erik Hohmann
- Medical School, University of Pretoria, Pretoria, South Africa; Department of Orthopaedics Surgery and Sports Medicine, Burjeel Hospital for Advanced Surgery, Dubai, UAE.
| | - Keough Natalie
- Department of Anatomy, University of Pretoria, Pretoria, South Africa; Department of Anatomy and Cellular Biology, College of Medicine & Health Sciences, Khalifa University, Abu Dhabi, UAE
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Ek ET, Flynn JN, Boyce GN, Padmasekara G. The role of elbow positioning on arthroscopic assessment of the long head of biceps tendon in the beach chair position. ANZ J Surg 2022; 92:1820-1825. [PMID: 35557483 PMCID: PMC9541622 DOI: 10.1111/ans.17764] [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: 01/17/2022] [Revised: 04/03/2022] [Accepted: 04/23/2022] [Indexed: 11/27/2022]
Abstract
Background Tendinopathy of the long head of biceps (LHB) tendon is a common cause of anterior shoulder pain and dysfunction. The extra‐articular portion within the bicipital groove undergoes frequent load and friction during shoulder movements and pathology within this area is frequently missed during arthroscopic assessment. Methods We quantified the arthroscopically assessable length of tendon within the shoulder in 14 consecutive patients undergoing subpectoral biceps tenodesis. After biceps tenotomy at the superior labrum, the tagged tendon was maximally tensioned and marked at the biceps outlet with the elbow in extension and flexion. The distance in distance between the two were measured. Results Mean distance from the superior labral insertion of the biceps to the outlet was 16.4 ± 4.1 mm (range, 11–25). With tension on the biceps with elbow extension, the mean measurable distance was 31.3 ± 6.7 mm (range, 19–45). With elbow flexion, this increased to 39.5 ± 5.9 mm (range, 25–52). Mean increase in visible tendon length was 8.2 ± 4.3 mm (range, 5–21) (p = 0.002). Conclusion Elbow flexion results in an average increase of 26.2% more extra‐articular tendon visualized at arthroscopy. Therefore, we believe that elbow flexion is a useful adjunct, especially when performed in conjunction with techniques that pull the tendon into the joint, thus allowing for more complete arthroscopic assessment of the LHB, increasing detection of symptomatic biceps tendonitis. Level of evidence: Level IV.
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Affiliation(s)
- Eugene T Ek
- Melbourne Orthopaedic Group, Melbourne, Victoria, Australia.,Department of Surgery, Monash Medical Centre, Monash University, Melbourne, Victoria, Australia
| | | | - Glenn N Boyce
- Melbourne Orthopaedic Group, Melbourne, Victoria, Australia
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Vajda M, Szakó L, Hegyi P, Erőss B, Görbe A, Molnár Z, Kozma K, Józsa G, Bucsi L, Schandl K. Tenodesis yields better functional results than tenotomy in long head of the biceps tendon operations-a systematic review and meta-analysis. INTERNATIONAL ORTHOPAEDICS 2022; 46:1037-1051. [PMID: 35254476 PMCID: PMC9001564 DOI: 10.1007/s00264-022-05338-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 02/01/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Pathology of the long head of the biceps tendon (LHBT) is a common disorder affecting muscle function and causing considerable pain for the patient. The literature on the two surgical treatment methods (tenotomy and tenodesis) is controversial; therefore, our aim was to compare the results of these interventions. METHODS We performed a meta-analysis using the following strategy: (P) patients with LHBT pathology, (I) tenodesis, (C) tenotomy, (O) elbow flexion and forearm supination strength, pain assessed on the ten-point Visual Analog Scale (VAS), bicipital cramping pain, Constant, ASES, and SST score, Popeye deformity, and operative time. We included only randomized clinical trials. We searched five databases. During statistical analysis, odds ratios (OR) and weighted mean differences (WMD) were calculated for dichotomous and continuous outcomes, respectively, using the Bayesian method with random effect model. RESULTS We included 11 studies in the systematic review, nine of these were eligible for the meta-analysis, containing data about 572 patients (279 in the tenodesis, 293 in the tenotomy group). Our analysis concluded that tenodesis is more beneficial considering 12-month elbow flexion strength (WMD: 3.67 kg; p = 0.006), 12-month forearm supination strength (WMD: 0.36 kg; p = 0.012), and 24-month Popeye deformity (OR: 0.19; p < 0.001), whereas tenotomy was associated with decreased 3-month pain scores on VAS (WMD: 0.99; p < 0.001). We did not find significant difference among the other outcomes. CONCLUSION Tenodesis yields better results in terms of biceps function and is non-inferior regarding long-term pain, while tenotomy is associated with earlier pain relief.
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Affiliation(s)
- Mátyás Vajda
- Institute for Translational Medicine, Medical School, University of Pécs, Szigeti út 12, 2nd floor, 7624 Pécs, Hungary
- Saint George University Teaching Hospital of County-Fejér, Seregélyesi u. 3., 8000 Székesfehérvár, Hungary
- Department of Orthodaedics, Medical School, University of Pécs, Akác u. 1, 7632 Pécs, Hungary
| | - Lajos Szakó
- Institute for Translational Medicine, Medical School, University of Pécs, Szigeti út 12, 2nd floor, 7624 Pécs, Hungary
| | - Péter Hegyi
- Institute for Translational Medicine, Medical School, University of Pécs, Szigeti út 12, 2nd floor, 7624 Pécs, Hungary
- Centre for Translational Medicine, Semmelweis University, Üllői út 26, Budapest, 1085 Hungary
| | - Bálint Erőss
- Institute for Translational Medicine, Medical School, University of Pécs, Szigeti út 12, 2nd floor, 7624 Pécs, Hungary
- Centre for Translational Medicine, Semmelweis University, Üllői út 26, Budapest, 1085 Hungary
| | - Anikó Görbe
- Institute for Translational Medicine, Medical School, University of Pécs, Szigeti út 12, 2nd floor, 7624 Pécs, Hungary
| | - Zsolt Molnár
- Institute for Translational Medicine, Medical School, University of Pécs, Szigeti út 12, 2nd floor, 7624 Pécs, Hungary
- Department of Anaesthesiology and Intensive Therapy and Pain Management, Poznan University of Medical Sciences, 49 Przybyszewskiego St, 60-355 Poznan, Poland
| | - Kincső Kozma
- Department of Ophtalmology, Medical School, University of Pécs, Rákóczi út 2, 7623 Pécs, Hungary
| | - Gergő Józsa
- Department of Paediatrics, Surgical Division, University of Pécs, József Attila u. 7, 7623 Pécs, Hungary
| | - László Bucsi
- Saint George University Teaching Hospital of County-Fejér, Seregélyesi u. 3., 8000 Székesfehérvár, Hungary
- Department of Orthodaedics, Medical School, University of Pécs, Akác u. 1, 7632 Pécs, Hungary
| | - Károly Schandl
- Saint George University Teaching Hospital of County-Fejér, Seregélyesi u. 3., 8000 Székesfehérvár, Hungary
- Department of Orthodaedics, Medical School, University of Pécs, Akác u. 1, 7632 Pécs, Hungary
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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.
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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
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Fujiwara Y, Yamamoto S, Kato Y, Kurata S, Fujii S, Inoue K, Inoue T, Mondori T, Nakagawa Y, Tanaka Y. Usefulness of ultrasound in diagnosing long head of the biceps tendon malposition in patients with rotator cuff tears. J Med Ultrason (2001) 2022; 49:289-295. [PMID: 35320435 DOI: 10.1007/s10396-022-01200-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 02/15/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE This study aimed to determine the role of preoperative shoulder ultrasonography (SUS) in detecting positional abnormalities of the long head of the biceps tendon (LHBT) and predicting subscapularis (SSC) tears in patients with rotator cuff injuries. METHODS A total of 331 patients (365 shoulders) who had undergone arthroscopic shoulder surgery for the treatment of rotator cuff tears were included in the study. Their preoperative SUS and magnetic resonance imaging (MRI) findings were examined retrospectively to assess the presence of LHBT abnormalities at the bicipital groove. Using arthroscopic findings as the standard of reference, the sensitivity, specificity, and diagnostic accuracy of SUS and MRI were calculated for detection of LHBT malposition. Furthermore, the correlation between SSC rupture and preoperative LHBT condition was evaluated by MRI and SUS. RESULTS LHBT malposition was preoperatively diagnosed with a sensitivity of 92%, specificity of 90%, and accuracy of 91% with SUS, and a sensitivity of 74%, specificity of 84%, and accuracy of 80% with MRI. Preoperative SUS was significantly superior to MRI in terms of sensitivity, specificity, and accuracy (p < 0.001 each). Further, the preoperative SUS LHBT findings could predict well the presence or absence of intraoperative SSC rupture (odds ratio: 1.73, p < 0.001). CONCLUSION SUS is a useful diagnostic modality for preoperative detection of LHBT malposition and prediction of SSC tears in patients with rotator cuff tears.
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Affiliation(s)
- Yoshiko Fujiwara
- Department of Clinical Laboratory, Uda City Hospital, 815 Haibarahagihara, Uda, Nara, 633-0298, Japan.
| | - Syuichi Yamamoto
- Department of Clinical Laboratory, Uda City Hospital, 815 Haibarahagihara, Uda, Nara, 633-0298, Japan
| | - Yumi Kato
- Department of Clinical Laboratory, Uda City Hospital, 815 Haibarahagihara, Uda, Nara, 633-0298, Japan
| | - Shimpei Kurata
- Department of Orthopaedic Surgery, Uda City Hospital, 815 Haibarahagihara, Uda, Nara, 633-0298, Japan
| | - Shuhei Fujii
- Department of Orthopaedic Surgery, Uda City Hospital, 815 Haibarahagihara, Uda, Nara, 633-0298, Japan
| | - Kazuya Inoue
- Department of Orthopaedic Surgery, Uda City Hospital, 815 Haibarahagihara, Uda, Nara, 633-0298, Japan
| | - Takashi Inoue
- Department of Evidence-Based Medicine, Institute for Clinical and Translational Science, Nara Medical University Hospital, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Takamitsu Mondori
- Department of Orthopaedic Surgery, Uda City Hospital, 815 Haibarahagihara, Uda, Nara, 633-0298, Japan
| | - Yoshiyuki Nakagawa
- Department of Orthopaedic Surgery, Uda City Hospital, 815 Haibarahagihara, Uda, Nara, 633-0298, Japan
| | - Yasuhito Tanaka
- Department of Orthopaedic Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
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Mardani-Kivi M, Asadi K, Izadi A, Leili EK. Rotator cuff repair with or without proximal end detachment for long head of the biceps tendon tenodesis. Clin Shoulder Elb 2022; 25:101-105. [PMID: 35295070 PMCID: PMC9185117 DOI: 10.5397/cise.2021.00493] [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: 09/11/2021] [Accepted: 10/18/2021] [Indexed: 11/25/2022] Open
Abstract
Background Rotator cuff tears cause pathologies of the long head of the biceps tendon (LHBT). One of the surgical treatments for such a tear is LHBT tenodesis to the humerus. This study aims to compare simultaneous rotator cuff repair and LHBT tenodesis with or without detachment of the proximal end of the LHBT (PELHBT) from its site of adhesion to the glenoid. Methods This retrospective study involved patients affected by LHBT pathology with rotator cuff tear. The patients were divided into two groups, with or without PELHBT detachment from the glenoid. Therapeutic outcomes were investigated by evaluation of patient satisfaction, pain based on visual analog scale, shoulder function based on Constant score and simple shoulder test, and biceps muscle strength based on the manual muscle testing grading system before surgery, at 6 months, and at the final visit after surgery. Results Groups 1 and 2 comprised 23 and 26 patients, respectively, who showed no significant differences in demographic characteristics (p>0.05). Shoulder function, biceps muscle strength, pain, and satisfaction rate improved over time (p<0.05) but were not significantly different between the two groups (p>0.05). No post-surgical complication was found in either group. Conclusions There was no difference in final outcomes of tenodesis with or without detachment of the PELHBT from the supraglenoid tubercle. Such tendon detachment is not necessary.
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Affiliation(s)
- Mohsen Mardani-Kivi
- Orthopedic Research Center, Department of Orthopedic, Poursina Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Kamran Asadi
- Orthopedic Research Center, Department of Orthopedic, Poursina Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Amin Izadi
- Department of Orthopedic, Guilan University of Medical Sciences, Rasht, Iran
| | - Ehsan Kazemnejad Leili
- Statistics Department, School of Health, Guilan University of Medical Sciences, Rasht, Iran
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Histopathology of long head of biceps tendon removed during tenodesis demonstrates degenerative histopathology and not inflammatory changes. BMC Musculoskelet Disord 2022; 23:185. [PMID: 35219297 PMCID: PMC8882305 DOI: 10.1186/s12891-022-05124-z] [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: 08/17/2021] [Accepted: 02/14/2022] [Indexed: 11/17/2022] Open
Abstract
Background The aim of this study is to describe and quantitatively analyze the histopathology of proximal long head biceps (LHB) tendinopathy in patients who have undergone LHB tenodesis. The hypothesis is that severe histopathologic changes of the LHB tendon (LHBT) will most likely be reflected with improved postoperative clinical outcomes. Methods The study included patients with isolated LHB tendinopathy or LHB tendinopathy associated with concomitant shoulder pathologies. All had failed conservative treatment (12 months) and had a positive pain response (> 50% reduction) pre-operatively after LHB tendon injection with local anesthetic. All underwent biceps tenodesis procedure between 2008 and 2014. Tendon specimens were collected and histologically analyzed with the semi-quantitative Bonar scoring system. Minimum follow-up time was 1 year. A subset of patients was retrospectively reviewed postoperatively and evaluated employing visual analogue score (VAS), short form survey (SF-12), American Shoulder and Elbow Surgeon (ASES) score, Disability of Arm, Shoulder and Hand (DASH) score, and Oxford Shoulder Score (OSS) and postoperative return to work status. Results Forty-five biceps tendon specimens were obtained from 44 patients (mean age 50 ± 9.6 years). Histopathological analyses demonstrated advanced degenerative changes with myxoid degeneration and marked collagen disorganization. Minimal inflammation was identified. There were no regional differences in histopathological changes. Clinical outcomes did not correlate significantly with severity of histopathologic changes. Conclusions This study confirms that LHBT specimens in patients undergoing tenodesis demonstrate with the use of the Bonar score histopathologic changes of chronic degeneration and not inflammation. The correct histopathologic terminology for this process is LHB tendinosis. The histopathological changes appear uniform throughout the entire length of the LHBT which may inform the nature of the procedure performed.
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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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Malavolta EA, de Sousa AC, Gracitelli MEC, Assunção JH, de Andrade e Silva FB, Ferreira AA. Biceps tenotomy or tenodesis in association with rotator cuff repair: is there an influence on functional results? A retrospective cohort study. SAO PAULO MED J 2022; 140:237-243. [PMID: 35293936 PMCID: PMC9610255 DOI: 10.1590/1516-3180.2021.0219.r1.28062021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 06/28/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Instability or tears of the long head of the biceps tendon (LHBT) may be present in more than 35% of rotator cuff repairs (RCR). OBJECTIVE To compare clinical results from patients undergoing arthroscopic RCR, according to the procedure performed at the LHBT. DESIGN AND SETTING Retrospective cohort study designed at the shoulder and elbow clinic of Instituto de Ortopedia e Traumatologia, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Brazil. METHODS Functional results among patients were compared using the American Shoulder and Elbow Surgeons (ASES) and University of California Los Angeles (UCLA) scales, according to the LHBT approach adopted: no procedure, tenotomy or tenodesis. RESULTS We evaluated 306 shoulders (289 patients): 133 underwent no procedure at the LHBT, 77 tenotomy and 96 tenodesis. The ASES scale at 24 months showed no difference (P = 0.566) between the groups without LHBT procedure (median 90.0; interquartile range, IQR 29), tenotomy (median 90.0; IQR 32.1) or tenodesis (median 94.4; IQR 22.7); nor did the UCLA scale (median 33; IQR 7 versus median 31; IQR 8 versus median 33; IQR 5, respectively, P = 0.054). The groups differed in the preoperative functional assessment according to the ASES and UCLA scale, such that the tenodesis group started from higher values. However, there was no difference in pre and postoperative scores between the groups. CONCLUSION Tenodesis or tenotomy of the LHBT, in the sample analyzed, did not influence the clinical results from RCR, as assessed using the ASES and UCLA scales.
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Affiliation(s)
- Eduardo Angeli Malavolta
- MD, PhD. Attending Orthopedic Surgeon, Department of Orthopedics and Traumatology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR.
| | - Alana Caselato de Sousa
- MD. Attending Orthopedic Surgeon, Department of Orthopedics and Traumatology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR.
| | - Mauro Emilio Conforto Gracitelli
- MD, PhD. Attending Orthopedic Surgeon, Department of Orthopedics and Traumatology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR.
| | - Jorge Henrique Assunção
- MD. Attending Orthopedic Surgeon, Department of Orthopedics and Traumatology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR.
| | - Fernando Brandão de Andrade e Silva
- MD, PhD. Attending Orthopedic Surgeon, Department of Orthopedics and Traumatology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR.
| | - Arnaldo Amado Ferreira
- MD, PhD. Head of the Shoulder and Elbow Group, Department of Orthopedics and Traumatology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR.
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Clinical Outcomes of Revision Biceps Tenodesis for Failed Long Head of Biceps Surgery: A Systematic Review. Arthroscopy 2021; 37:3529-3536. [PMID: 34023436 DOI: 10.1016/j.arthro.2021.04.063] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 04/24/2021] [Accepted: 04/24/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE We summarize the indications, assess the modes of failure, and analyze the clinical and functional outcomes of revision biceps tenodesis after failed primary surgical treatment of long head of biceps (LHB) pathology. METHODS A computerized search of PubMed, EMBASE, and CINAHL databases and manual screening of selected article reference lists was performed in September 2020. Randomized controlled trial, cohort, case-control, and case series studies reporting clinical outcomes of revision biceps tenodesis following failed LHB surgery were eligible. Patient demographics, indications for revision, intraoperative findings, surgical techniques, and patient-reported outcomes were recorded. Functional assessment and pain scores were assessed and summarized as forest plots with means and 95% confidence intervals. RESULTS Five of 465 identified studies met inclusion criteria, encompassing 70 revision biceps tenodesis procedures with mean follow-up of 2.4-6.4 years. The failed index procedure was biceps tenodesis in 62 patients and tenotomy in 8 patients. The most common indications for revision were pain or cramping and rerupture, cited by 4 and 3 articles, respectively. After failed conservative treatment, open subpectoral revision tenodesis was performed with concomitant arthroscopic debridement in 65 of 70 cases. Common intraoperative findings at time of revision were adhesions or scarring (39.0-83.0%), fixation failure (8.7-75.0%), and biceps rupture (17.4-80.0%). Revision tenodesis patients reported good to excellent functional outcomes with improvements in Single Assessment Numeric Evaluation, American Shoulder and Elbow Surgeons Shoulder, and visual analog scale pain scores, and satisfaction ranged from 88.0 to 100%. All studies demonstrated moderate quality of evidence and risk of bias when critically appraised. CONCLUSION This systematic review of 5 moderate risk of bias studies demonstrated that the most common reasons for revision biceps tenodesis were pain or cramping and rerupture. Open subpectoral revision tenodesis with concomitant arthroscopic debridement provided improvements in functional scores with high patient satisfaction at mid-term follow up. LEVEL OF EVIDENCE IV, Systematic Review of level III and IV investigations.
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Concomitant Biceps Tenodesis Improves Outcomes for SLAP Repair: Minimum 2-Year Clinical Outcomes after SLAP II-IV Repair Versus Tenodesis Versus Both. Arthrosc Sports Med Rehabil 2021; 3:e2007-e2014. [PMID: 34977660 PMCID: PMC8689264 DOI: 10.1016/j.asmr.2021.10.007] [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] [Received: 11/09/2020] [Accepted: 10/11/2021] [Indexed: 01/02/2023] Open
Abstract
Purpose To investigate clinical outcomes, return to sport, and complication rate in patients with an isolated SLAP II-IV tear treated with biceps tenodesis (BT), SLAP-repair (SLAP-R), or both (SLAP-R+BT). Methods A retrospective analysis of prospectively collected data was performed in patients who underwent surgery between February 2006 and February 2018 for isolated SLAP II-IV lesions with either BT, SLAP-R, or SLAP-R+BT and had minimum 2-year follow-up. Patients were excluded if they were older than 45 years of age, had anterior shoulder instability, rotator cuff tears, glenohumeral osteoarthritis, or concomitant fractures about the shoulder. Clinical outcomes were assessed by the use of the American Shoulder and Elbow Society Score, Single Assessment Numerical Evaluation Score, Quick Disabilities of the Arm, and Shoulder and Hand Score, the General Health Short Form-12 Physical Component, and patient satisfaction. Results There were 38 shoulders in the isolated BT group with 1 (2.6%) shoulder requiring revision, 13 in the SLAP-R group with no patient requiring revision, and 21 in the SLAP-R+BT group with 2 (9.5%) shoulders requiring revision. Minimum 2-year follow-up was obtained in >85% of each group. Mean age at time of surgery was significantly different between the groups (36.5 years BT vs 27.7 years SLAP-R vs 36.5 years SLAP-R+BT; P = .003). While patient-reported outcomes improved significantly from pre- to postoperatively for the BT (P < .001) and SLAP-R+BT groups (P < .001), they did not significantly improve for the isolated SLAP-R group (P values ranging .635 to .123). The BT and SLAP-R+BT groups showed significant improvement in return to sport pre- to postoperatively whereas the SLAP-R group did not. The SLAP-R+BT group had the most patients reaching minimal clinical important difference, substantial clinical benefit, and patient acceptable symptom state American Shoulder and Elbow Society Score scores; however, this was not statistically significant. Conclusions SLAP II-IV lesions treated with BT or both SLAP-R+BT demonstrated improved outcomes compared with isolated SLAP-R at minimum 2-year follow-up. Concomitant biceps tenodesis should be considered when performing repair of SLAP II-IV tears. Level of Evidence III; Retrospective comparative study.
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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.
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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
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Panico L, Roy T, Namdari S. Long Head of the Biceps Tendon Ruptures: Biomechanics, Clinical Ramifications, and Management. JBJS Rev 2021; 9:01874474-202110000-00007. [PMID: 34695033 DOI: 10.2106/jbjs.rvw.21.00092] [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: 11/14/2022]
Abstract
» Pathology of the long head of the biceps tendon is a common source of shoulder pain and often occurs in combination with other shoulder disorders. » Nonsurgical management, including rest and activity modification, use of nonsteroidal anti-inflammatory drugs, physical therapy, and corticosteroid injections, is usually the first line of treatment. » Patients with symptoms that are refractory to nonsurgical management are indicated for biceps tenotomy or various tenodesis procedures. » Although several studies have reported a higher incidence of "Popeye" deformity, muscle cramping, and pain in the bicipital groove postoperatively with tenotomy compared with tenodesis, there are no substantial differences in functional scores or patient satisfaction between the 2 techniques. » To date, both tenotomy and tenodesis have been shown to be effective options in the management of long head of the biceps tendinopathy, and there are advantages to each procedure.
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Affiliation(s)
- Leighann Panico
- Department of Orthopedic Surgery, UPMC Pinnacle, Harrisburg, Pennsylvania
| | - Trinava Roy
- Rowan University School of Osteopathic Medicine, Stratford, New Jersey
| | - Surena Namdari
- Rothman Orthopaedic Institute, Philadelphia, Pennsylvania
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Tangtiphaiboontana J, Figoni AM, Luke A, Zhang AL, Feeley BT, Ma CB. The effects of nonsteroidal anti-inflammatory medications after rotator cuff surgery: a randomized, double-blind, placebo-controlled trial. J Shoulder Elbow Surg 2021; 30:1990-1997. [PMID: 34174448 DOI: 10.1016/j.jse.2021.05.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 05/11/2021] [Accepted: 05/16/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Nonsteroidal anti-inflammatory drugs (NSAIDs) are frequently used for postoperative pain management. However, animal studies have demonstrated negative effects of NSAIDs on bone and tendon healing after commonly performed procedures such as rotator cuff repair. The purpose of this study was to evaluate the effects of postoperative NSAID use on opioid use, pain control, and shoulder outcomes after arthroscopic rotator cuff repair. METHODS A randomized, double-blind, placebo-controlled trial of postoperative NSAID use was performed in patients undergoing primary arthroscopic rotator cuff surgery at a single institution. Patients were randomized to receive ibuprofen or placebo for 2 weeks postoperatively, in addition to opioid medication. They were instructed to keep a daily pain diary for the first week after surgery, which was returned at their first postoperative visit for analysis. Visual analog scale (VAS) pain scores, shoulder range of motion, and 12-item Short Form Survey, Disabilities of the Arm, Shoulder and Hand, and American Shoulder and Elbow Surgeons (ASES) scores were collected. Assessment of rotator cuff healing was performed using ultrasound at 1 year postoperatively. RESULTS A total of 50 patients in the placebo group and 51 patients in the ibuprofen group were included for analysis. There were no differences in age, race, sex, history of preoperative NSAID or opioid use, or operative findings between groups. The amount of mean total morphine milligram equivalents (MMEs) used in the first postoperative week was lower in the ibuprofen group than in the placebo group (168 MMEs vs. 211 MMEs, P = .04). Early VAS scores on postoperative days 3, 4, 5, and 6 were lower in the ibuprofen group, but there was no difference in mean VAS scores between groups by 6 weeks after surgery. At 6 months, mean forward flexion and the mean ASES score were higher in the ibuprofen group than in the placebo group: 162° vs. 153° (P = .03) and 86 vs. 78 (P = .02), respectively. There were no differences in shoulder motion or 12-item Short Form Survey, Disabilities of the Arm, Shoulder and Hand, or ASES scores at 1 year. At 1 year after surgery, 7 patients in the ibuprofen group had evidence of tendon retear diagnosed on ultrasound (5 partial and 2 full thickness) compared with 13 patients in the placebo group (5 partial and 8 full thickness), but this difference was not statistically significant (P = .20). CONCLUSION Postoperative ibuprofen use reduces opioid requirements and decreases patient pain levels in the first week after arthroscopic rotator cuff repair. In addition, ibuprofen use after rotator cuff repair does not lead to an increased risk of tendon retear.
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Affiliation(s)
| | - Andrew M Figoni
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Anthony Luke
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Alan L Zhang
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Brian T Feeley
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - C Benjamin Ma
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA, USA
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50
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Izumi M, Harada Y, Kajita Y, Muramatsu Y, Morimoto T, Morisawa Y, Iwahori Y, Ikeuchi M. Expression of Substance P and Nerve Growth Factor in Degenerative Long Head of Biceps Tendon in Patients with Painful Rotator Cuff Tear. J Pain Res 2021; 14:2481-2490. [PMID: 34429647 PMCID: PMC8379684 DOI: 10.2147/jpr.s320811] [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: 05/20/2021] [Accepted: 07/27/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Degenerative long head of biceps tendon (LHBT) has been recognized as a notable pain source in patients with rotator cuff tear (RCT). Tenotomy or tenodesis of LHBT is frequently indicated together with arthroscopic rotator cuff repair (ARCR) aiming for complete pain relief; however, it has not been fully investigated whether resected LHBT is really a source of pain. The purpose of this study was to investigate expression levels of pain-associated mediators in LHBT and its association with preoperative pain profiles. Methods Twenty-seven RCT patients who underwent ARCR with LHBT resection were included. Each LHBT was resected due to its abnormal arthroscopic findings including tenosynovitis, hypertrophy, and partial tear. Worst macroscopic lesion of the LHBT was obtained, and expression levels of substance P (SP) and nerve growth factor (NGF) were evaluated using enzyme-linked immunosorbent assay (ELISA). Ten healthy knee flexor tendons were analyzed as non-degenerative samples. Preoperatively, subjective shoulder pain VAS and pain duration were investigated. Conventional LHBT pain provocation tests (Speed, Yergason, O’Brien) were performed. Pressure pain threshold (PPT) of bilateral LHBT on the groove was recorded. Results Levels of SP and NGF expression were significantly higher compared with non-degenerative tendons (P<0.01). Shoulder pain VAS and pain duration were not directly associated with SP and NGF expression level. Patients with positive O’Brien test expressed greater SP than negative patients (P=0.001). Significant negative correlation between the PPT ratio (ipsilateral/contralateral) and SP expression level was observed (r=−0.453, P=0.034). Conclusion Greater expression of SP and NGF in degenerative LHBT supported our hypothesis that it would be a pain source in RCT patients. SP was likely to be expressed highly in patients with localized pressure pain hypersensitivity and positive O’Brien test (ie, altered mechanistic pain profile of LHBT), which may help when considering simultaneous LHBT resection during ARCR. Clinical Registration UMIN000023943.
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Affiliation(s)
- Masashi Izumi
- Department of Orthopaedic Surgery, Kochi Medical School, Kochi University, Nankoku-City, Japan
| | - Yohei Harada
- Department of Orthopaedic Surgery, Aichi Medical University, Nagakute, Japan.,Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yukihiro Kajita
- Department of Orthopaedic Surgery, Aichi Medical University, Nagakute, Japan
| | - Yoshitaka Muramatsu
- Department of Orthopaedic Surgery, Aichi Medical University, Nagakute, Japan.,Department of Orthopaedic Surgery, Saiseikai Futsukaichi Hospital, Futsukaichi, Japan
| | - Toru Morimoto
- Department of Orthopaedic Surgery, Kochi Medical School, Kochi University, Nankoku-City, Japan
| | - Yutaka Morisawa
- Department of Orthopaedic Surgery, Aki General Hospital, Aki, Japan
| | - Yusuke Iwahori
- Department of Orthopaedic Surgery, Aichi Medical University, Nagakute, Japan.,Department of Orthopaedic Surgery, Sports Medicine and Joint Center, Asahi Hospital, Kasugai, Japan
| | - Masahiko Ikeuchi
- Department of Orthopaedic Surgery, Kochi Medical School, Kochi University, Nankoku-City, Japan
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