Abstract
PurposeTo present the clinical and imaging findings and results of treatment in patients with intra-articular long head of the biceps tendon (LHBT) adhesion to the undersurface of the rotator cuff found incidentally during shoulder arthroscopy.MethodsPatients with intra-articular LHBT adhesion to the undersurface of the rotator cuff found incidentally during arthroscopy were included with a minimal 2-year follow-up. Demographic data, images, and physical examinations were recorded. LHBT release, tenotomy, or tenodesis were performed according to the patient’s age and surgeon’s preference.ResultsTwelve patients were included in the study. All of them presented with chronic anterior shoulder pain and positive Speed and O’Brien tests. The average age was 46.8 ± 17 years (range 20-79 years) and the pain sustained from 6 to 96 (average 25.5 ± 28.6) months. Before the operation, 6 patients had a positive Jobe’s test, 1 had a positive lift-off test, and all had positive O’Brien and Speed tests and tenderness over the LHBT. Three release, 4 tenotomy, and 5 LHBT tenodesis were done in addition to other procedures if needed. All range of motion except external rotation, pain visual analog score, and functional outcome scores showed significant improvement at 6 months after surgery. There were no significant differences in range of motion and functional scores between 6 months and 12 months postoperatively. No difference was found in LHBT scores at 6 and 12 months after the operation. Magnetic resonance imaging revealed thickened coracohumeral ligament overlying the LHBT.ConclusionsPatients who had intra-articular LHBT adhesion to the undersurface of the rotator cuff and underwent release of the adhesion around LHBT, tenotomy, or tenodesis all had good clinical outcomes. The lesion was observed in 2.2% of all shoulder arthroscopies. Although difficult to diagnose before surgery, surgeons should be aware of this unusual condition in patients with chronic and insidious anterior shoulder pain.Level of EvidenceLevel IV, Therapeutic case series.
Highlights
MethodsPatients with intra-articular long head of the biceps tendon (LHBT) adhesion to the undersurface of the rotator cuff found incidentally during arthroscopy were included with a minimal 2-year follow-up
To present the clinical and imaging findings and results of treatment in patients with intra-articular long head of the biceps tendon (LHBT) adhesion to the undersurface of the rotator cuff found incidentally during shoulder arthroscopy
The lesion was observed in 2.2% of all shoulder arthroscopies
Summary
Patient Enrollment From May 2013 to July 2017, patients receiving arthroscopy for intra-articular examination, rotator cuff repair, LHBT tenodesis/tenotomy, release of refractory frozen shoulder, soft-tissue repairs for shoulder instability, acromioplasty for internal impingement, debridement for calcific tendonitis, and SLAP repairs were included. Constant score,[16] pain visual analog scale (PVAS), subjective shoulder value (SSV),[17] range of motion (ROM), O’Brien test, Speed tests, and tenderness over the LHBT were investigated before operation as well as physical examinations of rotator cuff. The arm was internally and externally rotating to evaluate for the presence of any LHBT instability or laxity of the soft-tissue pulley.[19] A probe and, if necessary, a 70 scope were used to assist in the dynamic examination to assess LHBT instability.[10] the arm was brought into forward elevation and rotation to see the possible medial/inferior subluxation of the LHBT. Two-tailed P values of less than .05 were considered significant
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