Unusual Case of Long Head of Biceps Tendon Synovial Chondromatosis

Introduction

Synovial chondromatosis is a rare benign tumor involving the major joints. This condition results from metaplasia of synovium into chondrocytes leading to formation of multiple loose bodies. Extra articular glenohumeral joint synovial chondromatosis involving long head of biceps is very rare.

Case Report

A 38-year-old male presented with history of insidious onset, dull aching pain in right shoulder for 6 months. Clinicoradiological examination revealed calcific mass around the long head of biceps tendon. The calcific mass and loose bodies were removed en bloc. Histopathological examination concurred to be synovial chondromatosis.

Conclusion

We hereby report a rare case of long head biceps tendon synovial chondromatosis of shoulder which was successfully treated by combined arthroscopic and open method. The results of surgical excision are excellent.

MR arthrography: correlation between anatomic intraarticular variants of the long head of the biceps tendon (long head biceps tendon) and superior labral anterior to posterior (SLAP) lesions

Background

The purpose of this work is to characterize the anatomy of the intraarticular portion of the long head of the biceps tendon (long head biceps tendon) using magnetic resonance (MR) arthrography by investigating whether anatomical variants may facilitate the onset of a supraequatorial lesion (superior labral anterior to posterior, SLAP).

Materials and methods

In 482 shoulder MR arthrographies, we considered the anatomical variants of the intraarticular portion of the long head of the biceps tendon classified according to Dierickx’s arthroscopic classification; lesions of supraequatorial structures were considered in the data analysis. For each anatomical variant, correlation with SLAP and the odd ratio were statistically evaluated, using Fisher’s exact (or chi-squared) test and logistic regression analysis, respectively.

Results

In the mesotenon-type variant, the SLAP frequency was higher than expected [χ² (df = 4) = 14.9, p = 0.005] with a higher risk of developing a type I SLAP (p = 0.0003). In the adherent-type variant, the type II SLAP frequency was higher than expected [χ² (df = 3) = 18.1, p = 0.0004] with a higher risk of developing type II SLAP (p = 0.0001). Two cases of “split” (SPL) long head biceps tendon had III and type IV SLAP, respectively. These patients have a higher risk for type IV SLAP [odds ratio (OR) 19.562, 95% confidence interval (CI) 1.604–238.541, p = 0.001]. An increased risk of developing SLAP type II was calculated for male subjects (OR 3.479, 95% CI 1.013–11.951, p = 0.019).

Conclusions

It is possible that adherence of the long head biceps tendon to the supraspinatus more often predisposes to a lesion of the superior glenoid labrum (SLAP), in view of the close relationships between the fibrocartilage and the bicipital anchor, probably related to the limited excursion of the intraarticular long head biceps tendon.

Anatomical variants of the intraarticular portion of the long head of the biceps tendon should be studied with MR arthrography.

Some anatomical variants are more frequently associated with supraequatorial lesions.

The higher frequency of lesions in the presence of certain anatomical variants is probably related to the limited excursion of the intraarticular long head biceps tendon.

Arthroscopic repair of massive rotator cuff tear. The role of the LHB distal tenotomy

PURPOSE

The aim of the study was to evaluate the results of an all arthroscopic technique for the treatment of massive rotator cuff tears using the long head of biceps as a graft to reconstruct the superior capsule and to reinforce the cuff.

METHODS

A retrospective review of a consecutive series of arthroscopic repair of massive rotator cuff tears using the long head of biceps tendon was conducted. Twenty-five patients underwent surgery, and none were lost at follow-up. Minimum follow-up period was more than 12 months. Constant, UCLA and VAS scores as clinical outcome were analyzed. Time for surgical procedures was also registered. Two alternative procedures (transosseous or anchors) were employed to fix laterally the long head of biceps to the greater tuberosity and to reinforce the cuff. This choice was essentially determined by the bone quality of the greater tuberosity.

RESULTS

All patients of both groups (Transosseous: 15 and Anchors: 10) showed a significant improvement of clinical and functional scores. Difference of the operative times between two procedures was statistically significant in favor of the anchor approach. No intraoperative complications were recorded. Postoperative shoulder stiffness was found in two male patients. In no case biceps tenodesis was performed: Popeye sign was easily detected in 16 patients but they did not complain any superior arm pain and weakness.

CONCLUSION

This technique represents a valid solution for treatment of massive rotator cuff tears resulting safe, easier and cost saving in comparison with other published techniques.

A Rare Anatomical Variation in the Origin of the Tendon of Long Head of Biceps in a 30-Year-Old Male: A Case Report and Review of Literature

INTRODUCTION

Early studies on human embryology reveal a migration of the tendon of long head of biceps from the synovium and fibrous capsule to an intra-articular position [1, 2, 3]. Any hindrance in the normal course of events of development, pathological or otherwise, may result in variations from the normal anatomy.

CASE REPORT

Here, we discuss a case of a rare anatomical variant of the origin of long head of biceps tendon discovered incidentally in a 30-year-old manual laborer. The patient had an insidious onset and gradually progressive right shoulder pain, especially in initiating abduction, with a feeling of instability for 5 months. On examination, apprehension test and anterior drawer test were present and sulcus sign was positive. Partial-thickness supraspinatus tear and fraying of the anteroinferior glenoid labrum were noted in the imaging. After giving a fair trial of conservative management, the patient was posted for an arthroscopic repair of the supraspinatus tear and the anteroinferior glenoid labrum when the anomalous origin of the tendon of long head of biceps was discovered incidentally. This origin was from the inferior surface of the supraspinatus muscle outside the capsule. The tendon was left intact as it was not found to be inflamed or degenerated and was not the source of instability.

CONCLUSION

Due to the rarity of this anatomical variant, definite conclusions cannot be drawn currently regarding its pathological nature. Shoulder arthroscopists should be aware of its potential to become abnormally thickened and causing shoulder dysfunction.

Recurrent shoulder stabilization with open bankart repair and long head biceps transfer

There are several treatment options for recurrent shoulder instability. The Latarjet addresses bone loss via coracoid transfer, and creates a "sling effect" on the humeral head with the conjoint tendon. It does however carry a high potential risk of complications including graft resorption, hardware failure, and neurologic injury. It is hypothesized that the long head of the biceps can function similarly, without the donor site morbidity of a coracoid transfer. We present a case of recurrent instability and musculocutaneous nerve palsy following primary arthroscopic stabilization three years prior, and treatment via long head of the biceps stabilization.

Surgical indications for long head biceps tenodesis: a systematic review

PURPOSE

Tenodesis as a treatment for a symptomatic long head of biceps (LHB) tendon is becoming more prevalent and new techniques exist which are purported to make the procedure faster and more effective. The determination of appropriate surgical indications for the procedure will facilitate proper analysis and comparisons of the varied techniques. This review analyses the reported indications in the literature in an attempt to guide future research and treatment.

METHODS

The EMBASE and MEDLINE databases were searched to identify surgical studies that report indications for LHB tenodesis. After title, abstract searches, and full-text reviews, 39 studies were included. Study information was extracted including author, publication date, patient numbers, patient age, follow-up period, procedure performed, surgical indications, and study design.

RESULTS

Although indications were variable and often non-descriptive, of the 39 included studies, the most common indications for LHB tenodesis were partial tearing (51 %), instability (49 %), or tenosynovitis (44 %), SLAP tear (28 %), and positive clinical exam for LHB pain (26 %). Most studies were of low quality of evidence, such as case series (33.0 %) and retrospective studies (43.5 %), and were of low-to-moderate methodological quality.

CONCLUSION

Although indications used for LHB tenodesis are inconsistently reported, the most common indications include LHB tearing, instability, and tenosynovitis. Other indications include clinical exam indicating LHB pathology, SLAP tears and subjective shoulder pain. Rigorous reporting of indications and preoperative/operative findings should be emphasized in future studies, allowing surgeons to appropriately analyse outcomes of LHB tenodesis of different techniques within patient groups with distinct indications.

LEVEL OF EVIDENCE

Systematic review, Level IV.

The effect of long and short head biceps loading on glenohumeral joint rotational range of motion and humeral head position

PURPOSE

To evaluate the effect of loading the long and short heads of the biceps on glenohumeral range of motion and humeral head position.

METHODS

Eight cadaveric shoulders were tested in 60° abduction in the scapula and coronal plane. Muscle loading was applied based on cross-sectional area ratios. The short and long head of the biceps were loaded individually followed by combined loading. Range of motion was measured with 2.2 Nm torque, and the humeral head apex position was measured using a MicroScribe. A paired t test with Bonferroni correction was used for statistics.

RESULTS

Long head loading decreased internal rotation in both the scapular (17.9 %) and coronal planes (5.7 %) and external rotation in the scapular plane (2.6 %) (P < 0.04). With only short head loading, maximum internal rotation was significantly increased in the scapular and coronal plane. Long head and short head loading shifted the humeral head apex posteriorly in maximum internal rotation in both planes with the long head shift being significantly greater than the short head. Long head loading also shifted the humeral apex inferiorly in internal rotation and inferiorly posteriorly in neutral rotation in the scapular plane. With the long head unloaded, there was a significant superior shift with short head loading in both planes.

CONCLUSION

Loading the long head of the biceps had a much greater effect on glenohumeral range of motion and humeral head shift than the short head of the biceps; however, in the absence of long head loading, with the short head loaded, maximum internal rotation increases and the humeral head shifts superiorly, which may contribute to impingement following tenodesis of the long head of the biceps. These small changes in rotational range of motion and humeral head position with biceps tenodesis may not lead to pathologic conditions in low-demand patients; however, in throwers, biceps tenodesis may lead to increased contact pressures in late-cocking and deceleration that will likely translate to decreased performance therefore every effort should be made to preserve the biceps-labral complex.

Slap variant with an absent long head of biceps

Congenital absence of the long head of biceps is a rare arthroscopic finding. We present a unique case of congenital absence of the long head of biceps tendon in the presence of a Superior labrum anterior posterior (SLAP) variant lesion. Current theories regarding the aetiology of SLAP lesion consider the long head of biceps tendon to either avulse or peel-off the labrum from the glenoid rim. Our finding of SLAP variant lesion in the absence of the long head of biceps tendon suggests that other processes must play a part in the causation of this injury, independent of the long head of biceps.