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

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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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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Atypical biceps-related complication of proximal humerus fracture leading to internal shoulder impingement due to tendon stump dislocation

BMJ Case Reports ◽

10.1136/bcr-2019-232124 ◽

2020 ◽

Vol 13 (2) ◽

pp. e232124

Author(s):

Fabio Ramos Poroes ◽

Romain Desmarchelier ◽

Stefan Bauer

Keyword(s):

Tendon Rupture ◽

Proximal Humerus Fracture ◽

Proximal Humerus ◽

Constant Score ◽

Biceps Tendon ◽

Humerus Fracture ◽

Related Complication ◽

Biceps Tendon Rupture ◽

Long Head ◽

Improved Function

Non-displaced proximal humerus fractures are usually managed non-operatively despite of minor malalignment. Biceps tendon rupture due to attrition after malunion is rare around the proximal humerus. Rupture of the long head of biceps (LHB) tendon usually occurs inside the joint close to the origin at the labrum. Treatment is usually non-operative with good outcomes. We report a rare case of a 48-year-old female patient with persistent locking and internal impingement 8 months after a proximal humerus fracture with anterior angulation leading to extra-articular reversed LHB tendon rupture with intra-articular dislocation of the proximal stump. Interposition of the tendon (3.5 cm) between the glenoid and the humeral head was confirmed on MRI arthrogram. Arthroscopic proximal tenotomy and stump removal resulted in immediate relief with improved function (subjective shoulder value 95%; Constant Score: 96). False interpretation of symptoms as posttraumatic stiffness should be avoided by a thorough examination and complementary MRI arthrogram investigation.

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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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The Rotator Interval and Long Head Biceps Tendon: Anatomy, Function, Pathology, and Magnetic Resonance Imaging

Magnetic Resonance Imaging Clinics of North America ◽

10.1016/j.mric.2012.01.012 ◽

2012 ◽

Vol 20 (2) ◽

pp. 229-259 ◽

Cited By ~ 16

Author(s):

Yoav Morag ◽

Asheesh Bedi ◽

David A. Jamadar

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Biceps Tendon ◽

Rotator Interval ◽

Resonance Imaging ◽

Long Head Biceps Tendon ◽

Long Head ◽

Long Head Biceps

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Long head of the biceps tendon and rotator interval

MUSCULOSKELETAL SURGERY ◽

10.1007/s12306-013-0290-z ◽

2013 ◽

Vol 97 (S2) ◽

pp. 99-108 ◽

Cited By ~ 18

Author(s):

M. Zappia ◽

A. Reginelli ◽

A. Russo ◽

G. F. D’Agosto ◽

F. Di Pietto ◽

...

Keyword(s):

Biceps Tendon ◽

Rotator Interval ◽

Long Head

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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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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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