Tendon Of Long Head Research Articles

The Effects of Kinesiotape on the Thickness of the Long Head of the Biceps Tendon in Athletes With Subacromial Impingement Syndrome

Background and Aims The tendon of the biceps long head is one of the most important causes of shoulder pain and often plays a multifactorial role in subacromial impingement syndrome. The present study aimed to determine the effect of kinesiotape application on the tendon thickness of the biceps long head, pain, and proprioception of shoulder joint in athletes with subacromial impingement syndrome. Methods In this quasi-experimental study, 20 male athletes with subacromial impingement syndrome were selected purposefully and conveniently. The subjects were randomly assigned to two groups: group 1 received a real kinesiotape, and group 2 received a sham kinesiotape. Tendon thickness of the biceps long head was measured by MRI, shoulder proprioception was measured by an imaging technique, and the pain was measured by visual analog scale (VAS) immediately and 24 hours after using kinesiotape. The Shapiro-Wilk test was used to determine the normality of the distribution, and repeated measures analysis of variance was used to compare the mean differences between the two groups. The significance level was set at P<0.05. Results There were no significant differences in the thickness of the biceps tendon between the two groups in the three stages of measurement (P=0.147). There was a significant difference between the two groups regarding the joint position sense at 45 degrees (P<0.001), but there was no significant difference at 90 degrees (P˃0.05). There was a significant difference between the pain scores of the two groups after the kinesiology tape application (P<0.001). Conclusion Kinesiotape can reduce pain and improve the proprioception sense in athletes with subacromial impingement syndrome.

Rare case of intra-articular biceps incarceration following traumatic massive rotator cuff tear

Rare case of intra-articular biceps incarceration following traumatic massive rotator cuff tear

Evaluation of stiffness of rotator cuff tendons, coracohumeral ligament, tendon of long head of biceps and posterior capsule by strain and shear wave elastography in frozen shoulder vs normal shoulder

Background: Frozen shoulder is an idiopathic condition which presents with the loss of both active and passive movement at the shoulder joint over a period of time, associated with pain on movement. The wide range of clinical conditions with similar symptoms make the diagnosis difficult, hence making imaging studies mandatory. An increase in stiffness is noted by shear wave and strain ultrasound elastography of rotator cuff tendons, coracohumeral ligament, tendon of long head of biceps, posteriorcapsuleina patient affected with frozen shoulder. Objectives: To evaluate the stiffness of rotator cuff tendons, coracohumeral ligament, tendon of long head of biceps and posterior capsule in frozen shoulder by strain elastography and shear wave elastography and compare it with normal shoulder. Materials and Methods: The study was conducted with twenty-nine patients with frozen shoulder. Limited and painful motion without tendinitis or tendon tears were considered. in inclusion criteria. Strain and shear wave lastography were performed on rotator cuff tendons, coracohumer alligament, tendon of long head of biceps and posterior capsule on affected side and normal side to assess and compare the strain ratios and stiffness values on both sides. Receiveroperatingcharacteristiccurvaturewasplottedfortheobtainedvalues.

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

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

Return to Play Prediction Accuracy of the MLG-R Classification System for Hamstring Injuries in Football Players: A Machine Learning Approach.

Muscle injuries are one of the main daily problems in sports medicine, football in particular. However, we do not have a reliable means to predict the outcome, i.e. return to play from severe injury. The aim of the present study was to evaluate the capability of the MLG-R classification system to grade hamstring muscle injuries by severity, offer a prognosis for the return to play, and identify injuries with a higher risk of re-injury. Furthermore, we aimed to assess the consistency of our proposed system by investigating its intra-observer and inter-observer reliability. All male professional football players from FC Barcelona, senior A and B and the two U-19 teams, with injuries that occurred between February 2010 and February 2020 were reviewed. Only players with a clinical presentation of a hamstring muscle injury, with complete clinic information and magnetic resonance images, were included. Three different statistical and machine learning approaches (linear regression, random forest, and eXtreme Gradient Boosting) were used to assess the importance of each factor of the MLG-R classification system in determining the return to play, as well as to offer a prediction of the expected return to play. We used the Cohen's kappa and the intra-class correlation coefficient to assess the intra-observer and inter-observer reliability. Between 2010 and 2020, 76 hamstring injuries corresponding to 42 different players were identified, of which 50 (65.8%) were grade 3r, 54 (71.1%) affected the biceps femoris long head, and 33 of the 76 (43.4%) were located at the proximal myotendinous junction. The mean return to play for grades 2, 3, and 3r injuries were 14.3, 12.4, and 37days, respectively. Injuries affecting the proximal myotendinous junction had a mean return to play of 31.7days while those affecting the distal part of the myotendinous junction had a mean return to play of 23.9days. The analysis of the grade 3r biceps femoris long head injuries located at the free tendon showed a median return to play time of 56days while the injuries located at the central tendon had a shorter return to play of 24days (p = 0.038). The statistical analysis showed an excellent predictive power of the MLG-R classification system with a mean absolute error of 9.8days and an R-squared of 0.48. The most important factors to determine the return to play were if the injury was at the free tendon of the biceps femoris long head or if it was a grade 3r injury. For all the items of the MLG-R classification, the intra-observer and inter-observer reliability was excellent (k > 0.93) except for fibres blurring (κ = 0.68). The main determinant for a long return to play after a hamstring injury is the injury affecting the connective tissue structures of the hamstring. We developed a reliable hamstring muscle injury classification system based on magnetic resonance imaging that showed excellent results in terms of reliability, prognosis capability and objectivity. It is easy to use in clinical daily practice, and can be further adapted to future knowledge. The adoption of this system by the medical community would allow a uniform diagnosis leading to better injury management.

Detailed Morphometry and Morphology of Bicipital Groove of Humerus among North Indian Population

Introduction: Bicipital Groove (BG) represents an indentation on the proximal humerus which lodges tendon of Long Head of Biceps (LHB) brachii with synovial sheath. It’s medial and lateral walls are formed by lesser and greater tubercles respectively and the transverse humeral ligament converts it into a tunnel. Aim: To find a detailed morphometry attributing to morphological classification of BG among North Indian population. Materials and Methods: The present observational study was conducted over a period of one year on 100 adult intact dry humerii of unknown sexes obtained from Osteology Museum, Department of Anatomy, Shree Guru Gobind Singh Tricentenary (SGT) University, Gurugram, Haryana, India for several morphometric parameters like length, width, depth, length of medial and lateral walls as per descriptive statistics using Statistical Package for the Social Sciences (SPSS) version 21.0. The BG was classified according to the depth, opening angle and medial wall angles. Morphological features like Supratubercular Ridge (STR) of Meyer’s, bony spur on the floor of the groove or thickening of the walls were also observed and the frequency distribution was presented and Independent t-test was applied to compare the parameters on both sides. Results: Out of 100 sample, the mean of each parameter was length 72.98±7.54 mm, width 9.12±2.18.mm, depth 5.49±1.56 mm, medial wall and lateral wall length 54.83±8.62 mm and 60.82±8.01 mm respectively, opening angle 72.27±18.12º and medial angle 65.27±10.71º. Mostly BG had a depth of 4-6 mm with an incidence of 48%. Opening angle of BG was small (<95º) in 84% of humerus and maximum belonged to type 1 (90º to 75º) variety. Around 34% bones were showing morphological changes, out of which STR was 47.05%, bony spur on the floor of BG was 20.58% with wall thickening in 32.35% of total humerus. Conclusion: The detailed morphometry and classification of BG will serve as a reference base for North Indian population. It will be also useful for the clinicians as they should be well verged with the various morphological appearances of BG among dry bones and radiographs for proper diagnosis and treatment.

A new significance of an old structure: Aponeurotic expansion of supraspinatus tendon and its relationships with biceps brachii long head and rotator cuff tendons

PurposeTo investigate the relationship between aponeurotic expansion of supraspinatus tendon and disorders of biceps brachii long head (LHB), supraspinatus and subscapularis tendons. MethodsImages of 3.0 T shoulder magnetic resonance images (MRI) of a total of 154 patients and 157 shoulders (3 cases with bilateral imaging) between the ages of 18–45 were retrospectively evaluated for the presence of aponeurotic expansion. When identified it was further categorized according to its thickness. Tendinopathy and tears of LHB, supraspinatus and subscapularis tendons and LHB subluxations were evaluated individually. Statistical analyses were performed using Chi-square, Fisher's exact, Mann–Whitney U and Kruskall–Wallis tests. Odds ratio and multiple logistic regression analyses were performed when applicable. p < 0.05 was considered as statistically significant. ResultsA total of 82 male and 72 female cases with a mean age of 34 (±8.2) were included. Aponeurotic expansion could be identified in 31 cases (19.8 %). MRI findings for LHB disorders in this group was significantly higher (p = 0.01). The adjusted odds ratio of having LHB tendinopathy in the presence of aponeurotic expansion was 3.25 (% 95 CI:1.29−8.19). No significant correlation was found between presence of aponeurotic expansion and subscapularis or supraspinatus tendon disorders (p = 0.66 and p = 0.792 respectively). Age was a significant variable for disorders of all three tendons (p < 0.001). ConclusionOn 3.0 T MRI, findings of LHB tendon disorders were significantly more common in cases with aponeurotic expansion of supraspinatus tendon. This anatomical variation may have an unrecognized clinical significance.

Ultrasound-Guided Standard vs Dual-Target Subacromial Corticosteroid Injections for Shoulder Impingement Syndrome: A Randomized Controlled Trial

ObjectiveTo compare dual-target injection with standard ultrasound (US)-guided subacromial injection in patients with subacromial impingement syndrome (SIS) and possible disorders of the biceps long-head tendons. DesignDouble-blind, randomized controlled trial. SettingRehabilitation outpatient clinic. ParticipantsPatients with SIS (N=60). Intervention(1) US-guided standard subacromial bursa; (2) dual-target (subacromial bursa plus proximal biceps long-head tendon) injection, with 40-mg triamcinolone acetonide administered to patients in each group. Main Outcome MeasuresClinical assessments were performed at baseline. The outcomes, including results from a self-administered questionnaire, the Shoulder Pain and Disability Index (SPADI), and a self-pain report, the visual analog scale (VAS) scores for pain at rest, at night, and during overhead activities, were evaluated at baseline and at the first and third months postintervention. ResultsNo significant difference was observed in baseline evaluations between groups (n=30 in each treatment arm) prior to injections. Both groups exhibited significant SPADI and VAS-score improvements after the first month. The dual-target injection group had less rebounding pain at the 3-month follow-up. The standard injection group had more patients reporting worsening pain within 1 day postinjection. ConclusionUS-guided dual-target corticosteroid injection showed similar short-term efficacy to standard subacromial injections, but with an extended duration of symptom relief. Therefore, dual-target corticosteroid injections may be useful for shoulder pain treatment in patients with SIS.

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

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

Biceps long tendon: Pain generator not requiring tenodesis in total shoulder arthroplasty

Since 2002, the long head of the biceps tendon has been identified as a pain generator following total shoulder arthroplasty, and routine tenodesis during shoulder replacement has been recommended by some to prevent pain. However, while randomized clinical trials directly investigating the impact of tenodesis on overall outcomes after arthroplasty are lacking, biomechanical and in vivo studies have provided evidence of an important stabilizing role of the long-head tendon that may be linked to better function post-arthroplasty. As a result, at this time routine tenodesis of the long-head tendon of the biceps is an unanswered question during shoulder arthroplasty procedures.

VARIATION IN THE INSERTION OF BICEPS BRACHII MUSCLE: A CASE REPORT

Introduction: Biceps brachii is a large, fusiform muscle of upper limb having two heads of origin; the short head arising by a thick flattened tendon from the apex of the coracoid process Paper Submission Dateand the long head from supraglenoid tubercle of the scapula. The flattened tendon at the lower end rotates as it passes through the cubital fossa to its insertion into the posterior border of tuberosity of the radius. Case History: During routine cadaveric dissection of undergraduate teaching program in SRMS IMS, Bareilly,we found rare variation in the insertion of biceps. We observed unilateral Paper Publication Date variation in the insertion of biceps muscle. The biceps tendon at its insertion was divided into July 2016 three distinct parts. Main tendon of long head inserts on radial tuberosity. This tendon of long head sends musculotendinous slip to pronator teres muscle. The short head sends DOI musculotendinous slip to flexor carpi radialis and its tendon does not insert on radial tuberosity despite formation of common belly with long head. The origin of muscle is normal and from two heads short head and long head. The muscle is supplied by musculocutaneous nerve. Conclusion: The triple tendon insertion may allow an element of independent function of each portion of the biceps, and during repair of an avulsion, the surgeon should ensure correct orientation of both tendon components.

VARIATION IN THE INSERTION OF BICEPS BRACHII MUSCLE: A CASE REPORT

Introduction: Biceps brachii is a large, fusiform muscle of upper limb having two heads of origin; the short head arising by a thick flattened tendon from the apex of the coracoid process Paper Submission Dateand the long head from supraglenoid tubercle of the scapula. The flattened tendon at the lower end rotates as it passes through the cubital fossa to its insertion into the posterior border of tuberosity of the radius. Case History: During routine cadaveric dissection of undergraduate teaching program in SRMS IMS, Bareilly,we found rare variation in the insertion of biceps. We observed unilateral Paper Publication Date variation in the insertion of biceps muscle. The biceps tendon at its insertion was divided into July 2016 three distinct parts. Main tendon of long head inserts on radial tuberosity. This tendon of long head sends musculotendinous slip to pronator teres muscle. The short head sends DOI musculotendinous slip to flexor carpi radialis and its tendon does not insert on radial tuberosity despite formation of common belly with long head. The origin of muscle is normal and from two heads – short head and long head. The muscle is supplied by musculocutaneous nerve. Conclusion: The triple tendon insertion may allow an element of independent function of each portion of the biceps, and during repair of an avulsion, the surgeon should ensure correct orientation of both tendon components.

Positional relationship between intramuscular tendon of supraspinatus and long head of biceps at the glenoid surface level in magnetic resonance imaging

Positional relationship between intramuscular tendon of supraspinatus and long head of biceps at the glenoid surface level in magnetic resonance imaging

The shoulder.

The shoulder.

Anthropometric study of bicipital groove and its clinical implication

Objective: Bicipital groove along with the transverse humeral ligament bridging it offers stability and smooth functioning of the tendon of long head of biceps brachii muscle and prevents its subluxation during multidirectional biomechanical movements of arms. Hence, various anatomical information of the bicipital groove is vital as deformities of the bicipital tendon and its synovial sheath have been associated with a variety of reasons of shoulder pain and disability. Therefore, an attempt is made in this study to determine the length, width, and depth of bicipital groove along with the transverse diameter, anterior-posterior diameter and length of the humerus. Materials and Methods: The study was carried out on 60 unpaired dry humeri (right = 33, left = 27). The length, depth and width of the bicipital groove were measured using the vernier caliper. Results: The mean length, width and depth of the bicipital groove in the present study were 7.41, 1.08 and 0.55 cm. The mean length, width and A-P diameter of the humerus in the present study were 30.4, 3.0 and 2.6 cm. In the present study, the mean length of the bicipital groove corresponded to 24.37% of the total length of humerus, the mean width was 36% of the total humeral width, and the mean depth was 21.1% of the total anteroposterior width of the humerus. There was no significant correlation between right and left side as P > 0.05. Conclusion: This study determined the morphometric parameters of the bicipital groove and will be important for anthropologists, orthopedic surgeons, and clinical anatomists.

Morphology of the bicipital aponeurosis: a cadaveric study

The bicipital aponeurosis (BA) is a fascial expansion which arises from the tendon of biceps brachii and dissipates some of the force away from its enthesis. It helps in dual action of biceps brachii as supinator and flexor of forearm. The aim of the present work was to study the morphology of BA. Thirty cadavericupper limbs (16 right and 14 left side limbs) were dissected and dimensions ofthe BA were noted. The average width of aponeurosis at its commencement on the right was 15.74 mm while on the left it was 17.57 mm. The average angle between tendon and aponeurosis on the right was 21.16° and on the left it was 21.78°. The fibres from the short head of the biceps brachii contributed to the formation of proximal part of aponeurosis. Fascial sheath over the tendon oflong head of biceps brachii was seen to form the distal part of the aponeurosis. In 5 cases, large fat globules were present between the sheath and the tendon. Histologically: The aponeurosis showed presence of thick collagen bundles. Fascials heath covering the tendon of long head extended towards the aponeurosis and passed superficial to the tendon of biceps. Blood vessels and adipose tissue were found to be present between fascial sheath and the tendon. This morphological description of BA may be helpful 1) in elucidating the dynamic role that BA plays in normal functioning and 2) to the surgeons in the repair of ruptured biceps brachii tendon.

Comparative Evaluation of Various Techniques of Arthroscopic Tenodesis for Tendon of Long Head of Biceps (multicenter study)

Fifty six patients under 50 years participated in a multicenter study on the comparison of long term (12 – 14 months) results after application of different tenodesis techniques, i.e. sub- and suprapectoral one with fixation by interferent and anchor fixatives. Dicision on patient’s participation in the study was made intraoperatively if rotator cuff pathology was identified and indications to the tendon of long head of biceps were determined. Results were evaluated by Constant – Murley score and SF-36 questionnaire. Statistically significant (p

Distal Pectoralis Major Tears

Distinction between musculotendinous tears of the pectoralis major and distal tendon avulsions is important, as the latter typically requires surgical repair. The objective of this study was to characterize the sonographic appearances of surgically proven distal tendon avulsion tears of the pectoralis major. A retrospective search of the radiology database (2001-2011) revealed 22 cases of pectoralis major tears on sonography, of which 9 had surgical correlation. Sonograms were retrospectively characterized by 3 fellowship-trained musculoskeletal radiologists in consensus with respect to the location and size of the fluid collection and the presence of tendon or tendonlike tissue superficial to the biceps brachii tendon. At surgery, complete distal tendon avulsions or tears of the sternal head of the pectoralis were present in all 9 cases: isolated in 6 and combined with clavicular head tears in 3. The location of the fluid collection was at the musculotendinous junction in 89% (8 of 9) and medial to the biceps brachii tendon in 11% (1 of 9), with a mean largest dimension of 3.8 cm (range, 0.7-6.2 cm). In no case was fluid seen at the humeral attachment of the pectoralis. In 67% (6 of 9), linear thickened hypoechoic tissue was seen superficial to the biceps brachii tendon, which simulated an abnormal but intact tendon, whereas in 33% (3 of 9), a normal distal pectoralis tendon was seen. Surgically proven distal pectoralis major tendon avulsions most commonly showed fluid collections at the musculotendinous junction and not at the humeral shaft, with either a normal tendon or hypoechoic tendonlike tissue over the biceps brachii long-head tendon. These findings may potentially cause misdiagnosis of distal tendon avulsions or tears as musculotendinous injuries.

“ROCAMBOLE-LIKE” BICEPS TENODESIS: TECHNIQUE AND RESULTS

Objective: To present a new technique for bicipital tenodesis and its results: accomplished partially via arthroscopy and grounded in concepts of the normal and pathological anatomy of the tendon of the biceps long head. It is based on the predisposition of this tendon towards becoming attached to the intertubercular sulcus after rupture or tenotomy (auto-tenodesis). Methods: Evaluations were conducted on 63 patients (63 shoulders), aged from 32 to 77 years (average 55), consisting of 32 females (51%) and 31 males (49%). Thirty-five of the patients (55.6%) were over 60 years of age and 28 patients (44.4%) were under 60 years of age. Eighteen were sports participants (28.6%). Fourteen had injuries associated with the subscapularis (22.2%). The average follow up was 43 months (ranging from 12 to 74 months). The right shoulder accounted for 48 cases (76.2%), of which one was a left-handed individual and 47 were right-handed. The left shoulder accounted for 15 (23%) of the patients, of whom two were left-handed and 13 were right-handed. There were no bilateral occurrences. The statistical analysis were done using SPSS version 18. Pearson's chi-square test and continuity corrections were used to investigate the statistical significance of associations between variables. Associations were taken to be statistically significant when p was less than 0.05. Results: Residual Popeye deformity was perceived by seven patients (11.1%); it was only observed by the examiner in 15 cases (23.8%); and neither the patient nor the examiner observed it in 41 cases (65%). There were no statistically valid influences from age, participation in contact or throwing sports, subscapularis tendon-associated injury or Popeye deformity. Fifty-eight patients (92.06%) were satisfied, two patients were dissatisfied (3.17%) and three patients were indifferent (4.76%). Conclusion: The technique presented high patient satisfaction rates (92.06%) and residual deformity was perceived by 11.1% of the patients. The appearance did not have any statistically valid correlation with ages over or under 60 years (p = 0.883), sports practice (p = 0.195) or subscapularis-associated injury (p = 0.958).

Calcification of the Superior Glenoid Labrum

Calcific tendonitis predominantly affects the rotator cuff tendons. Other reported sites of occurrence include the tendon of the long head of biceps, the trapezius and pectoralis major muscles. We report a rare case of calcification within the posterosuperior glenoid labrum of the shoulder.