Long Head Of Biceps Pathology Research Articles

Arthroscopic biceps tenodesis using press-fit bony plug: a case series study.

To assess the feasibility, operative time, clinical outcomes, possible complications, and failure rates of all-through arthroscopic biceps tenodesis using press-fit bony plug technique. This prospective case series study involved 30 skeletally mature patients with long head of biceps pathology (tendinitis after failure of conservative treatment, subluxation, dislocation, or tendon tears). All patients were followed up for 24months at least. Twenty-nine patients regained full shoulder and elbow range of motion; one case suffered from reflex sympathetic dystrophy. There was a significant improvement in the constant, ASES, and VAS scores when comparing the pre-operative and post-operative values. The average biceps strength was 96% compared to the opposite healthy side. No cases were complicated by neuro-vascular deficits or failure of the tenodesis. Press-fit biceps tenodesis is safe and accessible with low economic demands. We recommend this technique to be used more often when addressing patients with long head of biceps pathologies. Registration number: N-1562023. Registration date: June 2022 "Retrospectively registered".

CLINICAL EFFECTIVENESS OF TENOTOMY VERSUS TENODESIS FOR LONG HEAD OF BICEPS TENDON PATHOLOGY: A SYSTEMATIC REVIEW AND META-ANALYSIS

There remains much debate regarding the optimal method for surgical management of patients with long head of biceps pathology. The aim of this study was to compare the outcomes of tenotomy versus tenodesis.This systematic review and meta-analysis was registered on PROSPERO (ref: CRD42020198658). Electronic databases searched included EMBASE, Medline, PsycINFO, and Cochrane Library. Randomized controlled trials (RCTs) comparing tenotomy versus tenodesis were included. Risk of bias within studies was assessed using the Cochrane risk of bias v2.0 tool and the Jadad score. The primary outcome included patient reported functional outcome measures pooled using standardized mean difference (SMD) and a random effects model. Secondary outcome measures included pain (visual analogue scale VAS), rate of Popeye deformity, and operative time.860 patients from 11 RCTs (426 tenotomy vs 434 tenodesis) were included in the meta-analysis. Pooled analysis of all PROMs data demonstrated comparable outcomes between tenotomy vs tenodesis (SMD 0.14, 95% CI −0.04 to 0.32; p=0.13). Sensitivity analysis comparing RCTs involving patients with and without an intact rotator cuff did not change the primary outcome. There was no significant difference for pain (VAS). Tenodesis resulted in a lower rate of Popeye deformity (OR 0.29, 95% CI 0.19 to 0.45, p < 0.00001). Tenotomy demonstrated a shorter operative time (MD 15.21, 95% CI 1.06 to 29.36, p < 0.00001).Aside from a lower rate of cosmetic deformity, tenodesis yielded no measurable significant benefit to tenotomy for addressing pathology in the long head of biceps. A large multi-centre clinical effectiveness randomised controlled trial is needed to provide clarity in this area.

Clinical effectiveness of tenotomy versus tenodesis for long head of biceps pathology: a systematic review and meta-analysis

ObjectivesThe comparative clinical effectiveness of common surgical techniques to address long head of biceps (LHB) pathology is unclear. We synthesised the evidence to compare the clinical effectiveness of tenotomy versus...

Wide-Awake Shoulder Nanoscopic Long Head of Biceps Tenotomy

Arthroscopic long head of biceps tenotomy is an established technique for addressing shoulder pain associated with long head of biceps pathology. Arthroscopic techniques, compared with open surgery, have demonstrated improvements in outcomes for patients including rapid recovery, but either regional or general anesthesia is required, which is associated with complications. We describe a novel technique using a Nanoscope needle arthroscopy system that allows for long head of biceps tenotomy to be performed under local anesthetic in the outpatient or office setting.

A meta-analysis of level I evidence comparing tenotomy vs tenodesis in the management of long head of biceps pathology

The ideal surgical treatment of long head of biceps pathology is unclear. This review evaluates Level I studies comparing tenotomy and tenodesis for the management of long head of biceps pathology. Medline, EMBASE, and the Cochrane Library databases were searched from database inception though April 17, 2020. Clinical outcomes including Constant-Murley Shoulder Outcome Score, American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) shoulder score, pain on visual analog scale, postoperative strength, and Popeye deformity were evaluated. Dichotomous outcomes were pooled into relative risk ratios whereas continuous outcomes were pooled into weighted mean differences using random effects meta-analysis. A total of 5 studies (227 tenotomy and 227 tenodesis patients) met the final inclusion criteria. Postoperative improvement across all outcomes was observed regardless of surgical treatment. Pooled analysis demonstrated no statistically significant difference for Constant-Murley Shoulder Outcome Score, ASES, pain, or flexion strength. Tenodesis was superior to tenotomy in reducing the risk of Popeye deformity (relative risk ratio 3.07, confidence interval 1.87, 5.02; P < .001). Tenotomy and tenodesis of the long head of the biceps results in comparable postoperative clinical and functional outcomes. Tenodesis is superior to tenotomy in preventing Popeye deformity postoperatively.

Clinical Effectiveness of Various Surgical Procedures Addressing Long Head of Biceps Pathology: Protocol for a Systematic Review and Meta-Analysis.

Introduction:The long head of biceps tendon is a common source of anterior shoulder pain and impaired function. Multiple surgical procedures are available as treatment options, but the optimal procedure is not known. The aim of this systematic review and meta-analysis is to review the literature to assess the clinical effectiveness of various surgical procedures to treat pain arising from the long head of biceps.Methods:The study protocol was designed and registered prospectively on PROSPERO (International prospective register for systematic reviews). Electronic databases used for the literature search will include MEDLINE, EMBASE, PsycINFO, and The Cochrane Library. Randomised controlled trials (RCTs) evaluating surgical procedures on the long head of biceps will be included. Our primary outcome is any functional patient-reported outcome measure related to the shoulder. Secondary outcomes will include the rate of ‘Popeye’ deformity, the rate of biceps cramping pain, the rate of complications, objective measurements of strength testing such as dynamometer, and other patient-reported outcome measures not specific to the shoulder such as the Visual-Analog Scale (VAS) for pain. Methodological quality of included studies will be assessed using The Cochrane Risk of Bias Tool 2.0 and the Jadad score. Inconsistency and bias across included studies will be assessed statistically. Comparable outcome data will be pooled and analysed quantitatively or qualitatively as appropriate.Ethics and dissemination:No ethical clearances required for this study. We plan to publish this systematic review and meta-analysis in a peer-reviewed journal. It will also be presented at various national and international conferences.HighlightsEvaluating the clinical effectiveness of surgical procedures for long head of biceps pathology.Randomised controlled trials.Biceps tenodesis and biceps tenotomy.Systematic review compliant with the PRISMA guideline.

Shoulder pain syndrome in patients engaged in physical culture and sports: modern aspects of rehabilitation

The aim of the study was to estimate rehabilitation efficiency in the sportsmen and physical culture professionals with a shoulder pain syndrome. Materials and methods: 980 patients with a shoulder pain syndrome undergo rehabilitation treatment. The reasons of acute or chronic shoulder pain syndrome were: acute trauma (7% of cases) or chronic microtraumatization (93% of cases) of shoulder tissues during the physical culture activities and sport. Rotary cuff pathology was diagnosed in 88% of patients, long head of biceps pathology - in 5%, acromioclavicular joint pathology - in 4%, the subacromial bursitis in 2% of cases, damage of the glenoid labrum (Bankarta) in 1%. Clinical methods (including the quality of life questionnaire -DASH) and instrumental methods (USD and MRI) were used. The differentiated rehabilitation programs (with the use of modern physical therapy methods) were recommended considering features of shoulder pathology, a patients clinical condition and their physical (including sports) activity. Results: Excellent and good results were stated in 98% of patients with a shoulder pain syndrome. 2% of patients were directed for the surgical intervention (rotary cuff and glenoid labrum restoration). Compensation of a shoulder pain syndrome was stated in 82% of patients; in 16% of patients the pain syndrome had significantly decreased. In 87% of patients function of the injured shoulder joint was restored, in 11% of patients - it significantly improved. Strength of shoulder muscles and a humeroscapular rhythm were restored and the quality of life (according to the DASH questionnaire) improved in 98% of patients. Conclusion. Use of the differentiated programs of rehabilitation using modern physical techniques allows to receive excellent and good results in all patients with a shoulder pain syndrome involved physical culture and sport.

Prevalence and risk factors for development of subscapularis and biceps pathology in shoulders with degenerative rotator cuff disease: a prospective cohort evaluation

The prevalence of subscapularis and long head of biceps (LHB) in relation to the presence and severity of posterosuperior (PS) rotator cuff disease is not known. Subjects with asymptomatic rotator cuff tears were enrolled for this prospective longitudinal study (n = 354) and followed annually with shoulder ultrasonography and clinical evaluations to assess for the presence of subscapularis, LHB, and PS rotator cuff pathology and pain development. Subscapularis pathology developed in 14% of shoulders over a median follow-up of 5 years, with partial-thickness tearing occurring most commonly (83%). Age, sex, and hand dominance were not associated with subscapularis pathology. A greater proportion of concomitant full-thickness PS cuff tears were observed in shoulders that developed subscapularis tears (76% vs. 50%, P = .002). The PS cuff tear width (10 mm vs. 14 mm, P = .01) at the time of enrollment and both tear width (10 mm vs. 15 mm, P = .003) and length (12 mm vs. 15.5 mm, P = .02) at the time of diagnosis of subscapularis pathology were greater in subscapularis-torn shoulders. LHB pathology was prevalent in 34% of shoulders, with dislocation/subluxation occurring in 63%and higher prevalence in subscapularis-torn shoulders (71% vs. 12%, P < .01). Subscapularis-torn shoulders were more likely to develop pain (67% vs. 45%, P = .004), and concomitant PS cuff tear enlargement was associated with greater risk for pain development (76% vs. 36%, P = .01). The development of subscapularis and LHB pathology is significantly related to the size of the PS cuff tear. Subscapularis involvement is associated with greater risk of pain development in degenerative rotator cuff disease.

Trends in Open and Arthroscopic Long Head of Biceps Tenodesis.

In young and active patients, long head of biceps (LHB) tenodesis has become a common procedure for managing LHB pathology, but it remains unclear whether it is performed in isolation or along with other shoulder procedures and whether open and arthroscopic techniques produce different complications. We sought to determine and compare open and arthroscopic LHB tenodesis in terms of (a) trends in overall use, (b) trends in use in isolation and in association with rotator cuff repair (RCR) and superior labral tear from anterior-to-posterior (SLAP) debridement/repair, and (c) the rates of post-operative complications. We performed a retrospective analysis of data from an insurance database to identify LHB tenodesis procedures performed from 2011 to 2014. The overall annual rates of open and arthroscopic LHB tenodesis were determined and then stratified according to concurrent RCR and SLAP repair/debridement. A multivariate logistic regression analysis that controlled for patient demographics (age, sex, comorbidity) was performed. Overall, 8547 patients underwent LHB tenodesis, of which 43.5% were open and 56.5% were arthroscopic procedures. There was a significant increase in the utilization of LHB tenodesis from 2011 to 2014. In isolation, open LHB tenodesis was the more common technique overall and by year. Arthroscopic LHB tenodesis was the most common tenodesis technique performed in conjunction with RCR and SLAP repair/debridement. The overall complication rate was 2.9%; only wound dehiscence demonstrated a difference between techniques. The rates of open and arthroscopic LHB tenodesis procedures increased significantly from 2011 to 2014, with open techniques more common when LHB tenodesis is performed in isolation and arthroscopic techniques more common when performed as a concomitant procedure. Our use of a population database did not allow us to evaluate biomechanical or cost-related phenomena, and future research should examine these and other relevant differences between these two LHB tenodesis techniques.

Physical examination tests and imaging studies based on arthroscopic assessment of the long head of biceps tendon are invalid.

The aim of this study was to evaluate whether glenohumeral arthroscopy is an appropriate gold standard for the diagnosis of long head of biceps (LHB) tendon pathology. The objectives were to evaluate whether the length of tendon that can be seen at arthroscopy allows visualisation of areas of predilection of pathology and also to determine the rates of missed diagnoses at arthroscopy when compared to an open approach. A systematic review of cadaveric and clinical studies was performed. The search strategy was applied to MEDLINE, PubMed and Google Scholar databases. All relevant articles were included. Critical appraisal of clinical studies was performed using a validated quality assessment scale. Five articles were identified for inclusion in the review. This included both clinical and cadaveric studies. The overall population comprised 18 cadaveric specimens and 575 patients. Out of the five included studies, three reported the length of LHB tendon visualised during arthroscopy and four reported the rate of missed LHB diagnosis. Cadaveric studies showed that the use of a hook probe allowed arthroscopic visualisation of between 34 and 48% of the overall length of the LHB. In the clinical series, the rate of missed diagnoses at arthroscopy when compared to open exploration ranged between 33 and 49%. Arthroscopy allows visualisation of only a small part of the extra-articular LHB tendon. This leads to a high rate of missed pathology in the distal part of the tendon. Published figures for sensitivities and specificities of common physical examination and imaging tests for LHB pathology that are based on arthroscopy as the gold standard are therefore invalid. In clinical practice, it is important to note that a "negative" arthroscopic assessment does not exclude a lesion of the LHB tendon as this technique does not allow visualisation of common sites of distal pathology. IV.

Surgical indications for long head biceps tenodesis: a systematic review.

Tenodesis as a treatment for a symptomatic long head of biceps (LHB) tendon is becoming more prevalent and new techniques exist which are purported to make the procedure faster and more effective. The determination of appropriate surgical indications for the procedure will facilitate proper analysis and comparisons of the varied techniques. This review analyses the reported indications in the literature in an attempt to guide future research and treatment. The EMBASE and MEDLINE databases were searched to identify surgical studies that report indications for LHB tenodesis. After title, abstract searches, and full-text reviews, 39 studies were included. Study information was extracted including author, publication date, patient numbers, patient age, follow-up period, procedure performed, surgical indications, and study design. Although indications were variable and often non-descriptive, of the 39 included studies, the most common indications for LHB tenodesis were partial tearing (51%), instability (49%), or tenosynovitis (44%), SLAP tear (28%), and positive clinical exam for LHB pain (26%). Most studies were of low quality of evidence, such as case series (33.0%) and retrospective studies (43.5%), and were of low-to-moderate methodological quality. Although indications used for LHB tenodesis are inconsistently reported, the most common indications include LHB tearing, instability, and tenosynovitis. Other indications include clinical exam indicating LHB pathology, SLAP tears and subjective shoulder pain. Rigorous reporting of indications and preoperative/operative findings should be emphasized in future studies, allowing surgeons to appropriately analyse outcomes of LHB tenodesis of different techniques within patient groups with distinct indications. Systematic review, Level IV.

The use of Shoulder Ultrasound in a One-Stop Clinic: Diagnostic Accuracy for Rotator Cuff Tear and Biceps Tendon Pathology

Background Ultrasonography is useful in diagnosing rotator cuff tears in one-stop shoulder clinics. The present study aimed to investigate one-stop shoulder clinic ultrasonographic accuracy when diagnosing rotator cuff tears and their size, as well as long head of biceps (LHB) tendon pathology. Methods One hundred and twenty-two patients who underwent shoulder arthroscopy following pre-operative ultrasonography in a one-stop shoulder clinic were analyzed retrospectively. Results Partial thickness cuff tears were detected with a sensitivity and specificity of 65.0% and 94.0%, respectively, and full thickness tears at 94.8% and 93.8%, respectively. Full thickness tears were further analyzed as small tears, (&lt;1 cm), with a sensitivity and specificity of 50.0% and 96.6%, respectively; moderate (1 cm to 3 cm), at 88.5% and 93.8%, respectively; and large/massive tears (&gt;3 cm) at 73.1% and 99.0%, respectively. LHB pathology diagnosis sensitivity and specificity was 62.5% and 100%. Further analysis revealed a sensitivity and specificity of LHB dislocation of 83.3% and 100%, respectively, and rupture of 61.1% and 99.0%, respectively. Conclusions This is the first study to report shoulder ultrasonographic accuracy at a one-stop clinic when investigating cuff tear size and LHB pathology. Ultrasonography at a one-stop clinic is a cost-effective accurate method of managing patients with shoulder pathology.

Computed tomography analysis of the coracoid process and anatomic structures of the shoulder after arthroscopic coracoid decompression: A cadaveric study

The purpose of this anatomic study is to define the morphologic changes of the coracoid and surrounding soft tissue after arthroscopic coracoid decompression. We obtained 5 fresh-frozen forequarter cadaveric specimens, 3 female and 2 male, with a mean age of 86.2 years. Arthroscopic coracoid decompression was performed, and intraarticular pathology was documented. Preoperative and postoperative measures of coracoid overlap, coracoid index, and coracohumeral distance were made on limited-cut axial computed tomography scans. Dissection was performed to assess anatomic relationships after coracoid decompression. Arthroscopic findings revealed subscapularis pathology and glenohumeral arthritis in all specimens, long head of biceps pathology in 3, and supraspinatus pathology in 2. Gross dissection confirmed the pathologic findings. Arthroscopic coracoid decompression effectively improves coracoid overlap, coracoid index, and coracohumeral distance. The adjacent major neurovascular structures are at a safe distance from the decompression site.