Osteochondroma of the bicipital tuberosity causing an avulsion of the distal biceps tendon

Osteochondromas are one of the most common benign bone tumors. They usually arise from the metaphyses of long bones. Involvement of the bicipital tuberosity is rare. To date, no reports have described avulsed rupture of the distal biceps tendon caused by an osteochondroma of the bicipital tuberosity. This article presents a case of avulsion of the distal biceps tendon secondary to sessile osteochondroma of the bicipital tuberosity in a 65-year-old right-handed sedentary worker who presented with insidious pain and limited motion in his left elbow for 2 months. Intraoperative findings showed a bony mass of 25×23×5 mm with osteocartilaginous nodules on the bicipital tuberosity. The distal biceps tendon with an avulsed bony fragment was displaced proximally, with a 20-mm gap between the tendon and the bicipital tuberosity. After complete excision of the mass, footprint preparation at the bicipital tuberosity was performed using a 4.0-mm burr and anatomic reattachment of the distal biceps tendon with a 5.0-mm suture anchor. The pathologic diagnosis of osteochondroma was confirmed microscopically. We suggest that osteochondroma of the bicipital tuberosity be considered as a cause of painful limitation of forearm rotation or avulsed rupture of the distal biceps tendon.     

Biceps tendinitis caused by an osteochondroma in the bicipital groove: a rare cause of shoulder pain in a baseball player

Tendinitis of the long head of the biceps brachii muscle is commonly seen in athletes who do repetitive overhead motions. Common causes of biceps tendinitis include impingement syndrome, subluxation of the biceps tendon, and attrition tendinitis, whereas biceps tendinitis secondary to a bone neoplasm is rare. A case of biceps tendinitis caused by an osteochondroma arising in the left humeral bicipital groove in a 25-year-old male baseball player is reported. The tumor was hook-shaped, originated from the inferomedial portion of the humeral lesser tubercle, and surrounded the biceps tendon. Symptoms of increasing pain and inability to throw resulted from direct irritation of the biceps tendon by the tumor. Total excision of the tumor relieved the symptoms within 3 weeks. To our knowledge, there have been no reported cases in the English-language literature of biceps tendinitis caused by an osteochondroma.     

Premature hamstring graft amputation during harvesting in ACL reconstruction

IntroductionThere are some possible complications during or after hamstring graft harvesting such as premature graft amputation, medial collateral ligament injury and infrapatellar branch of the saphenous nerve injury. Premature graft amputation can occur by inadequate removal of the accessory branches of the hamstring tendons, poor surgical technique and/or too sharp tendon stripper. In this study, we report a case of premature hamstring graft amputation due to degeneration caused by osteochondroma at the posteromedial aspect of the proximal tibia.Case presentationWe reported the case of a 28-year-old Thai male who had an ACL injury was scheduled for ACL reconstruction. In this case, we had planned to use a hamstring graft for double-bundle ACL reconstruction. During the gracilis tendon harvesting, the graft was prematurely amputated by a tendon stripper at the level of the osteochondroma. The premature graft amputation was sent for pathology, which showed degenerated tissue.ConclusionIn cases of osteochondroma at the posteromedial aspect of the proximal tibia, it is a chance of premature hamstring graft amputation. We suggest removing the osteochondroma before harvesting the tendon grafts to avoid the risk of premature graft transection.     

Repair of tears of the subscapularis

BACKGROUND: Rotator cuff tears involving the subscapularis are less common than those involving the superior aspect of the rotator cuff. The purpose of the present study was to report the results of repair of isolated tears of the subscapularis. METHODS: The records on eighty-four shoulders that had undergone open repair of the subscapularis tendon were reviewed. The mean age of the patients at the time of surgery was 53.2 years. The mean interval from the onset of symptoms to the time of surgery was 12.5 months. Fifty-seven tears were traumatic, and twenty-seven were degenerative. Twenty-three tears involved the superior one-third of the subscapularis tendon, forty-one tears involved the superior two-thirds, and twenty tears were complete. Fifty-four shoulders had a dislocation or subluxation of the long head of the biceps tendon, and ten shoulders had a rupture of the long head of the biceps tendon. Forty-eight shoulders underwent concomitant biceps tenodesis, thirteen shoulders underwent concomitant biceps tenotomy, and four shoulders underwent concomitant recentering of the biceps. Patients were evaluated clinically and radiographically at a mean of forty-five months (range, twenty-four to 132 months) postoperatively. RESULTS: The mean Constant score increased from 55.0 points preoperatively to 79.5 points postoperatively. Seventy-five patients were satisfied or very satisfied with the result. Preoperatively, four shoulders had mild glenohumeral arthritis. Postoperatively, twenty-five shoulders had mild glenohumeral arthritis and two shoulders had moderate glenohumeral arthritis. Tenodesis or tenotomy of the biceps tendon at the time of subscapularis repair was associated with improved subjective and objective results, independent of the preoperative condition of the biceps tendon. CONCLUSIONS: Repair of isolated subscapularis tears yields acceptable improvement in shoulder function in selected patients. Additionally, the results of the present study support routine tenodesis or tenotomy of the long head of the biceps tendon at the time of subscapularis repair.     

Partial rupture of the distal biceps tendon

Partial rupture of the distal biceps tendon is a relatively rare event, and various degrees of partial tendon tears have been reported. In the current study four patients with partial atraumatic distal biceps tendon tears (mean age, 59 years; range, 40-82 years) are reported. In all four patients, a common clinical pattern emerged. Pain at the insertion of the distal biceps tendon in the radius unrelated to any traumatic event was the main symptom. In all patients the diagnosis was based on magnetic resonance imaging or computed tomography imaging. In three of four patients the partial rupture of the tendon caused a significant bursalike lesion. The typical appearance was a partially ruptured biceps tendon, with contrast enhancement signaling the degree of degeneration, tenosynovitis, and soft tissue swelling extending along the tendon semicircular to the proximal radius. In three patients, conservative treatment was successful. Only one patient needed surgery, with reinsertion of the tendon resulting in total functional recovery.     

Cross-sectional area of the tendon and the muscle of the biceps brachii in shoulders with rotator cuff tears

Background The intraarticular portion of the long head of the biceps tendon is often widened in shoulders with cuff tears. It is unclear whether this is a local phenomen or is caused by muscle hypertrophy.

Methods We investigated morphological changes of the biceps brachii in 14 embalmed shoulders: 7 with intact rotator cuff and 7 with rotator cuff tears.

We measured the cross-sectional area (CSA) of the tendon of the long head of the biceps (LHB) at 9 levels between the glenoid origin and the musculotendinous junction. The muscle volume and the muscle fiber length of the long and short heads of the biceps were measured to calculate the physiological CSA (PCSA) by dividing the volume by the fiber length.

Results The CSA of the LHB tendon at the entrance to the bicipital groove was greater in cuff tear shoulders than in normal shoulders. The PCSA of the biceps was similar in normal and cuff tear shoulders.

Interpretation Hypertrophy of the LHB tendon appears to be a localized morphological change near the entrance to the bicipital groove.     

肱二头肌长头肌腱的解剖学观测及意义

目的 了解肥二头肌长头肌腱在结节间沟处的解剖学特点。方法 在２０具防腐尸体上,对肱二头肌长头肌腱的行走、毗邻结构以及解剖学特点进行观测。并在６０例骨性标本上,对结节间沟进行观测。结果 肱二头肌长头肌腱在结节间沟内小结节处爱到明显地挤压,在此处肱二头肌长头肌腱变薄变窄。骨性标本上,小结节向结节间沟骨内明显增生,使结节间沟在此处明显变窄。结论 肱二头肌长头肌腱在结节间沟小结节处较易受到磨损和挤压,此处     

Reconstruction by biceps tendon rerouting for posterolateral rotatory instability of the knee: Modification of the Clancy technique

We present a biceps rerouting technique for posterolateral rotatory instability using a modification of the biceps femoris tendon tenodesis of Clancy. The distinguishing features of this technique are the approach to the lateral femoral epicondyle through the interval between the iliotibial band and biceps femoris muscle, and fixation of the transferred biceps tendon at the isometric point. Reconstruction for posterolateral rotatory instability by modified biceps tendon rerouting can result in objectively and functionally acceptable knee function.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 17, No 6 (July-August), 2001: pp 664–667     

Cross-sectional area of the tendon and the muscle of the biceps brachii in shoulders with rotator cuff tears: a study of 14 cadaveric shoulders

Background The intraarticular portion of the long head of the biceps tendon is often widened in shoulders with cuff tears. It is unclear whether this is a local phenomen or is caused by muscle hypertrophy.

Methods We investigated morphological changes of the biceps brachii in 14 embalmed shoulders: 7 with intact rotator cuff and 7 with rotator cuff tears.

We measured the cross-sectional area (CSA) of the tendon of the long head of the biceps (LHB) at 9 levels between the glenoid origin and the musculotendinous junction. The muscle volume and the muscle fiber length of the long and short heads of the biceps were measured to calculate the physiological CSA (PCSA) by dividing the volume by the fiber length.

Results The CSA of the LHB tendon at the entrance to the bicipital groove was greater in cuff tear shoulders than in normal shoulders. The PCSA of the biceps was similar in normal and cuff tear shoulders.

Interpretation Hypertrophy of the LHB tendon appears to be a localized morphological change near the entrance to the bicipital groove.     

Significance of the hypoechoic area around the long biceps tendon in shoulder sonography--underlying pathology]

OBJECTIVE: The objective was to evaluate the sonographic sign of a hypoechoic area ("halo-sign") around the long biceps tendon as an equivalent of intraarticular effusion. METHODS: Part 1: Ten patients scheduled for shoulder arthroscopy underwent ultrasonography immediately before surgery. If there was no hypoechoic area around the long biceps tendon 30 ml of NaCl-solution (0.9%) were injected into the joint. After repetitive passive motion the patient underwent a second ultrasonography. Part 2: Ten consecutive patients with a hypoechoic area around the long biceps tendon underwent shoulder arthroscopy. During this procedure they were examined for intraarticular effusion. Patients with rheumatoid disease were excluded from the study. RESULTS: Part 1: In 9 of 10 patients a hypoechoic area around the long biceps tendon was induced by injection into the joint. The area was 1.07 +/- 0.13 cm2. In one case we could not induce the described phenomenon. Part 2: In all patients with a hypoechoic area around the long biceps tendon an intraarticular effusion was found at arthroscopy. CONCLUSION: A hypoechoic area around the long biceps tendon correlates with fluid in the synovial sheet and indicates effusion within the glenohumeral joint.     

Sonography in soft-tissue trauma of the shoulder

Seventy-five patients with soft-tissue trauma in the shoulder region were examined by ultrasonography. Normal conditions were found in 21 patients, distension of the acromioclavicular joint in 17, muscle hematoma or edema in 9, biceps tendinitis in 8, hematoma or partial rupture of the biceps tendon in 5, rupture of the biceps tendon in 1, and supraspinatus tendinitis or partial rupture in 14. A correlation was found between the sonography and clinical course; normal sonography was consistent with recovery in less than 1 week, whereas patients with pathologic changes in the supraspinatus or biceps tendon generally had symptoms for at least 1 month. We concluded that sonography is a useful diagnostic tool for evaluation of soft-tissue trauma in the shoulder.     

Tenoplasty of the long head of the biceps in massive rotator cuff tear

AIM: It was the aim of this study to investigate the success of biceps tenoplasty in massive interval rotator cuff tears. METHOD: Fifteen patients, who had a massive rotator cuff tear in the area of the interval and a pathology of the long head of the biceps tendon, were examined clinically and by MRI. A primary reconstruction of the rotator cuff tear was possible in none of the patients. All patients had a secondary reconstruction with a biceps tenoplasty. The Constant Score was determined postoperatively and the satisfaction of the patients was explored. RESULTS: The mean age at the time of the operation was 55 years. The examination was 23 months postoperatively. A simultaneous rupture of the supraspinatus- and subscapularis tendon was seen in 12 patients, an additional rupture of the infraspinatus tendon in 3 patients intraoperatively. The long head of the biceps was dislocated in 10 patients and subluxated in 5 patients. The postoperative determined Constant Score was 82.7 points. The personal satisfaction was investigated by asking for the German schoolmarks, which extend from 1 (excellent) to 6 (not satisfactory). The preoperative schoolmark was 5.2 and the postoperative schoolmark 1.4. In the MRI examination one rerupture could be seen, an atrophy of the supraspinatus tendon was evaluated in four patients. Knowing the postoperative result, all patients would have repeated the operation. CONCLUSION: The biceps tenoplasty is a suitable operative method to achieve a better function and relief of pain in massive interval rotator cuff tears with simultaneous pathology of the long head of the biceps tendon. A high degree of personal satisfaction for the patient can be achieved.     

Stabilization of the long head of the biceps tendon in the context of early repair of traumatic subscapularis tendon tears

BACKGROUND: Tears of the subscapularis tendon commonly are associated with instability of the long head of the biceps tendon. Standard surgical treatment includes tenodesis or tenotomy of the biceps tendon. However, chronic discomfort from spasms and cosmetic disadvantages have been reported following both procedures, while the potential for functional impairments remains controversial. We investigated the outcome of stabilization of the long head of the biceps tendon in the context of early repair of traumatic tears of the subscapularis tendon. METHODS: We performed stabilization of an unstable, structurally intact long head of the biceps tendon in twenty-one patients in the acute phase after a traumatic tear of the subscapularis tendon. The average period from the injury to the surgery was 6.2 weeks. Open tendon stabilization and subscapularis reconstruction were performed with transosseous sutures. The follow-up consisted of clinical examination (with determination of the absolute, age and gender-related, and individual relative Constant scores; clinical evaluation of the long head of the biceps; and subjective determination of shoulder function) and dynamic ultrasound examination. RESULTS: The average follow-up period was 28.4 months. The mean absolute Constant score increased from 26.3 points preoperatively to 79.3 points postoperatively (p < 0.01). The mean age and gender-related Constant score improved from 28.0% to 87.0% (p < 0.01). Seven patients showed clinical symptoms consistent with mild biceps tendinopathy. Using dynamic ultrasound examination, we found two cases of recurrent instability (medial subluxation) of the long head of the biceps tendon. Secondary rupture of the long head of the biceps tendon occurred in one patient, twenty-six months after the surgery. CONCLUSIONS: The functional outcomes of stabilization of the long head of the biceps tendon in the context of early repair of a traumatic tear of the subscapularis tendon were comparable with the results of tenodesis or tenotomy reported in previous studies. The cosmetic results were superior, and chronic discomfort from spasms was not observed. Stabilization of the tendon of the long head of the biceps can be recommended as a treatment option for selected patients and should be discussed as an alternative to tenodesis or tenotomy, particularly in a young patient.     

Osteochondroma of the Distal Tibia Complicated by a Tibialis Posterior Tendon Tear

Osteochondroma of the bone can irritate the overlying soft tissue, resulting in pain and discomfort. Rarely, a tendon tear can occur by an impinging bony mass. We report a case of osteochondroma of the distal tibia in a 23-year-old female patient that was complicated by a partial tear of the tibialis posterior tendon. She was treated with excision of the bony mass combined with tendon debridement and repair. The follow-up examination at 5 years postoperatively showed successful results.     

Entrapment of the long head of the biceps tendon: the hourglass biceps--a cause of pain and locking of the shoulder

We describe an unrecognized mechanical condition affecting the long head of the biceps (LHB) tendon with entrapment of the tendon within the joint and subsequent pain and locking of the shoulder on elevation of the arm. We identified 21 patients with a hypertrophic intraarticular portion of the LHB tendon during open surgery (14 patients) or arthroscopic surgery (7 patients). All cases but one were associated with a rotator cuff rupture. Patients were treated by biceps tenotomy (2 patients) or tenodesis (19 patients) after removal of the hypertrophic intraarticular portion of the tendon and appropriate treatment of concomitant lesions. Minimum follow-up was 1 year. All patients presented with anterior shoulder pain and loss of active and passive elevation averaging 10 degrees to 20 degrees. A dynamic intraoperative test, involving forward elevation with the elbow extended, demonstrated entrapment of the tendon within the joint in each case. This test creates a characteristic buckling of the tendon and squeezing of it between the humeral head and the glenoid (hourglass test). The mean Constant score improved from 38 to 76 points at the final follow-up (P <.05). Complete and symmetric elevation was restored in all cases after resection of the intraarticular portion of the LHB tendon. The hourglass biceps is caused by a hypertrophic intraarticular portion of the tendon that is unable to slide into the bicipital groove during elevation of the arm; it can be compared with the condition of trigger finger in the hand. A loss of 10 degrees to 20 degrees of passive elevation, bicipital groove tenderness, and radiographic findings of a hypertrophied tendon can aid in the diagnosis. A definitive diagnosis is made at surgery with the hourglass test: incarceration and squeezing of the tendon within the joint during forward elevation of the arm with the elbow extended. The hourglass biceps is responsible for a mechanical block, which is similar to a locked knee with a bucket-handle meniscal tear. Simple tenotomy cannot resolve this mechanical block. Excision of the intraarticular portion of the LHB tendon, during bipolar biceps tenotomy or tenodesis, must be performed. The hourglass biceps is an addition to the familiar pathologies of the LHB (tenosynovitis, prerupture, rupture, and instability) and should be considered in cases of shoulder pain associated with a loss of elevation.     

Mechanical properties of the long‐head of the biceps tendon are altered in the presence of rotator cuff tears in a rat model

Rotator cuff tears are disabling conditions that result in changes in joint loading and functional deficiencies. Clinically, damage to the long‐head of the biceps tendon has been found in conjunction with rotator cuff tears, and this damage is thought to increase with increasing tear size. Despite its importance, controversy exists regarding the optimal treatment for the biceps. An animal model of this condition would allow for controlled studies to investigate the etiology of this problem and potential treatment strategies. We created rotator cuff tears in the rat model by detaching single (supraspinatus) and multiple (supraspinatus + infraspinatus or supraspinatus + subscapularis) rotator cuff tendons and measured the mechanical properties along the length of the long‐head of the biceps tendon 4 and 8 weeks following injury. Cross‐sectional area of the biceps was increased in the presence of a single rotator cuff tendon tear (by ～150%), with a greater increase in the presence of a multiple rotator cuff tendon tear (by up to 220%). Modulus values decreased as much as 43 and 56% with one and two tendon tears, respectively. Also, multiple tendon tear conditions involving the infraspinatus in addition to the supraspinatus affected the biceps tendon more than those involving the subscapularis and supraspinatus. Finally, biceps tendon mechanical properties worsened over time in multiple rotator cuff tendon tears. Therefore, the rat model correlates well with clinical findings of biceps tendon pathology in the presence of rotator cuff tears, and can be used to evaluate etiology and treatment modalities. © 2008 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 27:416–420, 2009     

Partial rupture of the distal biceps brachii tendon. A case report

Traumatic rupture of the lacertus fibrosus in the biceps aponeurosis and elongation of a normal-appearing biceps tendon caused weakening in elbow flexion and forearm supination. Normal function was restored by shortening of the biceps tendon and aponeurosis 8 months after the accident.     

Surgical technique and functional results of irreparable cuff tears reconstructed with the long head of the biceps tendon.

The purpose of the study was to evaluate the results obtained from patients who were treated with open surgical technique using the long head of the biceps tendon for irreparable tears of the rotator cuff tendons. Between May 1992 and January 1997, 14 patients underwent rotator cuff reconstruction of irreparable tears at our clinic. These patients were evaluated before and after a minimum follow-up of 26 months (mean: 40.2 months) following surgery with the Constant's functional score. The long heads of the biceps tendons were found to be hypertrophied in all 14 shoulders and in 10 of them they were also subluxated. After re-seating the surgically enlarged biceps tendon onto the center of the uncovered head region, the biceps tendon to cuff tendon repair and the biceps tenodesis were done in all shoulders. The mean functional Constant's score before surgery was 46.7 points (poor) and the mean postoperative score at the final follow-up was 75.35 points (good). Satisfactory results were achieved in 85.7% of the patients. These results suggest that this surgical technique can be used to attain a painless and functional shoulder after irreparable cuff tear reconstruction.     

Diagnostic value of sonography in lesions of the biceps tendon

Lesions of the biceps tendon have been studied with plain radiographs and arthrograms of the intertubercular groove. Sometimes, however, especially when the rotator cuff has a full-thickness tear anteriorly, the sheath of the biceps tendon fails to fill with contrast medium, thus preventing diagnosis of dislocation of the tendon. To solve this problem the authors have tried sonography of the biceps tendon. The suitability of sonography for examining the intertubercular groove and the biceps tendon was assessed in ten volunteers. Thirty patients with chronic shoulder pain were subsequently studied by radiography, arthrography, and sonography. The observations made with these examinations were compared, and in 21 of the patients who were treated by operation with the surgical observations as well. Sonography seemed to provide accurate information about the configuration of the intertubercular groove and the position of the biceps tendon. The technique could be used to show dislocation of the tendon in cases in which the tendon sheath is not visualized in arthrography. Tenderness and the site of this in relation to the anterior upper end of the humerus could also be verified with sonography.