Plane Talk About Shoulder Radiographs

Abstract

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.     

Rupture of the Short Head of the Biceps and Coracoid Fractures: Mechanism and Refixation

Injuries of the short head of the biceps are rarely seen in clinics as seen by a lack of published articles. Most of the literature report on coracoid fractures, whereas these scapula process fractures remain less common in the upper extremity. They are caused by direct impact or are associated with acromioclavicular or anterior shoulder dislocation as it may occur in sports. The attached biceps short head, coracobrachialis and pectoral minor tendon are likely to tension an avulsion and displace a fragment. The most favorable treatment is a non-operative therapy, especially if the displacement of fragments is little and the coracoclavicular ligaments maintain the fragments in position. Widely displaced fractures cause a high nonunion rate and surgical reposition and fixation is recommended in such cases. Different fixation techniques are present due to its rare and heterogenic occurrence. However, surgically treated fractures are likely to heal and patients gain full range of motion after three months. We present a case report from our department and demonstrate different operative techniques in a cadaver model.     

Distal biceps brachii tendon repair: Suture anchor technique

Rupture of the biceps brachii tendon has been associated with significant loss of flexion and supination strength.Several techniques have been described with reports of clinical success. The single incision suture anchor repair technique produces clinical results comparable with other methods of fixation with low complication rates. The procedure can be performed through a limited 3-cm transverse incision with minimal dissection. The surgical technique and postoperative rehabilitation are described.     

上盂唇病变的诊断与治疗

越来越多的证据表明上盂唇（SLAP）病变是引起肩关节疼痛和不稳定的一个重要原因。随着关节镜下对肱二头肌腱附着部位的深入研究和关节镜器械、操作技术等的发展,人们对SLAP病变的发病机制、临床表现、分类和治疗等方面的认识也不断深化。选用恰当的技术,SLAP病变在关节镜下能得到安全和有效的治疗,大多数患者能恢复正常活动,甚至能恢复投掷运动.     

Repair of chronic distal biceps tendon ruptures: Indications and use of tendon grafts

Reconstruction of chronic distal biceps tendon ruptures is complicated by the substantial retraction and poor quality of the remaining muscle and tendon tissue. Several types of tendon grafts have been described to augment the repair and restore length including both allografts and autografts. To date, we have found the Achilles tendon allografts to be perhaps the most reliable and versatile graft to reconstruct the chronic distal biceps tendon rupture and, when required, it has provided satisfactory clinical results in this difficult clinical setting.     

Complications of distal biceps tendonrepairs

Surgical repair is the most reliable and appropriate method of restoring flexion and supination strength of the elbow and forearm following acute rupture of the distal biceps tendon. Although there may be small measurable deficits in power, endurance, and terminal forearm rotation when carefully evaluated, the vast majority of patients regain near normal upper extremity motion and function and can return to preinjury activities. There are currently two basic surgical approaches for distal biceps tendon repair, using one anterior incision or using one anterior and one lateral incision. Anterior repair alone has the advantage of a minimal risk of heterotopic bone formation but carries a greater chance of injury to the posterior interosseous nerve. In turn, the two-incision technique markedly diminishes the risk of radial nerve palsy but is associated with a greater likelihood of heterotopic bone formation limiting forearm rotation. Re-rupture of the distal biceps tendon following repair is uncommon with either technique, and the risk of all complications appears to increase with a delay in surgical intervention following rupture. When motion limiting heterotopic ossification does occur, surgical resection can proceed when the process becomes mature as defined by plain radiographs. Fortunately, functional forearm motion can be commonly restored in these cases with careful attention to surgical details and postoperative rehabilitation.     

低强度电刺激治疗大鼠股二头肌急性拉伤的实验研究

目的:采用低强度电刺激治疗股二头肌急性拉伤,观察其对肌肉损伤部位结构重塑的影响。方法:雄性SD大鼠36只,随机分为正常对照组和实验组,后者又依取材时间分为D0组、D7组、D7-20Hz组、D14组和D14-20Hz组,每组6只。各实验组采用电刺激使股二头肌强直收缩,同时以角速度960°.s-1伸膝摆腿反向拉伸,建立股二头肌急性拉伤动物模型。造模完成后,D7-20Hz组和D14-20Hz于动物造模后第5天开始进行20Hz电刺激治疗,每日2次,每次30分钟,间隔4小时,其余组继续喂养不做干预。正常对照组在实验开始当天,D0组、D7组、D7-20Hz组、D14组和D14-20Hz组分别在相应时间(实验当天,第7、7、14、14天)进行在体力矩测试,观测最大等长力矩值以及最优角度。然后处死动物,分离股二头肌,固定、切片、HE染色,光镜下观察股二头肌组织形态。结果:光镜观察可见,拉伤后第7天D7组肌纤维出现修复,但不成熟,肌纤维排列不严整,大小不一。经过电刺激治疗后,同期的D7-20Hz组新生的肌纤维更成熟,成簇排列,结构更严整,边界更清晰。第14天D14组和D14-20Hz组两组肌纤维基本修复。D0组关节最大等长力矩值下降至(0.246±0.026)Nm,与正常对照组(0.337±0.025)Nm比较有显著性差异(P<0.05);D7-20Hz组和D14-20Hz组关节最大等长力矩值分别与D7组和D14组比较均无显著性差异(P>0.05)。D0组最优角度为144.50°±3.71°,与正常对照组130.00°±3.54°比较存在显著性差异(P<0.01);D14组在120.00°±3.53°,与正常对照组比较有显著性差异(P<0.05)。经电刺激治疗后D14-20Hz最优角度出现在125.00°±3.53°,与D14组比较存在显著性差异(P<0.05)。结论:股二头肌急性拉伤后早期采用低强度电刺激治疗,可有效促进损伤肌肉结构重塑,虽不能在两周内明显提高关节最大等长力矩,但可优化关节力矩-角度关系。     

最大随意收缩诱发肌肉疲劳的表面肌电信号变化

目的 研究最大随意收缩（MVC）诱发肌肉疲劳的表面肌电（sEMG）信号的变化规律。方法 10名青年志愿者完成肱二头肌非疲劳性持重负荷试验和疲劳性最大随意收缩试验。采用线性和非线性信号处理方法,分析MVC下降到80％、70％、60％和50％时刻的sEMG信号特征变化并与非疲劳性活动时相同肌肉活动水平的sEMG信号进行比较。结果 疲劳状态下的平均肌电值（AEMG）和确定性线段百分比（％DET）显著高于非疲劳状态,而平均功率谱（MPF）和Lempel—Ziv复杂度[C（n）]显著低于非疲劳状态。随着肌肉疲劳的发展,MPF和C（n）显著递减,而AEMG和％DET无显著变化。AEMG、MPF和C（n）在疲劳状态和负荷水平间存在显著的交互作用。结论最大随意收缩诱发肱二头肌疲劳过程中,sEMG信号的MPF和C（n）单调递减;疲劳和非疲劳状态的sEMG信号特征存在显著差异。     

Mini open and sub pectoral bicepstenodesis

The function of the biceps tendon in the shoulder remains controversial. This tendon can be a source of significant anterior shoulder pain that can lead to persistent shoulder dysfunction.     

Single incision, transosseous suture repair technique for acute distal biceps tendon rupture

We describe a technique for repair of the distal biceps tendon using a single anterior incision, limited volardissection, and transosseous sutures through the radial tuberosity. This technique is simple, safe, and strong, allowing for prompt rehabilitation and recovery. Unlike the two-incision technique, there is no risk for heterotopic ossification or proximal radioulnar synostosis. Careful and limited dissection results in a low risk for iatrogenic neurovascular injury. Transosseous sutures have been shown to be stronger than suture anchors, allowing for more aggressive early motion and an early return to full motion. In addition, there is no additional cost for using transosseous sutures, as opposed to suture anchors or Endobutton (Arthrex Inc., Naples, FL), which may be quite expensive     

Repair of acute distal biceps tendon ruptures

Distal biceps tendon ruptures are most common in men between the ages of 40 and 60 years and usually arecaused by an unexpected extension force applied to the flexed arm. The most successful treatment of complete rupture of the distal biceps tendon is anatomical repair. The two-incision technique consistently restores flexion and supination strength. We have not found heterotopic ossification or synostosis to compromise results.