Clinical and Sonographic Evaluation of Bicortical Button for Proximal Biceps Tenodesis.

Use of a cortical button for proximal biceps tenodesis has demonstrated strength comparable to that of other types of fixation in biomechanical models, but few studies have evaluated the clinical outcome of such fixation. In the study reported here, 18 patients who underwent open subpectoral biceps tenodesis with a bicortical button were assessed, at minimum 12-month follow-up, with the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, a pain scale, physical examination, biceps supination strength testing, and ultrasonographic evaluation (to determine tenodesis integrity and proximity of the button to the axillary nerve). No patient had symptoms of axillary nerve damage, clinical deformity, or tenodesis failure. Mean DASH score was 15.15 (scale range: 0, none to 100, extreme difficulty), and mean pain score was 12.6 (scale range: 0, none to 100, worst pain). Seventy-eight percent of patients had no bicipital groove tenderness, 89% had full elbow range of motion, and 94% had full shoulder range of motion. Mean forearm supination strength of the operated arm (125.04 lb) was significantly (P = .01) less than that of the nonoperated arm (134.39 lb). Mean (SD) distance from button to posterior circumflex humeral artery was 18.17 (9.0) mm. The study results suggest that subpectoral biceps tenodesis with a bicortical button is a safe, stable procedure that results in excellent functional outcomes.

Lower extremity nerve entrapments in athletes.

Nerve entrapments are a potential cause of lower extremity pain in athletes. Signs and symptoms suggestive of nerve entrapment include anesthesia, dysesthesias, paresthesias, or weakness in the distribution of a peripheral nerve. The physical examination may reveal an abnormal neurologic examination finding in the distribution of a peripheral nerve, positive nerve provocative testing, and positive Tinel sign over the area of entrapment. Electrodiagnostic studies, radiographs, magnetic resonance imaging studies, and sonographic evaluation may assist with the diagnosis of these disorders. Initial treatment usually involves conservative measures, but surgical intervention may be required if conservative treatment fails. This article discusses the diagnosis and treatment of common lower extremity nerve entrapments in athletes. A high index of suspicion for nerve entrapments enables the clinician to identify these conditions in a timely manner and institute an appropriate management program, thus improving patient outcomes.