Atypical tear of the long head of the biceps tendon in a young male adult

A 34-year-old man, with previous anabolic steroid abuse, presented with right shoulder pain following an underhand bowling swing. Examination indicated a Popeye sign of the right biceps, and positive Speeds, Yergason and O’Brian’s tests. MRI indicated a complete tear of the intra-articular portion of the long head of biceps tendon (LHBT). Interestingly, the tear occurred within the glenohumeral joint allowing the proximal portion of the LHBT to uniquely coil and fold on itself deep to the subscapularis causing mechanical symptoms. He was treated conservatively with physical therapy but failed to achieve pain relief and proceeded with arthroscopic debridement of the folded portion of the LHBT stump, which significantly improved clinical outcomes at 18 months postoperative. We report the first case of an LHBT tear during bowling in a young adult with a rare occurrence of the proximal portion of the LHBT uniquely coiling and folding on itself deep to the subscapularis.

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Suprapectoral vs. Intra Articular Biceps Tenodesis: A Comparison of Clinical Outcomes

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967118s00108 ◽

2018 ◽

Vol 6 (7_suppl4) ◽

pp. 2325967118S0010

Author(s):

Brian M. Godshaw ◽

Nicholas Kolodychuk ◽

Benjamin Bryan Browning ◽

Gerard Williams ◽

Rachel Burdette ◽

...

Keyword(s):

Clinical Outcomes ◽

Outcome Measures ◽

Glenohumeral Joint ◽

Short Form ◽

Biceps Tendon ◽

Biceps Tenodesis ◽

Measured Time ◽

Long Head ◽

Distally Based

Objectives: The long head of the biceps tendon is a frequent pain generator within the shoulder. It is subjected to trauma and wear within the glenohumeral joint and within the intertubercular groove. Tenodesis of this tendon is a common treatment option for patients experiencing biceps tendon related pain. There are several different techniques to perform this procedure. Proximal intra-articular tenodesis can be performed but leaves the tendon within the intertubercular groove. Alternatively, suprapectoral tenodesis can be performed removing the tendon from the bicipital groove and sheath while avoiding conversion to an open procedure. Further, suprapectoral tenodesis limits complications associated with an open distally based incision. Several studies have compared these techniques to tenotomy or open-subpectoral tenodesis. This is the first study to directly compare patient outcomes between intra-articular and suprapectoral bicep tenodeses. Methods: Retrospective review of patients undergoing intra-articular or suprapectoral arthroscopic biceps tenodesis from 2010 - 2015. Clinical outcomes were measured at set intervals post-operatively (3 months, 6 months, and 12 months) and compared to pre-operative scores. Outcome measures included short form-12, both physical (PSF) and mental (MSF) component scores, and the American Shoulder and Elbow Surgeons score (ASES). Results: A total of 96 patients were available for this study, 43 had intra-articular tenodesis and 56 had suprapectoral tenodesis. There was no difference in functional outcomes between intra and extra articular biceps tenodesis at 1-year post-operative. The intra-articular group had a quicker improvement in scores with the greatest increase at 3 months post-operatively, specifically in PSF group (p=0.016): however, this difference leveled off at 1-year follow up (p=0.238). The intra-articular group had greater absolute scores at all measured time points, but not significantly. Both groups showed improvement in all outcome measures and there was found to be no difference in changes for ASES, PSF, or MSF (p=0.262, p=0.489, and p=0.907 respectively). Conclusion: This study demonstrates that both intra-articular and surpapectoral techniques are acceptable options for biceps tenodesis. Despite leaving the biceps tendon within the glenohumeral joint and intertubercular groove, the intra-articular technique offers similar improvement in outcome measures to the suprapectoral technique.

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Shoulder biomechanics in normal and selected pathological conditions

EFORT Open Reviews ◽

10.1302/2058-5241.5.200006 ◽

2020 ◽

Vol 5 (8) ◽

pp. 508-518

Author(s):

Patrick Goetti ◽

Patrick J. Denard ◽

Philippe Collin ◽

Mohamed Ibrahim ◽

Pierre Hoffmeyer ◽

...

Keyword(s):

Rotator Cuff ◽

Glenohumeral Joint ◽

Biceps Tendon ◽

Tendon Healing ◽

Upward Migration ◽

Superior Capsular Reconstruction ◽

Long Head ◽

Favourable Environment ◽

The Stability ◽

Cuff Repair

The stability of the glenohumeral joint depends on soft tissue stabilizers, bone morphology and dynamic stabilizers such as the rotator cuff and long head of the biceps tendon. Shoulder stabilization techniques include anatomic procedures such as repair of the labrum or restoration of bone loss, but also non-anatomic options such as remplissage or tendon transfers. Rotator cuff repair should restore the cuff anatomy, reattach the rotator cable and respect the coracoacromial arch whenever possible. Tendon transfer, superior capsular reconstruction or balloon implantation have been proposed for irreparable lesions. Shoulder rehabilitation should focus on restoring balanced glenohumeral and scapular force couples in order to avoid an upward migration of the humeral head and secondary cuff impingement. The primary goal of cuff repair is to be as anatomic as possible and to create a biomechanically favourable environment for tendon healing. Cite this article: EFORT Open Rev 2020;5:508-518. DOI: 10.1302/2058-5241.5.200006

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A Concise and Comprehensive Description of Shoulder Pathology and Procedures: The 4D Code System

Advances in Orthopedics ◽

10.1155/2012/930543 ◽

2012 ◽

Vol 2012 ◽

pp. 1-10 ◽

Cited By ~ 1

Author(s):

Laurent Lafosse ◽

Tom Van Isacker ◽

Joseph B. Wilson ◽

Lewis L. Shi

Keyword(s):

Glenohumeral Joint ◽

Biceps Tendon ◽

Fatty Infiltration ◽

Three Dimensional ◽

Classification Systems ◽

Shoulder Pathology ◽

Comprehensive Picture ◽

Calcific Tendonitis ◽

Simple Language ◽

Long Head

Background. We introduce a novel description system of shoulder pathoanatomy. Its goal is to provide a comprehensive three-dimensional picture, with an additional component of time; thus, we call it the 4D code.Methods. Each line of the code starts with right versus left and a time designation. The pillar components are recorded regardless of pathology; they include subscapularis, long head of biceps tendon, supraspinatus, infraspinatus, and teres minor. Secondary elements can be added if there is observed pathology, including acromioclavicular joint, glenohumeral joint, labrum, tear configuration, location and extent of partial cuff tear, calcific tendonitis, fatty infiltration, and neuropathy.Results. We provide two illustrative examples of patients which show the ease and effectiveness of the 4D code. With a few simple lines, significant amount of information about patients’ pathology, surgery, and recovery can be easily conveyed.Discussion. We utilize existing validated classification systems for parts of the shoulder and provide a frame work to build a comprehensive picture. The alphanumeric code provides a simple language that is universally understood. The 4D code is concise yet complete. It seeks to improve efficiency and accuracy of the communication, documentation, and visualization of shoulder pathology within individual practices and between providers.

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Posterior Shoulder Instability in the Patients with Bilateral Congenital Absence of Long Head of Biceps Tendon: A Case Report

Clinics in Shoulder and Elbow ◽

10.5397/cise.2018.21.4.240 ◽

2018 ◽

Vol 21 (4) ◽

pp. 240-245

Author(s):

Sung Hyun Yoon ◽

Kang Heo ◽

Jae Sung Yoo ◽

Sung Joon Kim ◽

Joong Bae Seo

Keyword(s):

Shoulder Instability ◽

Biceps Tendon ◽

Magnetic Resonance Images ◽

Labral Tear ◽

Congenital Absence ◽

Posterior Shoulder Instability ◽

First Case ◽

Posterior Shoulder ◽

Long Head ◽

Glenoid Dysplasia

Rare cases of a congenital absence of the long head of the biceps tendon (LHBT) have been reported, and its incidence is unknown. In a literature review of the congenital absence of the LHBT, only 1 case was associated with posterior shoulder instability and severe posterior glenoid dysplasia. This paper reports the first case of a patient with a bilateral congenital absence of the LHBT with posterior shoulder instability without glenoid dysplasia or posterior glenoid tilt. The patient experienced a traffic accident while holding the gear stick with his right hand. After the accident, a posteroinferior labral tear with paralabral cysts was detected on the magnetic resonance images. The congenital absence of the LHBT was assumed to have affected the posterior instability that possibly increased the susceptibility to a subsequent traumatic posterior inferior labral tear. This case was identified as a posterior inferior tear caused by a traumatic ‘gear stick injury’.

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Arthroscopic Tenotomy of the Long Head of the Biceps Tendon and Section of the Anterior Joint Capsule Produce Moderate Osteoarthritic Changes in an Experimental Sheep Model

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18147471 ◽

2021 ◽

Vol 18 (14) ◽

pp. 7471

Author(s):

Umile Giuseppe Longo ◽

Francisco Forriol ◽

Vincenzo Candela ◽

Salvatore Maria Tecce ◽

Sergio De Salvatore ◽

...

Keyword(s):

Shoulder Joint ◽

Glenohumeral Joint ◽

Biceps Tendon ◽

Joint Capsule ◽

Quantitative Mri ◽

Degenerative Changes ◽

Histological Evaluation ◽

Sheep Model ◽

Long Head ◽

Development And Evolution

Osteoarthritis (OA) of the glenohumeral (GH) joint is a common cause of shoulder pain, resulting in considerable invalidity. Unfortunately, the study of its pathogenesis is challenging. Models of OA are necessary to identify specific targets for therapy and to be able to interfere with the development and evolution of OA. This study aims to assess the effect of an arthroscopic tenotomy of the long head of the biceps tendon (LHBT) and section of the anterior glenohumeral joint capsule on the ovine glenohumeral joint. In addition, the authors aim to validate and evaluate the reliability of a modified semi-quantitative MRI score to assess joint degeneration in a sheep’s shoulder. Eight skeletally mature sheep received an arthroscopic tenotomy of the LHBT and section of the anterior joint capsule and were euthanized four months after surgery. All animals tolerated the surgery well, and no complication was recorded for six weeks. Moderate degenerative changes to the ovine shoulder joint were found on MRI and histological evaluation. The arthroscopic tenotomy of the LHBT and the anterior glenohumeral joint capsule section caused moderate degenerative changes to the ovine shoulder joint.

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Ultrasound guided injection of the rotator interval – Gaurav-Botchu technique

Journal of Ultrasonography ◽

10.15557/jou.2021.0013 ◽

2021 ◽

Vol 21 (84) ◽

pp. e77-e79

Author(s):

Gaurav Kant Sharma ◽

◽

Rajesh Botchu ◽

Keyword(s):

Glenohumeral Joint ◽

Biceps Tendon ◽

Lateral Approach ◽

Rotator Interval ◽

Ultrasound Guided ◽

Target Zone ◽

Coracohumeral Ligament ◽

Biceps Tendon Rupture ◽

Long Head ◽

Joint Injections

Ultrasound-guided injection of the shoulder via the rotator interval can be challenging. The procedure is used for arthrograms, hydrodilatation and intra-articular glenohumeral joint injections. The conventional approach to the rotator interval is from lateral to medial. However, the placement of the needle in the target zone i.e. between the coracohumeral ligament and the long head of the biceps, can be difficult and challenging. Inadvertent injection performed with the needle in the long head of the biceps tendon can result in a biceps tendon rupture. We describe a new method (Gaurav-Botchu technique) to access the target zone (between the coracohumeral ligament and the long head of the biceps tendon) via a medial to lateral approach, which increases the target zone.

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Editorial Commentary: Long Head Biceps Tendon Autograft Is an Ideal and Cost-effective Graft Choice in Superior Capsular Reconstruction of the Glenohumeral Joint

Arthroscopy The Journal of Arthroscopic and Related Surgery ◽

10.1016/j.arthro.2021.05.041 ◽

2021 ◽

Vol 37 (9) ◽

pp. 2768

Author(s):

Ilya Voloshin

Keyword(s):

Glenohumeral Joint ◽

Biceps Tendon ◽

Cost Effective ◽

Editorial Commentary ◽

Graft Choice ◽

Superior Capsular Reconstruction ◽

Long Head Biceps Tendon ◽

Long Head ◽

Long Head Biceps ◽

Tendon Autograft

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Ocular myocysticercosis: an unusual case of ptosis

Nepalese Journal of Ophthalmology ◽

10.3126/nepjoph.v5i2.8745 ◽

2013 ◽

Vol 5 (2) ◽

pp. 279-280 ◽

Cited By ~ 3

Author(s):

S Agrawal ◽

Somesh Ranjan ◽

A Mishra

Keyword(s):

Unusual Case ◽

Taenia Solium ◽

Clinical Manifestations ◽

Young Male ◽

Rectus Muscle ◽

Oral Prednisolone ◽

Male Adult ◽

Ocular Cysticercosis ◽

Magnetic Resonance Imaging Mri ◽

The Right

Background: Cysticercosis is common in endemic countries like India. It can have various clinical manifestations depending on the tissue involved. It refers to a parasitic infestation by Cysticercus cellulosae, the larval form of the pork tapeworm or Taenia solium. Objective: To report an unusual case of ocular cysticercosis involving the levator palpebrae superioris and superior rectus muscle of the right eye. Case description: A young, male adult was diagnosed by Magnetic Resonance Imaging (MRI) scan of the skull and orbit to have right-sided ocular cysticercosis. The patient was treated with oral prednisolone and albendazole, to which he showed a significant improvement. Conclusion: Ocular myocysticercosis can be diagnosed by MRI and be treated medically with steroid and albendazole. Nepal J Ophthalmol 2013; 5(10): 279-281 DOI: http://dx.doi.org/10.3126/nepjoph.v5i2.8745

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