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Almeida GG, Graf N, Wildermuth S, Fischer T, Waelti S, Jacxsens M, Leschka S, Dietrich TJ. Diagnostic performance of long head of biceps tendon tears on MRI: systematic review and meta-analysis. Eur Radiol 2024; 34:4309-4320. [PMID: 38148406 DOI: 10.1007/s00330-023-10521-6] [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: 07/19/2023] [Revised: 11/07/2023] [Accepted: 11/21/2023] [Indexed: 12/28/2023]
Abstract
OBJECTIVES The purpose of this meta-analysis was to determine the diagnostic performance of conventional MRI and MR arthrography for tendinosis, and partial and complete tears of the long head of the biceps tendon (LHBT) using arthroscopy as the reference standard. MATERIALS AND METHODS A systematic review was performed using predefined data fields in PubMed, and all articles published from January 2000 up to April 2022 were retrospectively pooled and reviewed. Six MRI studies on complete tear (n = 555) and ten studies on partial tear/tendinosis (n = 2487) were included in the analysis. Two of the included studies in each group investigated the use of MR arthrography. The data sets were analyzed using a univariate approach with the DerSimonian and Laird random effects model and the proportional hazards model. RESULTS MRI shows high specificities in diagnosing complete tears of the LHBT ranging from 93.0 to 99.0%. Diagnostic sensitivity was more heterogeneous ranging from 55.9 to 90.0%. The overall negative likelihood ratio was 0.29 (95% CI: 0.17-0.50) and the overall positive likelihood ratio was 37.3 (95% CI: 11.9-117.4). The mean sensitivity in diagnosing partial tear/tendinosis of the LHBT was 67.8% (95% CI: 54.3-78.9%) and the specificity was 75.9% (95% CI: 63.6-85.0%), resulting in a balanced accuracy of 71.9%. The overall negative likelihood ratio was 0.44 (95% CI: 0.32-0.59) and the overall positive likelihood ratio was 2.64 (95% CI: 1.91-3.65). CONCLUSION MRI is highly specific for the diagnosis of complete tears of the LHBT, whereas diagnostic sensitivity was more heterogeneous. The diagnosis of partial tears and/or tendinosis of the LHBT remains challenging on MRI, which may warrant complementary clinical examination or other imaging modalities to increase diagnostic confidence in equivocal cases. CLINICAL RELEVANCE STATEMENT Conventional MRI and MR arthrography have high diagnostic performance for complete tendon tear when compared to arthroscopy. The diagnosis of tendinosis/partial tears remains challenging and may require comparison with clinical tests and other imaging modalities. KEY POINTS •There is no clear consensus regarding the primary imaging modality for the evaluation of LHBT disorders. •Conventional MRI and MR arthrography are highly specific in diagnosing complete tears of the LHBT. •Diagnosis of partial tears/tendinosis of the LHBT on conventional MRI and MR arthrography remains a diagnostic challenge.
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Affiliation(s)
- Gonçalo G Almeida
- Radiology and Nuclear Medicine, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland.
| | - Nicole Graf
- Clinical Trials Unit, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland
| | - Simon Wildermuth
- Radiology and Nuclear Medicine, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland
- Faculty of Medicine, University of Zurich, Pestalozzistrasse 3, 8091, Zurich, Switzerland
| | - Tim Fischer
- Radiology and Nuclear Medicine, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland
- Faculty of Medicine, University of Zurich, Pestalozzistrasse 3, 8091, Zurich, Switzerland
| | - Stephan Waelti
- Radiology and Nuclear Medicine, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland
- Faculty of Medicine, University of Zurich, Pestalozzistrasse 3, 8091, Zurich, Switzerland
| | - Matthijs Jacxsens
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland
| | - Sebastian Leschka
- Radiology and Nuclear Medicine, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland
- Faculty of Medicine, University of Zurich, Pestalozzistrasse 3, 8091, Zurich, Switzerland
| | - Tobias Johannes Dietrich
- Radiology and Nuclear Medicine, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland
- Faculty of Medicine, University of Zurich, Pestalozzistrasse 3, 8091, Zurich, Switzerland
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Bagga IKB, Ramteke SU, Keoliya A. Progressive Physiotherapy Rehabilitation Program for a Patient With Biceps Tenodesis Recovery: A Case Report. Cureus 2024; 16:e56085. [PMID: 38618423 PMCID: PMC11009903 DOI: 10.7759/cureus.56085] [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: 02/29/2024] [Accepted: 03/13/2024] [Indexed: 04/16/2024] Open
Abstract
The present case report investigates the effectiveness of a progressive physiotherapy rehabilitation program in aiding the recovery of a patient who underwent biceps tenodesis. It is a surgical procedure involving the reattachment or relocation of the biceps tendon to alleviate pain and enhance function in conditions, like tendinitis or tears. The rehabilitation program is specifically tailored to address the distinct challenges associated with biceps tenodesis recovery, focusing on gradual exercises aimed at improving strength, range of motion (ROM), and functional capacity. Through a comprehensive analysis, this case report seeks to offer insights into the potential advantages and obstacles of employing a specialized physiotherapy approach in the holistic care of individuals undergoing biceps tenodesis, contributing to the ongoing development of postoperative rehabilitation strategies.
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Affiliation(s)
- Ishwin Kaur B Bagga
- Department of Sports Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Swapnil U Ramteke
- Department of Sports Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Ashish Keoliya
- Department of Sports Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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McDevitt AW, Young JL, Cleland JA, Hiefield P, Snodgrass SJ. Physical therapy interventions used to treat individuals with biceps tendinopathy: a scoping review. Braz J Phys Ther 2024; 28:100586. [PMID: 38219522 PMCID: PMC10825607 DOI: 10.1016/j.bjpt.2023.100586] [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: 06/14/2022] [Revised: 11/23/2023] [Accepted: 12/17/2023] [Indexed: 01/16/2024] Open
Abstract
BACKGROUND Shoulder pain related to pathology of the long head of the biceps tendon (LHBT) can be debilitating. Chronic LHBT tendinopathy is a common condition that is difficult to treat. Little consensus exists regarding the optimal approach to treating individuals with LHBT tendinopathy. OBJECTIVE To systematically scope the literature to identify and present the available information regarding physical therapist interventions used for the management of individuals with LHBT tendinopathy including types of interventions used or recommended. METHODS A scoping review of physical therapist interventions used to treat LHBT was conducted of the CINAHL, Embase, Medline, and SportDiscus databases. Full text records reporting physical therapist-based interventions in individuals with proximal LHBT pathology were included. Articles not written in English were excluded. RESULTS Of the 4059 records identified, 14 articles met the inclusion criteria. Interventions used to treat LHBT tendinopathy identified in quantitative studies included: extracorporeal shock wave therapy, polarized light, ultrasound, low-level laser, iontophoresis, general exercise, eccentric training, stretching, dry needling, and joint mobilization. Interventions described in literature reviews, clinical commentaries, and a Delphi study included: therapeutic modalities, manual therapy, exercise, dry needling, and patient education. CONCLUSION This scoping review reported interventions primarily based on therapeutic modalities in quantitative studies while literature reviews, clinical commentaries, and a Delphi study described the addition of manual therapy, patient education, exercise, and dry needling. Overall, there is a dearth of evidence detailing the conservative management of LHBT tendinopathy.
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Affiliation(s)
- Amy W McDevitt
- University of Colorado Anschutz Medical Campus, Department of Physical Medicine and Rehabilitation, Physical Therapy Program, Aurora, CO, United States of America; Discipline of Physiotherapy, The University of Newcastle, Callaghan, Australia.
| | - Jodi L Young
- Bellin College, Doctor of Science in Physical Therapy Program, Green Bay, WI, United States of America
| | - Joshua A Cleland
- Tufts University School of Medicine, Department of Public Health and Community Medicine, Doctor of Physical Therapy Program, Boston, MA, United States of America
| | - Paisley Hiefield
- University of Colorado Anschutz Medical Campus, Department of Physical Medicine and Rehabilitation, Physical Therapy Program, Aurora, CO, United States of America
| | - Suzanne J Snodgrass
- Discipline of Physiotherapy, The University of Newcastle, Callaghan, Australia
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Vigié R, Bonnevialle N, Hao KA, Berhouet J, Charousset C. Tenotomy or tenodesis versus conservation of the long head of the biceps tendon in the repair of isolated supraspinatus tears: A systematic review of the literature. Orthop Traumatol Surg Res 2023; 109:103673. [PMID: 37657502 DOI: 10.1016/j.otsr.2023.103673] [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: 01/18/2023] [Revised: 03/20/2023] [Accepted: 04/14/2023] [Indexed: 09/03/2023]
Abstract
BACKGROUND Few studies have directly compared the outcomes of rotator cuff repair (RCR) with or without concomitant LHBT tenotomy or tenodesis. The aim of this literature review was to assess: (i) whether an adjuvant procedure on the LHBT at the time of RCR gives better functional results than RCR alone; and (ii) whether reoperation rates are higher after RCR alone or RCR+tenotomy or tenodesis. METHODS A literature search was carried out on PubMed, MEDLINE, Embase, Web of Science and the Cochrane database for papers published in English or French between 1st January, 2010, and 31st December, 2021. Included studies compared the results of RCR alone with RCR+concomitant tenotomy or tenodesis in patients with tears of the supraspinatus tendon or rotator cuff. ARTICLES A total of 626 articles were identified in the literature search and 168 were retained for more detailed examination. Forty-seven articles were read in their entirety and nine articles comparing RCR with or without concomitant tenotomy or tenodesis of the LHBT were retained for the analysis. RESULTS Nine articles comparing the results of RCR alone versus RCR+LHBT tenotomy or tenodesis were reviewed. The majority of patients were more than 50 years old and male. The rate of lesions to the LHBT in the studies included ranged from 26.8-60.2%. Eight of the nine studies compared the functional results of RCR alone versus RCR+tenotomy or tenodesis, with six reporting no significant difference, one reporting better outcomes after concomitant biceps surgery and one reporting worse outcomes after a biceps procedure. DISCUSSION This review did not provide a strong answer to our questions, owing to the heterogenicity of clinical evaluation and low level of evidence of the studies. However, it appears that in the absence of biceps pathology or in the presence of small lesions, the LHBT could be preserved. The rate of revision did not seem to be higher and cuff healing lower in this situation. Therefore, further randomized studies are required to identify the role of concomitant procedure of the biceps in case of small isolated supraspinatus repair. LEVEL OF EVIDENCE III; systematic review.
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Affiliation(s)
- Rémy Vigié
- CHU de Toulouse, hôpital Pierre-Paul-Riquet, Toulouse, France
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Carvalho FF, Nolte PC, Pinheiro J, Guehring T, Egenolf M, Chatterjee T. Improvement in long head of biceps function and lower rate of biceps deformities after subpectoral tenodesis with cortical button and interference screw vs. arthroscopic tenotomy: a 4-year follow-up. JSES Int 2022; 6:820-827. [PMID: 36081695 PMCID: PMC9446215 DOI: 10.1016/j.jseint.2022.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background This study aimed to evaluate clinical, cosmetic, and strength midterm outcomes in arthroscopic biceps tenotomy and subpectoral biceps tenodesis using bicortical endobutton and interference screw. Methods In this retrospective study, inclusion criteria were long head of the biceps (LHB) pathologies treated either with tenotomy or an additional tenodesis. Postoperative assessment included Long Head of Biceps Score (LHBS), age-adjusted Constant-Murley Score, and Subjective Shoulder Value. Elbow flexion and forearm supination strength were measured. The presence of Popeye sign, cramps, and tenderness over the bicipital grove was evaluated. Statistical analysis of continuous variables without normal distribution was performed using Mann-Whitney U test. Grouped analysis was performed using 2-way analysis of variance. Binominal data were analyzed using chi-square test. Results A total of 73 patients with a mean age of 63.1 ± 9.6 years and a mean follow-up of 4.2 ± 0.5 years were included. Tenotomy was performed in 34 and tenodesis in 39 patients. Tenodesis group displayed a significantly higher LHB score (P = .0006), but no significant differences were detected for the age-adjusted Constant-Murley Score and Subjective Shoulder Value. Tenodesis group showed a significantly lower rate of Popeye deformities (P = .0007) and tenderness over the bicipital groove (P = .004). Patients from the tenotomy group with biceps deformity showed a significantly higher mean contralateral supination strength (P = .002) but no significant difference in contralateral elbow flexion compared with patients without biceps deformity. There was one (1.4%) complication in the tenotomy group (postoperative shoulder stiffness). Conclusion Both techniques resulted in comparable outcome scores on preselected patients, with tenodesis leading to better LHB function. Tenodesis did not improve elbow flexion and forearm supination strength beyond the tenotomy; however, it reduced the frequency of biceps deformities and tenderness over the bicipital groove. Patients with a strong contralateral forearm supination strength could be at risk of developing a biceps deformity after tenotomy.
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Affiliation(s)
- Filipe Ferreira Carvalho
- Evangelisches Krankenhaus, Clinic for Trauma and Orthopaedic Surgery, Bad Dürkheim, Germany
- Medical Faculty Heidelberg of Heidelberg University, Heidelberg, Germany
- Corresponding author: Filipe Ferreira Carvalho, MD, MSc, Evangelisches Krankenhaus, Orthopädie und Unfallchirurgie, Dr.-Kaufmann-Str. 2, 67098 Bad Dürkheim, Germany.
| | - Philip-Christian Nolte
- BG Trauma Center Ludwigshafen at the University of Heidelberg, Clinic for Trauma and Orthopaedic Surgery, Ludwigshafen, Germany
| | - Joao Pinheiro
- Evangelisches Krankenhaus, Clinic for Trauma and Orthopaedic Surgery, Bad Dürkheim, Germany
| | - Thorsten Guehring
- Diakonie Klinikum, Paulinenhilfe, Clinic for Trauma Orthopaedic Surgery, Stuttgart, Germany
| | - Michael Egenolf
- Evangelisches Krankenhaus, Clinic for Trauma and Orthopaedic Surgery, Bad Dürkheim, Germany
| | - Thomas Chatterjee
- Evangelisches Krankenhaus, Clinic for Trauma and Orthopaedic Surgery, Bad Dürkheim, Germany
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Szewczyk B, Konschake M, Podgórski M, Zielinska N, Markanicz M, Borowski A, Olewnik Ł. A proposal for a new classification of the long head of the biceps brachii. SURGICAL AND RADIOLOGIC ANATOMY : SRA 2022; 44:963-970. [PMID: 35788885 DOI: 10.1007/s00276-022-02961-4] [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: 03/31/2022] [Accepted: 05/11/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The anterior compartment of the arm consists of three muscles: the biceps brachii, brachialis and coracobrachialis. The aim of the present study was to characterize possible variations in the morphology of the proximal attachments of the long head of the biceps brachii and to propose an accurate classification of the area which can be useful for planning surgical procedures and planning rehabilitation in the region. MATERIALS AND METHODS Eighty (40 left and 40 right, 40 female, 40 male) upper limbs fixed in 10% formalin solution were examined. RESULTS The main tendon of the long head of the biceps brachii demonstrated three types of attachment. The most common type, Type I (53.75%), was characterized by a single attachment only for the supraglenoid tubercle. Type III (33.75%) was characterized by a single attachment to the glenoid labrum. Type II (12.5%) was characterized by a double attachment to the glenoid labrum and the supraglenoid tubercle. Additionally, two types of the accessory tendon of the long head of the biceps brachii were identified (Type A-B). Type A (14 cases) was attached to the capsule of the humeral joint, and Type B (six cases) was attached to the greater tubercle of the humerus. CONCLUSION The long head of the biceps brachii is characterized by high morphological variability. The new classification proposes three types of proximal attachment (I-III), with two types of accessory long head of the biceps brachii (A-B) tendon. A thorough understanding of the morphological variability of the long head of the biceps brachii is necessary when planning arthroscopic procedures or even planning rehabilitation procedures.
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Affiliation(s)
- Bartłomiej Szewczyk
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, Poland
| | - Marko Konschake
- Institute of Clinical and Functional Anatomy, Medical University of Innsbruck, Innsbruck, Austria
| | - Michał Podgórski
- Department of Diagnostic Imaging and Interventional Radiology, Medical University of Lodz, Lodz, Poland
| | - Nicol Zielinska
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, Poland
| | - Maja Markanicz
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, Poland
| | - Andrzej Borowski
- Orthopaedics and Paediatric Orthopaedics Department, Medical University of Lodz, Lodz, Poland
| | - Łukasz Olewnik
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, Poland.
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Hou Y, Zhang T, Liu W, Lu M, Wang Y. The Effectiveness of Ultrasound-Guided Subacromial-Subdeltoid Bursa Combined With Long Head of the Biceps Tendon Sheath Corticosteroid Injection for Hemiplegic Shoulder Pain: A Randomized Controlled Trial. Front Neurol 2022; 13:899037. [PMID: 35775042 PMCID: PMC9237414 DOI: 10.3389/fneur.2022.899037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 05/23/2022] [Indexed: 11/13/2022] Open
Abstract
Background Subacromial-subdeltoid (SASD) bursa and long head of the biceps tendon (LHBT) sheath corticosteroid injection are commonly used to treat shoulder pain associated with arthritic shoulder conditions, but effectiveness in the stroke population is unclear. This study aimed to investigate the clinical effectiveness of ultrasound-guided SASD bursa combined with LHBT sheath corticosteroid injection for hemiplegic shoulder pain (HSP) compared with SASD bursa injection alone. Methods 60 patients with HSP were randomly allocated to the dual-target group (n = 30) and single-target group (n = 30). The single-target group received SASD bursa corticosteroid injection alone, and the dual-target group received SASD bursa and LHBT sheath corticosteroid injection. The primary endpoint was pain intensity measured on a visual analog scale (VAS). The secondary endpoint was passive range of motion (PROM) of the shoulder, Upper Extremity Fugl-Meyer assessment (UEFMA) score, and Modified Barthel Index (MBI) score. PROM and pain intensity VAS were assessed at baseline and weeks 1, 4, and 12 post-treatment. UEFMA and MBI were recorded at baseline and weeks 4 and 12 post-treatment. Results A total of 141 patients with HSP were screened, and 60 patients were included. Significant differences in the VAS, PROM, UEFMA and MBI were observed at all follow-ups in both groups. The dual-target group showed a significant difference in VAS score compared with the single-target group (3.3 vs. 3.7, p = 0.01) at week 4 and week 12 (2.5 vs. 3.2, p < 0.001). Moreover, the dual-target group showed statistically significant differences in flexion (p < 0.001) at week 12, extension rotation (p < 0.001) at week 12, and abduction at week 1 (p = 0.003) and weeks 4 and 12 (p < 0.001) compared with the single-target group. There were significant differences in FMA and MBI scores in the two groups before and after treatment (p < 0.001), with a more significant increase in the dual-target group compared with the single-target group (p < 0.001) at week 12. Conclusion The combination of SASD bursa and LHBT sheath corticosteroid injection is superior to SASD bursa injection alone in reducing shoulder pain and improving functional activities in patients with HSP. Clinical Trial Registration www.chictr.org.cn, Unique identifier: ChiCTR2100047125.
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Affiliation(s)
- Yajing Hou
- Rehabilitation Medicine Center, Fuxing Hospital, Capital Medical University, Beijing, China
| | - Tong Zhang
- School of Rehabilitation Medicine, Capital Medical University, Beijing, China
- Department of Neurological Rehabilitation, Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing, China
| | - Wei Liu
- Rehabilitation Medicine Center, Fuxing Hospital, Capital Medical University, Beijing, China
| | - Minjie Lu
- Rehabilitation Medicine Center, Fuxing Hospital, Capital Medical University, Beijing, China
| | - Yong Wang
- Rehabilitation Medicine Center, Fuxing Hospital, Capital Medical University, Beijing, China
- *Correspondence: Yong Wang
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Zhang X, Liu H. Letter to the Editor concerning "Tenodesis yields better functional results than tenotomy in long head of the biceps tendon operations-a systematic review and meta-analysis". INTERNATIONAL ORTHOPAEDICS 2022; 46:1673-1674. [PMID: 35403866 DOI: 10.1007/s00264-022-05396-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 03/29/2022] [Indexed: 02/05/2023]
Affiliation(s)
- Xiang Zhang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Rd, Chengdu, 610041, China
| | - Hao Liu
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Rd, Chengdu, 610041, China.
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Evaluation and Management of the Contact Athlete's Shoulder. J Am Acad Orthop Surg 2022; 30:e584-e594. [PMID: 35171860 DOI: 10.5435/jaaos-d-20-01374] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 12/10/2021] [Indexed: 02/01/2023] Open
Abstract
Shoulder injuries are common in contact athletes and vary in severity because of the required complex interplay of shoulder stability and range of motion for proper function. Pathology varies based on sport but most commonly includes shoulder instability, acromioclavicular injuries, traumatic rotator cuff tears, and brachial plexus injuries. Acute management ranges from reduction of shoulder dislocations to physical examination to determine the severity of injury. Appropriate radiographs should be obtained to evaluate for alignment and fracture, with magnetic resonance imaging commonly being necessary for accurate diagnosis and management. Treatments range from surgical stabilization in shoulder instability to repeat examinations and physical therapy. Return-to-play decision making can be complex with avoidance of reinjury and player safety being of utmost concern. Appropriate evaluation and treatment are vital because repeat injury can lead to long-term effects due to the relatively high effectsometimes seen in contact sports.
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Technical Note: Subpektorale Tenodese der langen Bizepssehne in Mini-open-Technik. ARTHROSKOPIE 2021. [DOI: 10.1007/s00142-021-00498-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Kawashima I, Sugaya H, Takahashi N, Matsuki K, Tokai M, Hiraiwa H, Imagama S. Assessment of the Preserved Biceps Tendon After Arthroscopic Rotator Cuff Repair in Patients ≤ 55 Years. Arthrosc Sports Med Rehabil 2021; 3:e1273-e1278. [PMID: 34712963 PMCID: PMC8527261 DOI: 10.1016/j.asmr.2021.04.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 04/27/2021] [Indexed: 11/15/2022] Open
Abstract
Purpose We assessed hypertrophy of preserved long head of the biceps tendon (LHBT) and vascularity in the bicipital groove after arthroscopic rotator cuff repair in ≤55-year-old patients and compared postoperative pain between shoulders with or without vascularity in the bicipital groove. Methods Patients who underwent arthroscopic rotator cuff repair between 2015 and 2017 were reviewed. Inclusion criteria were arthroscopic rotator cuff repair and ≤55 years old. Exclusion criteria were a history of contralateral rotator cuff repair, revision surgery, partial repair or superior capsular reconstruction, shoulder dislocation or fracture, torn LHBT at surgery, LHBT tenodesis, retears, <1-year follow-up, and incomplete follow-up data. Cross-sectional area (CSA) of the LHBT and vascularity in the bicipital groove were examined preoperatively and 1 year after surgery using ultrasonography. Shoulder pain at postoperative 1 year was assessed using the pain subscore of the University of California at Los Angeles scale. The data were compared between shoulders with negative and positive vascularity. Results Fifty-seven shoulders were included in this study. There was no side-to-side difference in preoperative CSA. No difference was found between preoperative and postoperative CSA in the affected shoulders. Postoperative vascularity was identified in 28 (49%) shoulders. Mean pain score was significantly higher in the negative vascularity group than the positive vascularity group (9 and 8, respectively; P = .002). Conclusions The preserved LHBT did not show hypertrophy 1 year after arthroscopic repair of medium-sized or smaller posterosuperior rotator cuff tear in ≤55-year-old patients. However, 49% of the shoulders postoperatively demonstrated lower-grade vascularity in the bicipital groove. Healthy LHBT can be preserved in ≤55-year-old patients with posterosuperior medium-sized or smaller rotator cuff tears. Level of Evidence III, retrospective comparative prognostic trial
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Affiliation(s)
- Itaru Kawashima
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan 466-8550.,Sports Medicine and Joint Center, Funabashi Orthopaedic Hospital, Funabashi, Chiba, Japan 274-0822
| | - Hiroyuki Sugaya
- Tokyo Sports & Orthopaedic Clinic, Toshima, Tokyo, Japan 170-0012
| | - Norimasa Takahashi
- Sports Medicine and Joint Center, Funabashi Orthopaedic Hospital, Funabashi, Chiba, Japan 274-0822
| | - Keisuke Matsuki
- Sports Medicine and Joint Center, Funabashi Orthopaedic Hospital, Funabashi, Chiba, Japan 274-0822
| | - Morihito Tokai
- Tokyo Sports & Orthopaedic Clinic, Toshima, Tokyo, Japan 170-0012
| | - Hideki Hiraiwa
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan 466-8550
| | - Shiro Imagama
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan 466-8550
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Kim JY, Park HY, Del Sol SR, Bryant S, Gardner B, Chakrabarti MO, Perinovic S, McGahan PJ, Chen JL. Arthroscopic Single Portal, Single Anchor Knotless Subscapularis Repair with Concomitant Tenodesis of the Long Head of the Biceps Tendon. Arthrosc Tech 2021; 10:e1117-e1123. [PMID: 33981559 PMCID: PMC8085439 DOI: 10.1016/j.eats.2021.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 01/08/2021] [Indexed: 02/03/2023] Open
Abstract
Anterior shoulder pathology involving the subscapularis is often associated with the biceps tendon because both anatomic structures intersect the lesser tuberosity. Standard procedures for such pathology often involve simultaneous subscapularis repairs and biceps tenodesis. Single anterior portal subscapularis repairs have been emerging in the past 5 years because of cost-effectiveness and efficiency. Biceps tenodesis is a common procedure performed both open and arthroscopically. This technique takes advantage of the close relation between the long head of the biceps tendon and subscapularis tendon to restore the functional length-tension relation and preserve function through fixation using a single portal and a single knotless suture anchor.
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Affiliation(s)
- Joo Yeon Kim
- Address correspondence to: Joo Yeon Kim, B.A., Advanced Orthopaedics and Sports Medicine, 450 Sutter St., Ste. 400, San Francisco, CA 94108, U.S.A.
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Simon M, Lutter C, Schöffl V. Rupture of the Short Head of the Biceps Brachii Muscle Belly Caused by a Rock-Climbing Accident. Wilderness Environ Med 2020; 31:327-331. [PMID: 32709490 DOI: 10.1016/j.wem.2020.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 04/07/2020] [Accepted: 04/16/2020] [Indexed: 01/03/2023]
Abstract
The case of a 42-y-old rock climber who sustained a complete, isolated rupture of the short head of the biceps brachii muscle after falling onto his upper arm while bouldering is presented. This is the first description of this rare injury after a climbing accident. Moreover, there is no definitive consensus on whether and when surgical intervention is necessary in such a case. We performed a direct end-to-end suture of the muscle belly through an open surgical approach. Postoperatively, we performed a detailed follow-up, including clinical examinations and sonography and magnetic resonance imaging to check the integrity of the suture. After 6 mo, our patient had regained a full range of motion without functional complaints or pain. Concerning the sports-specific outcome, we only found a slight decrease in rock-climbing abilities (Union Internationale des Associations d'Alpinisme Scale of Difficulty grade VII+ postsurgery compared to VIII preinjury). In conclusion, we suggest that early surgical reapproximation of the muscle belly might be the best treatment option for this severe but rare injury in athletes.
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Affiliation(s)
- Michael Simon
- Department of Sports Orthopedics, Sports Medicine, Sports Traumatology, Klinikum Bamberg, Bamburg, Germany; Department of Orthopedics and Traumatology, Klinikum Bamberg, Bamburg, Germany.
| | - Christoph Lutter
- Department of Sports Orthopedics, Sports Medicine, Sports Traumatology, Klinikum Bamberg, Bamburg, Germany; Department of Orthopedics and Traumatology, Klinikum Bamberg, Bamburg, Germany
| | - Volker Schöffl
- Department of Sports Orthopedics, Sports Medicine, Sports Traumatology, Klinikum Bamberg, Bamburg, Germany; Department of Orthopedics and Traumatology, Klinikum Bamberg, Bamburg, Germany; Department of Trauma and Orthopedic Surgery, Friedrich Alexander University, Erlangen-Nuremberg, Germany
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Ayzenberg M, Hiller AD, Vellinga R, Snyder SJ. Arthroscopic supraglenoid origin-preserving biceps tenodesis: a reliable, simple, and cost-conscious technique. J Shoulder Elbow Surg 2020; 29:S73-S79. [PMID: 32643611 DOI: 10.1016/j.jse.2020.03.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 03/19/2020] [Accepted: 03/20/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to assess the midterm clinical and ultrasonographic outcomes of a new all arthroscopic supraglenoid origin-preserving tenodesis technique of the long head of the biceps (LHB) brachii tendon in the setting of small to medium-sized rotator cuff repairs. MATERIALS AND METHODS Thirty patients (33 shoulders) meeting inclusion criteria were identified who underwent LHB tenodesis with this technique in the setting of small to medium-sized rotator cuff repair at a mean age at surgery of 65.6 years between 2015 and 2017. Rotator cuff tears were repaired using the Southern California Orthopedic Institute (SCOI) row technique. The biceps tenodesis was incorporated into the anterior anchor of the rotator cuff repair after bony groove preparation, including débridement and bone vent placement. Frayed edges of the biceps tendon were gently débrided, but the intra-articular glenoid attachment was left intact. Patients were assessed at follow-up by clinical and ultrasonographic examination, as well as a satisfaction questionnaire, the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) score and visual analog scale (VAS) score. RESULTS Mean follow-up was 32.9 months for the 27 patients (30 shoulders), resulting in a 91% follow-up. Average ASES score was 94.4. Average patient-reported satisfaction with shoulder function was 9.4 of 10 and with biceps contour was 9.9 of 10. Average VAS score was 0.6 of 10, and 73% of patients reported a VAS score of 0. Ultrasonography demonstrated an intact biceps tendon in 27 of 28 shoulders and an intact supraspinatus tendon in all 28 shoulders. Mean range of motion was 170° in forward flexion, 169° in abduction, 49° in external rotation, and to thoracic vertebrae 12 in internal rotation. Mean muscle grading during Jobe test was 4.8 of 5. There were no intraoperative complications. No patients required revision surgery. CONCLUSIONS In situ arthroscopic biceps tenodesis with maintenance of the glenoid attachment incorporated into rotator cuff repair yields a high rate of healing and consistently excellent functional and cosmetic outcomes as well as patient satisfaction while saving surgical time and cost.
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Affiliation(s)
- Mark Ayzenberg
- Southern California Orthopedic Institute, Van Nuys, CA, USA.
| | | | - Ryan Vellinga
- Southern California Orthopedic Institute, Van Nuys, CA, USA
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Affiliation(s)
| | | | - Wei Lu
- The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong Province, China
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Hong CK, Chang CH, Hsu KL, Kuan FC, Wang PH, Su WR. Patients older than 55 years prefer biceps tenodesis over tenotomy to the same degree as young patients. J Orthop Sci 2020; 25:416-422. [PMID: 31160159 DOI: 10.1016/j.jos.2019.05.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 05/09/2019] [Accepted: 05/13/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND 55 years of age used to be the cutoff point when deciding between biceps tenotomy and tenodesis for treating biceps tendon pathologies. METHODS Patients aged ≥18 years who had tendonitis in the long head of the biceps and were admitted for arthroscopic surgery were included. A questionnaire with a series of questions assessing patients' current symptoms, their concerns about their outcomes, and personal demographic information was introduced to the participants on the day before the surgery. The patients' preference toward tenotomy and tenodesis was assessed, and χ2 tests and logistic regressions were used to test the association with the categorical and ordinal variables, respectively. RESULTS A total of 135 patients enrolled in the study, with 83 males and 52 females, the mean age of which was 56 years (range, 18-75 years). Of all patients, 86 (63.7%) preferred biceps tenodesis as opposed to tenotomy; meanwhile, there was no difference in preference toward tenodesis in each age- and gender-subgroup (range, 55.1% to 71.4%). The different subgroups had specific factors that were predictive of choosing either a tenotomy or tenodesis. In most subgroups, concerns about postoperative arm appearance and the so-called "Popeye" deformity due to tenotomy were factors predictive of choosing biceps tenodesis, whereas concern about longer rehabilitation due to tenodesis was the factor predictive of choosing biceps tenotomy. CONCLUSIONS Biceps tenodesis is a more preferable choice for patients with biceps tendinopathies in all age and gender subgroups. Patients' concerns on postoperative arm appearance, "Popeye" deformity due to tenotomy, and longer rehabilitation due to tenodesis are the most important predictive factors.
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Affiliation(s)
- Chih-Kai Hong
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
| | - Chih-Hsun Chang
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
| | - Kai-Lan Hsu
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan.
| | - Fa-Chuan Kuan
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan.
| | - Ping-Hui Wang
- Department of Orthopedics, Chi-Mei Medical Center, Tainan, Taiwan.
| | - Wei-Ren Su
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Medical Device R & D Core Laboratory, National Cheng Kung University Hospital, Tainan, Taiwan.
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Cheng C, Chen B, Xu H, Zhang Z, Xu W. Efficacy of concomitant acromioplasty in the treatment of rotator cuff tears: A systematic review and meta-analysis. PLoS One 2018; 13:e0207306. [PMID: 30439995 PMCID: PMC6237382 DOI: 10.1371/journal.pone.0207306] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Accepted: 10/28/2018] [Indexed: 12/23/2022] Open
Abstract
Background Scientific evidence is not clear regarding the routine use of acromioplasty in the treatment of rotator cuff repair. The aim of this study was to compare clinical outcomes between patients undergoing arthroscopic rotator cuff repair with and without concomitant acromioplasty. Methods Medline, Cochrane Library, and EMBASE databases were searched to identify eligible studies focused on arthroscopic rotator cuff repair with and without acromioplasty from January 2000 to February 2018. Postoperative functional outcomes, visual analog scale (VAS) for pain and reoperation rate were extracted for systemic analysis. Results Six randomized controlled trials (RCTs) and one cohort study (CS), including 651 patients, fulfilled our selection criteria. The results showed a significant difference in American Shoulder and Elbow Surgeons (ASES) score, but not in the Constant score, University of California-Los Angeles (UCLA) score, or Simple Shoulder Test (SST) score, in the treatment of rotator cuff tear with or without concomitant acromioplasty at the final follow-up. In the subgroup analysis, the results showed no significant differences between the two treatments in reoperation rate at the final follow-up or VAS score at 6 months postoperatively and final follow-up, but there was a significant difference in VAS score at 12 months postoperatively in favor of acromioplasty treatment. The evidence quality for each outcome evaluated by the GRADE system was low. Conclusions In summary, our present study demonstrated that acromioplasty treatment is significantly superior to nonacromioplasty in shoulder pain relief at 12 months postoperatively and in ASES score improvement at the final follow-up in conjunction with rotator cuff repair. However, these significant differences were not clinically relevant. Thus, there were no differences in shoulder function or pain scores for patients undergoing rotator cuff repair with and without acromioplasty. Further high-quality studies with larger sample sizes and long-term follow-ups are needed to clarify this issue.
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Affiliation(s)
- Cong Cheng
- Orthopedics Department, The Second Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang Province, China
| | - Bin Chen
- Orthopedics Department, The Second Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang Province, China
| | - Hongwei Xu
- Orthopedics Department, The Second Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang Province, China
| | - Zhongwei Zhang
- Orthopedics Department, The Second Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang Province, China
| | - Weibin Xu
- Orthopedics Department, The Second Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang Province, China
- * E-mail:
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