Proximal Biceps Tendon Research Articles

The biomechanical performance of a new forked knotless biceps tenodesis compared to a knotless and suture anchor tenodesis

Biomechanical comparison of three different fixation techniques for a proximal biceps tenodesis. Eighteen human cadaver specimens were used for the testing. A tenodesis of the proximal biceps tendon was performed using a double-loaded suture anchor (5.5-mm Corkscrew, Arthrex), a knotless anchor (5.5-mm SwiveLock, Arthrex) or a forked knotless anchor (8-mm SwiveLock, Arthrex). Reconstructions were cyclically loaded for 50 cycles from 10-60 to 10-100N. Cyclic displacement and ultimate failure loads were determined, and mode of failure was evaluated. Cyclic displacement at 60N revealed a mean of 3.3±1.1mm for the Corkscrew, 5.4±1.4mm for the 5.5-mm SwiveLock and 2.9±1.6mm for the 8-mm forked SwiveLock. At 100N, 5.1±2.2mm were seen for the Corkscrew anchor, 8.7±2.5mm for the 5.5-mm SwiveLock and 4.8±3.3mm for the 8-mm forked SwiveLock anchor. Significant lower cyclic displacement was seen for the Corkscrew anchor (p<0.020) as well as the 8-mm SwiveLock anchor (p<0.023) compared to the 5.5-mm SwiveLock anchor at 60N. An ultimate load to failure of 109±27N was found for the Corkscrew anchor, 125±25N were measured for the 5.5-mm SwiveLock anchor, and 175±42N were found for the 8-mm forked SwiveLock anchor. Significant differences were seen between the 8-mm SwiveLock compared to the 5.5-mm SwiveLock (p<0.044) as well as the Corkscrew anchor (p<0.009). No significant differences were seen between the Corkscrew and the 5.5-mm SwiveLock anchor. The new 8-mm forked SwiveLock anchor significantly enhances construct stability compared to a 5.5-mm double-loaded Corkscrew anchor as well as the 5.5-mm SwiveLock suture anchor. However, a restrictive postoperative rehabilitation seems to be important in all tested reconstructions in order to avoid early failure of the construct.

Two-Year Outcomes Following Arthroscopic Treatment for Partial-Thickness Tears of the Supraspinatus Tendon

Objectives:Treatment for partial-thickness (PT) supraspinatus tears are largely based on surgeon intuition since little is known regarding the outcomes of specific treatment methods. Therefore, the purpose of this study was to evaluate the outcomes following arthroscopic management of partial-thickness supraspinatus tears.Methods:Institutional Review Board approval was obtained prior to initiation of this study. All data were prospectively collected and retrospectively analyzed. Between March 2006 and April 2011, 61 shoulders underwent arthroscopic treatment for PT supraspinatus tears. Inclusion criteria were: age >18 years, primary arthroscopic treatment for a PT supraspinatus tear, and were 2 years removed from the index surgery. Treatments included debridement (< 50% thickness), side-to-side repair with sutures and repair (> 50% thickness) using either single- (50-75%) or double-row (>75%) suture anchor constructs. Concomitant treatments were recorded. Demographic data were collected pre- and postoperatively along with ASES, SF-12 PCS, QuickDASH, SANE and satisfaction after minimum two-year follow-up. Data regarding intraoperative findings, treatments, complications and revision surgeries were collected. Treatment failure was defined as subsequent surgery on the supraspinatus tendon. Outcomes data were compared with preoperative baselines along with various demographic and surgical variables. Statistical significance was set at p<0.05.Results:69 shoulders (38 men, 29 women, 2 bilateral) with a mean age of 52 years (range, 20-74) underwent arthroscopic treatment for PT supraspinatus tears. There were 2 complications (2.9%): 1 shoulder developed axillary nerve symptoms and 1 developed a superficial wound infection. 8 of the 69 shoulders (11.6%) underwent subsequent surgery on the index shoulder unrelated to the rotator cuff before final follow-up and were omitted from the outcomes analysis. 24/61 shoulders had bursal-sided tears (39.3%) and 37/61 had articular-sided tears (60.7%). 31 shoulders (50.8%) had a tear involving <25% of the tendon thickness. 35 tears (57.4%) were repaired whereas 26 tears (42.6%) underwent debridement alone. 28 shoulders also had proximal biceps tendon lesions (45.9%), 28 had SLAP tears (45.9%) and 18 had other pathologies. Treatment failure occurred in 4 shoulders (6.6%) and they were subsequently removed from outcomes analysis. 57 shoulders had a mean follow-up of 41.3 months (range, 24.0-74.2 months). All postoperative outcomes scores and pain scores improved significantly over preoperative baselines (p<0.05) (Table 1). ASES scores returned to levels of age-matched normals. Tears that underwent debridement only demonstrated significantly worse QuickDASH scores compared to the rest of the cohort (mean 12.0 [SE 4.3] versus mean 7.8 [SE 2.1]; p<0.05) whereas shoulders that underwent acromioplasty demonstrated significantly improved QuickDASH scores compared to the rest of the cohort (mean 6.8 [SE 2.1] versus mean 13.6 [SE 3.5]; p=0.026).Conclusion:Arthroscopic treatment for PT supraspinatus tears provides excellent outcomes and satisfaction in the majority of patients. There were no differences in outcomes between articular- versus bursal-sided supraspinatus tears; however, QuickDASH scores were affected negatively by debridement and positively by acromioplasty.

Bilateral hypoplasia of the minor tubercle of the humerus with medial luxation of the biceps tendon in two Quarter Horses

Summary Two Quarter Horses were examined at the Washington State University Veterinary Teaching Hospital with forelimb lameness. Case 1 was a 4-year-old female with a 4 month history of intermittent forelimb lameness that had partially responded to oral anti-inflammatories. The horse was in full training and actively competing in cutting. Case 2 was a one-year-old filly bred for cutting that presented with a right forelimb lameness of 3 weeks’ duration, which was not responsive to oral anti-inflammatories. The horse was not in training. On lameness examination, Case 1 was grade 1/5 (American Association of Equine Practitioners scale) lame in the left forelimb in a straight line on a hard surface, extension and flexion of the shoulder was resented and exacerbated the lameness. Case 2 was grade 3/5 lame in the right forelimb in a straight line on a hard surface, flexion and extension of the shoulder was resented and exacerbated the lameness. Both horses had a characteristic dished appearance to the dorsal aspect of the shoulder, with prominence of the proximal aspect of the humerus. Ultrasound and proximodistal oblique (skyline) radiographic views of the scapulohumeral joints demonstrated bilateral hypoplasia of the minor tubercle of the humerus with bilateral medial luxation of the proximal biceps tendon in both cases. To the authors' knowledge this is the first report of 2 cases of bilaterally affected horses, as well as the first report of the condition in the Quarter Horse breed.

Diagnostic accuracy in detecting tears in the proximal biceps tendon using standard nonenhancing shoulder MRI.

BackgroundThere is a paucity of data in the literature evaluating the performance of noncontrast MRI in the diagnosis of partial and complete tears of the proximal portion of the long head of the biceps (LHB) tendon. The objective of this study was to evaluate the accuracy of noncontrast magnetic resonance imaging (MRI) compared to arthroscopy for the diagnosis of pathology involving the intra-articular portion of the LHB tendon.MethodsWe conducted a retrospective review of 66 patients (mean age 57.8 years, range 43–70 years) who underwent shoulder arthroscopy and evaluation of the LHB tendon after having had a noncontrast MRI of the shoulder. Biceps pathology was classified by both MRI and direct arthroscopic visualization as either normal, partial tearing, or complete rupture, and arthroscopy was considered to be the gold standard. We then determined the sensitivity, specificity, and positive- and negative-predictive values of MRI for the detection of partial and complete LHB tears.ResultsMRI identified 29/66 (43.9%) of patients as having a pathologic lesion of the LHB tendon (19 partial and ten complete tears) while diagnostic arthroscopy identified tears in 59/66 patients (89.4%; 50 partial and 16 complete). The sensitivity and specificity of MRI for detecting partial tearing of the LHB were 27.7% and 84.2%, respectively (positive predictive value =81.2%, negative predictive value =32.0%). The sensitivity and specificity of MRI for complete tears of the LHB were 56.3% and 98.0%, respectively (positive predictive value =90.0%, negative predictive value =87.5%).ConclusionStandard noncontrast MRI of the shoulder is limited in detecting partial tears and complete ruptures of the intra-articular LHB tendon. Surgeons may encounter pathologic lesions of the LHB tendon during arthroscopy that are not visualized on preoperative MRI.

간섭나사를 이용한 관절경적 상완 이두건 대흉근 상부 건 고정술의 임상적 결과

Purpose: The purpose of this study is to evaluate the clinical results of arthroscopic biceps long head suprapectoral tenodesis using an interference screw. Materials and Methods: We reviewed the cases of 30 patients who underwent arthroscopic biceps long head suprapectoral tenodesis using an interference screw between January 2008 and January 2010. The minimum follow up period was one year. Twenty patients had rotator cuff tears. The results were analyzed by VAS, ASES, tenderness in the bicipital groove, fixation failure, and the degree of deformity. Results: VAS, ASES scores showed a statistically significant increase during the final observation in all patients, compared with those before surgery. However, five patients (17%) had anterior shoulder pain and tenderness in the biceps groove, and three patients (10%) had Popeye deformity. Better results were achieved in patients without rotator cuff tear than in patients with rotator cuff tear (p Conclusion: Arthroscopic biceps long head tenodesis above the pectoralis major using an interference screw in patients with a pathologic lesion of the proximal biceps tendon showed good results at the last follow up. However, further study for tenderness in the biceps groove in 17% of patients is needed.

Armpje drukken: aanval de beste verdediging?

Fractures of the humeral shaft are relatively rare and account for 1 to 2% of all fractures. These fractures occur at any age, but the incidence increases from the fifth decade.Midshaft fractures typically result from trauma such as a direct blow or bending force to the humerus and, less commonly, from a fall on an outstretched hand or elbow. Midshaft fractures may also result from strong muscle contractions such as in rowing, spear throwing and baseball pitching.Arm wrestling has become a popular sport practiced by both professionals and amateurs. The most illustrious injuries are those of the humeral shaft fracture, fracture-separation of the medial humeral epicondyle in teenagers, a fracture of the olceranon, subscapularis and proximal biceps tendon rupture and an anterior dislocation of the elbow. Among these, the most frequent is the humeral shaft fracture.The most common complications associated with humeral shaft fractures from arm wrestling are neurovascular compromise. This occurs in 10 to 23% of mid-shaft fractures. Regarding treatment, a functional brace is indicated in minimally displaced humeral shaft fractures. An operation is performed by open reduction and internal fixation or with use of an intramedullary nail. We report on three cases with spiral fractures of the distal humerus from arm wrestling. The aim of this case report was to discuss the biomechanical analysis of the forces which act during arm wrestling as well as to explain the mechanism of the injury and match tactics: Is attack the best form of defence?

Biomechanical characterization of unicortical button fixation: a novel technique for proximal subpectoral biceps tenodesis.

Proximal biceps tenodesis is one method for treating biceps-related pain. Tenodesis protects the length-tension relationship of the biceps muscle, maintains strength, and provides a better cosmetic appearance than tenotomy. The purpose of this investigation was to compare the mechanical properties of a unicortical metal button and an interference screw in proximal biceps tenodesis. Six pairs of fresh-frozen shoulders were dissected, leaving the proximal biceps tendon as a free graft. On each pair of shoulders, a biceps tenodesis was performed using an interference screw or a unicortical metal button. The specimens were mounted and a cyclic load (10-60 N) was applied at 1 Hz for 200 cycles, followed by an axial load to failure. The displacement, ultimate load to failure, and mode of failure were recorded. Displacement in response to cyclic loading was 3.7 ± 2.2 mm for the interference screw and 1.9 ± 1.0 mm for the cortical button (P = 0.03). Load at failure for the interference screw was 191 ± 64 N (stiffness: 24 ± 11 N/mm) and 183 ± 61 N (stiffness: 24 ± 7. N/mm) for the unicortical button (P = n.s. for both cases). As a novel technique for subpectoral biceps tenodesis, a unicortical button demonstrated significantly less displacement in response to cyclic loading than the interference screw. The ultimate load to failure and stiffness for the two methods were not different. In this way, a unicortical button may provide a reliable alternative method of fixation with a potentially lower risk of post-operative humeral fracture and a construct that permits early mobilization following biceps tenodesis.

Isolated rupture of a single bundle of a bifid distal biceps brachii tendon

I njury of the biceps tendon nearly always affects the proximal biceps tendon, usually in the setting of rotator cuff injury with involvement of the restraints of the long head of the biceps. Significant injury to the distal biceps tendon is far less common, with an estimated rate of 1.2 per 100,000 patients per year. In these patients, differentiation between a partial and complete tear is of central importance in the determination of subsequent management. Unfortunately, even in the presence of tendon retraction owing to disruption of the bicipital aponeurosis or lacertus fibrosis, identification of complete rupture can be confounded by associated hemorrhage, edema, bursitis, or scarring in the setting of an acute or chronic injury. Furthermore, accurate characterization of distal biceps tendon injury can be complicated by the presence of normal variants of conventional biceps tendon anatomy. For instance, with bifid insertion of the distal biceps tendon, isolated rupture of a single bundle of a bifid tendon can mimic a partial tear of a nonbifurcated tendon. In such patients, MRI may offer the only noninvasive means to identify anatomic variations and their associated injuries. In this article, we describe a rare MRI diagnosis of isolated tendon rupture confined to the medial bundle of a congenitally bifid distal biceps tendon and provide radiographic-pathologic correlation in the form of intraoperative photographs that confirm the imaging findings. To our knowledge, this is only the fifth such case to be reported in the literature, and only the second with operative correlation. Potential implications of this anatomic variation on subsequent management are discussed. The patient gave consent to publish this case. CASE REPORT

The Biceps Muscle from Shoulder to Elbow

The biceps brachii plays an integral role in movement of the shoulder and elbow, and pathology can occur in athletes of all ages. Injuries of the proximal biceps tendon can be seen in overhead athletes as a result of chronic impingement, tendon instability, or tensile overload, often with accompanying lesions of the labrum or rotator cuff. Presentation may be insidious or can be precipitated by an acute event. Injuries to the distal biceps are more common in athletes involved in strength training such as weightlifters, or occasionally in contact sports. Although injury to the proximal and distal biceps can often be diagnosed clinically, MRI is an excellent imaging modality to evaluate the extent of disease and involvement of adjacent structures. This article reviews the anatomy of the biceps brachii from the shoulder to elbow and discusses commonly occurring pathology of the biceps and adjacent anatomical structures.

Malignant Soft Tissue Tumors of the Biceps Muscle Mistaken for Proximal Biceps Tendon Rupture

Tears of the proximal long head of the biceps tendon are among the most common tendon tears in the body. In most cases, the diagnosis is easily determined based on the history and physical examination. However, malignant soft tissue tumors can simulate proximal biceps tendon tears. Although tumors simulating tears of the distal biceps tendon at the elbow have been reported, to the authors' knowledge, no previous cases of tumors simulating or being mistaken for proximal biceps tendon tears have been reported.This article describes 2 cases of malignant sarcomas initially mistaken for tears of the long head of the biceps tendon. In the first case, a 62-year-old woman developed swelling in her arm after feeling a twinge in her shoulder. A magnetic resonance imaging scan was misread as a biceps tendon tear and not treated by the examining physician. In the second case, a mass appeared with little trauma in the brachium of a 70-year-old man. On physical examination, the mass was hard to palpation. In each case, biopsy revealed a soft tissue sarcoma. Both patients underwent wide excision with radiation and are currently disease free. These 2 cases emphasize the importance of obtaining a good history and of performing a thorough shoulder and arm examination in patients with deformities consistent with tears of the long head of the biceps tendon.

Clinical Anatomy, Biomechanics, Physiologic Function, History, Examination, and Radiographic Evaluation of the Biceps

The proximal biceps tendon is a unique structure that can be a pain generator frustrating for both patient and clinician. Its anatomic position in close relation to other critical structures of the joint, such as the RC, makes it prone for biomechanical stresses, as well as difficult to isolate as a sole cause of shoulder pain and dysfunction. The tendon originates with variable fiber insertions from the glenoid labrum and supraglenoid tubercle with slight anatomic variations. Before entering the intertubercular groove, the tendon is guided by the structures of the pulley system, which include the tendon of the supraspinatus and subscapularis muscle. Therefore, lesions of the long head of the biceps tendon are often combined with other significant pathologies of the glenohumeral joint. The function of the long head of the biceps tendon may be more of a proprioceptive one, although significant stress may arise when the rotator cuff is insufficient. An accurate history and complete physical examination are critical to find the exact diagnosis and initiate the correct treatment.

Preliminary Study of 1.5-T MR Arthrography of the Shoulder With 3D Isotropic Intermediate-Weighted Turbo Spin Echo

The purpose of this study was to assess the performance of a near-isotropic 3D turbo spin-echo sequence in comparison with a standard 2D protocol and with arthroscopy in direct 1.5-T MR arthrography of the shoulder. Dilute gadolinium was injected into three cadaver shoulders, and 3D turbo spin-echo and 2D sequences were evaluated with respect to the signal-to-noise and contrast-to-noise ratios of key tissues. In a prospective study, the 3D intermediate-weighted fat-suppressed sequence (reformatted in three planes) was added to shoulder MR arthrography of 43 consecutively registered patients, 13 of whom later underwent arthroscopy. Two radiologists independently graded the 3D and 2D images in separate sessions to visualize normal anatomic features and to detect pathologic changes in the labrum, cartilage, cuff, and glenohumeral ligaments, assigning confidence levels to their readings. One reader repeated the readings of images of 10 patients. Reports of subsequent arthroscopy were available for 13 patients. The sequences performed comparably with respect to signal-to-noise and contrast-to-noise ratios in the cadavers. The 3D images suffered from mildly increased blurring, but the readers were significantly more confident in assessing the proximal biceps tendon and curved portions of the labrum and in their findings of partial tears of the articular side of the supraspinatus tendon and posterior labral tears on the 3D images. A larger number of partial-thickness cartilage defects were found on 2D images. The 3D turbo spin-echo sequence is a promising technique that can be used in shoulder arthrography with image quality and results comparable to those of traditional 2D techniques. Use of the 3D technique may result in greater anatomic detail in evaluating small obliquely oriented structures, including the curved portions of the labrum and the intraarticular portion of the biceps tendon.

Effects of Arm Position on Maximizing Intra-Articular Visualization of the Biceps Tendon: A Cadaveric Study

The purpose of this study was to assess the intra-articular length of the biceps tendon in various shoulder and arm positions and identify the position in which the extra-articular portion of the tendon is maximally visualized within the glenohumeral joint. We measured 18 positions in 4 fresh-frozen cadaveric shoulders for a total of 72 measurements. In each measurement the position of the proximal biceps tendon was measured relative to a baseline measurement in neutral position (0° shoulder flexion, 0° shoulder abduction, 0° elbow flexion, 0° shoulder rotation). Positions measured ranged between the following: 0° and 30° shoulder flexion; 0° and 40° shoulder abduction; 0° and 90° elbow flexion; and 0° neutral, 30° internal, and 30° external shoulder rotation. The position creating the greatest increase in intra-articular biceps tendon length from baseline was 30° shoulder flexion, 40° shoulder abduction, 90° elbow flexion, and 0° rotation. On average, 56% of the tendon within the bicipital groove is brought into view by the maximal position relative to baseline. In maximizing intra-articular biceps tendon length, the effect of elbow flexion was highly significant (P < .001) and the combined effect of shoulder flexion-abduction was significant (P = .016). The position of 30° shoulder flexion, 40° shoulder abduction, and 90° elbow flexion significantly increases the excursion of the proximal biceps tendon relative to a neutral position. Over 50% of the tendon within the bicipital groove at baseline can be pulled out of the groove by placing the extremity in the maximal position and using an arthroscopic probe. Rotation of the humerus does not improve intra-articular excursion. Maximizing the intra-articular tendon length by arm positional change is likely to be useful for arthroscopic examination of the biceps tendon.

In vitro changes in human tenocyte cultures obtained from proximal biceps tendon: multiple passages result in changes in routine cell markers

Results of in vitro cell models are commonly used to promote new therapies (e.g., platelet-rich plasma), and clinicians have to be aware of the specific limitations of such models. To gain a sufficient and effective cell load, many current in vitro models use cells multiplied through various passages. This is especially important in tendon-like cell (TLC) models, since native tendon tissue is not available unlimited and contains limited amount of tenocytes. The purpose was to determine the occurrence of phenotypic changes following extended monolayer culture of TLCs, according to cell-passage number. Tendon samples were obtained from 15 healthy patients undergoing biceps tenodesis. Tendons were digested and cultured (monolayer) for six passages. Tendon-specific markers (collagens I and III, decorin, tenascin-C, and tenomodulin) and their histology were analyzed using gene expression and protein content assays. Native cells, the cells cultured and cells passaged one to six times were analyzed at each passage. Gene expression of types I and III collagen of cultured TLCs significantly decreased after two passages. Gene expression of decorin, tenascin-C, and tenomodulin exhibited a trend of decreased gene expression with increased passage. Protein levels of types I and III collagen and decorin decreased after four passages. The significant findings let conclude that tenocyte-like cells obtained from human LHB can be maintained in monolayer culture at low passages, before the signs of phenotypic drift are present. But researchers must be aware of rapid phenotypic drift at higher passage numbers. Therefore, only cells within the first 3 passages should be used as a precaution for in vitro monolayer cell models, and one has to be aware of the phenotypic changes if TLCs passaged multiple times are used. The clinical relevance of this data is that understanding of in vitro TLC models, and their limitations may finally help the clinician to judge the potential of experimental data of new biologic treatment options.

Assessment of the long head of the biceps tendon of the shoulder with 3T magnetic resonance arthrography and CT arthrography

We studied the assessment of proximal biceps tendon lesions including degeneration, tendon luxation, and partial and complete tendon tears with 3T MR arthrography and CT arthrography. Thirty-six patients who underwent both studies, as well as arthroscopy were included in the study. The images were randomized and blinded and independently reviewed by two musculoskeletal radiologists. The pooled sensitivity for lesion detection for CT arthrography was 31% and the specificity 95%. The pooled sensitivity for MR arthrography was 27% and the specificity 94%. There were no statistically significant differences between CT and MR. The interobserver agreement calculated with the kappa statistic was poor for CT and for MR. Both CT arthrography and MR arthrography perform poorly in the detection of biceps tendon pathology of the shoulder.

Läsionen der Bizepssehnen am Oberarm

The biceps muscle of the arm is even well known to laymen because of its partially prominent appearance. It fulfills a very important function in the arm due to its capacity for flexion and supination. Lesions of the short proximal biceps tendon are a rare occurrence. The long biceps tendon that runs through the glenohumeral joint is a frequent source of pain. Tenotomy with or without tenodesis is often a judicious treatment approach. Spontaneous ruptures due to underlying degenerative changes are also frequently observed. The resultant loss of strength in forearm flexion and supination is however fairly minor so that surgical management is only sensibly indicated for cosmetic reasons. The frequent underlying lesions of the supraspinatus and/or subscapularis tendons should be addressed as these represent significant associated pathological conditions. Complete rupture of the distal biceps tendon is typically seen in physically active men. Loss of strength after conservative therapy is extensive (30-40% for flexion and >50% for supination). Fixation of the tendon at the radial tuberosity holds out the prospect of good functional outcome. Chronic partial lesions of the distal biceps tendon can be particularly painful and have to be considered in the differential diagnosis of elbow pain.

간섭나사를 이용한 흉근하 상완 이두근 건 고정술의 단기 추시 결과

Purpose: Our purpose was to retrospectively analyze clinical results of subpectoral tenodesis of the proximal biceps tendon using an interference screw. Materials and Methods: We reviewed 23 cases of patients receiving tenodesis of the proximal biceps tendon between January 2008 and January 2009 for whom we had follow-up data for at least 1 year. Twenty-three cases were operated on using subpectoral tenodesis; 16 of these cases had a rotator cuff tear. The results were judged using a visual analog scale (VAS), ASES, tenderness on the biceps groove, fixation failure and the degree of deformity (BAD). Results: VAS and ASES scores were significantly improved in all patients by the time of the final observation. There were no significant complications or fixation failures. The patients without a tear of the rotator cuff had a better result than patients with a tear of the rotator cuff, but the difference between the two groups was not significant (p>0.05). Conclusion: In patients with pathology of the long head of the biceps brachii, benefits of subpectoral interference screw tenodesis include pain relief, maintenance of functional biceps, muscle strength, and cosmesis. Subpectoral biceps tenodesis using interference screw fixation appears to be a promising, reproducible, reliable technique for addressing anterior shoulder pain related to pathology of the long head of the biceps brachii.

Biceps Brachii Tendon Ruptures: A Review of Diagnosis and Treatment of Proximal and Distal Biceps Tendon Ruptures

The biceps brachii is a unique muscle with 2 proximal tendons and a single distal tendon. Although these tendons are part of the same muscle, they have significantly different functions. It is hypothesized that the long head of the biceps acts as a pain generator in the shoulder, though the biomechanical function is still under debate. Conversely, the distal biceps tendon is the major supinator of the forearm and serves a secondary flexor. As such, injuries to these tendons must be evaluated independently. Biceps brachii ruptures most often occur in middle-aged men following a traumatic event. Injuries to the long head of the biceps are primarily treated nonoperatively with adequate results. Injuries of distal tendon occur less often, but are receiving significant attention in the literature in regard to treatment options. Surgical repair of distal biceps ruptures is indicated in patients who want to restore supination strength and endurance. It is unclear which operative technique is superior, although the most recent data suggest increased strength of the cortical button repair. This article provides a comprehensive review of both proximal and distal biceps brachii ruptures in addition to our treatment algorithm.

Simultaneous Acute Rotator Cuff Tear and Distal Biceps Rupture in a Strongman Competitor

Acute rotator cuff tear is commonly associated with tearing of the proximal biceps tendon, but has never been reported to occur simultaneously with a distal biceps tendon rupture. A 38-year-old right-hand-dominant strongman competitor attempted a 300-pound overhead axle press and experienced immediate pain in the right shoulder and elbow. He had no known systemic risk factors for tendon ruptures including hyperparathyroidism, hemodialysis, alcoholism, rheumatoid arthritis, statin medications, fluoroquinolones, and steroid use.Right shoulder magnetic resonance imaging (MRI) showed a full-thickness supraspinatus tear with 3 cm of retraction. There was minimal fatty infiltration of the supraspinatus on the sagittal cuts consistent with acute rupture. The subscapularis was intact. The long head of the biceps tendon had mild medial subluxation but was completely within the bicipital groove. Right elbow MRI showed a complete distal biceps tendon rupture. Thirteen days after his injury, the patient underwent arthroscopic supraspinatus repair and proximal biceps tenodesis. Distal biceps tendon repair was performed using the modified 2-incision muscle-splitting technique. At 24-month follow-up, the patient was pain free and had returned to full activity including weightlifting but had not returned to strongman competition.This is the first report of simultaneous acute full thickness ruptures of the rotator cuff and distal biceps tendon. This case report underscores the importance of a complete physical examination and a high index of suspicion for additional concomitant injuries, particularly in athletes with unusually high stresses to the body.

Anatomic and Biomechanical Study of the Biceps Vinculum, a Structure Within the Biceps Sheath

To evaluate the anatomic, biomechanical, and histologic properties of the biceps vinculum and its potential role as a restraint to distal migration of the biceps after tenotomy. Eight human shoulders were dissected to define the anatomic parameters of the biceps vinculum. Histologic studies were performed by sectioning through the vinculum-tendon attachment and performing H&E staining. The strength of the vinculum was tested biomechanically after sectioning the biceps origin and applying a uniaxial tension at a rate of 1 mm/s until failure. With regard to anatomy, the vinculum was present in all specimens, attached to the biceps tendon and proximal humerus. Excursion testing showed that the vinculum prevented the biceps origin from migrating distal to the groove entrance. The mean dimensions of the structures and excursion were as follows: biceps origin to vinculum, 43.4 mm; vinculum width on biceps side, 46.2 mm; vinculum width on bone side, 69.3 mm; length of tendon with proximal pull, 42.6 mm; and length of tendon with distal pull, 2.25 mm. With regard to histology, the membranous tissue of the biceps vinculum consisted of loose soft tissue with fat, arteries, and veins. The vinculum was seen to loosely attach to the biceps tendon and more intimately attach to the periosteal/bone side. With regard to biomechanical testing, the maximum force to failure of the vinculum was variable, ranging from 17.4 N to 227.6 N, with a mean value of 102.7 +/- 76 N. The biceps vinculum was a consistent membranous structure intimately associated with the biceps tendon and attached to the proximal humerus. After tenotomy at the biceps origin, the vinculum prevented distal migration of the proximal biceps tendon past the groove entrance in all specimens. Biomechanical testing showed that the vinculum provided variable resistance to distal pull. The properties described may help to explain why biceps tenotomy does not routinely result in a Popeye biceps deformity.