Mechanical properties of the long head of the biceps tendon

In this study, the geometric and mechanical properties of the long head of the biceps tendon were determined in order to elucidate its role in shoulder stability. We used a laser-micrometer system to measure the cross-sectional area and shape of seven fresh-frozen tendons at three levels: proximal, middle, and distal levels. The cross-sectional areas were found to be 22.7±9.3 mm², 22.7±3.5 mm², and 10.8±2.7 mm², respectively. While statistically significant differences could not be demonstrated between the magnitudes of the areas, a consistent difference in shape was noted between the proximal and middle levels, the tendon being flatter as it progressed over the humeral head and more triangular as it passed through the bicipital groove. We then performed cyclic relaxation tests and uniaxial tensile testing of the tendons which revealed a cyclic stress relaxation of 18±4% over ten cycles. All tensile failures occurred within the midportion of the tendon substance. Additionally, the modulus was calculated between 3% and 6% strain and found to be 421±212 MPa, while the ultimate tensile strength, ultimate strain, and strain energy density were 32.5±5.3 MPa, 10.1±2.7%, and 1.9±0.4 MPa, respectively. These mechanical properties of the long head of the biceps tendon are of the same order of magnitude as tendons from other joints. The high stiffness of this tendon indicates that it has an ability to support the large load transferred to it by the muscle and to act as a humeral head depressor.     

Intracapsular origin of the long head of the biceps tendon

A developmental anomaly of the long head of the biceps tendon was found in a cadaveric shoulder. Findings on arthroscopy, routine MR imaging, and MR arthrography were compared and correlated with results of anatomic dissection. MR arthrography appears to be a very good diagnostic imaging method for depicting this anomaly prior to arthroscopy. Received: 21 October 1998 Revision requested: 23 November 1998 Revision received: 14 December 1998 Accepted: 18 December 1998     

Intra-articular variations of the long head of the biceps tendon

Purpose  

The long head of the biceps tendon (LHBT) generally runs free through its course in the glenohumeral joint. It can rarely be seen as attached to the joint capsule or the rotator cuff in different patterns. Although these variations are usually considered harmless in the literature, they may occur in conjunction with the labral pathologies. This study was designed to determine their prevalence and investigate their relationship with intra-articular pathologies encountered during arthroscopy.     

Fibroma of the tendon sheath of the long head of the biceps tendon

Fibroma of the tendon sheath is a benign tumor that is less common than giant cell tumor of the tendon sheath. Both tumors may present as a painless, slowly enlarging mass. Radiological findings may be similar for both tumors. Histologically, fibroma of the tendon sheath lacks the hemosiderin-laden macrophages that are typical for giant cell tumor of the tendon sheath. We report on a 49-year-old woman with fibroma of the tendon sheath of the long head of the biceps tendon. In our case, on MR images, we observed band-like hypointense areas centrally in the tumor, mild patchy contrast enhancement, and most importantly, no decrease of signal intensity on gradient echo images. These characteristics reflected histological findings.     

Bilateral congenital absence of the long head of the biceps tendon

Absence of the long head of the biceps tendon is a rare anomaly particularly when it occurs bilaterally. We present the magnetic resonance and arthroscopy findings in a patient with bilateral congenital absence of the long head of the biceps who presented with bilateral shoulder pain. Identification of a shallow or absent intertubercular groove may aid in differentiating congenital absence of the long head of the biceps from a traumatic tendon rupture.     

Assessment of instability of the long head of the biceps tendon by MRI

Objective. To determine whether MRI can identify instability of the long head of the biceps tendon (LBT) in the rotator interval. Design and patients . A retrospective review was carried out of 19 patients, all arthroscopically examined, nine of whom had surgically confirmed instability of the LBT. Results. A LBT perched on the lesser tuberosity correctly indicated all nine cases of instability with one false positive. In six of seven cases where the LBT was oval in shape, no instability of the biceps tendon existed, whereas LBT instability was present in eight of 12 patients with a flat long head of the biceps tendon. In seven of eight acutely angled intertubercular sulci there was no instability of the LBT while eight of 11 obtusely angled sulci were associated with LBT instability. By consensus impression, instability of the LBT could be determined with 67% sensitivity, 90% specificity, 86% positive predictive value, and 75% negative predictive value. Conclusions. A flat LBT perched on the lesser tuberosity with an obtusely angled intertubercular sulcus suggests the diagnosis of instability of the LBT in the correct clinical setting. Received for publication: 3 May 2000 Revision requested: 2 July 2000 Revision received: 27 September 2000 Accepted: 27 November 2000     

Chondral print on humeral head: an indirect sign of long head biceps tendon instability

Long head biceps (LHB) tendon pathologies are becoming increasingly recognized causes of shoulder pain in the published literature. Instability of LHB presenting as dislocation or subluxation has been recently recognized as a possible cause of disabling pain or discomfort of the shoulder. A clinical diagnosis of LHB instability is very difficult and often confounding because of association with other shoulder pathologies. However, an early diagnosis of LHB instability is important in order to prevent the evolution of lesions of the biceps pulley until an internal anterosuperior impingement of the shoulder (ASI) and subscapular tear occur. The advent of arthroscopy contributed to enhance understandings. The goal of this article is to describe an arthroscopic sign, the chondral print on the humeral head, associated with a LHB instability, that when present can be very useful to help the surgeon to make the diagnosis of unstable LHB tendon.     

Ultrasound-guided percutaneous tenotomy of the long head of the biceps tendon: a non-reliable technique

Purpose

To evaluate the feasibility of ultrasound-guided percutaneous tenotomy of the long head of the biceps tendon via a keyhole incision.

Methods

This was an anatomical study performed on twelve embalmed cadaveric shoulder joints. The rotator cuff and the position of the long head of the biceps tendon were explored by ultrasound prior to beginning the procedure. The biceps tenotomy was performed under ultrasound guidance by a highly experienced sonographer who was trained in shoulder tendon exploration. Arthroscopic exploration of the shoulder was performed immediately after the percutaneous biceps tenotomy to assess the quality and the location of the biceps tenotomy.

Results

Three out of twelve tendons (25%) were completely sectioned at the level of the glenoid insertion. More seriously, iatrogenic lesions of the cartilage of the humeral head, the supraspinatus tendon and the subscapularis tendon were observed.

Conclusion

This study shows that ultrasound-guided percutaneous tenotomy of the long head of the biceps tendon is not reliable.     

肱二头肌长头腱撕裂的肩关节MRI评价

目的 评价肩关节MRI对肱二头肌长头腱撕裂的诊断价值,并对比分析肩关节MR造影和常规肩关节MRI的诊断性能.方法 由2名影像诊断医师独立回顾分析215例肩关节MR图像,包括107例肩关节MR造影和108例常规肩关节MRI,分析结果与肩关节镜手术相比较.计算MRI评价肱二头肌长头腱撕裂的诊断敏感性、特异性和准确性.采用Kappa分析2名影像诊断医师评价的一致性.结果 215例中,肱二头肌长头腱完伞撕裂7例,部分撕裂29例,无撕裂179例.医师甲用肩关节MRI评估肱二头肌长头腱撕裂(包括完全和部分)的敏感性、特异性和准确性分别为72.2%(26/36)、91.6%(164/179)和88.4%(190/215),医师乙分别为80.6%(29/36)、93.8%(168/179)和91.6%(197/215),2名医师的评估结果间一致性好(Kappa=0.681).肱二头肌长头腱完全撕裂,2名医师的诊断敏感性、特异性和准确性均为100%(7/7)、100%(208/208)和100%(215/215).利用肩关节MR造影评价肱二头肌长头腱撕裂时,医师甲的准确性为93.4%(100/107),医师乙为96.3%(103/107),均明显高于常规肩关节MRI的结果[医师甲为83.3%(90/108),医师乙为87.0%(94/108),P值均<0.05].结论 肩关节MRI是评价肱二头肌长头腱撕裂比较可靠的方法,而且肩关节MR造影的准确性优于常规肩关节MRI.     

Permanent disabilities in the displaced muscle from rupture of the long head tendon of the biceps

Patients with a displaced muscle belly because of rupture of the long head biceps tendon were investigated for local pain and other disabilities, together with strength and endurance loss. Eleven patients (median age 59 years, minimum follow-up 6 months) were included, and minimum follow-up was 6 months. Magnetic resonance imaging (MRI) of both upper arms allowed investigation of muscle atrophy and evaluation of any other degenerative signs in the displaced muscle. All patients reported pain or disability locally in the displaced muscle in certain situations, and strength and endurance were reduced by 25%. MRI revealed the displaced muscle to be unreduced in size and with no signs of degeneration. Generally, operative reattachment of the displaced muscle is not advocated in middle-aged or older patients. In order to elucidate this subject, we present a retrospective consecutive series of patients with considerable disabilities in the displaced muscle belly independent of shoulder disabilities.     

Anatomical reconstruction of knee posterolateral complex with the tendon of the long head of biceps femoris

BACKGROUND: There is no consensus about the best way to reconstruct the knee posterolateral complex. HYPOTHESIS: Anatomical reconstruction of the knee posterolateral complex with the tendon of the long head of biceps femoris can restore knee posterolateral stability. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Anatomical reconstruction of the fibular collateral ligament, popliteofibular ligament, and popliteus tendon was performed consecutively in 28 patients with chronic posterolateral knee injuries. Two distally pedicled tendon slips more than 16 cm long were created from the tendon of the long head of the biceps femoris. The posterior tendon slip was used to reconstruct the popliteofibular ligament and popliteus tendon, and the anterior slip were doubled to reconstruct the lateral collateral ligament. The patients were followed up for 2 to 4 years. RESULTS: At the latest follow-up, examinations showed that 96.4% (27/28) of the patients had a normal or nearly normal reconstructed fibular collateral ligament as judged by manual examination. All patients had a normal or nearly normal reconstructed popliteofibular ligament and popliteus tendon as judged by manual examination. CONCLUSION: Anatomical reconstruction of the knee posterolateral complex with the tendon of the long head of biceps femoris is effective in restoring knee posterolateral stability.     

Magnetic resonance imaging of the long head of the biceps tendon: benefit of coplanar image

PURPOSE: To evaluate coplanar imaging of the long head of the biceps tendon. METHODS: We retrospectively compared coronal oblique magnetic resonance images aligned with the principal supraspinatus tendon and with the intra-articular biceps tendon in 21 patients. Magnetic resonance images were analyzed for lesions depicted, including superior labral anteroposterior (SLAP) tears. Arthroscopic findings were reviewed. RESULTS: Coronal oblique images aligned with intra-articular biceps tendon depicted 18 (86%) of 21 coplanar intra-articular biceps tendons. Coplanar images identified 6 cases of tendinosis, 1 tear, 3 intra-articular ruptures, and 20 (95.2%) of 21 exact origins of the tendon. Arthroscopy revealed 18 SLAP tears. The detection of SLAP lesions between both coronal oblique magnetic resonance images was significantly different (P = 0.007). CONCLUSION: Advantages included imaging of the intra-articular biceps tendon with least partial-volume effects, definition of SLAP lesions and the tendinous origin at the supraglenoid tubercle, depiction of intra-articular bicipital ruptures, and increased sensitivity and specificity for intra-articular lesions.     

Arthroscopic release of the long head of the biceps tendon: functional outcome and clinical results

BACKGROUND: Treatment of chronic, refractory biceps tendinitis remains controversial. The authors sought to evaluate clinical and functional outcomes of arthroscopic release of the long head of the biceps tendon. HYPOTHESIS: In specific cases of refractory biceps tendinitis, site-specific release of the long head of the biceps tendon may yield relief of pain and symptoms. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Fifty-four patients diagnosed with biceps tendinitis underwent arthroscopic release of the long head of the biceps tendon as an isolated procedure or as part of a concomitant shoulder procedure over a 2-year period. Patients were not excluded for concomitant shoulder abnormality, including degenerative joint disease, rotator cuff tears, Bankart lesions, or instability. Nine of 40 patients had an isolated arthroscopic release of the biceps tendon. At a minimum of 2 years, the American Shoulder and Elbow Surgeons; the University of California, Los Angeles; and the L'Insalata shoulder questionnaires as well as ipsilateral and contralateral metrics were used for evaluation. RESULTS: The L'Insalata; University of California, Los Angeles; and American Shoulder and Elbow Surgeons scores were 77.6, 27.6, and 75.6, respectively. Seventy percent had a Popeye sign at rest or during active elbow flexion; 82.7% of men and 36.5% of women had a positive Popeye sign (P < .05); 68% were rated as good, very good, or excellent. No patient reported arm pain at rest distally or proximally; 38% of patients complained of fatigue discomfort (soreness) isolated to the biceps muscle after resisted elbow flexion. CONCLUSION: Arthroscopic release of the long head of the biceps tendon is an appropriate and reliable intervention for patients with chronic, refractory biceps tendinitis. Cosmetic deformity presenting as a positive Popeye sign and fatigue discomfort were the primary complaints. CLINICAL RELEVANCE: Although tenotomy is not the ideal intervention for patients of all ages with various shoulder abnormalities, data suggest that it may be an acceptable surgical intervention for a specifically selected cohort of individuals.     

磁共振与超声在肱二头肌长头腱损伤的诊断价值比较

目的 探讨磁共振(MR)和超声(US)检查在肱二头肌长头腱损伤中的诊断价值.方法 收集肩关节镜检证实的肱二头肌长头腱损伤患者80例,均行MR及US检查,以肩关节镜检结果为评价标准,分别计算MR和US诊断肱二头肌长头腱损伤的准确性、敏感性、特异性,比较2种检查方法的有效性.结果 80例患者中,肩关节镜证实肱二头肌长头腱完全撕裂19例,部分撕裂45例,肌腱炎10例,脱位6例.MR与US诊断肱二头肌长头腱完全撕裂、部分撕裂、肌腱炎及脱位的准确性分别为98.7%、92.5%、97.5%、100%和96.2%、85.0%、96.3%、98.7%.MR与US诊断肱二头肌长头腱完全撕裂、肌腱炎及脱位准确性差异无统计学意义(P>0.05),但MR诊断部分撕裂的准确性高于US(P<0.05).结论 MR在判断肱二头肌长头腱部分撕裂优于US.US检查可作为常规检查方法用于排查怀疑有肱二头肌长头腱损伤的患者.     

Posterior dislocation of the long head of biceps tendon: case report and review of the literature

Posterior or lateral dislocation of the long head of biceps is a rare complication of shoulder dislocation that can result in inability to relocate the humerus. The diagnosis should be suspected when certain radiographic features are present at the initial presentation. Other imaging modalities can aid diagnosis when clinical management is unsuccessful or protracted. We present a case of surgically proven posterior dislocation of the biceps tendon with conventional radiographic, computed tomography and magnetic resonance imaging assessment. The literature on this subject is reviewed, and imaging features associated with the diagnosis are described.     

Case report: Broad insertion of a large subscapularis tendon in association with congenital absence of the long head of the biceps tendon

Skeletal Radiology - Congenital absence of the long head of the biceps (LHB) tendon is a rare variation in shoulder anatomy. The authors present a case of congenital absence of the long head of the...