Predictive factors of long head of the biceps tendon disorders—the bicipital groove morphology and subscapularis tendon tear

Background The diagnostic accuracy of magnetic resonance imaging (MRI) is low for detecting a subscapularis tendon tear. Purpose To identify MRI findings that may predict the presence of a clinically significant subscapularis tendon tear requiring surgical repair. Material and Methods We reviewed shoulder MR images of patients who had undergone arthroscopic rotator cuff repair at our institution between June 2018 and May 2019. Patients were divided into two groups: the study group (n = 51), with an intermediate- to high-grade partial thickness tear of the subscapularis tendon suspected on preoperative MRI and intermediate or higher grade of the tendon tear proven on arthroscopy; and the control group (n = 18), with an intermediate- to high-grade partial thickness tear of the subscapularis tendon suspected on preoperative MRI but no tear or low-grade partial thickness tear of the tendon shown on arthroscopy. Preoperative MR images were retrospectively evaluated by two readers for the size of the subscapularis tendon tear, bone reactions at the lesser tuberosity, and long head of the biceps tendon (LHBT) pathology. Results The subscapularis tendon tear measured by reader 2 was larger in the study group than in the control group. The prevalence of a tear ( P = 0.006 for reader 1; P = 0.011 for reader 2) and malposition ( P < 0.001 for both readers) of the LHBT were significantly greater in the study group. Conclusion A tear and malposition of the LHBT on MR images may predict the presence of a clinically significant subscapularis tendon tear.

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Association of high sensitivity C-reactive protein with tearing of the long head of the biceps tendon

BMC Musculoskeletal Disorders ◽

10.1186/s12891-019-2908-2 ◽

2019 ◽

Vol 20 (1) ◽

Cited By ~ 1

Author(s):

Ji-Yong Gwark ◽

Hyung Bin Park

Keyword(s):

Biceps Tendon ◽

High Sensitivity ◽

Subscapularis Tendon ◽

C Reactive Protein ◽

Tendon Tear ◽

Reactive Protein ◽

Subscapularis Tendon Tear ◽

Post Test ◽

Hs Crp ◽

Long Head

Abstract Background This study proposed to investigate whether high-sensitivity C-reactive protein (hs-CRP) is an independent risk factor for long head of biceps tendon (LHBT) tear and whether hs-CRP can increase accuracy in diagnosing LHBT tear. Methods This study involved 582 shoulders of 557 consecutive patients who received arthroscopic examinations at the authors’ institution between January 2010 and July 2018. The strengths of associations between LHBT tear and various factors were determined by calculating the odds ratios (ORs), with 95% confidence intervals (CIs), using logistic regression analyses. The studied variables were demographic, physical, social, metabolic, comorbidity, hs-CRP, and pain on a visual analog scale (VAS) factors, as well as those related to rotator cuff tear (RCT). Significant factors in the multivariable logistic analysis were evaluated to determine their diagnostic values, including their likelihood ratios and post-test probabilities for LHBT tear. Results In the multivariable analysis, five variables were significant: age, retraction degree of Patte, subscapularis tendon tear, hs-CRP > 1 mg/L, and pain VAS (p ≤ 0.01). The best combination of determinations for diagnosing LHBT tear, which yielded a strong positive likelihood ratio of 19.07 and a high post-test probability of 96%, was age ≥ 67 years, subscapularis tendon tear, grade of Patte ≥2, hs-CRP > 1, and pain VAS ≥ 7. Conclusions Serum hs-CRP > 1 mg/L is an independent risk factor for LHBT tear, along with the expected risk factors of age, subscapularis tendon tear, retraction degree of Patte, and pain VAS. Serum hs-CRP > 1 mg/L increases the diagnostic accuracy for LHBT tear. Level of evidence Level IV, Clinical case series.

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Hidden Long Head of the Biceps Tendon Instability and Concealed Intratendinous Subscapularis Tears

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119898123 ◽

2020 ◽

Vol 8 (1) ◽

pp. 232596711989812

Author(s):

Sang Hoon Chae ◽

Tae Wan Jung ◽

Sang Hyeon Lee ◽

Myo Jong Kim ◽

Seung Min Park ◽

...

Keyword(s):

Retrospective Study ◽

Predictive Value ◽

Scoring System ◽

Biceps Tendon ◽

Arthroscopic Surgery ◽

Subscapularis Tendon ◽

Tendon Tear ◽

Cutoff Value ◽

Subscapularis Tendon Tear ◽

Arthroscopic Findings

Background: Few studies have described the characteristics of a concealed intratendinous subscapularis tear (CIST), and there is a lack of research on the preoperative predictability of such lesions. Purpose: To describe the characteristics of a CIST as seen on magnetic resonance imaging (MRI) and intraoperatively and to develop a scoring system for predicting such lesions. Study Design: Case series; Level of evidence, 4. Methods: Retrospectively, we identified 43 patients with CISTs among 442 consecutive patients who had undergone rotator cuff repair from July 2014 to June 2016. Range of motion, visual analog scale results for pain and function, and patient-reported outcome scores were evaluated preoperatively and at 1 and 2 years postoperatively. CISTs were classified arthroscopically as small (<5 mm), medium (5-10 mm), and large (>10 mm). We performed repair (≥50%) or debridement (<50%) depending on the total subscapularis tendon tear size including the CIST. Preoperative MRI findings were analyzed by 2 observers and were correlated with the arthroscopic findings. A 10-point scoring system was developed based on characteristics during the physical examination (anterior tenderness, bear hug sign), MRI (biceps tendon displacement and subluxation, subscapularis signal change just lateral to the lesser tuberosity), and arthroscopic surgery (medial biceps tendon lesion, combined subscapularis tendon tear), with a cutoff value of ≥7 predicting a CIST. After the retrospective study, we prospectively enrolled 95 patients to validate the 10-point CIST scoring system. Results: All 43 patients diagnosed with a CIST during the retrospective study improved both range of motion and functional scores at 1 year postoperatively. The interrater agreement of the 2 observers was substantial for the evaluation of all parameters except for subscapularis tear classification, which was moderate. On arthroscopic surgery, 11 small, 19 medium, and 13 large CISTs were detected. The preliminary prospective study showed a sensitivity of 61.9%, specificity of 94.3%, positive predictive value of 89.0%, negative predictive value of 75.7%, and accuracy of 80.0% when the cutoff value was set at ≥7 on the CIST scoring system. Conclusion: A CIST can be suspected using a combination of preoperative MRI and intra-articular diagnostic arthroscopic findings, but a definitive diagnosis requires an arthroscopic view. On the 10-point CIST scoring system, a score of ≥5 can be suggestive of a CIST, and a score of ≥7 is most likely to predict a CIST.

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Yergason's Test: Discrepancies in Description and Implications for Diagnosing Biceps Subluxation

Athletic Training Education Journal ◽

10.4085/1947-380x-3.4.143 ◽

2008 ◽

Vol 3 (4) ◽

pp. 143-147 ◽

Cited By ~ 1

Author(s):

Robert W. Pettitt ◽

Scott R. Sailor ◽

Gary Lentell ◽

Cary Tanner ◽

Steven R. Murray

Keyword(s):

Biceps Tendon ◽

Athletic Trainers ◽

Instructional Materials ◽

Positive Sign ◽

Subscapularis Tendon ◽

Bicipital Groove ◽

Certification Examination ◽

Wide Range ◽

Long Head ◽

Board Of Certification

Yergason described the case of a woman with bicipital pain that was confirmed with isolated forearm supination. Since publication of this respective case report in 1931, orthopedic assessment textbooks have provided a wide range of descriptions for Yergason's Test and what a positive sign implicates. Vast differences in hand placement, along with the vernacular for shoulder, forearm, and elbow motions, have been associated with Yergason's Test. Many authors associate pain with the maneuver as a diagnosis for a rupture of the transverse humeral ligament (THL) and subsequent subluxation of the long head of the biceps tendon (LBT). Interestingly, many now believe that the THL is not a distinct ligament; rather, support of the LBT within the bicipital groove occurs from a fibrous extension of the subscapularis tendon. Thus, evaluation of the subscapularis when a subluxing LBT is suspected is critical. The discrepancies of Yergason's Test among orthopedic assessment textbooks shall be summarized along with a brief review of contemporary views on how to clinically evaluate the subluxing LBT. Until consensus is reached on hand placement and joint movements to provoke subluxation of the LBT, Yergason's Test should be removed from instructional materials and the Board of Certification examination for athletic trainers, if applicable.

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Measurements of Tendon Movement Within the Bicipital Groove After Suprapectoral Intra-articular Biceps Tenodesis in a Cadaveric Model

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120977538 ◽

2021 ◽

Vol 9 (1) ◽

pp. 232596712097753

Author(s):

Brian J. Kelly ◽

Alan W. Reynolds ◽

Patrick J. Schimoler ◽

Alexander Kharlamov ◽

Mark Carl Miller ◽

...

Keyword(s):

Biceps Tendon ◽

Full Range ◽

Elbow Flexion ◽

Biceps Tenodesis ◽

Bicipital Groove ◽

Biceps Tenotomy ◽

Flexion Extension ◽

Before And After ◽

Long Head ◽

Scapular Motion

Background: Lesions of the long head of the biceps can be successfully treated with biceps tenotomy or tenodesis when surgical management is elected. The advantage of a tenodesis is that it prevents the potential development of a cosmetic deformity or cramping muscle pain. Proponents of a subpectoral tenodesis believe that “groove pain” may remain a problem after suprapectoral tenodesis as a result of persistent motion of the tendon within the bicipital groove. Purpose/Hypothesis: To evaluate the motion of the biceps tendon within the bicipital groove before and after a suprapectoral intra-articular tenodesis. The hypothesis was that there would be minimal to no motion of the biceps tendon within the bicipital groove after tenodesis. Study Design: Controlled laboratory study. Methods: Six fresh-frozen cadaveric arms were dissected to expose the long head of the biceps tendon as well as the bicipital groove. Inclinometers and fiducials (optical markers) were used to measure the motions of the scapula, forearm, and biceps tendon through a full range of shoulder and elbow motions. A suprapectoral biceps tenodesis was then performed, and the motions were repeated. The motion of the biceps tendon was quantified as a function of scapular or forearm motion in each plane, both before and after the tenodesis. Results: There was minimal motion of the native biceps tendon during elbow flexion and extension but significant motion during all planes of scapular motion before tenodesis, with the most motion occurring during shoulder flexion-extension (20.73 ± 8.21 mm). The motion of the biceps tendon after tenodesis was significantly reduced during every plane of scapular motion compared with the native state ( P < .01 in all planes of motion), with a maximum motion of only 1.57 mm. Conclusion: There was a statistically significant reduction in motion of the biceps tendon in all planes of scapular motion after the intra-articular biceps tenodesis. The motion of the biceps tendon within the bicipital groove was essentially eliminated after the suprapectoral biceps tenodesis. Clinical Relevance: This arthroscopic suprapectoral tenodesis technique can significantly reduce motion of the biceps tendon within the groove in this cadaveric study, possibly reducing the likelihood of groove pain in the clinical setting.

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