Abstract
Abstract
Background
The biceps muscle’s long head (LHB) with its tendon and origin represents the most important cause of anterior shoulder pain. Conservative treatments (non-steroid antiinflammatory drugs, injections with steroids and physiotherapy) will normally be the first line of treatment. Long-standing pain will usually lead to surgical treatment with either tenodesis or tenotomy as alternative procedures. The main aim of our investigation was to find structural changes that may change the surgical treatment logarithm in these patients. Secondary aims were 1) to see if experimental settings would better visualize such changes on MRI, and correlate this to histological examinations. 2) to see if visualized changes to histology and MRI would have significant correlations to clinical findings and surgical practice.
Methods
The patients were evaluated at 1) the first outpatient contacts with the orthopedic surgeon, 2) pre-operative 1.5-Tesla MRI, 3) per-op findings with arthroscopy, 4) experimental 7-Tesla MRI, and 5) histology with standard H+E-staining.
Findings
Our experimental study showed that all the degenerative changes in the LHB-tendon were in the intraarticular part of the tendon, not in the intertubercular sulcus part (shown clearly at the experimental work). None of the preoperative 1.5 Tesla MRI helped us in the clinical decision-making. We did also construct a grading system of peroperative evaluation of the LHB-tendon degeneration that will be useful in clinical decision-making.
Interpretation
Our experimental study showed a pathological-anatomical correlate to the anterior shoulder pain. In our opinion, it is important to remove the degenerated intraarticular part of the tendon, this in order to avoid postoperative inflammation, pain and prolonged sick leave. A subpectoral biceps tenodesis with removal of the proximal part of the tendon is accordingly the treatment of choice in these patients.
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