Long Head Of Biceps Brachii Research Articles

The association between ultrasonographic findings and pain, physical function, and symptoms in patients with shoulder pain.

Shoulder ultrasonography (US) is commonly employed to differentiate the causes of shoulder pain. However, the correlation between ultrasonographic findings and the individual's functional disability and daily activities remains unexplored. To investigate the relationship between shoulder US findings and physical function, disability, and pain. The study investigated patients with shoulder pain. Tendons of supraspinatus, infraspinatus, subscapularis, and long head of biceps brachii, acromiohumeral distance, and acromioclavicular joint (ACJ) degeneration were evaluated using US. The QuickDASH questionnaire was employed to evaluate physical function, symptoms, and disability, while the visual analog scale (VAS) was utilized to assess pain levels. The study included 84 patients (69 [82.1%] women, mean age = 55.7 ± 11.9 years). Ultrasonographic examination revealed ACJ degeneration in 61 (21.4%) patients and biceps tendinitis in 21 (25%) patients. In addition, supraspinatus tendinosis was identified in 51 (61%) patients, while 28 (33%) exhibited a supraspinatus tear. The patients demonstrated a mean VAS score of 7.03 ± 1.49 and mean QuickDASH score of 45.6 ± 15.3. Individuals with a supraspinatus tear exhibited higher VAS (P = 0.008) and QuickDASH (P = 0.016) scores. Patients presenting with ACJ degeneration demonstrated increased VAS scores (P = 0.014), whereas those with biceps tendinopathy showed higher QuickDASH scores (P = 0.035). The results obtained from our research demonstrate significant correlations between ultrasonographic data and pain, disability, and physical manifestations. The findings of this study indicate that shoulder US provides valuable information regarding the difficulties individuals face in their daily tasks and the degree of pain they endure.

Raised body mass index and reduced muscle bulk reduces the incidence of Popeye's deformity post tenotomy of long head of biceps brachii

ObjectivesThe development of the Popeye’s deformity is a known complication of long head of bicep tendon (LHBT) tenotomy. Incidence of developing Popeye’s deformity after LHBT tenotomy ranges between 13 - 70%. While this complication is well tolerated, it can be avoided with proper patient selection. We aim to study patient and clinical factors resulting in the development of the Popeye’s deformity after LHBT tenotomy so as to better identify suitable surgical candidates. Methods91 patients underwent unilateral rotator cuff repairs and concomitant LHBT tenotomy between March 2013 and March 2017. Assessment of patient factors contributing to Popeye’s deformity included patient demographics and physical attributes were analysed and correlated. Patients also completed a questionnaire regarding their overall post-operative satisfaction. Prospectively collated Visual Analogue Pain (VAS), Constant-Murley Shoulder Score (CSS), UCLA Shoulder Score (UCLA) and Oxford Shoulder Score (OSS) were compared at 6 and 24 months post-operation between patients who developed Popeye’s deformity and those who did not. ResultsThe incidence of post-tenotomy Popeye’s sign was 58.9%. Majority of patients were satisfied with their procedure, postoperative function and cosmesis. Patients who developed Popeye’s sign had a statistically significant lower body mass index (BMI) (24.9 ± 4.2 kg/m2 versus 27.3 ± 4.3 kg/m2, p = 0.048) (rpb = - 0.210, p > 0.05) and had a greater biceps circumference (in flexion) to wrist circumference ratio (1.91 ± 0.16 versus 1.83 ± 0.13, p = 0.012) (rpb = 0.319, p < 0.05) compared to those who did not. Nevertheless, the development of Popeye’s sign did not affect clinical outcomes (VAS, CSS, UCLA and OSS, p > 0.05) at 24 months. ConclusionsThe incidence of Popeye’s deformity is high post LHBT tenotomy. There was a greater incidence in patients with lower BMI and greater biceps brachii muscle bulk. However, this complication is well tolerated. By better selecting our patients, we can achieve better outcomes and minimise potential complications. Level of evidenceLevel III Evidence. Retrospective comparative study.

Establishment and evaluation of a rabbit model of frozen shoulder induced by persistent strain injuries and ice compression

To evaluate the rabbit modle of frozen shoulder induced by persistent strain injuries and ice compression. Twelve clean, healthy male New Zealand rabbits with a mass of (2 500±500) g were selected and randomly divided into a blank group and a control group with 6 rabbits in each group. In the control group, the rabbits were modeled with persistent strain injuries and ice compression, the general conditions of the rabbits and the active and passive activities of the shoulder joint were observed and their body weights were recorded. MRI was performed on the affected shoulder joints at 6 d and 29 d after modelling to observe the fluid and soft tissue;HE staining was used to observe the morphology of the rabbit biceps longus tendon and the synovial membrane of the joint capsule;Masson staining was used to observe the fibrous deposits of the rabbit biceps longus tendon and the synovial membrane of the joint capsule, and the fibrous deposits were analysed semi-quantitatively by Image J software. Six days after the end of modeling, the active movement of the shoulder joints in the control group was limited, the passive movement was not significantly limited, and they walked with a limp;29 days after the end of the modeling, the active and passive movements of the shoulder joints in the model group were severely limited. Compared with the blank group (2.50±0.14) kg, the body weight of the model group (2.20±0.17) kg was significantly reduced(P<0.01). MRI showed that 6 days after modelling, the muscles around the shoulder joint were not smooth in shape, the joint capsule structure was narrowed and a large amount of fluid was seen in the joint cavity;29 days after modelling, the muscles around the shoulder joint were rough in shape, structure of the joint capsule was unclear and the fluid in the joint cavity was reduced compared with 6 days after modelling. Pathological staining showed that the long-headed biceps tendon fibres in the control group were disorganised, curled or even broken, and the synovial tissue of the joint capsule was heavily vascularised, with collagen fibre deposits and severe inflammatory cell infiltration. The fiber deposition of the long head of biceps brachii in the model group [(23.58±3.41)%, (27.56±3.70)%] and synovial tissue [(41.78±5.59)%, (62.19±7.54)%] were significantly higher than those in the blank group [(1.79±1.03) %, (1.29±0.63) %] at 7 and 30 days after modeling and synovial tissue fiber deposition [(8.15±3.61) %, (11.29±7.10) %], as shown by the semi-quantitative analysis of Masson staining results by Image J software. And the longer the time, the more severe the fibrosis (P<0.01). The behavioral, imaging and pathological findings showed that the rabbit frozen shoulder model with persistent strain injuries and ice compression is consistent with the clinical manifestations and pathogenesis of periarthritis, making it an ideal method for periarthritis research.

Difference in Stiffness between Biceps Brachii Muscle Bellies Using Shear Wave Elastography

The Shear Wave Elastography of muscles can provide real-time information on the stiffness of muscles; however, the difference in stiffness between biceps brachii muscle bellies requires more research. Understanding the variables that affect muscle stiffness will assist in the development of Shear Wave Elastography as a diagnostic tool for muscle stiffness pathologies. This study’s aim is to determine the Shear Wave Velocity of the short and long head of biceps brachii and the change in stiffness with elbow flexion to create a reliable protocol for pathological muscle assessment. The muscle belly of the short and long heads of bilateral biceps brachii of 38 healthy participants were scanned supine with the arm at full extension and at 30° and 60° elbow flexion. A log transform of the SWV was used as the response variable in the regression analysis, and the intraclass correlation coefficient was determined for reliability. The Shear Wave Velocity of the short head was lower than the long head on average. By fitting Bayesian mixed effect regression models to the data, the estimated posterior predictive mean velocities for the short head at full extension, 30°, and 60° were 3.14 m/s, 2.65 m/s, and 2.62 m/s, respectively; and 3.91 m/s, 3.02 m/s, and 3.15 m/s, respectively, for the long head of the biceps brachii. The intraclass correlation coefficients (0.64–0.92) were good to excellent. Shear Wave Elastography can detect the consistent difference in the stiffness of the two muscle bellies of the biceps brachii at multiple elbow angles. The assessment of muscle stiffness with Shear Wave Elastography should consider the morphology of the muscles.

Redefining superior escape of the humeral head: A radiographic and magnetic resonance imaging study

Background The underlying shoulder pathology in radiographic superior escape of the humeral head and association between acromiohumeral interval (AHI) on radiographs and magnetic resonance imaging (MRI) are poorly understood. Methods A retrospective review of shoulder radiographs and MRI scans was undertaken. AHI was measured using both modalities. Deltoid bulk, long head of biceps brachii subluxation/tear, and rotator cuff disease (tendon involvement, severity, fatty infiltration) were noted using MRI. Results A total of 167 patients were included. MRI measurements of AHI were significantly smaller than radiographic measurements ( p = 0.010). AHI was significantly smaller in patients with at least one partial or full thickness rotator cuff tear ( p &lt; 0.0001) and in patients with increased fatty infiltration based on Goutallier grade ( p = 0.004). In the presence of two or more tendon tears, long head of biceps brachii rupture was associated with superior escape ( p &lt; 0.001). In patients with superior escape (AHI &lt;6 mm), the number of rotator cuff tendon tears ranged from 0 to 3 and Goutallier grades from 0 to 4 representing a wide disease spectrum. Discussion Radiographic superior escape of the humeral head is correlated with full thickness rotator cuff tears, fatty infiltration, and long head of biceps brachii rupture. However, superior escape can occur with a single or no tendon injury with minimal fatty infiltration. Level of evidence Level III; Retrospective Case-Control Design; Prognosis Study.

A very rare case of a thoracobrachialis muscle

The anterior arm compartment includes the biceps brachii muscle, brachialis muscle, and coracobrachialis muscle, and they are characterized by different morphological variations. During standard anatomical dissection of right upper limb, an variant muscle was found. It originated from the fascia covering the long head of biceps brachii and from the tendon of pectoralis major muscle. It also connected to the brachial fascia. It also demonstrated a long thin tendon which was distally attached to the medial epicondyle of humerus. Knowledge about the morphological variations in this region is clinically important because of their direct correlation with neurovascular structures, which may lead to pathologies such as tingling, muscle weakness, paresthesia, and loss of sensation.

Identification of EIMD Level Differences Between Long- and Short Head of Biceps Brachii Using Echo Intensity and GLCM Texture Features

ABSTRACT Purpose: This study aimed to compare the time-course changes of exercise-induced muscle damage (EIMD) levels in the long head of biceps brachii (LHB) and short head of the biceps brachii (SHB) using echo intensity (EI) and to determine the efficiency of the gray level co-occurrence matrix (GLCM) texture parameters. Methods: The participants performed 30 maximal eccentric contractions of the elbow flexor. Along with muscle damage indicators, including circumference, range of motion, muscle soreness, and maximal voluntary isometric contraction (MVIC), the EI and GLCM texture features of the LHB and SHB was also assessed using B-mode ultrasonography. All measurements were assessed pre- and immediately post-exercise and after 24, 48, 72, and 96 h. Results: The muscle damage indicators indicated significant changes after the eccentric contractions (p < 0.01 for circumference, range of motion, muscle soreness, and MVIC). The EI of LHB significantly increased following the contractions (p < 0.01), but that of SHB did not (p > 0.05). In contrast, for the GLCM texture parameters, there were significant changes in the SHB (p < 0.01 for homogeneity, energy, and entropy). Conclusion: Thus, this study demonstrated that EIMD severity is different between LHB and SHB even within the same muscle. In the GLCM features, the time course of SHB after eccentric contraction revealed different patterns compared with those of LHB. Therefore, even if there are no changes in EI within a target muscle following muscle contractions, new information on muscle quality can be obtained through GLCM analysis.

Study On The Pathogenesis Of Post-Stroke Shoulder Pain Based On The Characteristics Of Magnetic Resonance Imaging-A Retrospective Study

Abstract Background High morbidity has been proved frequently happened in post-stroke shoulder pain (PSSP), but the specific pathogenesis of PSSP still remains unclear. Therefore, further research needs to be done to investigate this field. Objective The aim of this study which reviewed the features of magnetic resonance imaging (MRI) on shoulder joint of patients with PSSP, is to find the consequence of pathogenesis. Methods This study starts from June 2017 to August 2021, 74 PSSP patients who accepted MRI examination were selected in the Department of rehabilitation medicine of the Second Affiliated Hospital of Nanjing Medical University (inpatient and outpatient). This study sorted out and summarized patients’ MRI characteristics, analyzing differences of MRI appearance according to age, gender, hemiplegic side, stroke type and onset time. Results After examining all PSSP patients’ MRI characteristics, this study found 56 (75.67%) had supraspinatus tendon injury, 11 (14.86%) infraspinatus tendon injury, 24 (32.43%) subscapular tendon injury, 2 (2.7%) teres minor tendon injury, 60 (81.08%) tendon sheath effusion (inflammation) of long head of biceps brachii, 23 (31.08%) humeral head bone marrow edema and 64 (86.49%) shoulder joint capsule effusion. Moreover, there were 6 cases of acromial descending sac effusion (8.11%), 11 cases of coracoid descending sac effusion (14.86%), 8 cases of synovial thickening (10.81%), and 1 case of ossifying myositis (1.35%). Conclusion No significant differences were found in MRI features according to gender and hemiplegic side .The results showed the injury of supraspinatus tendon significantly increased in the older group compared to the younger group (P=0.039).The patients with supraspinatus tendon injury and tendon sheath effusion (inflammation) of long head of biceps brachii have higher cerebral infarction than patients with cerebral hemorrhage (P=0.002, P=0.028). Based on the time of onset, the participants were divided into three groups: within 1 month, 1–3 months and more than 3 months. The results suggested significant differences in humeral head bone marrow edema and shoulder joint capsule effusion numbers among the three groups (P=0.049, P=0.002). The results of this research could help to improve the accuracy of clinical diagnosis and treatment of PSSP, putting forward a more reasonable treatment scheme.

Double plate technique and tendon fixation of long head of biceps brachii in treating Neer 3 to 4 partial fractures of proximal humerus

To explore clinical effect of double plate technique in treating Neer 3 to 4 partial fractures of proximal humerus. From May 2018 to December 2020, 38 patients with proximal humeral classified to Neer 3 to 4 partial fractures were treated with double plate technique and long head tendon fixation of biceps brachii, including 23 males and 15 females, aged from 41 to 89 years old with an average of (67.00 ± 9.76) years old;23 patients classified to Neer 3 fracture, 15 classified to Neer 4 fracture;the time from injury to operation ranged from 5 to 12 days with an average of (8.00±2.86) days. Degree of pain was evaluated by numerical rating scale(NRS) on the third day after operation; change of height of humeral head and angle of humeral neck stem were measured and compared between 2 days and 1 year after operation. Neer score was used to evaluate recovery of shoulder joint after operation at 1 year after operation. All 38 patients were followed up for 12 to 19 months with an average of (14.00±1.59) months. NRS score at 3 days after operation was (1.95±0.73) points. Fracture healing time ranged from 2.2 to 3.2 months with an average of(2.60±0.27) months. There were no significant difference in the height of humeral head and angle of humeral neck trunk between two days and 1 year after operation(P>0.05). Four Neer 4 fracture patients occurred absorption of greater tubercle of humerus and partial cystic change of humeral head, but the activity function of shoulder joint was good. Postoperative Neer score at 1 year was 89.50±5.19, and 20 patients got excellent results, 16 good, and 2 moderate. Double plate technique and long head tendon fixation of biceps brachii were used to treat Neer 3 to 4 fractures of proximal humerus has good clinical effect, and postoperative pain was mild, without special instruments.

A Case Series on Morphological Variations of Biceps Brachii in Adult Human Cadavers and its Clinical Implications

Biceps brachii, a powerful forearm supinator, is a muscle in which many anatomical variations have been reported. Biceps brachii anomalies may play an important role in neurovascular compression syndromes in the arm and also affect shoulder joint movements. Three significant morphological variations in Biceps brachii were noted during routine dissection of upper limbs used for undergraduate teaching purposes. An extra articular origin of tendon of long head of Biceps brachii which was passing through the subpectoral tunnel formed by Pectoralis major was observed in one right upper limb. Nonfusion of two bellies of Biceps brachii with an accessory bicipital tendon was observed in one right upper limb. Presence of one supernumerary head of Biceps Brachii with a communicating branch between Median and Musculocutaneous nerves was observed in one right upper limb. Knowledge of these variations is essential for Surgeons and Orthopaedicians during surgery involving shoulder, arm and elbow regions. Key words: Biceps brachii, Supernumerary heads, Extra articular.

Correlation Analysis of Rotator Cuff Injury and Biceps Brachii Longhead Tendinopathy by Ultrasonography

Correlation Analysis of Rotator Cuff Injury and Biceps Brachii Longhead Tendinopathy by Ultrasonography

Tender point examination with palpation in different shoulder pathologies: A retrospective study

BackgroundShoulder pain is a common symptom for non-traumatic shoulder pathologies and affects 4.7–66.7% of entire population. Even with the latest technological advantages, palpation still is a cost and time efficient tool to evaluate the shoulder pathologies. Our aim was to investigate and compare palpation findings in different shoulder pathologies. MethodWe used first assessments of impingement syndrome (IS) (n = 205), rotator cuff tear (RCT) (n = 185) and frozen shoulder (FS) (n = 210) patients who received treatment between 2010 and 2019 years. Two experienced physiotherapists palpated predefined points: long head of biceps brachii, pectoralis minor, lateral intermuscular septum, proximal tendons of extensor group. These points categorized into “proximal”, “mid-proximal”, “mid-distal”, “distal”, “irregular”. We also grouped patients by their BMIs. ResultsWe found RCT patients had higher BMI than IS and FS patients (p < 0.001, p = 0.001); more tender intermuscular septum points and night pain than IS patients (p = 0.001, p = 0.003) and more extensor group proximal tendon points than IS and FS patients (p < 0.001, p = 0.001). “No tenderness” group had lesser resting pain than distal group (p < 0.001) and lesser activity and night pain than middle-proximal, middle-distal, and distal groups (all ps < 0.002). Distal group had higher night pain than middle-proximal group (p = 0.003). Morbidly obese patients had higher night pain than normal and overweight patients (p = 0.003 and p = 0.009). ConclusionsTender point distribution varies depending on the pathology with biceps brachii being the most common. RCT patients had higher night pain related to more distal tender points. Patients with higher night pain had increased tenderness in septum intermuscular and extensor muscles’ proximal tendons.

Correlation of the Expression of IGF-1, TGF-β1 and BMP12 with Tendon Degeneration Caused by Overused Tendon of the Long Head of Biceps Brachii

Objective: To assess the association of the expression of insulin-like growth factor-1 (IGF-1), transforming growth factor beta-1 (TGF-β1) and bone morphogenetic protein-12 (BMP-12) with tendon degeneration in rats caused by overuse of biceps brachii long head tendon. Methods: Sixteen Sprague-Dawley (SD) rats were randomly divided into normal group (n = 8) and overuse group (n = 8). Rats were fed routinely in normal group and were treated by small animal treadmills for continuous 6 weeks of exercise at 1 h/day in overuse group followed by analysis of histological morphology of the tendon of the long head of biceps brachii by Hematoxylin-eosin (HE) staining, the expression levels of IGF-1, TGF-β1 and BMP-12 by Western blotting. Correlation analysis was used to analyze the correlation of the protein expression with the pathological score. Results: HE staining showed normal morphology of biceps brachii long head tendon in normal group (with dense structure, uniform arrangement and no fiber damage) and abnormal morphology in overuse group (with disordered structure, uneven arrangement and some of breakage fibers). The pathological score in overuse group was significantly higher than that in normal group (p &lt; 0.05). Compared with those in normal group, the protein levels of IGF-1, TGF-β1 and BMP-12 were significantly elevated in overuse group (p &lt; 0.05). Conclusion: The expression of IGF-1, TGF-β1 and BMP-12 in overused tendon of the long head of the biceps brachii are elevated, and positively correlated with tendon degeneration.

Straight proximal humeral nailing: Risk of iatrogenic tendon injuries with respect to different entry points in anatomical specimens

BackgroundThe purpose of the study was to evaluate the relationship of implant-related injuries to the adjacent anatomical structures in a newer generation straight proximal humeral nail (PHN) regarding different entry points. The proximity of the proximal lateral locking-screws of the MultiLoc proximal humeral nail (ML PHN) may cause iatrogenic tendon injuries to the lateral edge of the bicipital humeral groove (BG) as reference point for the tendon of the long head of biceps brachii (LBT) as well as the lateral insertion of the infraspinatus tendon (IST). Materials and methodsThe study comprised n = 40 upper extremities. Nail application was performed through a deltoid approach and supraspinatus tendon (SSP) split with a ML PHN. All tests were performed in three different entry points. First nail (N1) – standard position in line with the humeral shaft axis; second nail (N2) – a more lateral entry point; third alternative (N3) – medial position, centre of the humeral head. After nail placement, each specimen was screened for potential implant-related injuries or worded differently hit rates (HR) to the BG and the IST. The distances to the anatomical structures were measured and statistically interpreted. ResultsThe observed iatrogenic IST injury rate was 17.5% (n = 7/40) for N1, 5% (n = 2/40) for N2 and 62.5% (n = 25/40) for N3, which was statistically significantly higher (p < 0.001). Regarding the BG, the evaluated HR was 7.5% (n = 3/40) for both N1 and N2. Only the nail placed in the head centre (N3) showed an iatrogenic injury rate of 20% (n = 8/40) (p < 0.062). No statistically significant association between humeral head size and the HR could be observed (head diameter: IST: p = 0.323, BG: p = 0.621; head circumference: IST: p = 0.167; BG: p = 0.940). For the IST and BG, all distances in nail positions N1 and N2 as well as N2 and N3 differ statistically significant (p < 0.001). ConclusionsAn entry point for nail placement in line or slightly laterally to the humeral shaft axis – but still at the cartilage – should be advocated.

Proximal attachment of long head of biceps brachii to the bicipital tubercle of scapula and its functional significance

IntroductionLesions affecting the tendon of Long Head of Biceps brachii (LHB) are among the more frequent causes of pain and disability in the region of shoulder joint. Shoulder arthroscopy has shown that there is dual attachment of LHB to the Supraglenoid tubercle (SGT) and glenoid labrum, but the origin from the bony prominence on upper part of dorsal surface of neck of scapula has not been described in the literature reviewed. This bony elevation has been named as “Bicipital Tubercle (BT)”. What is astonishing is the fact that such a prominent BT has been either missed or ignored by earlier workers. MethodsDuring the dissection of the shoulder joint, the tendon of LHB could be separated into superficial and deeper laminae. The fibres of the superficial lamina could be traced to BT in approximately 80% cases. ResultsIn 70% of specimens LHB was seen to join the posterior labrum; in 20% the anterior labrum and in the remaining to both the labrum. In 57% of right and 65% of the left scapulae the BT was very prominent ConclusionThe efficiency of action of LHB is enhanced by its getting a firm attachment to the bicipital tubercle (BT). Thus in man the origin of the tendon of LHB has shifted from only the SGT to SGT plus labrum, and further has got an additional attachment to BT. This attachment to the BT seems to have been overlooked and demands its inclusion in all the future studies.

Fibrocartilaginous metaplasia identified in the long head of the biceps brachii

In the glenohumeral joint, the long head of biceps brachii (LHBB) is exposed to tension and compression loading. The short head of biceps brachii (SHBB) works only in tension. It is known that tendon under compression might develop fibrocartilaginous metaplasia that improves the resistance to compression but reduces the resistance to tension. This study evaluated the presence of cartilage in LHBB and SHBB samples, supporting its possible role in tendon tear. Between 2014 and 2016, 13 samples of LHBB and SHBB were collected during surgery for shoulder instability, glenohumeral arthritis, and massive rotator cuff tears. The samples were stained with hematoxylin and eosin, safranin-O, and Alcian blue (pH 1.0) for light microscopy. Immunohistochemistry was performed using anti-S100, anti-collagen I and II, and anti-tenascin-C antibodies. Histochemistry: LHBB samples showed matrix disorganization, with clusters of chondrocyte surrounded by collagen fibers and glycosaminoglycans. Safranin-O showed evident metachromasia. SHBB samples did not show any matrix disorganization or cartilaginous metaplasia. Immunohistochemistry: In all LHBB samples, anti-S100 and anti-collagen II showed cartilage in proximity of the tendon tear. Tenascin C immunostained closely to the disorganized matrix areas. SHBB, however, showed no positive areas for S-100, anti-collagen II, or tenascin C. According to our results, we hypothesize that the repeated stimulation in compression may induce the formation of fibrous cartilage. However, to date its role in tendon pathology remains to be clearly defined.

Super-selective cervical nerve root stimulation in contralateral C7 transfer: An intraoperative study

ObjectiveWe designed this study using super-selective intraoperative cervical nerve root stimulation aiming to support decision making about complete or partial contralateral C7 (cC7) nerve root transfer in patients with multiple cervical root avulsion injury. MethodsSuper-selective intraoperative stimulations of anterior, lateral, medial and posterior aspect of C5–C8 nerve roots were performed. Compound muscle action potentials (CMAP) were recorded in the lateral part of the deltoid (DM), long head of biceps brachii (BCM), brachioradial (BRM), long head of triceps brachii (TCM), and extensor digitorum communis (EDC) muscle. Muscle strength was documented immediately after cC7 transfer procedures and on scheduled follow-up visits according to the Medical Research Council (MRC) scale. ResultsIn the DM, stimulation of the posterior aspect of C5 resulted in the largest CMAP amplitudes (2.0 mV ± 1.9; 80% ± 28.3). The BCM CMAPs induced by the different aspects of C6 all revealed homogenous stimulation results. Stimulation of the lateral aspect of C7 induced the largest amplitude of TCM CMAPs (1.3 mV ± 1.0; 67.1% ± 43.3). CMAP amplitudes of individual muscles and individual contributions of cervical nerve roots to the TCM varied between subjects. Overall donor side morbidity was low, no permanent motor deficit occurred. ConclusionA super-selective intraoperative cervical nerve root stimulation may help minimize donor side morbidity in transfer procedures. Individual differences of cervical nerve root innervation pattern need to be addressed in future electrophysiological studies. SignificanceOur study outlines individual differences of cervical nerve root innervation pattern.

Biceps Tenodesis versus Tenotomy in Treatment of Lesions of Long Head of Biceps Brachii in Patients Undergoing Arthroscopic Shoulder Surgery

Objectives:To compare subjective patient-reported outcomes and objective clinical results between biceps tenotomy and tenodesis in patients with lesions of the long head of biceps tendon (LHBT).Methods:The study is a prospective, randomized, controlled trial targeting patients +18 years undergoing arthroscopic shoulder surgery to manage a lesion of the LHBT (+/- rotator cuff repair). Patients were excluded if they had previous surgery on their affected shoulder or any other significant medical comorbidity that could alter the effectiveness of the surgical intervention. Patients were allocated intraoperatively to undergo tenodesis or tenotomy via computer randomization once a LHBT lesion was confirmed. The primary outcome measure was the American Shoulder and Elbow Society standardized assessment of shoulder function (ASES). Secondary outcomes included: Western Ontario Rotator Cuff index (WORC), surgery time, patient reported pain and cramping, presence of a cosmetic deformity, elbow flexion and supination strength, and power. Study time points were pre, and 3, 6, 12, and 24 months post-operative. Magnetic resonance imaging (MRI) was conducted at 12-months post-operative.Results:Fifty-six participants were randomly assigned to each group. Table 1 summarizes the results to 12-months post-operative (collection of data to 24-months post-operative is ongoing until 2017). There were no significant differences in ASES score at pre- or post-surgery time points. In addition, no significant differences were found in WORC, surgery time, pain, or cramping. There was one significant difference in strength identified, the ratio of affected versus unaffected elbow flexion strength was greater in the tenodesis group (0.9 (SD=0.2)) versus the tenotomy group (0.8 (SD=0.3)) at 6-months post-operative. Otherwise, there were no differences in strength ratio identified for elbow flexion or supination strength or power at any time point. At 12-months post-surgery, the relative risk of cosmetic deformity in the tenotomy group relative to the tenodesis group based on patient report was 1.36 (p=0.41) with 12 out of 33 patients in the tenotomy group reporting a bulge in their upper arm compared to 8 out of 30 in the tenodesis group. Similar results were found based on clinical evaluation with a relative risk of 1.7 (p=0.36). MRI findings were available on 40 patients at the 12-month post-operative period. Of 23 in the tenodesis group, one was not intact and retracted 18 cm and two were partially torn. Of the 17 in the tenotomy group, none appeared retracted.Conclusion:Arthroscopic treatment of lesions of LHBT, whether tenodesis or tenotomy, was shown to have favourable results. Elbow flexion strength favoured tenodesis at 6-months, but otherwise there were no significant differences between groups. As data continues to be gathered to 24-month post-operative, longer-term benefits and drawbacks of each procedure may become evident.Table 1.Demographies and outcome measures by group. Tenodesis Tenotomy p-value Randomized (Men/Women) 56 (46/10)56 (43/13)0.48 Mean (SD) age (yrs) 58.8 (10.6)56.0 (8.2)0.13 Total surgery time (mins) 88 (42)77 (36)0.33 ASES: Pre 48.1 (17.7)47.7 (15.8)0.91 3-months 65.6 (19.1)61.1 (22.3)0.29 6-months 75.5 (18.3)71.6 (23.5)0.38 12-months 79.6 (20.3)77.9 (20.2)0.74 WORC: Pre 34.5 (15.5)36.5 (13.2)0.5 3-months 54.9 (20.4)54.5 (21.0)0.94 6-months 69.1 (21.3)62.5 (22.7)0.16 12-months 75.3 (21.4)72.6 (22.8)0.65 Pain: 3-months 5.3 (3.2)5.9 (3.0)0.34 6-months 6.6 (2.9)6.5 (3.6)0.96 12-months 7.8 (2.6)7.1 (3.1)0.31 Cramping: 3-months 7.4 (3.0)8.1 (2.6)0.26 6-months 7.7 (2.6)7.8 (2.9)0.88 12-months 8.3 (2.4)7.7 (3.0)0.4 Elbow flex strength (affected/unaffected ratio): 3-months 0.78 (0.4)0.79 (0.2)0.92 6-months 0.90 (0.2)0.80 (0.3)0.04* 12-months 0.98 (0.3)0.90 (0.2)0.2 Supination strength (affected/unaffected ratio): 3-months 0.88 (0.3)0.88 (0.3)0.99 6-months 1.01 (0.2)0.92 (0.3)0.25 12-months 1.01 (0.2)1.03 (0.3)0.83 Power (affected/unaffected ratio): 3-months 0.53 (0.3)0.55 (0.2)0.72 6-months 0.78 (0.4)0.72 (0.3)0.42 12-months 0.81 (0.3)0.74 (0.3)0.33*Significant at p<0.05.

Biceps Tenodesis Versus Tenotomy in Treatment of Lesions of Long Head of Biceps Brachii in Patients Undergoing Arthroscopic Shoulder Surgery

Objectives:To compare subjective patient-reported outcomes and objective clinical results between biceps tenotomy and tenodesis in patients with lesions of the long head of biceps tendon (LHBT).Met...

Ultrasonographic Validation of Anatomical Landmarks for Localization of the Tendon of the Long Head of Biceps Brachii.

Objectives. To establish anatomical landmarks for biceps tendon groove localization based on intrinsic anatomical relations and to validate the localization with ultrasonographic measurement. Design. Perspective, observational, single-blinded pilot study. Participants. 25 healthy male and female volunteers ages 24–50 years. Methods. We used two anatomical landmarks, the medial epicondyle vertical line related landmark and the coracoid process landmark. The distance from the groove skin mark to the medial epicondyle vertical line and the coracoid process was measured horizontally and was measured at 0° and 45° of shoulder external rotation, respectively. Results. Medial epicondyle vertical lines were 9.3 mm/21.5 mm medial to the groove at 0°/45° of shoulder external rotation, respectively. Correlation coefficients were 0.04/0.10, 0.32/0.42, and 0.26/0.37 for weight, height, and BMI in 0°/45° of shoulder external rotation, respectively. The distance between the coracoid process and the groove was 44.0 mm/62.2 mm in 0°/45° of shoulder external rotation, respectively. Correlation coefficients were 0.36/0.41, 0.36/0.54, and 0.18/0.12 for weight, height, and BMI in 0°/45° of shoulder external rotation, respectively. Conclusions. The medial epicondyle vertical line and the coracoid process landmark are both useful anatomical landmarks to localize the biceps groove. The anatomical landmark based localization is essentially not correlated with subject's weight, height, or BMI.