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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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Nada MG, Almalki YE, Basha MAA, Libda YI, Zaitoun MMA, M Abdalla AAEH, Almolla RM, Hassan HA, Dawoud TM, Eissa AHZ, Alduraibi SK, Eldib DB, Ziada YMAA. Biceps Pulley Lesions: Diagnostic Accuracy of Nonarthrographic Shoulder MRI and the Value of Various Diagnostic Signs. J Magn Reson Imaging 2024; 59:1299-1311. [PMID: 37675811 DOI: 10.1002/jmri.29004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 07/07/2023] [Accepted: 07/07/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND There is limited data in the literature regarding the role of nonarthrographic MRI for detecting biceps pulley (BP) lesions. PURPOSE To assess the accuracy of nonarthrographic MRI for detecting BP lesions, and to evaluate the diagnostic value of various MRI signs (superior glenohumeral ligament discontinuity/nonvisibility, long head of biceps (LHB) displacement sign or subluxation/dislocation, LHB tendinopathy, and supraspinatus and subscapularis tendon lesions) in detecting such lesions. STUDY TYPE Retrospective. POPULATION 84 patients (32 in BP-lesion group and 52 in BP-intact group-as confirmed by arthroscopy). FIELD STRENGTH/SEQUENCE 1.5-T, T1-weighted turbo spin echo (TSE), T2-weighted TSE, and proton density-weighted TSE spectral attenuated inversion recovery (SPAIR) sequences. ASSESSMENT Three radiologists independently reviewed all MRI data for the presence of BP lesions and various MRI signs. The MRI signs and final MRI diagnoses were tested for accuracy regarding detecting BP lesions using arthroscopy results as the reference standard. Furthermore, the inter-reader agreement (IRA) between radiologists was determined. STATISTICAL TESTS Student's t-tests, Chi-squared, and Fisher's exact tests, and 4-fold table test were used. The IRA was calculated using Kappa statistics. A P-value <0.05 was considered statistically significant. RESULTS The sensitivity, specificity, and accuracy of nonarthrographic MRI for detecting BP lesions were 65.6%-78.1%, 90.4%-92.3%, and 81%-86.9%, respectively. The highest accuracy was noticed for the LHB displacement sign (84.5%-86.9%), and the highest sensitivity was registered for the LHB tendinopathy sign (87.5%). Furthermore, the highest specificity was observed for the LHB displacement sign and LHB subluxation/dislocation sign (98.1%-100%). The IRA regarding final MRI diagnosis and MRI signs of BP lesions was good to very good (κ = 0.76-0.98). DATA CONCLUSION Nonarthrographic shoulder MRI may show good diagnostic accuracy for detecting BP lesions. The LHB displacement sign could serve as the most accurate and specific sign for diagnosis of BP lesions. LEVEL OF EVIDENCE 3 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Mohamad Gamal Nada
- Department of Radiology, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Yassir Edrees Almalki
- Division of Radiology, Medical College, Najran University, Najran, Kingdom of Saudi Arabia
- Department of Internal Medicine, Medical College, Najran University, Najran, Kingdom of Saudi Arabia
| | | | - Yasmin Ibrahim Libda
- Department of Radiology, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Mohamed M A Zaitoun
- Department of Radiology, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | | | - Rania Mostafa Almolla
- Department of Radiology, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Hanan A Hassan
- Department of Radiology, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Tamer Mahmoud Dawoud
- Department of Diagnostic Radiology, Faculty of Human Medicine, Tanta University, Tanta, Egypt
| | - Ahmad Hassan Zaki Eissa
- Department of Orthopedic Surgery and Traumatology, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Sharifa Khalid Alduraibi
- Department of Radiology, College of Medicine, Qassim University, Buraidah, Kingdom of Saudi Arabia
| | - Diaa Bakry Eldib
- Department of Radiology, Faculty of Human Medicine, Benha University, Benha, Egypt
| | - Yara Mohammed Ahmad Ali Ziada
- Department of Radiology, General Organization for Teaching Hospitals and Medical Institutes (GOTHI), Al-Ahrar Teaching Hospital, Zagazig, Egypt
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Stein P, Wuennemann F, Schneider T, Zeifang F, Burkholder I, Weber MA, Kauczor HU, Rehnitz C. Detection and Quantitative Assessment of Arthroscopically Proven Long Biceps Tendon Pathologies Using T2 Mapping. Tomography 2023; 9:1577-1591. [PMID: 37736979 PMCID: PMC10514832 DOI: 10.3390/tomography9050126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 08/18/2023] [Accepted: 08/21/2023] [Indexed: 09/23/2023] Open
Abstract
This study evaluates how far T2 mapping can identify arthroscopically confirmed pathologies in the long biceps tendon (LBT) and quantify the T2 values in healthy and pathological tendon substance. This study comprised eighteen patients experiencing serious shoulder discomfort, all of whom underwent magnetic resonance imaging, including T2 mapping sequences, followed by shoulder joint arthroscopy. Regions of interest were meticulously positioned on their respective T2 maps, capturing the sulcal portion of the LBT and allowing for the quantification of the average T2 values. Subsequent analyses included the calculation of diagnostic cut-off values, sensitivities, and specificities for the detection of tendon pathologies, and the calculation of inter-reader correlation coefficients (ICCs) involving two independent radiologists. The average T2 value for healthy subjects was measured at 23.3 ± 4.6 ms, while patients with tendinopathy displayed a markedly higher value, at 47.9 ± 7.8 ms. Of note, the maximum T2 value identified in healthy tendons (29.6 ms) proved to be lower than the minimal value measured in pathological tendons (33.8 ms), resulting in a sensitivity and specificity of 100% (95% confidence interval 63.1-100) across all cut-off values ranging from 29.6 to 33.8 ms. The ICCs were found to range from 0.93 to 0.99. In conclusion, T2 mapping is able to assess and quantify healthy LBTs and can distinguish them from tendon pathology. T2 mapping may provide information on the (ultra-)structural integrity of tendinous tissue, facilitating early diagnosis, prompt therapeutic intervention, and quantitative monitoring after conservative or surgical treatments of LBT.
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Affiliation(s)
- Patrick Stein
- Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany
| | - Felix Wuennemann
- Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany
- Institute of Diagnostic and Interventional Radiology & Neuroradiology, Helios Dr. Horst Schmidt Clinics Wiesbaden, Ludwig-Erhard-Straße 100, 65199 Wiesbaden, Germany
| | - Thomas Schneider
- Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany
| | - Felix Zeifang
- Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, University Hospital Heidelberg, Schlierbacher Landstraße 200A, 69118 Heidelberg, Germany
- Ethianum Clinic Heidelberg, Voßstraße 6, 69115 Heidelberg, Germany
| | - Iris Burkholder
- Department of Nursing and Health, University of Applied Sciences of the Saarland, 66117 Saarbruecken, Germany
| | - Marc-André Weber
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Center Rostock, Ernst-Heydemann-Straße 6, 18057 Rostock, Germany
| | - Hans-Ulrich Kauczor
- Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany
| | - Christoph Rehnitz
- Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany
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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: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [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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Saremi H, seifrabiei M. Subscapularis tendon tear classification and diagnosis: A systemic review and meta-analysis. Front Surg 2023; 10:916694. [PMID: 37009599 PMCID: PMC10050355 DOI: 10.3389/fsurg.2023.916694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 01/23/2023] [Indexed: 03/17/2023] Open
Abstract
BackgroundIn the current study, we performed a systematic review and meta-analysis regarding the comparison of accuracy, sensitivity, and specificity of the techniques in diagnosing SSC tendon tears. Also, we performed a systematic review of the classification of SSC tendon tears.MethodsEnglish language, peer-reviewed journal publications from the first date available to March 2022 were extracted by searching PubMed and Web of Science databases. A forest plot was used to graphically show the results of pooled sensitivity, specificity, and accuracy of different diagnostic modalities.ResultsThere were six studies on using MRI to diagnose subscapularis tendon tears, five studies on MRI, four studies on clinical examination, one on ultrasonography, and one on CT arthrography. Pooled sensitivity values for MRI, MRA, clinical examination, ultrasonography, and CT arthrography were 0.71 (CI: 0.54; 0.87), 0.83 (0.77; 0.88), 0.49 (0.31; 0.67), 0.39 (0.29; 0.51), and 0.90 (0.72–0.97), respectively. The pooled specificity values for MRI, MRA, clinical examination, ultrasonography, and CT arthrography were 0.93 (CI: 0.89; 0.96), 0.86 (0.75; 0.93), 0.89 (0.73; 0.96), 0.93 (0.88; 0.96), and 0.90 (0.69; 0.98), respectively. The pooled diagnostic accuracy values for MRI, MRA, clinical examination, ultrasonography, and CT arthrography were 0.84 (CI: 0.80; 0.88), 0.85 (0.77; 0.90), 0.76 (0.66; 0.84), 0.76 (0.70; 0.81), and 0.90 (0.78; 0.96), respectively.ConclusionAccording to our systematic review and meta-analysis, MR arthrography was the most accurate in diagnosing subscapularis tears. MR arthrography was the most sensitive, and MRI and ultrasonography were the most specific in detecting subscapularis tears.
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Affiliation(s)
- Hossein Saremi
- Department of Orthopedics, Faculty of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
- Correspondence: Hossein Saremi
| | - Mohamadali seifrabiei
- Social Medicine Department, Community Medicine Specialist, Faculty of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
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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: 0.5] [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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Kao JT, Chiu CH, Hsu KY, Chang SS, Chan YS, Chen ACY. Arthroscopic diagnosis of long head of biceps tendon instability in refractory anterior shoulder pain: A comparison study between pulley tear and non-tear lesions. Biomed J 2022; 46:163-169. [PMID: 35065282 PMCID: PMC10104962 DOI: 10.1016/j.bj.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 12/23/2021] [Accepted: 01/10/2022] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Long head of the biceps tendon (LHBT) instability and biceps reflection pulley (BRP) lesions are common cause of refractory anterior shoulder pain. We described a technique using dynamic arthroscopy to determine associated intraarticular pathologies. METHODS Patients with refractory anterior shoulder pain and arthroscopically-diagnosed LHBT instability were enrolled. LHBT instability and the integrity of BRP and concomitant intra-articular lesions were investigated by ramp test. Demographics and arthroscopic findings were compared between patients with and without BRP tear. RESULTS Forty patients were enrolled. BRP tear was noted in 25 patients (group A) and superior glenohumeral ligament (SGHL) insufficiency through ramp test in 15 patients (group B). Concomitant intraarticular pathologies were noted in 27 patients, including 19 in group A (76%) and eight in group B (53%), without significant group-wise difference (p = 0.138). The incidence of articular-side subscapularis tear was significantly higher in group A (p = 0.021), and those of the other intraarticular pathologies were similar between groups A and B. Fraying at the articular side of the subscapularis and supraspinatus tendons was frequent in group B, without difference of incidence as compared to group A (p = 0.5 and p = 0.084, respectively). CONCLUSIONS LHBT instability was a common disorder in patients with refractory shoulder pain. In those patients, dynamic assessment of BRP lesions and SGHL insufficiency and meticulous survey of associated intra-articular pathologies, including subscapularis tear are necessary for making accurate diagnosis and treatment decision.
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向 先, 刘 宇, 陈 荣, 刘 宇, 弓 爵, 李 丹, 王 卫. [Effectiveness comparison of arthroscopic intertubercular groove and open subpectoral tenodesis for long head of biceps tendon tendinopathy]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2021; 35:1293-1297. [PMID: 34651483 PMCID: PMC8505942 DOI: 10.7507/1002-1892.202103223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 08/05/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To compare the effectiveness of arthroscopic intertubercular groove and open subpectoral tenodesis in treatment of long head of biceps tendon (LHBT) tendinopathy. METHODS A clinical data of 80 patients with LHBT tendinopathy who were admitted between June 2013 and May 2017 and met the selection criteria was retrospectively analyzed. After cutting LHBT under arthroscopy, the arthroscopic intertubercular groove tenodesis was performed in 40 cases (group A) and open subpectoral tenodesis was performed in 40 cases (group B). There was no significant difference in the gender, age, side of the affected shoulder joint, disease duration, and preoperative pain visual analogue scale (VAS) score, Constant score, American Society of Shoulder and Elbow Surgery (ASES) score, Disability of Arm, Shoulder, and Hand (DASH) score, LHBT score (LHBS) between the two groups ( P>0.05). The operation time and the scores of shoulder joint pain and function at 12 months after operation were compared between the two groups. RESULTS The operation time was (3.6±2.5) minutes in group A and (8.5±2.3) minutes in group B, showing a significant difference ( t=18.584, P=0.000). The incisions of the two groups healed by first intention, and there was no complication such as infection or thrombosis. All patients were followed up. The follow-up time was 24-30 months (mean, 26.0 months) in group A and 24-31 months (mean, 26.0 months) in group B. Both Speed test and Yergason test were negative at 3 months after operation. MRI showed that there was no obvious effusion around the LHTB and no dislocation of LHTB. At 12 months after operation, the VAS score, Constant score, ASES score, DASH score, and LHBS score of the two groups all improved when compared with preoperative ones ( P<0.05), and there was no significant difference in the differences before and after operation between the two groups ( P>0.05). No Popeye sign appeared during the follow-up. CONCLUSION The arthroscopic intertubercular groove and open subpectoral tenodesis can effectively relieve shoulder pain and improve function, but the former has shorter operation time and less trauma.
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Affiliation(s)
- 先祥 向
- 大连大学附属中山医院运动医学科(辽宁大连 116001)Department of Sports Medicine, Affiliated Zhongshan Hospital of Dalian University, Dalian Liaoning, 116001, P.R.China
| | - 宇鹏 刘
- 大连大学附属中山医院运动医学科(辽宁大连 116001)Department of Sports Medicine, Affiliated Zhongshan Hospital of Dalian University, Dalian Liaoning, 116001, P.R.China
| | - 荣进 陈
- 大连大学附属中山医院运动医学科(辽宁大连 116001)Department of Sports Medicine, Affiliated Zhongshan Hospital of Dalian University, Dalian Liaoning, 116001, P.R.China
| | - 宇 刘
- 大连大学附属中山医院运动医学科(辽宁大连 116001)Department of Sports Medicine, Affiliated Zhongshan Hospital of Dalian University, Dalian Liaoning, 116001, P.R.China
| | - 爵 弓
- 大连大学附属中山医院运动医学科(辽宁大连 116001)Department of Sports Medicine, Affiliated Zhongshan Hospital of Dalian University, Dalian Liaoning, 116001, P.R.China
| | - 丹妹 李
- 大连大学附属中山医院运动医学科(辽宁大连 116001)Department of Sports Medicine, Affiliated Zhongshan Hospital of Dalian University, Dalian Liaoning, 116001, P.R.China
| | - 卫明 王
- 大连大学附属中山医院运动医学科(辽宁大连 116001)Department of Sports Medicine, Affiliated Zhongshan Hospital of Dalian University, Dalian Liaoning, 116001, P.R.China
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Image Quality and Diagnostic Performance of Accelerated Shoulder MRI With Deep Learning-Based Reconstruction. AJR Am J Roentgenol 2021; 218:506-516. [PMID: 34523950 DOI: 10.2214/ajr.21.26577] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background: Shoulder MRI using standard multiplanar sequences requires long scan times. Accelerated sequences have tradeoffs in noise and resolution. Deep learning-based reconstruction (DLR) may allow reduced scan time with preserved image quality. Objectives: To compare standard shoulder MRI sequences and accelerated sequences without and with DLR in terms of image quality and diagnostic performance. Methods: This retrospective study included 105 patients (45 men, 60 women; mean age 57.6±10.9 years) who underwent a total of 110 3-T shoulder MRI examinations. Examinations included standard sequences (scan time, 9 minutes 23 seconds) and accelerated sequences (3 minutes 5 seconds; 67% reduction), both including fast spin echo sequences in three planes. Standard sequences were reconstructed using the conventional pipeline; accelerated sequences were reconstructed using both conventional pipeline and a commercially available DLR pipeline. Two radiologists independently assessed three image sets (standard, accelerated without DLR, accelerated with DLR) for subjective image quality and artifacts using 4-point scales (4=highest quality), and identified pathologies of subscapularis tendon, supraspinatus-infraspinatus tendon, biceps brachii long head tendon, and glenoid labrum. Interobserver and inter-image set agreement for the evaluated pathologies was assessed using weighted kappa statistics. In 27 patients who underwent arthroscopy, diagnostic performance was calculated using arthroscopic findings as reference. Results: Mean subjective image quality for readers 1 and 2 was 10.6±1.2 and 10.5±1.4 for standard, 8.1±1.3 and 7.2±1.1 for accelerated without DLR, and 10.7±1.2 and 10.5±1.6 for accelerated with DLR. Mean artifact score for readers 1 and 2 was 9.3±1.2 and 10.0±1.0 for standard, 7.3±1.3 and 9.1±0.8 for accelerated without DLR, and 9.4±1.2 and 9.8±0.8 for accelerated with DLR. Interobserver agreement ranged from kappa=0.813-0.951 except for accelerated without DLR for SST-IST (κ=0.673). Inter-image set agreement ranged from kappa=0.809-0.957 except for reader 1 for SST-IST (κ=0.663-0.700). Accuracy, sensitivity, and specificity for tears of the four structures was not different (p>.05) among image sets. Conclusions: Accelerated sequences with DLR provide 67% scan time reduction with similar subjective image quality, artifacts, and diagnostic performance as standard sequences. Clinical impact: Accelerated sequences with DLR may provide an alternative to standard sequences for clinical shoulder MRI.
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Long head biceps tendon instability: diagnostic performance of known and new MRI diagnostic signs. Skeletal Radiol 2021; 50:1863-1871. [PMID: 33733694 DOI: 10.1007/s00256-021-03710-1] [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: 06/10/2020] [Revised: 01/04/2021] [Accepted: 01/04/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The aim of this work was to evaluate the inter-observer agreement and diagnostic performance values of 7 MRI signs (3 known and 4 new) of long head biceps tendon instability. MATERIALS AND METHODS MRI of 86 patients were retrospectively evaluated. Inter-observer agreement and diagnostic performance of each diagnostic sign and of all combined signs (with the exception of detour sign) were tested for identification of biceps tendon instability, with arthroscopy as the reference standard. RESULTS Agreement between expert operators was moderate to good. Sensitivity, specificity, and sign accuracy showed a variation respectively of the following: humeral chondral print 72-80%, 62-68%, and 70-76%; subchondral bone edema 24-31%, 84-97%, and 50%; biceps tendon angle 60-71%, 97-100%, and 74-81%, biceps tendon-groove distance 31-47%, 90-100%, and 56-64%; long head biceps subluxation/dislocation on axial plane 49-53%, 97-100%, and 66-70%; displacement sign 74-80%, 74-100%, and 74-87%; detour sign 51-64%, 58-81%, and 62-64%; and all signs 98-100%, 32-61%, and 75-86%. CONCLUSION These diagnostic signs, both known and new, individually and/or in combination, provide a valid tool in the MRI diagnosis of long head biceps tendon instability.
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Carvalho CD, Cohen C, Belangero PS, Pochini ADC, Andreoli CV, Ejnisman B. Supraspinatus Muscle Tendon Lesion and Its Relationship with Long Head of the Biceps Lesion. Rev Bras Ortop 2020; 55:329-338. [PMID: 32616979 PMCID: PMC7316548 DOI: 10.1055/s-0039-3402472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Accepted: 02/05/2019] [Indexed: 10/27/2022] Open
Abstract
Objective To identify the clinical, radiological, and arthroscopic correlation of long head of the biceps tendon injuries and their influence on pain when associated with rotator cuff injuries. Methods Between April and December 2013, 50 patients were evaluated, including 38 (76%) women and 12 (24%) men, with a mean age of 65.1 years old. The patients were operated by the Shoulder and Elbow Group, Discipline of Sports Medicine, Orthopedics and Traumatology Department, Universidade Federal de São Paulo. The subjects underwent repair of the rotator cuff lesion with clinical, radiological and/or arthroscopic evidence of involvement of the long head of the biceps tendon. Results An association between pain at palpation of the intertubercular groove of the humerus and high-grade partial lesions (partial rupture of the tendon affecting more than 50% of its structure) was observed at the arthroscopy ( p = 0.003). There was also an association between the high-grade lesion of the long head of the biceps and injury to the supraspinatus muscle tendon ( p < 0.05). For each centimeter of the supraspinatus muscle tendon injury, the patient presented a 1.7 higher probability of having a high-grade lesion at the long head of the biceps. Conclusion Pain at the anterior shoulder region during palpation of the intertubercular groove of the humerus may be related to high-grade lesions to the long head of the biceps. Rotator cuff injury and its size are risk factors for high-grade injuries to the long head of the biceps tendon.
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Affiliation(s)
- Cassiano Diniz Carvalho
- Departamento de Ortopedia e Traumatologia, Centro de Traumatologia do Esporte (CETE), Escola Paulista de Medicina, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brasil
| | - Carina Cohen
- Departamento de Ortopedia e Traumatologia, Centro de Traumatologia do Esporte (CETE), Escola Paulista de Medicina, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brasil
| | - Paulo Santoro Belangero
- Departamento de Ortopedia e Traumatologia, Centro de Traumatologia do Esporte (CETE), Escola Paulista de Medicina, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brasil
| | - Alberto de Castro Pochini
- Departamento de Ortopedia e Traumatologia, Centro de Traumatologia do Esporte (CETE), Escola Paulista de Medicina, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brasil
| | - Carlos Vicente Andreoli
- Departamento de Ortopedia e Traumatologia, Centro de Traumatologia do Esporte (CETE), Escola Paulista de Medicina, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brasil
| | - Benno Ejnisman
- Departamento de Ortopedia e Traumatologia, Centro de Traumatologia do Esporte (CETE), Escola Paulista de Medicina, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brasil
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Baptista E, Malavolta EA, Gracitelli MEC, Alvarenga D, Bordalo-Rodrigues M, Ferreira Neto AA, de Barros N. Diagnostic accuracy of MRI for detection of tears and instability of proximal long head of biceps tendon: an evaluation of 100 shoulders compared with arthroscopy. Skeletal Radiol 2019; 48:1723-1733. [PMID: 30937471 DOI: 10.1007/s00256-019-03214-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 03/15/2019] [Accepted: 03/25/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate the diagnostic accuracy of magnetic resonance imaging (MRI) for detection of instability and tears of the proximal long head of biceps tendon (LHBT). To assess intraobserver and interobserver agreement. MATERIALS AND METHODS We performed a retrospective analysis of prospectively collected data of 100 consecutive shoulders who underwent non-contrast 1.5-T MRI prior to arthroscopic surgery due to rotator cuff injury. Images were independently analyzed by two musculoskeletal radiologists. LHBT was evaluated for presence of tearing (intact, longitudinal split, partial-thickness, or full-thickness) and position (normal, subluxated, and dislocated). Anterosuperior rotator cuff tears were also assessed. The reference standard was arthroscopic surgery. The ramp test was performed in order to evaluate LHBT stability. Diagnostic performance measures were determined and Kappa coefficients assessed agreement. RESULTS Concerning the detection of overall tears, sensitivity ranged from 71 to 73% and specificity was 73%. The specificity for full-thickness tears ranged from 75 to 96%. Overall displacement showed sensitivity ranging from 51 to 58% and specificity ranging from 70 to 86%. The specificity of overall displacement combined with anterosuperior rotator cuff tears ranged from 73 to 91%. Interobserver Kappa values were between 0.59 and 0.69. Intraobserver Kappa values were between 0.74 and 0.82. CONCLUSIONS MRI has moderate accuracy and good agreement for detection of LHBT tears and instability. There is a tendency for increased specificity for full-thickness tears and for instability in the coexistence of anterosuperior rotator cuff tears.
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Affiliation(s)
- Eduardo Baptista
- Department of Radiology and Oncology, School of Medicine, University of São Paulo (USP), 333 Dr. Ovídio Pires de Campos street, ground floor, Cerqueira César, São Paulo, SP, 05403-010, Brazil.
| | - Eduardo A Malavolta
- Department of Orthopedics and Traumatology, School of Medicine, University of São Paulo (USP), 333 Dr. Ovídio Pires de Campos street 3rd floor, Cerqueira César, São Paulo, SP, 05403-010, Brazil
| | - Mauro E C Gracitelli
- Department of Orthopedics and Traumatology, School of Medicine, University of São Paulo (USP), 333 Dr. Ovídio Pires de Campos street 3rd floor, Cerqueira César, São Paulo, SP, 05403-010, Brazil
| | - Daniel Alvarenga
- Department of Radiology and Oncology, School of Medicine, University of São Paulo (USP), 333 Dr. Ovídio Pires de Campos street, ground floor, Cerqueira César, São Paulo, SP, 05403-010, Brazil
| | - Marcelo Bordalo-Rodrigues
- Department of Radiology and Oncology, School of Medicine, University of São Paulo (USP), 333 Dr. Ovídio Pires de Campos street, ground floor, Cerqueira César, São Paulo, SP, 05403-010, Brazil
| | - Arnaldo A Ferreira Neto
- Department of Orthopedics and Traumatology, School of Medicine, University of São Paulo (USP), 333 Dr. Ovídio Pires de Campos street 3rd floor, Cerqueira César, São Paulo, SP, 05403-010, Brazil
| | - Nestor de Barros
- Department of Radiology and Oncology, School of Medicine, University of São Paulo (USP), 333 Dr. Ovídio Pires de Campos street, ground floor, Cerqueira César, São Paulo, SP, 05403-010, Brazil
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Teixeira P, Jaquet P, Bakour O, Jacquot A, Molé D, Sirveaux F, Blum A. CT arthrography of the intra-articular long head of biceps tendon: Diagnostic performance outside the labral-bicipital complex. Diagn Interv Imaging 2019; 100:437-444. [DOI: 10.1016/j.diii.2019.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 01/22/2019] [Accepted: 02/05/2019] [Indexed: 10/27/2022]
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The "Double Lasso-Loop" Technique Used for Arthroscopic Proximal Biceps Tenodesis. Arthrosc Tech 2019; 8:e291-e300. [PMID: 31016125 PMCID: PMC6475644 DOI: 10.1016/j.eats.2018.11.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Accepted: 11/04/2018] [Indexed: 02/03/2023] Open
Abstract
Disorders of the long head biceps tendon are among the most challenging of shoulder problems to diagnose and manage. In this Technical Note, we introduce an arthroscopic technique for proximal biceps tenodesis high in the groove at the articular margin of the humeral head using a single anchor and 2 self-cinching loops followed by 5 alternating half-hitches to secure the construct. This method is simple and enables stable fixation of the biceps tendon.
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15
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Taylor SA. Editorial Commentary: Thank You, Thank You, Thank You… for Demonstrating Histologic Evidence of Shoulder Bicipital Tunnel Disease in the Absence of Magnetic Resonance Imaging Findings. Arthroscopy 2018; 34:1797-1798. [PMID: 29804603 DOI: 10.1016/j.arthro.2018.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 03/03/2018] [Indexed: 02/02/2023]
Abstract
Bicipital tunnel disease is often unvisualized during standard diagnostic arthroscopy. Histolopathologic evidence of disease may be present even in the absence of magnetic resonance imaging findings. Surgical decision making is multifactorial.
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Rol M, Favard L, Berhouet J. Diagnosis of long head of biceps tendinopathy in rotator cuff tear patients: correlation of imaging and arthroscopy data. INTERNATIONAL ORTHOPAEDICS 2017; 42:1347-1355. [DOI: 10.1007/s00264-017-3616-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 08/09/2017] [Indexed: 11/25/2022]
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Simpfendorfer CS, Schickendantz MS, Polster JM. The Shoulder: What is New and Evidence-Based in Orthopedic Sports Medicine. CURRENT RADIOLOGY REPORTS 2017. [DOI: 10.1007/s40134-017-0228-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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19
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Gilmer BB, Harnden E, Guttmann D. Diagnosis of long head of the biceps tendon pathology: current concepts. J ISAKOS 2017. [DOI: 10.1136/jisakos-2017-000128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Möller I, Szkudlarek M. Imaging of regional pain syndromes; from syndromes to conditions using imaging? Best Pract Res Clin Rheumatol 2016; 30:707-719. [PMID: 27931963 DOI: 10.1016/j.berh.2016.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 06/17/2016] [Accepted: 06/18/2016] [Indexed: 11/17/2022]
Abstract
Musculoskeletal regional pain syndromes often lead to patient referrals in general and rheumatological practice. Detailed history taking and clinical examination can in most cases reveal the cause for pain and direct the subsequent management of the conditions. Yet, when in doubt, imaging methods have to support the clinical assessment. This paper presents the underlying pathologies of the most frequently encountered regional pain syndromes and the role of musculoskeletal ultrasonography and magnetic resonance imaging in their visualization. It presents data, where available, on diagnostic accuracy and comparisons with gold standards. The article stresses the advantages and disadvantages of the analyzed imaging modalities and suggests the future research agenda.
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Affiliation(s)
- Ingrid Möller
- Instituto Poal de Reumatologia, University of Barcelona, Barcelona, Spain; Department of Rheumatology, Zealand's University Hospital, Lykkebækvej 1, 4600, Køge, Denmark.
| | - Marcin Szkudlarek
- Department of Rheumatology, Zealand's University Hospital, Lykkebækvej 1, 4600, Køge, Denmark
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Lee RW, Choi SJ, Lee MH, Ahn JH, Shin DR, Kang CH, Lee KW. Diagnostic accuracy of 3T conventional shoulder MRI in the detection of the long head of the biceps tendon tears associated with rotator cuff tendon tears. Skeletal Radiol 2016; 45:1705-1715. [PMID: 27717975 DOI: 10.1007/s00256-016-2501-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 08/28/2016] [Accepted: 09/23/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate the diagnostic performance (DP) of 3T (3 Tesla field strength) conventional shoulder magnetic resonance imaging (MRI) in detecting the long head of the biceps tendon (LHBT) tears in association with rotator cuff tendon tears. MATERIALS AND METHODS This study included 80 consecutive patients who underwent arthroscopic surgery for rotator cuff tendon tears. Two radiologists independently evaluated the preoperative 3T shoulder MRI for the presence of LHBT tears. The DP of MRI was evaluated using the results of arthroscopy as the reference standard. We also evaluated the DP of several MR signs of LHBT in detection of partial LHBT tears. RESULTS Arthroscopic examination revealed 35 partial and 5 complete tears. According to the results of evaluation by reviewers 1 and 2, shoulder MRI exhibited sensitivities of 77.14 and 80 % and specificities of 71.11 and 73.33 % in detection of partial LHBT tears and sensitivities of 80 and 100 % and a specificity of 100% (both) in detection of complete LHBT tears. In detecting partial LHBT tears, increased T2 signal intensity of the LHBT exhibited high sensitivities (reviewers 1 and 2; 82.85 and 80 %, respectively) and the presence of intratendinous defects or C-signs exhibited the highest specificities (reviewers 1 and 2; 95.55 and 93.33 %, respectively), followed by abnormalities in shape and outer margins of the LHBT (reviewers 1 and 2; 91.11 and 82 %; 91.11 and 86.66 %, respectively). CONCLUSION Non-contrast-enhanced 3T shoulder MRI is potentially highly accurate in detection of complete LHBT tears, but moderately accurate in detection of partial LHBT tears.
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Affiliation(s)
- Ro Woon Lee
- Department of Radiology, Asan Foundation, Gangneung Asan Hospital, University of Ulsan, College of Medicine, 38, Bangdong-gil, Sacheon-Myeon, Gangneung-si, Gangwon-do, 25440, South Korea
| | - Soo-Jung Choi
- Department of Radiology, Asan Foundation, Gangneung Asan Hospital, University of Ulsan, College of Medicine, 38, Bangdong-gil, Sacheon-Myeon, Gangneung-si, Gangwon-do, 25440, South Korea.
| | - Man Ho Lee
- Department of Radiology, Andong Medical Center, 55, Taesa 2-gil, Andong-si, Gyeongsangbuk-do, 36694, South Korea
| | - Jae Hong Ahn
- Department of Radiology, Asan Foundation, Gangneung Asan Hospital, University of Ulsan, College of Medicine, 38, Bangdong-gil, Sacheon-Myeon, Gangneung-si, Gangwon-do, 25440, South Korea
| | - Dong Rock Shin
- Department of Radiology, Asan Foundation, Gangneung Asan Hospital, University of Ulsan, College of Medicine, 38, Bangdong-gil, Sacheon-Myeon, Gangneung-si, Gangwon-do, 25440, South Korea
| | - Chae Hoon Kang
- Department of Radiology, Asan Foundation, Gangneung Asan Hospital, University of Ulsan, College of Medicine, 38, Bangdong-gil, Sacheon-Myeon, Gangneung-si, Gangwon-do, 25440, South Korea
| | - Ki Won Lee
- Department of Orthopedic Surgery, Asan Foundation, Gangneung Asan Hospital, University of Ulsan, College of Medicine, 38, Bangdong-gil, Sacheon-Myeon, Gangneung-si, Gangwon-do, 25440, South Korea
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Lu H, Yang H, Shen H, Ye G, Lin XJ. The clinical effect of tendon repair for tendon spontaneous rupture after corticosteroid injection in hands: A retrospective observational study. Medicine (Baltimore) 2016; 95:e5145. [PMID: 27741145 PMCID: PMC5072972 DOI: 10.1097/md.0000000000005145] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Corticosteroid injections for hand tendinitis can lead to a rare significant complication of tendon spontaneous rupture. However, only sporadic cases were reported in the literature before. This study was designed to gauge the clinical effect of tendon repair in patients of tendon spontaneous rupture after corticosteroid injection and analyze our experience.This was a retrospective observational study of 13 patients (8 women and 5 men) operated between July 2011 and December 2015 for tendon spontaneous rupture after corticosteroid injection. Demographic data, clinical features, imaging data, and surgical treatments were carefully reviewed.The average age was 52.308 ± 15.381 years (range 29-71). The average injection times were 2.538 ± 1.664 times (range 1-6). The average rupture time (after last injection) was 10.923 ± 9.500 weeks (range 3-32). Nine patients were treated by tendon suture (69% of cases), and 4 patients were treated by tendon grafting (31% of cases). All patients received follow-up in our outpatient clinic. The sites of the tendon rupture (15 tendons of 13 patients had involved) include extensor pollicis longus (6 tendons, 40% of cases), extensor digiti quinti and extensor digiti minimi (4 tendons, 27% of cases), ring finger of extensor digitorum communis (3 tendons, 20% of cases), and middle finger of extensor digitorum communis (2 tendons, 13% of cases). Two patients who had tendon adhesion (15% of cases) were treated by tendon release. One patient who had tendon rerupture (8% of cases) was treated by tendon grafting. No patient had complications of infections, vascular, or nerve injury.Tendon spontaneous rupture is a serious complication after corticosteroid injection for tendinitis. Rigid standard of corticosteroid injection is very important. Magnetic resonance imaging was contributory to preoperative assess tendon defect and can be used to monitor healing quality of tendons during the follow-up.
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Affiliation(s)
- Hui Lu
- Department of Hand Surgery
- Correspondence: Hui Lu, Department of Hand Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, 79# Qingchun Road, Hangzhou 310003, Zhejiang Province, PR China (e-mail: )
| | | | | | - Ganmin Ye
- Departments of Orthopedics, Sanmen People's Hospital, Taizhou, Zhejiang Province, PR China
| | - Xiang-Jin Lin
- Department of Orthopedics, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou
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Verma NN. Editorial Commentary: Long Head Biceps Pathology: How Do We Find It? Arthroscopy 2016; 32:245. [PMID: 26814385 DOI: 10.1016/j.arthro.2015.12.008] [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: 11/30/2015] [Accepted: 12/01/2015] [Indexed: 02/02/2023]
Abstract
Identification of symptomatic long head biceps pathology continues to be a clinical challenge. Magnetic resonance imaging may fail to identify symptomatic lesions when present. Clinicians must maintain a high index of suspicion, and avoid over-reliance on diagnostic imaging in establishing a diagnosis or indicating surgery.
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