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Greif DN, Shaikh HJ, Neumanitis J, Ramirez G, Maloney MD, Bronstein RD, Giordano B, Nicandri GT, Voloshin I, Mannava S. Arthroscopic subacromial decompression improved outcomes in situationally depressed patients compared to clinically depressed or nondepressed patients. JSES Int 2024; 8:304-309. [PMID: 38464455 PMCID: PMC10920123 DOI: 10.1016/j.jseint.2023.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024] Open
Abstract
Background The purpose of this study is to evaluate patient reported outcomes after arthroscopic extensive débridement of the shoulder with subacromial decompression (SAD) for subacromial impingement using the Patient-Reported Outcomes Measurement Information System (PROMIS) system and evaluate if depression (Dep) (clinical or situational) impacts patients achieving a Minimal Clinically Important Difference (MCID). Methods Preoperative PROMIS Physical function (PF), Mood, and Dep scores were obtained at the closest date prior to arthroscopic rotator cuff repair and postoperative scores were collected at every clinical visit thereafter. Final PROMIS score used for data analysis was determined by the patients final PROMIS value between 90 to 180 days. Clinical Dep was determined by patients having a formal diagnosis of "Depression or Major Depressive Disorder" at the time of their surgery. Situationally depressed patients, those without a formal diagnosis yet exhibited symptomatic depressive symptoms, were classified by having a PROMIS-Dep cutoff scores larger than 52.5. Results A total of 136 patients were included for final statistical analysis. 13 patients had a clinical but not situational diagnosis of Dep, 86 patients were identified who had no instance of clinical or situational Dep (nondepressed). 35 patients were situationally depressed. All three cohorts demonstrated a significant improvement in postoperative PROMIS Dep, PI, and PF score relative to their preoperative value (P = .001). Situationally depressed patients achieved greater delta PROMIS-Dep compared to patients with major depressive disorder. Depressed patients had a higher chance of achieving MCID for PROMIS-Dep compared to nondepressed patients (P = .01). Logistic regression analysis demonstrated that underlying Dep did not alter the odds of obtaining MCID compared to nondepressed patients. Nonsmoking patients had significantly greater odds of achieving MCID for PF (P = .02). Discussion Patients improved after undergoing SAD regardless of underlying Dep or depressive symptoms. Depressed patients exhibited greater change in PROMIS scores compared to nondepressed patients. Smoking remains a risk factor for postoperative outcomes in patients undergoing SAD for subacromial impingement. Identifying and counseling patients with underlying depressive symptoms without a formal major depressive disorder diagnosis may lead to improved outcomes. These findings may help guide clinicians in deciding who would benefit the most from this procedure.
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Affiliation(s)
- Dylan N. Greif
- University of Rochester Department of Orthopaedics and Physical Rehabilitation, Rochester, NY, USA
| | - Hashim J.F. Shaikh
- University of Rochester Department of Orthopaedics and Physical Rehabilitation, Rochester, NY, USA
| | - James Neumanitis
- University of Rochester Department of Orthopaedics and Physical Rehabilitation, Rochester, NY, USA
| | - Gabriel Ramirez
- University of Rochester Department of Orthopaedics and Physical Rehabilitation, Rochester, NY, USA
| | - Michael D. Maloney
- University of Rochester Department of Orthopaedics and Physical Rehabilitation, Rochester, NY, USA
| | - Robert D. Bronstein
- University of Rochester Department of Orthopaedics and Physical Rehabilitation, Rochester, NY, USA
| | - Brian Giordano
- University of Rochester Department of Orthopaedics and Physical Rehabilitation, Rochester, NY, USA
| | - Gregg T. Nicandri
- University of Rochester Department of Orthopaedics and Physical Rehabilitation, Rochester, NY, USA
| | - Ilya Voloshin
- University of Rochester Department of Orthopaedics and Physical Rehabilitation, Rochester, NY, USA
| | - Sandeep Mannava
- University of Rochester Department of Orthopaedics and Physical Rehabilitation, Rochester, NY, USA
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Longo UG, De Salvatore S, Zollo G, Calabrese G, Piergentili I, Loppini M, Denaro V. Magnetic resonance imaging could precisely define the mean value of tendon thickness in partial rotator cuff tears. BMC Musculoskelet Disord 2023; 24:718. [PMID: 37689653 PMCID: PMC10492299 DOI: 10.1186/s12891-023-06756-5] [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: 01/16/2023] [Accepted: 07/25/2023] [Indexed: 09/11/2023] Open
Abstract
PURPOSE Rotator Cuff (RC) lesions are classified in full-thickness and partial-thickness tears (PTRCTs). To our knowledge, no studies investigated the mean size of shoulder tendons in healthy and PTRCT patients using MRI scans. The aim of the study was to provide data to obtain and compare the mean value of tendon sizes in healthy and PTRCTs groups. METHODS From 2014 to 2020, 500 were included in the study. They were divided into two groups: Group 1 (100 subjects) was composed of people positive for partial-thickness rotator cuff tears (PTRCTs), while the 400 subjects in Group 2 were negative for PTRCTs. RESULTS Overall, of the patients included in the study, 231 were females and 269 were males. The mean age of the patients was 49 ± 12.7 years. The mean thickness of the supraspinatus tendon (SSP) was 5.7 ± 0.6 mm in Group 1, 5.9 ± 0.6 mm in Group 2 (p < 0.001). The mean length of the ISP tendon was 27.4 ± 3.2 mm in Group 1, 28.3 ± 3.8 mm in Group 2 (p = 0.004). The mean width of the SSP tendon was 17 ± 1.6 mm in Group 1, 17.6 ± 2 mm in Group 2 (p = 0.004). The mean width of the infraspinatus tendon (ISP) tendon was 17.7 ± 1.4 mm in Group 1, 18.3 ± 2.1 mm in Group 2 (p = 0.02). CONCLUSION The anatomical data present in this paper may serve as a tool for surgeons to properly manage PTRCTs. The findings of the present study aimed to set the first step towards reaching unanimity to establish international cut-off values to perform surgery. Additionally, they could widely increase diagnostic accuracy, improving both conservative and surgical approaches. Lastly, further clinical trials using more accurate diagnostic MRI tools are required to better define the anatomical differences between PTRCT and healthy patients. LEVEL OF EVIDENCE Level II, Retrospective Comparative Trial.
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Affiliation(s)
- Umile Giuseppe Longo
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, Roma, 200 - 00128 Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, Roma, 21 - 00128 Italy
| | - Sergio De Salvatore
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, Roma, 21 - 00128 Italy
- Department of Orthopedics, Children’s Hospital Bambino Gesù, Palidoro, Rome, 00165 Italy
| | - Giuliano Zollo
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, Roma, 200 - 00128 Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, Roma, 21 - 00128 Italy
| | - Giovanni Calabrese
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, Roma, 200 - 00128 Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, Roma, 21 - 00128 Italy
| | - Ilaria Piergentili
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, Roma, 200 - 00128 Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, Roma, 21 - 00128 Italy
| | - Mattia Loppini
- IRCCS Humanitas Research Hospital, Rozzano, 20089 Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Italy
| | - Vincenzo Denaro
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, Roma, 200 - 00128 Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, Roma, 21 - 00128 Italy
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Cheppalli NS, Purudappa PP, Metikala S, Goel A, Singla A, Sambandam S. Using Biceps Tendon Autograft as a Patch in the Treatment of Massive Irreparable Rotator Cuff Tears Improves Patient-reported Outcome Scores: A Systematic Review. Arthrosc Sports Med Rehabil 2023; 5:e529-e536. [PMID: 37101869 PMCID: PMC10123426 DOI: 10.1016/j.asmr.2023.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 01/27/2023] [Indexed: 03/06/2023] Open
Abstract
Purpose To review the clinical studies describing the use of ipsilateral biceps tendon autograft for bridging irreparable massive rotator cuff tears (MRCTs). Methods A systematic review was conducted of MEDLINE, Embase, Cochrane, CINAHL, and Scopus databases using search terms "massive rotator cuff tear," "irreparable rotator cuff tear," and "long head of the biceps tendon." Only clinical human studies in which the biceps tendon was used as a bridging graft in MRCTs were included. All review studies, technique papers, and studies describing the use of biceps tendon as superior capsular reconstruction equivalent or rotator cable were excluded. Results A total of 45 studies were initially identified, of which only 6 studies met the inclusion criterion. All studies were retrospective in nature, with a total of 176 patients. All studies reported a clinically significant improvement in postoperative functional outcomes, although this was not compared to a control group in all the studies. Pain was assessed using the visual analog scale (VAS) in 4 studies, and all reported an improvement in postoperative VAS ranging from 5 to 6 points. One study reported an improvement in pain scale from Japanese Orthopedic Association from 13.1 to 22.5 (9 points). One study did not report a VAS score as this study was published before the VAS score was developed. All the reported studies saw improvements in range of motion. Conclusions The use of the long head of the biceps tendon as an interposition/bridging patch to augment the MRCT repair can reduce the VAS score, improve elevation and external rotation, and improve clinical and functional outcomes. Level of Evidence IV, systematic review of Level III and IV studies.
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Affiliation(s)
- Naga Suresh Cheppalli
- Department of Orthopedic and Rehabilitation University of New Mexico, Raymond Murphy Medical Centre, Albuquerque, New Mexico
| | | | | | - Akshay Goel
- Department of Orthopaedics, Marshall University, Joan C. Edwards School of Medicine, Huntington, West Virginia
- Address correspondence to Akshay Goel, M.D., Department of Orthopaedics, Marshall University, Joan C. Edwards School of Medicine, 1600 Medical Center Dr., Huntington, WV 25701
| | - Amit Singla
- St. Barnabas Hospital, Albert Einstein College of Medicine, Bronx, New York
| | - Senthil Sambandam
- University of Texas Southwestern and Dallas VAMC, Dallas, Texas, U.S.A
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Collagen and platelet-rich plasma in partial-thickness rotator cuff injuries. Friends or only indifferent neighbours? Randomised controlled trial. BMC Musculoskelet Disord 2022; 23:1109. [PMID: 36536333 PMCID: PMC9764482 DOI: 10.1186/s12891-022-06089-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Partial-thickness rotator cuff injuries (PTRCI) are the sum of degenerative, overload, and microtrauma processes. An external supply of collagen and platelet-rich plasma (PRP) could potentially counteract the deterioration of degenerative tendinopathy. This study aimed to compare the effectiveness of collagen with PRP, PRP alone, and collagen alone in the treatment of PTRCI. METHODS Ninety patients with PTRCI were randomised and treated with ultrasound-guided injections into the shoulder bursa every consecutive week: Group A - collagen with PRP (n = 30), Group B - collagen alone (n = 30), and Group C - PRP alone (n = 30). Primary outcomes were pain intensity measured in control points on a numeric rating scale (NRS), QuickDash, and EQ-5D-5L questionnaires at the initial assessment (IA) and control assessments after 6 (T1), 12 (T2), and 24 (T3) weeks, respectively. RESULTS No statistical differences were found between groups in primary outcomes, although there was a trend towards improvement in Groups A and C (opposite to Group B) between T2 and T3. The following parameters were also observed: rotator cuff discontinuity (n = 3, one case in each group) and rotator cuff regeneration (n = 22 in Group A, n = 20 in Group B, and n = 23 in Group C). CONCLUSIONS Combined therapy of collagen and PRP in PTRCI presents similar effectiveness to monotherapies with collagen or PRP. TRIAL REGISTRATION The study was prospectively registered on the NCT Trial Center (identification number: NCT04492748 ) on 30.07.2020.
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Pietroski AD, Burdick GB, Warren JR, Franovic S, Muh SJ. Patient-Reported Outcomes Measurements Information System (PROMIS) upper extremity and pain interference do not significantly predict rotator cuff tear dimensions. JSES Int 2021; 6:56-61. [PMID: 35141677 PMCID: PMC8811379 DOI: 10.1016/j.jseint.2021.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background Proper diagnosis of rotator cuff tears is typically established with magnetic resonance imaging (MRI); however, studies show that MRI-derived measurements of tear severity may not align with patient-reported pain and shoulder function. The purpose of this study is to investigate the capacity for the Patient-reported Outcomes Measurements Information System (PROMIS) computer adaptive tests to predict rotator cuff tear severity by correlating preoperative tear morphology observed on MRI with PROMIS upper extremity (UE) and pain interference (PI) scores. This is the first study to investigate the relationship between tear characteristics and preoperative patient-reported symptoms using PROMIS. Considering the essential roles MRI and patient-reported outcomes play in the management of rotator cuff tears, the findings of this study have important implications for both treatment planning and outcome reporting. Methods Two PROMIS–computer adaptive test forms (PROMIS-UE and PROMIS-PI) were provided to all patients undergoing rotator cuff repair by one of three fellowship-trained surgeons at a single institution. Demographic information including age, sex, race, employment status, body mass index, smoking status, zip code, and preoperative PROMIS-UE and -PI scores was prospectively recorded. A retrospective chart review of small to large full- or partial-thickness rotator cuff tears between May 1, 2017 and February 27, 2019 was used to collect each patient’s MRI-derived tear dimensions and determine tendon involvement. Results Our cohort consisted of 180 patients (56.7% male, 43.3% female) with an average age of 58.9 years (standard deviation, 9.0). There was no significant difference in PROMIS-UE or -PI scores based on which rotator cuff tendons were involved in the tear (P > .05). Neither PROMIS-UE nor PROMIS-PI significantly correlated with tear length or retraction length of the supraspinatus tendon (P > .05). The sum of tear lengths in the anterior-posterior and medial-lateral directions was weakly correlated with PROMIS-UE (P = .042; r = -0.152, r2 = 0.031) and PROMIS-PI (P = .027; r = 0.165, r2 = 0.012). Conclusion Rotator cuff tear severity does not significantly relate to preoperative PROMIS-UE and -PI scores. This finding underscores the importance of obtaining a balanced preoperative assessment of rotator cuff tears that acknowledges the inconsistent relationship between rotator cuff tear characteristics observed on MRI and patient-reported pain and physical function.
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Guimarães MV, Bonifácio ED, Carmo TCD, Araújo CAD. Design and Mechanical Evaluation of Sutureless Implants for the Surgery Treatment of Rotator Cuff Tears. J Biomech Eng 2021; 143:1109460. [PMID: 34008848 DOI: 10.1115/1.4051230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Indexed: 11/08/2022]
Abstract
Rotator cuff (RC) tears cause pain and functional disability of the shoulder. Despite advances in suture anchors, there are still reports about the incidence of surgical-related injuries to RC mainly associated with sutures. The purpose of this study was to design and evaluate the mechanical behavior of sutureless implants to repair RC tears. We hypothesized that the implants present mechanical characteristics suitable for the surgical treatment of RC tears as suture anchors. Three different implants (T1, T2, T3) were designed and fabricated with titanium: T1 has two rods and rectangular head; T2 has two rods with a small opening and enlarged rectangular head; and T3 has three rods and a circular head. The implants were fixed in rigid polyurethane foam blocks by a series of blows, and the applied mechanical loads along with the number of blows were quantified. Pullout tests using tapes fixed between the implant head and testing machine grip were conducted until implant failure. The maximum pullout strength and displacement of the implant relative to the rigid foam block were computed. Statistical significance was set at p < 0.05. Owing to its geometric configuration, implant T2 presented the best characteristics related to stability, strength, and ease of insertion. Implant T2 confirms our hypothesis that its mechanical behavior is compatible with that of suture anchors, which could lead to the reduction of RC repair failures and simplify the arthroscopic procedure.
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Affiliation(s)
- Marcília Valéria Guimarães
- School of Mechanical Engineering, Federal University of Uberlândia, João Naves de Avila Avenue, Uberlândia, MG 38400-902, Brazil
| | - Elton Diêgo Bonifácio
- School of Mechanical Engineering, Federal University of Uberlândia, João Naves de Avila Avenue, Uberlândia, MG 38400-902, Brazil
| | - Thiago Côrrea do Carmo
- Medical School, Federal University of Uberlândia, João Naves de Avila Avenue, Uberlândia, MG 38400-902, Brazil
| | - Cleudmar Amaral de Araújo
- School of Mechanical Engineering, Federal University of Uberlândia, João Naves de Avila Avenue, Uberlândia, MG 38400-902, Brazil
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Abstract
The cause of rotator cuff tears is multifactorial with both intrinsic and extrinsic contributing factors. Understanding the normal MR anatomy of the rotator cuff and using an appropriate search pattern can help readers identify common pathologic conditions. Accurate designation using classification systems for tear thickness, size, and degree of retraction and muscle fatty infiltration and atrophy are important in guiding surgical management. Knowledge of common disease locations for the rotator cuff tendons can help focus reader searches and increase sensitivity.
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Affiliation(s)
- Erin McCrum
- Division of Musculoskeletal Imaging, Department of Radiology, Duke University Medical Center, Duke University, Box 3808, Durham, NC 27707, USA.
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Razmjou H, Palinkas V, Christakis M, Kennedy D, Robarts S. Diagnostic Value of Acromiohumeral Distance in Rotator Cuff Pathology: Implications for Advanced-Practice Physiotherapists. Physiother Can 2020; 72:52-62. [PMID: 34385749 DOI: 10.3138/ptc-2018-0084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Purpose: The primary purpose of this study was to examine the inter-tester reliability and criterion validity of reduced acromiohumeral distance (AHD; <6 mm) visualized on plain radiographs in detecting rotator cuff (RC) pathology. The secondary objective was to examine the relationship between this radiographic feature and patient demographics and clinical examination. Method: This was a diagnostic study of patients seen in a tertiary care centre. Two advanced-practice physiotherapists measured AHD in two radiographic views. MRI was used as the gold standard. Results: A total of 150 consecutive patients (mean age 59 [SD 11] y, 57 women, 93 men) were included. AHD less than 6 millimetres was highly specific in both views for the presence of tear (99%), tear size (96%-98%), and fatty infiltration in the supraspinatus and infraspinatus muscles (93%-96%). The absence of AHD less than 6 millimetres was associated with a lack of advanced fatty infiltration in the supraspinatus and infraspinatus muscles (92%-100%). Sensitivity values were low for the presence and size of RC tear (21%-55%). We found a statistically significant positive association between the AHD categories and clinically observed muscle wasting and weakness of the RC muscles (p < 0.05). Conclusions: AHD less than 6 millimetres was reliably measured in plain radiographs and was strongly associated with important clinical and imaging features of advanced RC pathology; this may assist with clinical decision making by allowing judicious use of more costly investigations and referral for surgery.
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Affiliation(s)
- Helen Razmjou
- Department of Rehabilitation, Holland Orthopaedic & Arthritic Centre.,Sunnybrook Research Institute.,Department of Physical Therapy
| | - Veronica Palinkas
- Department of Rehabilitation, Holland Orthopaedic & Arthritic Centre.,Department of Physical Therapy
| | - Monique Christakis
- Department of Medical Imaging, Sunnybrook Health Sciences Centre.,Department of Medical Imaging, Faculty of Medicine, University of Toronto, Toronto
| | - Deborah Kennedy
- Department of Rehabilitation, Holland Orthopaedic & Arthritic Centre.,Department of Physical Therapy.,School of Rehabilitation Science, McMaster University, Hamilton, Ont
| | - Susan Robarts
- Department of Rehabilitation, Holland Orthopaedic & Arthritic Centre.,Sunnybrook Research Institute.,Department of Physical Therapy
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El Abiad JM, Faddoul DG, Baydoun H. Case report: Broad insertion of a large subscapularis tendon in association with congenital absence of the long head of the biceps tendon. Skeletal Radiol 2019; 48:159-162. [PMID: 29948038 DOI: 10.1007/s00256-018-2989-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 05/10/2018] [Accepted: 05/24/2018] [Indexed: 02/02/2023]
Abstract
Congenital absence of the long head of the biceps (LHB) tendon is a rare variation in shoulder anatomy. The authors present a case of congenital absence of the long head of the biceps tendon associated with a large insertion of the subscapularis muscle. The patient initially presented with shoulder pain on overhead activity. Shoulder examination was negative for signs of a torn biceps tendon. MRI revealed congenital absence of the LHB tendon, a rim rent tear of the supraspinatus, and a large insertion of the subscapularis muscle. This is the first reported case describing a large insertion of the subscapularis muscle associated with absence of the LHB tendon.5.
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Affiliation(s)
- Jad M El Abiad
- Department of Orthopedic Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | | | - Hasan Baydoun
- Department of Orthopedic Surgery, American University of Beirut Medical Center, Beirut, Lebanon.
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