Biceps Tendon Sheath Research Articles

Ultrasonographic and clinical study of post-stroke painful hemiplegic shoulder

Aim of the workTo describe the structural abnormalities of the painful hemiplegic shoulder (PHS) by ultrasound (U/S) and their relationship with some clinical variables. Materials and methodsEighty consecutive patients with post-stroke PHS were subjected to both clinical assessment and ultrasonographic examination of both shoulders. Ultrasonographic imaging data were classified into five grades. ResultsThe biceps tendon sheath effusion (51.25%) and the SA–SD bursitis (43.75%) were the most frequent abnormalities in the affected painful shoulder. No significant relationship (P=0.114) was found between the U/S grades of the painful hemiplegic shoulder and the Brunnstrom motor recovery stages. Ultrasonographic grades of the unaffected shoulder were significantly correlated with the stroke duration (P<0.001), the Brief Pain Inventory score (P<0.05), shoulder pain duration (P<0.001), and degree of spasticity (P<0.001). ConclusionUltrasonography is an essential method in evaluation of post-stroke PHS. However, the U/S grades were not correlated with the stages of motor recovery. Avoiding overuse of the unaffected shoulder will be helpful for prevention of shoulder injuries following hemiplegic stroke.

Lipoma arborescens of the biceps tendon sheath

Lipoma arborescens, described as lipomatous infiltration and distention of synovial villi resulting in a frond-like appearance, most frequently affects the suprapatellar recess of the knee. While there have been reports of this entity involving the upper extremity joints, bursa, and tendon sheaths, we present the first reported case of lipoma arborescens isolated to the biceps tendon sheath. We describe imaging and histologic findings with clinical correlation.

USE OF PLATELET RICH PLASMA FOR THE TREATMENT OF BICIPITAL TENDINOPATHY IN SPINAL CORD INJURY: A PILOT STUDY

IntroductionShoulder pain remains one of the most common complaints in the spinal cord injury (SCI) population. Several studies suggest that approximately 30–70% of people with SCI in the USA suffer...

Accuracy of the biceps tendon sheath injection: ultrasound-guided or unguided injection? A randomized controlled trial

Patients often localize pain in the anterior shoulder; however, this patient-localized pain does not necessarily correlate to the location of disease. Unguided shoulder injections are common in clinical practice. The accuracy of unguided biceps tendon sheath injections has not been studied. Patient management may be aided by the knowledge of injection accuracy. This study compared the accuracy of ultrasound-guided biceps tendon sheath injection with unguided injection. The study comprised 30 patients (30 shoulders) with reported anterior shoulder pain who had a primary diagnosis of tenosynovitis or tendinitis of the biceps tendon, or both. Shoulders were randomly allocated into ultrasound-guided and unguided injection groups. Computed tomography (CT) imaging was performed immediately after a contrast agent was injected into the biceps tendon sheath. The locations of contrast seen on CT scan were classified into 3 types: only within the tendon sheath (type 1); inside the tendon, tendon sheath, and surrounding area (type 2); and only the area outside the tendon sheath (type 3). Ultrasound-guided injections resulted in 86.7% type 1 and 13.3% type 2 locations. Unguided injections resulted in 26.7% type 1, 40.0% type 2, and 33.3% type 3 locations. The difference for each location type was significant (P < .05). Injection into the tendon sheath of the long head of the biceps brachii can be more accurately performed using ultrasound guidance than by the blind method.

MR evaluation of synovial injury in shoulder trauma

The purpose of this study was to determine magnetic resonance imaging (MRI) findings relevant to synovial injury of the shoulder in patients with and without acute shoulder trauma. Three hundred and nine consecutive shoulder MRI studies (185-male, 124-female, 50 ± 15 years old) were retrospectively evaluated for findings suggestive of synovial injury including rupture and/or diverticulum of the joint capsule, bursa, and biceps tendon sheath (BTS), ganglion/synovial cyst, geyser phenomenon, and sequel of previous shoulder dislocation (Hill-Sachs deformity). Patients with one or more of these findings were included in the MR-positive group, whereas the remaining subjects were used as MR negatives. Based on their medical records, patients were also divided into trauma and non-trauma groups, and statistical analysis was performed to evaluate the association between the aforementioned MRI findings and history of shoulder trauma. Fifty-six patients were included in the MR-positive group and 253 in the MR-negative group. In MR-positive group, the incidence of capsular rupture (CR) and subacromial/subdeltoid (SASD) bursal rupture was higher in trauma patients, whereas the incidence of BTS diverticulum and ganglion cyst was higher in subjects without trauma. Significant association was found between the history of acute trauma and CR, SASD bursal rupture, BTS rupture, and Hill-Sachs deformity. In shoulder MR examination, presence of CR and/or SASD bursal rupture is strongly suggestive of acute shoulder trauma. In addition, BTS rupture and Hill-Sachs deformity are more prevalent in patients with acute shoulder trauma. The presence of these features should alert MRI readers to assess for additional trauma-related internal derangements, if a respective history has not been provided.

A prospective study of shoulder pain in primary care: Prevalence of imaged pathology and response to guided diagnostic blocks

BackgroundThe prevalence of imaged pathology in primary care has received little attention and the relevance of identified pathology to symptoms remains unclear. This paper reports the prevalence of imaged pathology and the association between pathology and response to diagnostic blocks into the subacromial bursa (SAB), acromioclavicular joint (ACJ) and glenohumeral joint (GHJ).MethodsConsecutive patients with shoulder pain recruited from primary care underwent standardised x-ray, diagnostic ultrasound scan and diagnostic injections of local anaesthetic into the SAB and ACJ. Subjects who reported less than 80% reduction in pain following either of these injections were referred for a magnetic resonance arthrogram (MRA) and GHJ diagnostic block. Differences in proportions of positive and negative imaging findings in the anaesthetic response groups were assessed using Fishers test and odds ratios were calculated a for positive anaesthetic response (PAR) to diagnostic blocks.ResultsIn the 208 subjects recruited, the rotator cuff and SAB displayed the highest prevalence of pathology on both ultrasound (50% and 31% respectively) and MRA (65% and 76% respectively). The prevalence of PAR following SAB injection was 34% and ACJ injection 14%. Of the 59% reporting a negative anaesthetic response (NAR) for both of these injections, 16% demonstrated a PAR to GHJ injection. A full thickness tear of supraspinatus on ultrasound was associated with PAR to SAB injection (OR 5.02; p < 0.05). Ultrasound evidence of a biceps tendon sheath effusion (OR 8.0; p < 0.01) and an intact rotator cuff (OR 1.3; p < 0.05) were associated with PAR to GHJ injection. No imaging findings were strongly associated with PAR to ACJ injection (p ≤ 0.05).ConclusionsRotator cuff and SAB pathology were the most common findings on ultrasound and MRA. Evidence of a full thickness supraspinatus tear was associated with symptoms arising from the subacromial region, and a biceps tendon sheath effusion and an intact rotator cuff were associated with an intra-articular GHJ pain source. When combined with clinical information, these results may help guide diagnostic decision making in primary care.

Detection and quantification of glenohumeral joint effusion: reliability of ultrasound

To evaluate reliability of ultrasound for detection and quantification of glenohumeral joint effusion. With institutional review board approval and informed consent ultrasound of 30 consecutive patients before and after MR arthrography of the shoulder was performed. Presence and width of any anechoic collection was noted within various locations (biceps tendon sheath, subscapular recess (neutral position and internal rotation), posterior glenohumeral joint recess (neutral position and external rotation)). Injected fluid (8-12 ml) into the glenohumeral joint served as gold-standard. Widths of anechoic collections were correlated (Spearman rank correlation) with injected fluid. Glenohumeral anechoic collection was consistently seen in the posterior glenohumeral joint recess with the arm in external rotation (100%, 30/30), and in the biceps tendon sheath (97%, 29/30). Ultrasound was not sensitive at other locations (7%-17%). Mean width in anterior-posterior direction of anechoic collection in the posterior glenohumeral joint recess was 7 mm (range: 3-18 mm), 2 mm (range: 1-7 mm) in the biceps tendon sheath. Significant correlation (R = 0.390, p = 0.033) was found between width of anechoic collection and injected fluid in the posterior glenohumeral joint recess. Glenohumeral joint effusion can be detected and quantified most reliably in the posterior glenohumeral joint recess with the arm in external rotation.

Sonography of Patients with Hemiplegic Shoulder Pain After Stroke: Correlation with Motor Recovery Stage

This study was performed to clarify the cause of shoulder pain using sonography and to evaluate the relationship between the sonographic findings and the motor recovery stages in stroke patients with hemiplegic shoulder pain. Between March 2005 and January 2007, 71 consecutive stroke patients with hemiplegic shoulder pain underwent shoulder sonography. For comparison, bilateral shoulder joints were evaluated in 20 of the 71 patients. The interpretations of the sonographic findings were based on the findings of previously published studies. Whether a correlation existed between the sonographic findings and the motor recovery stages was determined. Subacromial-subdeltoid (SA-SD) bursal effusion (n = 36) was the most common abnormality seen on sonography. Tendinosis of the supraspinatus tendon (n = 7), partial-thickness tear of the supraspinatus tendon (n = 6), and full-thickness tear of the supraspinatus tendon (n = 2) were also noted. Biceps tendon sheath effusion (n = 39) and normal findings without any biceps tendon sheath effusion (n = 13) were detected. Clinicians managed each patient's shoulder pain on the basis of the sonographic findings. No statistically significant correlation was found between the grade of sonographic findings and Brunnstrom stage (p = 0.183). A shoulder with hemiplegia had a higher number of abnormal sonographic findings than a noninvolved shoulder (p = 0.007). The cause of shoulder pain was variable and there was no correlation between the stages of motor recovery and the grades of sonographic findings in patients with hemiplegic shoulder pain.

Polymyalgia rheumatica

Polymyalgia rheumatica (PMR) is a common chronic inflammatory rheumatic disease with unknown aetiology, affecting predominately people of middle age and older. Besides clinical symptoms and diagnostics, imaging techniques including sonography and magnetic resonance imaging may provide evidence of typical inflammatory lesions with bilateral bursitis subdeltoidea or subacromialis, tenosynovitis of the biceps tendon sheath and/or synovitis of the shoulder joints and thus may support the diagnosis of this disease in difficult cases. Corticosteroids are the cornerstone of treatment of PMR, but adverse events because of chronic corticosteroid use are observed in more than 50% of treated patients. Whether immunosuppressants, such as methotrexate and tumour necrosis factor-alpha inhibitors are effective in the therapy of PMR has still not yet been clarified.

EFFECT OF POSITIONING, SCAN PLANE, AND ARTHROGRAPHY ON VISIBILITY OF PERIARTICULAR CANINE SHOULDER SOFT TISSUE STRUCTURES ON MAGNETIC RESONANCE IMAGES

This study was performed to determine the effect of shoulder extension and flexion, imaging plane, and intraarticular paramagnetic contrast medium administration on the visibility of soft tissue structures surrounding the canine shoulder joint using magnetic resonance (MR) imaging. Eight dogs without shoulder disease were imaged using a 1.5 T MR scanner. In all dogs, T1- and T2-weighted spin-echo sequences in sagittal, transverse, and dorsal planes, and a sagittal short tau inversion recovery (STIR) sequence were acquired with the shoulder joint in extension. In five dogs, postintravenous contrast medium T1-weighted images were obtained and in five dogs, MR arthrography was performed in flexion and extension. Each specific soft tissue structure was assigned a visual assessment score of 0-3 and descriptive statistics were calculated. The biceps brachii, supraspinatus, and teres minor muscles and tendons, and the biceps tendon sheath were best seen in the sagittal and transverse planes. The infraspinatus was well-visualized in all planes, the subscapularis was best seen in the transverse and dorsal planes, and the capsuloligmentous complexes were best seen in the transverse and dorsal planes. Limb extension improved conspicuousness of the medial capsuloligamentous stuctures. Arthrography resulted in greater conspicuousness of the biceps brachii tendon, biceps tendon sheath, infraspinatus, supraspinatus, subscapularis, medial joint capsule, medial glenohumeral ligament, and the lateral joint capsule-glenohumeral ligament complex. The major periarticular anatomic structures of the normal canine shoulder were consistently identified using the protocols described in this investigation, but arthrography with the joint in extension resulted in the best visualization of all structures.

Synovial chondromatosis of the long biceps tendon sheath in a child: A case report and review of the literature

Synovial chondromatosis of the long biceps tendon sheath in a child: A case report and review of the literature

Diagnosis and Arthroscopic Treatment of Primary Synovial Chondromatosis of the Shoulder

Primary synovial chondromatosis of the shoulder is a rare condition. We present the case of a 24-year-old man with a 6-month history of right shoulder pain and decreased range of motion. Computed tomography and magnetic resonance imaging findings led us to the diagnosis of synovial chondromatosis of the shoulder. Arthroscopy revealed loose bodies in the glenohumeral joint, the biceps tendon sheath, and the subscapularis recess. Active intrasynovial proliferation of the axillary pouch was noted. All loose bodies were removed arthroscopically, and partial synovectomy was performed. Histologic examination confirmed the diagnosis of primary synovial chondromatosis. We recommend arthroscopic treatment for synovial chondromatosis of the shoulder because of low morbidity and early functional return.

Biceps tendon tenosynovitis - a sonologic marker of shoulder joint derangement

Objectives: To study biceps tendon sheath fluid collection using musculoskeletal ultrasound and evaluate its cause. Materials and Methods: A total of 15 patients with biceps tendon sheath fluid collection were studied. All these patients presented with history of shoulder pain with inability of overhead abduction of arm and painful circumduction. Discussion: Ten had history of trauma, four had acute trauma and six had an old history of trauma. Five had degenerative shoulder joint disease, out of these two had osteoarthritis and three had rheumatoid arthritis with subacromiodeltoid bursitis. All cases were evaluated on B mode high frequency ultrasound. The gray scale findings were correlated with clinical and arthroscopic findings. These patients were treated conservatively and followed up sequentially. Results: Diagnosis of tendonitis prompted us for a detailed joint examination which revealed rotator cuff tear in eight patients, these tears varied from acute to chronic and partial to complete thickness tears. Five patients had arthritis, two had osteoarthritis with erosion and pitting of the bony groove and three had bursitis secondary to rheumatoid arthritis with tendonitis. Conclusion: The utility of high frequency ultrasound as an imaging technique for biceps tendon is a useful adjunct to clinical examination. The procedure is non invasive, safe without risk of exposure to harmful radiation, cost effective, dynamic and a useful aid in diagnosis. The diagnosis of biceps tendon sheath fluid must prompt a musculoskeletal sonologist for a detailed evaluation of the shoulder.

B‐mode and power Doppler sonographic findings in the long bicipital tendon in ankylosing spondylitis

AbstractObjectives: The aim of this study was to assess B‐mode and power Doppler ultrasound findings of long head of biceps tendon in patients with ankylosing spondylitis (AS).Methods: Anthropometric measurements were carried out and disease activity and functional status were evaluated with BASDAI, BASFI, Dougados Functional Index (DFI) and Articular Index (DAI) in 30 patients with AS. The Shoulder Disability Questionnaire (SDQ) was performed. Pressure pain threshold (PPT) was measured on bilateral long head of biceps tendon and B‐mode and power Doppler ultrasound were carried out. Focal changes (hypoechogenic areas within the tendon), calcification of the tendon, and fluid collection inside or outside the tendon sheath at bicipital groove (peritendinous hypoechoic rim) and vascularity of the peritendinous region were assessed. A cumulative ultrasound score (CUSS) was obtained.Results: Focal changes were present in five tendons of four patients. Calcification of the tendon was present in three tendons of three patients. Biceps tendon sheath effusion (peritendinous hypoechoic rim) was observed in 10 tendons of eight patients. Thirteen tendons of eight patients had discernible flow signals, six were inside the tendon sheath (within the hypoechoic rim) and seven were outside the tendon sheath. Cumulative US score correlated significantly with DFI and ESR. There was not a significant correlation between CUSS and total PPT.Conclusion: Ultrasound examination of the long head of biceps tendon gives detailed information of the tendon and PDUS has the potential to be able to show inflammatory activity of the tendon.

견관절 및 상완 이두박건 건초내에 발생한 활액막 연골종증의 치험례 -2례 보고-

Synovial chondromatosis is a, relativly rare disease, moreover the shoulder joint is very rarely affected. The authors report two cases of synovial chondromatosis of the glenohuneral Joint and biceps tendon sheath that were managed by arthrclscopic loose body removal and partial synovectomy. Excellent subjective and objective results were obtained.

Arthroscopic treatment for synovial chondromatosis of the shoulder

Synovial chondromatosis of the shoulder is a rare condition. The following is a description of such a case with the presenting symptoms, radiographic features, intraoperative findings, and the arthroscopic technique for treatment of this disease. Loose bodies were found in the long head of the biceps tendon sheath, the subscapularis recess, and throughout the glenohumeral joint, causing erosive damage. We feel that arthroscopy allows for better visualization of the entire glenohumeral joint, including the long head of the biceps tendon sheath and the subscapularis recess, and for ease of loose body removal. Additional advantages of arthroscopy include decreased postoperative pain, early active range of motion, shorter course of rehabilitation, and earlier functional return.

Primary synovial chondromatosis of the shoulder

To demonstrate the various patterns of primary synovial chondromatosis (PSC) around the shoulder and to discuss a therapeutic algorithm. In this retrospective study, 6 patients with histologically proven PSC were operated on. The diagnosis was based on clinical examination, plain X-rays, ultrasonography and MRI in 5/6 patients. Also, a histological examination was done in all cases. According to the localisation of the disease, surgery was done by endoscopy alone, endoscopy together with open surgery or direct open surgery. In one case each, we saw an isolated disease of the subacromial bursa or the gleno-humeral joint. In two cases, we found an intraarticular affection together with the biceps tendon sheath. The other two patients showed a massive periarticular deposition of loose bodies together with a defect of the rotator cuff. All patients with intraarticular disease (5/6) showed different stages of chondromalacia. In 5 of 6 patients all bodies could be removed at surgery. At follow-up after 36 months the patients subjectively rated the result as satisfactory to excellent. In the patients with total removal of the bodies, no recurrences were seen on plain X-ray or ultrasonography. PSC around the shoulder appears with a variable pattern. According to the possible late complications described in the literature (i. e., secondary osteoarthritis, involvement of the rotator cuff and secondary malignant transformation), we find operative treatment justified. Surgery addressing removal of loose bodies and partial synovectomy allows good results. The operative approach (endoscopy or open surgery) is related to the localisation and severity of the condition.

Sonography of the shoulder after arthrography (arthrosonography): preliminary results.

The purpose of this study was to verify whether arthrosonography improves diagnostic accuracy in diseases of the shoulder and provides additional information for therapeutic planning, compared with conventional sonography. We prospectively studied 113 consecutive patients with chronic shoulder pain. Sonography was performed before and after arthrography, with the radiologist blinded to the results of arthrography. When a rotator cuff tear was detected sonographically, its type, location, and size were recorded; we also evaluated any changes in the subacromial-subdeltoid bursa and any abnormalities in the biceps tendon sheath. The diagnostic accuracy of conventional sonography and arthrosonography was compared with that of arthrography for rotator cuff tear. Changes in the subacromial-subdeltoid bursa and biceps tendon sheath seen on conventional sonography were also compared with those seen on arthrosonography. The sensitivity and specificity of conventional sonography in the diagnosis of rotator cuff tear were 86% (25/29) and 95% (80/84), respectively; for arthrosonography, the values were 97% (28/29) and 95% (80/84), respectively. The differences in sensitivity and specificity for the 2 sonographic techniques were not statistically significant (p > 0.05). The accuracy in localizing the tear was also not significantly different between the 2 sonographic techniques. Synovial proliferation was more easily detected with arthrosonography than it was with conventional sonography in the subacromial-subdeltoid bursa (p < 0.01) and in the biceps tendon sheath (p < 0.0001). Our preliminary results suggest that although arthrosonography was not superior to conventional sonography in the diagnosis of rotator cuff tears, it may provide a better assessment of the size of tears and additional information about synovial proliferation in the subacromial-subdeltoid bursa and the biceps tendon sheath.

Utility of MR arthrography in the diagnosis of adhesive capsulitis

Arthrographically, adhesive capsulitis is characterized by decreased joint volume; histologically, the capsule and synovium are thickened. We therefore compared using MR arthrography the joint volumes and capsule/synovial thickness of patients with and without adhesive capsulitis in order to assess the utility of MR arthrography in diagnosing adhesive capsulitis. The 1.5 T MR arthrography images of 28 subjects with (n=9) and without (n=19) adhesive capsulitis were compared. Adhesive capsulitis was diagnosed when there was an injected glenohumeral joint volume of less than 10 ml. Two masked observers working in consensus assessed the images for the relative amount of fluid in the biceps tendon sheath and axillary recess, corrugation at the margin of the capsule, capsule/synovial thickness, abnormalities of the rotator interval capsule, and for the presence of a cuff tear. There was a trend towards differences in capsular and synovial thickness (P>0.07) between the subjects with and without adhesive capsulitis; however, the controls had thicker synovium/capsules. Surprisingly, the amount of fluid in the axillary recess and biceps tendon sheath was not significantly different between the groups (P>0.25). There were more tears of the rotator cuff in controls than in patients with adhesive capsulitis (6, 3 vs 1, 1: complete, partial). Also, both corrugation (7 vs 0) and interval abnormalities (7 vs 0) were more common in the controls. There appear to be no useful MR arthrographic signs of adhesive capsulitis. Capsular/synovial thickness, static fluid volume, and the presence of corrugation are inconclusive as MR arthrographic signs for distinguishing shoulders with adhesive capsulitis from those without.

Ultrasonography of the glenohumeral joints--a helpful instrument in differentiation in elderly onset rheumatoid arthritis and polymyalgia rheumatica.

In a prospective study, the glenohumeral joints of 51 patients (aged 60 or above) were examined, using ultrasonography. Twenty-two patients were suffering from characteristic polymyalgia rheumatica (PMR) symptoms. In contrast, 29 other patients initially had similar complaints, but were diagnosed as having elderly onset rheumatoid arthritis (EORA, rheumatoid factor negative) upon development of typical symptoms. Ultrasound examination revealed glenohumeral joint inflammation in 40.9% (9/22) of the patients with PMR and 65.5% (19/29) of the patients with EORA. A discrete symmetrical biceps tendon sheath effusion was found in only three patients and unilateral in six patients with PMR. In contrast, 12 patients with EORA presented a massive effusion of the biceps tendon sheath, in some cases combined with a bilateral subdeltoid bursitis, and an intraarticular (i.a.) effusion/synovitis. To summarize our results: an i.a. effusion/synovitis, subdeltoid bursitis and biceps tendon sheath effusion were more frequent in patients with EORA, with a predominate symmetry and signs for massive inflammation. The typical ultrasonographic result in patients with PMR was a unilateral inflammation of the glenohumeral joint with predominate discrete biceps tendon sheath effusion and, in comparison with the EORA group, with signs of a low grade inflammation. We conclude that the results of our prospective study might be helpful in the differentiation of PMR and a rheumatoid factor negative subgroup of EORA at the first time of manifestation where clinical overlaps can be observed. However, ultrasonography of the glenohumeral joints might be a good and helpful instrument of differentiation in both diseases.