Proximal Humeral Migration Research Articles

The Proximal Biceps as a Pain Generator and Results of Tenotomy

Many palliative interventions have been proposed for patients in whom rotator cuff repair is not feasible as a result of advanced fatty infiltration, definitive loss of tendons, and proximal humeral migration. The long head of the biceps tendon has been proposed as a source of pain in patients with rotator cuff tears. This article presents a review of current concepts on the rationale for arthroscopic biceps tenotomy or tenodesis, and evaluates the objective, subjective, and radiographic results of these palliative procedures. On the basis of different studies, it seems that isolated arthroscopic biceps tenotomy or tenodesis is a valuable option for the treatment of rotator cuff tears in selected patients. Although it does not improve shoulder strength, tenotomy or tenodesis reduces pain and improves the functional range of motion with a high degree of patient satisfaction. However, the progressive radiographic changes that occur with long standing rotator cuff tears are not altered.

Arthroscopic subscapularis tendon repair: Technique and preliminary results

Purpose: Our objective was to evaluate the preliminary results of 25 consecutive arthroscopic subscapularis tendon repairs. Type of Study: Case series. Methods: All 25 shoulders had longer than 3 months follow-up, with an average of 10.7 months (range, 3 to 48 months). The average age was 60.7 years (range, 41 to 78 years). The average time from onset of symptoms to surgery was 18.9 months (range, 1 to 72 months). The shoulders were evaluated using a modified UCLA score, Napoleon test, lift-off test, radiographs, and magnetic resonance imaging (MRI). Indications for surgery included clinical and/or MRI evidence of a rotator cuff tear. An arthroscopic suture anchor technique devised by the senior author (S.S.B.) was used for repair. Results: UCLA scores increased from a preoperative average of 10.7 to a postoperative average of 30.5 (P <.0001). By UCLA criteria, excellent and good results were obtained in 92% of patients, with 1 fair and 1 poor result. Forward flexion increased from an average 96.3° preoperatively to an average 146.1° postoperatively (P =.0016). Eight of 9 patients with a positive Napoleon test had complete tears of the subscapularis. All 7 patients with a negative Napoleon test had a tear of the upper half only. The lift-off test could not be performed reliably due to pain or restricted motion in 19 of the 25 patients. Eight patients had isolated tears of the subscapularis. The remaining 17 patients had associated rotator cuff tears with an average total tear size of 5 × 8 cm. Ten patients had proximal migration of the humerus preoperatively. Eight of these 10 patients had durable reversal of proximal humeral migration following surgery. These 8 patients improved their overhead function from a preoperative “shoulder shrug” with attempted elevation of the arm to functional overhead use of the arm postoperatively. Conclusions: (1) The senior author has been able to consistently perform arthroscopic repair of torn subscapularis tendons, with good and excellent results, in 92% of patients. (2) The Napoleon test is useful in predicting not only the presence of a subscapularis tear, but also its general size. (3) Combined tears of the subscapularis, supraspinatus, and infraspinatus tendons are frequently associated with proximal humeral migration and loss of overhead function. Arthroscopic repair of these massive tears can produce durable reversal of proximal humeral migration and restoration of overhead function.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 18, No 5 (May-June), 2002: pp 454–463

Postoperative proximal migration in total shoulder arthroplasty: Incidence and significance

A retrospective review of 131 Neer total shoulder arthroplasties in 111 patients performed between 1974 and 1986 was undertaken to identify factors associated with proximal humeral migration. The influence of proximal migration on results was evaluated to clarify the indications for prosthetic constraint. The average follow-up period was 55 months (range: 24–124 mo). The results showed proximal migration in 22% of patients (29 shoulders). The migration was progressive in all cases, without corresponding increases in pain. Major rotator cuff tears were present in 21% of patients with a normal glenohumeral relationship and in 24% of the patients with proximal migration. Limited elevation was noted in patients with proximal migration, but all patients had improved range of motion and decreased postoperative pain. The cause of postoperative proximal migration is believed to be secondary to a combination of factors and not rotator cuff disruption alone. These data do not support the routine use of a constrained prosthesis for irreparable rotator cuff tears