Normal Biceps Research Articles

Cerebral Infarction Due to Polycythemia Vera: A Case Report

Introduction: Changes in blood viscosity can cause thrombosis in the brain, causing a stroke. Polycythemia vera is one of the causes of blood hyperviscosity. This study aimed to present cases of cerebral infarction related to polycythemia vera.
 Case presentation: A 55-year-old woman came to the emergency room with complaints of sudden weakness in the left limbs. One week before admission, the patient complained of headaches accompanied by spinning dizziness. Her left limbs often tingled and became weaker. There was an asymmetric facial deviation to the right, and the patient had difficulty communicating with unclear articulation. Specific examination of neurology shows dysarthria, left-sided motor type facial paralysis, examination of motor strength of the upper and lower extremities on the left 2 and 5 on the right, and the left upper limb often feels tingling. On the left limb, normal physiological biceps reflex was found, positive Chaddock pathological reflex. Morphological examination of peripheral blood showed normocytic normochromic with erythrosis and thrombocytosis and found giant platelets. This patient was diagnosed with an ischemic stroke caused by cerebral infarction, with polycythemia vera etiology, and accompanied by comorbid diseases of diabetes mellitus and uncontrolled hypertension.
 Conclusion: In patients with high-risk criteria for thrombosis, the management of phlebotomy, administration of low-dose aspirin, and cytoreduction in the form of hydroxyurea aims to achieve a hematocrit <45% so as to prevent worsening and recurrence of stroke.

Management of normal long head of the biceps tendon in isolated grade-1 supraspinatus tear: Research protocol for a multicenter prospective single-blind randomized study

BackgroundThe long head of the biceps (LHB) tendon is a common locus of pain in rotator cuff tear and of residual pain after tendon repair. Therefore, systematic LHB tenotomy, with or without tenodesis, is usually recommended. However, the recent literature suggests that long-term functional results of supraspinatus tendon repair are comparable between conservation of a normal biceps and tenotomy. The study objective is to compare functional results between sectioning and sparing a normal LHB in treating isolated grade-1 supraspinatus tendon tear. The study hypothesis is that sparing the normal LHB is clinically preferable to sectioning in the particular case of distal supraspinatus tear. Methods and analysisA French nationwide prospective single-blind randomized clinical study will include 194 patients undergoing arthroscopic repair of grade-1 supraspinatus tear with normal LHB. They will be randomized to 2 parallel groups: LHB sparing and sectioning. The main endpoint is Constant-Murley score, and secondary endpoints comprise ASES and SSV scores, clinical assessment of the biceps, pain on VAS, ultrasound assessment of cuff repair healing and conserved LHBs, impact on return to work and sport, pathologic assessment of sectioned LHBs, and analysis of risk factors for cuff repair failure. Ethical approval and publicationThe protocol has been approved by the data protection committee (art.L.1122-1) and meets the criteria of the Declaration of Helsinki and of the SPIRIT statement defining standard protocol items for clinical trials. Results will be published in a peer-reviewed journal. Level of evidencenot applicable.

Accessory heads of the biceps brachii muscle: A systematic review and meta-analysis.

The anatomy of the biceps brachii muscle has been a subject of interest to many researchers. In particular, the presence of one or more accessory heads has been reported to be the most common variation of the biceps brachii muscle. In fact, contemporary knowledge is quite inconsistent and lacks a definitive summary. Taking this into account, the present study aims to investigate the overall prevalence of the accessory heads and related questions, such as their broad morphological features, population variance, sexual dimorphism, side distribution or the changes in prevalence rates over time. A literature search of major scientific databases was conducted and produced 78 eligible articles, including 10,603 upper limbs, for our study. Relevant data were extracted and consequently analysed with the use of random-effects meta-analysis. As a result, the accessory heads occur with an overall prevalence of 9.6% (95% CI 8-11%) and by far the most common is the presence of a single accessory head (8.4%; 95% CI 7-10%). Additional sub-analyses revealed that accessory heads appear more frequently unilaterally and in males. Differences between the occurrence on the right or left side were not significant. Moreover, a decreasing trend in prevalence rates over time was observed, pointing towards an evolutionary adaptation. The innervation and blood supply of the accessory heads are nearly identical to that of the normal biceps brachii muscle. Although the accessory heads are usually asymptomatic, their potential presence must be kept in mind while interpreting various conditions. In addition, their direct clinical importance is speculated and is thought that they might be conductive to several pathological processes around the shoulder girdle and brachial region. While many of the morphological and morphometric aspects of the accessory heads are well documented, their functional value is still a matter for future investigations.

Prevalence of Subscapularis Tears and One-Year Clinical Outcomes in 593 Rotator Cuff Repairs

To report the prevalence of subscapularis tear repairs in a consecutive series by a single surgeon, and to report the clinical outcomes with regard to persistent disability or reoperation rate utilizing the concept of biceps preservation and early motion rehabilitation. 593 consecutive patients who underwent primary arthroscopic rotator cuff repair by a single surgeon from December 2015 to July 2017 are reported. All tears were graded by the LaFosse subscapularis tear classification . All patients were repaired with the same suture anchors with suture tape and had early motion rehabilitation. Patients with revision surgical repairs and massive cuff repair were excluded. Clinical failure was considered to be the need for repeat surgical procedure with documented repair failure, persistence of preoperative pain symptoms, MRI evidence of repair failure or patient dissatisfaction with the clinical outcome.. 409 out of 593 patients (69%) had subscapularis injury with varying degrees of biceps long head instability or pathology. There were 253 Lafosse grade 1, 107 grade 2, 17 grade 3, 1 grade 4 and no grade 5 tears. The most common pathologic finding was a flattened SGHL pulley attachment. 39 patients underwent biceps tenotomy/tenodesis as part of their treatment due to extensive biceps long head disease. The vast majority of patients had normal biceps morphology, and the biceps was preserved. Biceps pain was alleviated in over 95% of patients at one year follow-up in those treated with biceps preservation. The reoperation repeat repair rate was 5.2% for all patients. Subscapularis tears are much more prevalent than is commonly acknowledged in clinical practice. Repair of even complex subscapularis tears is met with high satisfaction and biceps tenotomy/tenodesis is uncommonly required to achieve superior outcomes.

The Value of Real-Time Shear Wave Elastography before and after Rehabilitation of Upper Limb Spasm in Stroke Patients.

Objective Our goal was to evaluate the efficacy of muscle spasm before and after rehabilitation by comparing shear wave propagation velocity (SWV) and Young's modulus (YM) in the normal and spastic biceps brachii in stroke patients. Methods A study of 60 stroke patients with upper limb spasm was performed; these patients were admitted from April 2018 to September 2019. The modified Ashworth scale (MAS) scores of the spastic biceps brachii before and after rehabilitation treatment were compared. SWV and YM on the spastic and normal biceps brachii before rehabilitation treatment, SWV and YM on the spastic and normal biceps brachii after rehabilitation treatment, and SWV and YM on the spastic biceps brachii before and after rehabilitation treatment were compared. Whether SWV and YM on the spastic biceps brachii are related to MAS was compared. Results There was a statistically significant difference in SWV and YM between the normal and spastic biceps brachii before (P < 0.01) and after (P < 0.05) the rehabilitation treatment. There was no statistically significant difference in SWV and YM in the normal biceps brachii before and after the rehabilitation treatment (P > 0.05). There was a statistically significant difference in SWV and YM in the spastic biceps brachii before and after the rehabilitation treatment (P < 0.01). SWV and FM of the spastic biceps brachii are correlated with MAS before and after rehabilitation treatment, and the correlation coefficient for SWV was 0.563 and 0.605 for YM (P < 0.05). Conclusion SWE can be used as a means of assessment before and after rehabilitation treatment.

Reconstruction of Chronic Distal Biceps Tendon Rupture With Autogenous Semitendinosis Graft Using the “Anatomic Length Method” and Concomitant Bicipital Aponeurosis Repair

We present a novel variation of a surgical technique for reconstruction of chronic distal biceps tendon ruptures using the “Anatomic Length Method.” Graft length for chronic distal biceps tendon rupture reconstruction is extremely variable and typically empirically determined by elbow position during final fixation. These techniques do not account for chronicity and varying degrees of retraction and muscle shortening. For this unique variation in the surgical technique, the graft length used is based on previous anatomic cadaveric measurements done in our center with an external distal biceps tendon length mean of 6.3 cm. In addition, our technique routinely reconstructs the bicipital aponeurosis. This allows for a highly reproducible surgical technique and restores a more normal biceps anatomy and muscle length-tension relationship.

MRI, arthroscopic and histopathologic cross correlation in biceps tenodesis specimens with emphasis on the normal appearing proximal tendon

PurposeTo correlate the histopathologic appearances of resected long head of the biceps tendon (LHBT) specimens following biceps tenodesis, with pre-operative MRI and arthroscopic findings, with attention to the radiologically normal biceps. Material and methodsRetrospective analysis of patients who had undergone preoperative MRI, subsequent arthroscopic subpectoral tenodesis for SLAP tears and histopathologic inspection of the excised sample between 2013 and 16. Those with a normal MRI appearance or mildly increased intrasubstance signal were independently analyzed by 2 blinded radiologists. A blinded orthopedic surgeon and pathologist reviewed all operative imaging and pathologic slides, respectively. ResultsTwenty-three LHBT resected samples were identified on MRI as either normal (Reader 1 n = 15; Reader 2 n = 14) or demonstrating low-grade increased signal (Reader 1 n = 8; Reader 2 n = 9). Of these, 86.9% demonstrated a histopathological abnormality. 50% of samples with histopathological abnormality demonstrated normal appearance on MRI. The most common reported histopathology finding was myxoid degeneration (73.9%) and fibrosis (52.2%). The most common arthroscopic abnormality was fraying (18.2%) and erythema (13.6%). Utilizing histopathology as the gold standard, the two radiologists demonstrated a sensitivity of 35.0% v 42.9%, specificity of 66.7% v 100%, PPV of 87.5% v 100%, and NPV of 13.3% v 14.3%. Corresponding arthroscopic inspection demonstrated a sensitivity of 31.6%, specificity of 66.6%, PPV 85.7% and NPV of 13.3%. There was moderate agreement between the two radiologists, κ = 0.534 (95% CI, 0.177 to 0.891), p = 0.01. ConclusionHistopathological features of low grade tendinosis including mainly myxoid degeneration and fibrosis are frequently occult on MR imaging.

Tenodesis renders better results than tenotomy in repairs of isolated supraspinatus tears with pathologic biceps

Many authors recommend systematic biceps tenotomy or tenodesis when repairing rotator cuff tears, regardless of whether the biceps is normal or pathologic. The purpose of this study was to determine whether 10-year outcomes of repairs of isolated supraspinatus tears are influenced by adjuvant biceps tenodesis or tenotomy. Patients who underwent repair of isolated supraspinatus tears were recalled for evaluation at a minimum follow-up of 10 years. A total of 249 patients (51% men) aged 56.7 ± 6.3 years were evaluated clinically (Constant score), of whom 182 were also evaluated using magnetic resonance imaging (Sugaya classification). The biceps was intraoperatively found to be pathologic in 52% of shoulders, of which 39% had a tenotomy and 54% had a tenodesis; it was found to be normal in 48% of shoulders, of which 88% were left intact. There were no significant differences in Constant scores for patients who had normal biceps without adjuvant procedures (77.1 ± 11.7) compared with patients who had pathologic biceps with either tenodesis (79.8 ± 11.5, P = .104) or tenotomy (75.3 ± 10.7, P = .420). However, for patients who had pathologic biceps, Constant scores were significantly better for those with tenodesis compared with those with tenotomy (P = .025). Multivariable regression revealed Constant scores to be significantly lower for women, as well as patients with fatty infiltration of stages 1 and 2, but significantly higher for patients who underwent tenodesis. Adjuvant biceps procedures are not required when repairing isolated supraspinatus tears, unless biceps pathology is observed intraoperatively, for which tenodesis grants better function and strength than tenotomy.

Knee Pain - Exercise

HISTORY: A 58-year-old male presented with a 4-week history of spontaneous knee pain. One year prior to presentation, he had bariatric surgery and increased his exercise regimen resulting in a 100 lb weight loss. He denies trauma or inciting injury. His pain localized to the posterolateral knee and is described as a 5/10 cramping pain. He describes a popping sensation and experiences a snapping moment in the lateral knee with deep squatting. He denies swelling and ecchymosis. He has tried ice, physical therapy and ibuprofen without relief. PHYSICAL EXAMINATION: Focused left knee exam revealed a palpable cystic structure in the lateral popliteal fossa. There is tenderness over the lateral joint line with no instability of the proximal tibiofibular joint or biceps femoris tendon. Range of motion was 0-140° with pain greater than 120° of flexion. When the knee is brought into deep flexion, there is an audible pop over the lateral aspect of the knee. When the knee is then brought into extension, there is reproduction of an audible pop and snapping moment of the lateral knee at end range extension. Flexion McMurray’s test is positive. Strength, reflexes, sensation, and pulses are normal throughout. DIFFERENTIAL DIAGNOSIS: 1. Snapping biceps femoris tendon 2. Snapping popliteus tendon 3. Lateral meniscus tear 4. Iliotibial band friction syndrome 5. Proximal tibiofibular joint instability TEST AND RESULTS: Three view x-rays of left knee: • Medial joint space narrowing. No acute fracture. Dynamic ultrasound of the left knee: • Normal biceps femoris tendon. Popliteal cyst noted. MRI of left knee without contrast: – Incomplete discoid lateral meniscus and small multiseptated popliteal cyst noted. FINAL WORKING DIAGNOSIS: Left knee discoid lateral meniscus with subluxation of the meniscus TREATMENT AND OUTCOMES: 1. Patient counseled on activity modification. 2. Dynamic ultrasound revealed no evidence of hamstring irregularities. 3. Unsuccessful ultrasound-guided aspiration of popliteal cyst attempted followed by an intra-articular corticosteroid injection. 4. After MRI evaluation, orthopedic surgery performed an arthroscopic partial meniscectomy of subluxing torn posterior horn and midbody saucerization of lateral meniscus. 5. He tolerated surgery well with no further subluxation of his meniscus in physical therapy.

192 Transcriptome Analysis for Pork Color – the Ham Halo Effect in Biceps Femoris.

Pork color is a major indicator of product quality that guides consumer purchasing decisions. For hams, consumers prefer a uniform pink color. Recently, industry has received an increase in consumer complaints about the lightness and non-uniformity of ham color, primarily lighter color in the periphery termed “ham halo” that is not caused by manufacturing procedures. This effect is seen in fresh and processed hams and the outer, lighter muscle is associated with lower myoglobin concentrations, pH and type I fibers. The objective of this study was to identify differences in gene expression profiles between light and normal colored biceps femoris muscle from pork hams. RNA was extracted from light and normal colored biceps femoris muscle from samples from the same animal showing an extreme ham halo effect, and over 50 million paired-end reads (2x75bp) per library were sequenced on an Illumina NextSeq 500. Seventy-six to 82% of trimmed high quality reads were mapped to the Sscrofa 10.2 assembly and unplaced scaffolds. Differentially expressed genes (DEGs) were identified using DESeq2 and GFOLD. DESeq2 identifies DEGs between groups and GFOLD identifies DEGs in samples from an individual animal. A total of 14,809 transcripts were expressed in biceps femoris; 14,766 were expressed in both light and normal muscle. DESeq2 identified 340 DEGs with 318 genes being more highly expressed in normal colored muscle. Within each animal, GFOLD identified an average of 768 DEGs. GFOLD identified 50 DEGs identified in at least 8 of the 10 animals, all of which were more highly expressed in normal colored muscle. Gene ontology (GO) enrichment analysis of these genes identified transition between fast and slow fibers, and skeletal muscle adaptation and contraction as the most significant biological process terms. Of the 340 DEGs, 319 mapped to 275 unique chromosomal regions; there were 33 clusters of 2 or more genes within 200 kb of a neighboring gene or long non-coding RNA, suggesting co-transcription of DEGs. Sixty-one DEGs resided within 200 kb of 93 unique QTL or SNP associations for color traits, pH, driploss, cookloss, purge, water-holding capacity or fiber type. The evaluation of gene expression by RNA-Seq identified DEGs between regions of the biceps femoris with the ham halo effect that may be candidate genes that contribute to the variation in color, pH and water-holding capacity of pork. USDA is an equal opportunity provider and employer.

All-Endoscopic Distal Biceps Repair: Cadaveric Portal Safety Analysis and Technical Feasibility Using 2 Fixation Techniques

The 2-part cadaveric study evaluated portal placement sites for distal biceps endoscopic repair. Technical feasibility and safety of an all-endoscopic repair using 2 fixation techniques (4 devices) was assessed. The study demonstrates the cadaveric anatomy-at-risk and presents guidelines for safe endoscopy in the cubital fossa and upper forearm region. Distal biceps tendon (DBT) injuries often require surgical intervention. Current treatment strategies use open surgical approaches to debride and repair the tendon. Endoscopic techniques have been suggested, however, the safety and feasibility of performing an endoscopic procedure in the upper forearm has not been evaluated. The purpose of this study was (1) to determine safe portal placement sites for endoscopy in the upper forearm, and (2) to analyze the feasibility and safety of performing an all-endoscopic repair of the ruptured distal biceps tendon using 2 fixation techniques (Button, suture anchors). The hypothesis of this study was that all-endoscopic DBT repair was possible without injury to neurovascular structures. 35 fresh frozen cadavers were used in 2 groups. In the first part of the study, 10 fresh frozen cadavers were used to analyze 5 possible portal sites (Parabiceps portal, two distal anterior portals [DAP 1 and DAP 2], tuberosity portal, and distal posterior portal) for distal biceps endoscopy. Nine neurovascular structures (cephalic vein; lateral cutaneous nerve; leash of vessels; radial nerve; superficial radial nerve; posterior interosseous nerve; radial artery; brachial artery; median nerve) were dissected, and their distances from portal sites were measured. In the second part, 25 fresh frozen cadaveric elbows were used. An endoscopic technique was used to explore the normal distal biceps and cubital fossa. The DBT was sectioned at the radial tuberosity. The tendon was then endoscopically reattached to the tuberosity using (1) button technique, with and without interference screw (15 cadaveric elbows), and (2) dual suture-anchor technique with 2 anchor types (10 cadaveric elbows). At the end of the procedure, each cadaver was dissected and nine neurovascular structures were assessed for injury. In addition, analysis of footprint of repaired DBT was performed, and placement site of fixation devices was evaluated. Compartmental pressures were obtained before and after procedure. In the first part (10 cadavers): parabiceps and distal posterior portals were safe. Radial artery was significantly ‘‘at risk’’ of injury from tuberosity portal. Similarly, superficial radial nerve (SRN) was ‘‘at risk’’ from the distal anterior portal 2, and the posterior interosseous nerve (PIN) was ‘‘at risk’’ from distal anterior portal (DAP 1). Overall, RA, SRN, and PIN were found to be significantly'' at risk'' (p<0.05). In the second part (25 cadavers): The normal and sectioned tendons, and the anterior and medial aspects of the tuberosity were clearly visualized via the parabiceps portal. Endoscopic repair was possible using all fixation devices. Neurovascular structures were at low risk for injury. A small rise in compartment pressures was noted before and after the procedure. Gapping and contact area varied between the different fixation devices. Endoscopic reattachment of the sectioned DBT was safe and feasible using all fixation devices. Parabiceps and distal posterior portals were safe, However, other 3 anterior portals were significantly closer to neurovascular structures, and open dissection is recommended if these portals are used. RA, SRN, and PIN were significantly ‘‘at risk’’ as compared to other structures amongst the portals studied.

A 3-Dimensional Anatomic Study of the Distal Biceps Tendon: Implications for Surgical Repair and Reconstruction.

BackgroundComplete rupture of the distal biceps tendon from its osseous attachment is most often treated with operative intervention. Knowledge of the overall tendon morphology as well as the orientation of the collagenous fibers throughout the musculotendinous junction are key to intraoperative decision making and surgical technique in both the acute and chronic setting. Unfortunately, there is little information available in the literature.PurposeTo comprehensively describe the morphology of the distal biceps tendon.Study DesignDescriptive laboratory study.MethodsThe distal biceps terminal musculature, musculotendinous junction, and tendon were digitized in 10 cadaveric specimens and data reconstructed using 3-dimensional modeling.ResultsThe average length, width, and thickness of the external distal biceps tendon were found to be 63.0, 6.0, and 3.0 mm, respectively. A unique expansion of the tendon fibers within the distal muscle was characterized, creating a thick collagenous network along the central component between the long and short heads.ConclusionThis study documents the morphologic parameters of the native distal biceps tendon. Reconstruction may be necessary, especially in chronic distal biceps tendon ruptures, if the remaining tendon morphology is significantly compromised compared with the native distal biceps tendon. Knowledge of normal anatomical distal biceps tendon parameters may also guide the selection of a substitute graft with similar morphological characteristics.Clinical RelevanceA thorough description of distal biceps tendon morphology is important to guide intraoperative decision making between primary repair and reconstruction and to better select the most appropriate graft. The detailed description of the tendinous expansion into the muscle may provide insight into better graft-weaving and suture-grasping techniques to maximize proximal graft incorporation.

Morphometric analyses of normal pediatric brachial biceps and quadriceps muscle tissue.

Pediatric normal brachial biceps (14 specimens) and quadriceps muscles (14 specimens) were studied by immunohistochemistry to quantify fiber-type, diameter and distribution, capillary density, presence of inflammatory cells (CD3, CD20, CD68) and expression of neonatal myosin and MHC class 1 proteins. Brachial biceps showed more fast-twitch fibers and lower capillary/fiber ratio than quadriceps. The mean diameter of both fiber types was smaller in biceps than quadriceps. Fast-fibers were smaller than slow-fibers, and capillary/fiber ratio was < 1.0 in both muscles. Fiber size and capillary / fiber ratio increased with age. Normal limits for infiltrating haematopoietic cells were <4 T lymphocytes, or CD68+ cells, very few B cells, < 6 neonatal myosin positive fibers, and no fibers MHC class 1 positive in one x20 field, for both muscles. The present comparison of quantitative findings between brachial biceps and quadriceps may allow standardization of the assessment of pathological changes in both pediatric muscles.

The Role of Sonography in Differentiating Full Versus Partial Distal Biceps Tendon Tears: Correlation With Surgical Findings

The purpose of this study was to determine the accuracy of ultrasound for distinguishing complete rupture of the distal biceps tendon versus partial tear and versus a normal biceps tendon. Surgical findings were used as the reference standard in cases of tear. Clinical follow-up was used to assess the normal tendons. The study population consisted of 45 consecutive elbow ultrasound cases with surgical confirmation and six cases of a clinically normal distal biceps tendon that underwent elbow ultrasound for suspicion of injury to a structure other than the biceps tendon. Cases underwent consensus review by two fellowship-trained musculoskeletal radiologists. Tendons were classified as normal biceps tendon, partial tear, or complete tear. The presence or absence of posterior acoustic shadowing at the distal biceps tendon was also assessed. The ultrasound findings were then compared with the surgical findings and clinical follow-up. Ultrasound showed 95% sensitivity, 71% specificity, and 91% accuracy for the diagnosis of complete versus partial distal biceps tendon tears. Posterior acoustic shadowing at the distal biceps had sensitivity of 97% and accuracy of 91% for indicating complete tear versus partial tear and sensitivity of 97%, specificity of 100%, and accuracy of 98% for indicating complete tear versus normal tendon. Ultrasound can play a role in the diagnosis of elbow injuries when a distal biceps brachii tendon tear is suspected.

MRI Study of Associated Shoulder Pathology in Patients With Full-thickness Subscapularis Tendon Tears

Subscapularis tendon tears are a well-established cause of shoulder pain. The objective of the current study was to evaluate the associated shoulder pathology in patients with full-thickness subscapularis tendon tears using magnetic resonance imaging. Forty-seven magnetic resonance imaging studies taken between 2008 and 2009 with a diagnosis of full-thickness subscapularis tendon tears were reviewed. The size of the subscapularis tendon tear, amount of muscle volume loss, Goutallier grade, biceps tendon pathology, coracohumeral distance, and associated rotator cuff tears were recorded. Statistical analysis was performed. Patients 55 years and older vs those 54 years and younger had an average subscapularis tear size of 35 vs 19 mm, an average Goutallier grade of 2.7 vs 0.8, and a total muscle volume loss of 25% vs 5%, respectively. Patients with a dislocated vs normal biceps tendons had an average subscapularis tear size of 37 vs 23 mm, an average Goutallier grade of 3 vs 0.9, and a total muscle volume loss of 28% vs 7%, respectively. Patients with vs without concomitant rotator cuff tears had an average subscapularis tear size of 32 vs 17 mm, an average Goutallier grade of 2.3 vs 0.6, and a total muscle volume loss of 21% vs 3%, respectively. Overall average coracohumeral distance measured in the axial plane was 10.8±4.6 mm. Average coracaohumeral distance was 14.8 vs 8.1 mm in patients with a Goutallier grade of 0 vs 3 or 4, resepectively, and 13.6 vs 8.5 mm in patients with no rotator cuff tear vs those with a supra- and infraspinatus tear, respectively. Increased age, dislocated biceps tendons, and concomitant rotator cuff tears in patients with full-thickness subscapularis tendon tears are associated with larger subscapularis tendon tear size, higher Goutallier grades, and increased subscapularis muscle volume loss. Decreased coracohumeral distance is associated with a higher Goutallier grade and rotator cuff tears.

Office-Based Elastographic Technique for Quantifying Mechanical Properties of Skeletal Muscle

Our objectives were to develop a new, efficient, and easy-to-administer approach to ultrasound elastography and assess its ability to provide quantitative characterization of viscoelastic properties of skeletal muscle in an outpatient clinical environment. We sought to show its validity and clinical utility in assessing myofascial trigger points, which are associated with myofascial pain syndrome. Ultrasound imaging was performed while the muscle was externally vibrated at frequencies in the range of 60 to 200 Hz using a handheld vibrator. The spatial gradient of the vibration phase yielded the shear wave speed, which is related to the viscoelastic properties of tissue. The method was validated using a calibrated experimental phantom, the biceps brachii muscle in healthy volunteers (n = 6), and the upper trapezius muscle in symptomatic patients with axial neck pain (n = 13) and asymptomatic (pain-free) control participants (n = 9). Using the experimental phantom, our method was able to quantitatively measure the shear moduli with error rates of less than 20%. The mean shear modulus ± SD in the normal biceps brachii measured 12.5 ± 3.4 kPa, within the range of published values using more sophisticated methods. Shear wave speeds in active myofascial trigger points and the surrounding muscle tissue were significantly higher than those in normal tissue at high frequency excitations (>100 Hz; P < .05). Off-the-shelf office-based equipment can be used to quantitatively characterize skeletal muscle viscoelastic properties with estimates comparable to those using more sophisticated methods. Our preliminary results using this method indicate that patients with spontaneous neck pain and symptomatic myofascial trigger points have increased tissue heterogeneity at the trigger point site and the surrounding muscle tissue.

Acute traumatic brachialis rupture in a young rugby player: a case report

A 17-year-old boy, who played fullback for a local rugby club, was referred with pain and swelling in the front of his left elbow after being injured while playing. The mechanism of injury suggested a hyperextension injury to his elbow. While tackling, the opponent’s knee hit his extended forearm, and he felt severe pain in the front of his elbow and had a dead-arm feeling. Since then, he had been unable to move his left elbow and had severe pain. The patient did not receive any treatment immediately and presented to us a week after his injury with marked bruising and swelling around the antecubital area of his left elbow. The elbow was held in 20 flexion, and there was pain on any further active or passive movement. The biceps tendon was difficult to palpate because of the swelling. There was no distal neurovascular deficit. The patient had undergone an ultrasound examination of the elbow before he was referred. It showed a normal biceps tendon (Fig. 1) and suggested a possible rupture and hematoma of brachialis muscle measuring about 60 mm in length, 13 mm in breadth, and 29 mm in width, just below the midpoint (Fig. 2). Owing to the unusual nature of this injury, a magnetic resonance image (MRI) of the elbow was ordered to confirm the diagnosis. The MRI, which was done about 2 weeks after the injury, showed

Long Head of Biceps Brachii Tendon Evaluation: Accuracy of Preoperative Ultrasound

The purpose of this study was to investigate the ability of ultrasound to accurately identify long head of biceps brachii (LHB) tendon abnormalities. The surgical findings for 66 consecutive patients who underwent arthroscopic shoulder surgery were retrospectively compared with the findings of preoperative ultrasound examination. Patients were excluded if more than 200 days elapsed between ultrasound and surgery. Ultrasound images were obtained using high-frequency transducers and were compared with findings at arthroscopy for the presence of LHB tendon abnormalities, including full-thickness tears, partial-thickness tears, or nontear abnormalities, including tendinosis and tenosynovitis. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated for full- and partial-thickness tears. Ultrasound correctly identified 90% (35/39) of normal LHB tendons, 88% (7/8) of full-thickness tears, 27% (3/11) of partial-thickness tears, and 22% (2/9) of tendons with nontear abnormality in those patients who underwent surgery. In the ultrasound diagnosis of full-thickness tear versus other findings, sensitivity was 0.88, specificity was 0.98, PPV was 0.88, NPV was 0.98, and accuracy was 0.97; in the ultrasound diagnosis of partial-thickness tear versus other findings, sensitivity was 0.27, specificity was 1.00, PPV was 1.00, NPV was 0.88, and accuracy was 0.88, in those patients who underwent surgery. Shoulder ultrasound is an accurate method to confirm a normal biceps tendon or full-thickness tear, but is less accurate in the diagnosis of partial-thickness tear and nontear abnormalities.

The Possibility and Potential Feasibility of Putting an Extra Functioning Free Muscle Transplant onto a Normal Limb

Functioning free muscle transplantation is currently and popularly used clinically to restore motor deficit caused by traumatic muscle loss or chronic muscle denervation. However, no one uses functioning free muscle transplantation in a normal subject who has no motor deficit. This study was designed to investigate the possible and potential feasibility of transferring an extra free muscle transplant onto a normal limb. A chimeric flap including biceps muscle with its neurovascular pedicles and a skin perforator flap was designed, harvested, and transferred from a Lewis inbred rat to the other rat overlying the original biceps following neurovascular repair where the ulnar nerve was chosen as the neurotizer. Sixteen rats were operated on and evaluated 6 months after surgery. Outcome measurements included arm circumferences, electrophysiologic studies, elbow flexion force, and muscle mass. The contralateral normal biceps was used as the control. All outcome measurements revealed that the extra muscle transfer resulted in significant increases in size and function of the operative limb without interfering with the original biceps function. The authors' study demonstrates the possible and potential application of using extra free muscle transplantation for functional and aesthetic augmentation purposes in a normal subject.

Bicipital groove morphology on MRI has no correlation to intra-articular biceps tendon pathology

Multiple authors have debated the contribution of intertubercular groove morphology to biceps tendon pathology. It has been proposed that the shallow groove, combined with the supertubercular ridge of Meyer, predisposes patients to bicipital disease. In this study we hypothesized that there would be a correlation between bicipital groove morphology and the intraoperative finding of biceps pathology. Seventy-five consecutive patients (average age of 63) undergoing arthroscopic rotator cuff repair surgery had their biceps tendons and intertubercular groove morphologies prospectively evaluated on closed MRI T1 axial cut images. The opening angle and medial wall angle of the bicipital groove was measured for each patient. At the time of surgery, the biceps tendon was classified as normal, inflamed, partially ruptured, or ruptured and the findings correlated to the bicipital groove measurements. The average opening angle was 81 degrees for normal biceps tendons and 77 degrees for torn biceps tendons. The average medial wall angle was 47 degrees for normal biceps tendons and 49 degrees for torn biceps tendons. Using Chi-square analysis, we found no statistically significant correlation between the bicipital groove average opening angle and medial wall angle on MRI and intraoperative biceps tendon pathology. This study does not support any correlation between intraarticular biceps tendon pathology and bicipital groove morphology.