ABSTRACT
BACKGROUND@#Biceps tenodesis is a technique frequently performed in shoulder surgeries. Various techniques have been described, but there is no consensus on which technique restores the length-tension relationship. Restoration of the physiologic length-tension relationship has been correlated to better functional outcomes, such as decreased incidence of residual pain or weakness of the biceps. The objective of this study was to measure the anatomic relationship of the origin of the biceps tendon with its zones in the upper extremity. This would provide an anatomic guide or an acceptable placement of the tenodesis to reestablish good biceps tension during surgery@*METHODS@#The study used nine adult cadavers (five males, four females) from the [withheld for blinded review]. Nine shoulder specimens were dissected and markers were placed at five points along each biceps tendon: (1) Labral origin (LO) (2) Superior bicipital groove (SBG) (3) Superior border of the pectoralis tendon (SBPMT) (4) Musculotendinous junction (MTJ) and (5) Inferior border of the pectoralis tendon (IBPMT). Using the origin of the tendon as the initial point of reference, measurements were made to the four subsequent sites. The humeral length was recorded by measuring the distance between the greater tuberosity and the lateral epicondyle as well as the tendon diameter at the articular surface.@*RESULTS@#The intraclass correlation coefficient was excellent across all measures. A total of nine cadavers were included. Mean age of patients was 66.33 years old, ranging from 52-82 years old. These were composed of five male and four female cadavers. The mean tendon length was 24.83mm ± 4.32 from the origin to the superior border of the bicipital groove, 73.50mm ± 6.96 to the Superior Border Pectoralis Major Tendon, 100.89mm ± 6.88 to the Musculotendinous Junction, and 111.11mm ± 7.45 to the Inferior Border Pectoralis Major Tendon. The mean tendon diameter at the articular origin was 6.44mm ± 1.76.@*CONCLUSION@#This study provided measurement guidelines that could restore the natural length-tension relationship during biceps tenodesis using the interference screw technique in Filipinos. A simple method of restoring a normal length-tension relationship is by doing tenodesis close to the articular origin and creating a bone socket of approximately 25mm in depth, using the superior border of the bicipital groove as a landmark.
Subject(s)
Tenotomy , TenodesisABSTRACT
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.
Resumo Objetivo Identificar a correlação clínica, radiológica, e artroscópica das lesões do tendão da cabeça longa do bíceps e sua influência na dor do paciente quando associada às lesões do manguito rotador. Métodos Entre abril e dezembro de 2013, foram avaliados 50 pacientes, sendo 38 (76%) do sexo feminino e 12 (24%) do sexo masculino, com idade média de 65,1 anos. Os pacientes foram operados pelo Grupo de Ombro e Cotovelo da Disciplina de Medicina Esportiva do Departamento de Ortopedia e Traumatologia da Universidade Federal de São Paulo. Os indivíduos foram submetidos a reparo da lesão do manguito rotador com evidência clínica, radiológica e/ou artroscópica de acometimento do tendão da cabeça longa do bíceps. Resultados Observou-se associação entre dor à palpação do sulco intertubercular do úmero com lesão parcial de alto grau (ruptura parcial acometendo mais de 50% do tendão) na artroscopia (p = 0,003). Encontramos ainda uma associação entre a lesão de alto grau da cabeça longa do bíceps e a lesão do tendão do músculo supraespinal (p < 0,05), sendo que, para cada centímetro de lesão do tendão do músculo supraespinal, o paciente apresenta probabilidade 1,7 maior de ter uma lesão de alto grau da cabeça longa do bíceps. Conclusão A dor na região anterior do ombro à palpação do sulco intertubercular do úmero pode estar relacionada às lesões de alto grau da cabeça longa do bíceps. A lesão do manguito rotador e o seu tamanho são fatores de risco para lesão de alto grau do tendão da cabeça longa do bíceps.
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Pain , Arthroscopy , Rupture , Tendon Injuries , Wounds and Injuries , Rotator Cuff , Elbow , Tendinopathy , Rotator Cuff InjuriesABSTRACT
Objective To investigate MR and US diagnotic value of long head of the biceps tendon injury.Methods A total of 80 patients with suspected injury of long head of the biceps tendon underwent arthroscopy surgery.All patients had MR and US examination preoperatively.The preoperative results were compared with the findings during the arthroscopy in order to assess the effectiveness of two methods.Results Among 80 patients, there were completely torn in 19 cases, partly torn in 45 cases, biceps tendon tenosynovitis in 10 cases, biceps tendon slippage in 6 cases.The accuracy of MR and US in the diagnosis of completely torn, partly torn, biceps tendon tenosynovitis, biceps tendon slippage were 98.7%,92.5%,97.5%,100% and 96.2%,85.0%,96.3%,98.7% respectively.There was no statistic difference between MR and US in diagnosing completely torn,biceps tendon tenosynovitis and biceps tendon slippage(P>0.05),but the accuracy of MR in diagnosing partly torn was higer than US(P<0.05).Conclusion MR determination of biceps tendon partial tear is of obvious advantages.US examination can be used as a routine method for the investigation of patients with suspected biceps tendon injury.
ABSTRACT
PURPOSE: Historically, a variety of tenodesis have been performed for the tendinopathy of the long head of biceps. Despite their good short-term results, long-term results of traditional tenodesis were controversial. Biceps tenotomy was first described by Walch in treatment of cases with massive rotator cuff tear. There were few reports for tenotomy as definite treatment method. We present the results of arthroscopic tenotomy of tendinopathy of long head of biceps. MATERIALS AND METHODS: From January 1998 to February 2000, 14 shoulders of 14 patients were treated with arthroscopic biceps tenotomy. Mean follow-up period was 30 months. A mean age was 55 years old. The pathologies of the long head were partial rupture in 8 cases, tendon subluxation in 3 cases, SLAP lesion in 2 cases, and tenosynovitis in 1 case. Concomitant pathologies were rotator cuff tears in 3 cases, subacromial bursitis in 3 cases and so, additional procedure were performed. Postoperative outcome was assessed by the American Shoulder and Elbow Surgeons (ASES) Scoring System. RESULTS: The mean preoperative ASES score was 35.0 and last follow up score was 85.2. Popeyes deformities were demonstrated in 6 cases, but none of the cases complained of pain or cosmetic problem. CONCLUSION: Arthroscopic tenotomy for long head of biceps tendon is simple procedure. It demostrate a rapid recovery without significant complication. It appears that the procedure is effective in pain relief and functional recovery.