Arthroscopic Evaluation of Subluxation of the Long Head of the Biceps Tendon and Its Relationship with Subscapularis Tears

고경환,김수철,유재철 대한정형외과학회 2017 Clinics in Orthopedic Surgery Vol.9 No.3

Background: The purpose of this study was to evaluate the angle between the long head of the biceps tendon (LHBT) and the glenoid during arthroscopic surgery and its correlation with biceps subluxation on magnetic resonance imaging (MRI). Furthermore, we evaluated the relationship of this angle with subscapularis tears and biceps pathologies. Methods: MRI and arthroscopic images of 270 consecutive patients who had undergone arthroscopic surgery were retrospectively evaluated. On MRI, 60 shoulders with biceps subluxation and 210 shoulders without subluxation were identified. On the arthroscopic view from the posterior portal, the angle between the LHBT and the glenoid (biceps-glenoid angle) was measured. The biceps-glenoid angle, tears of the LHBT, degenerative superior labrum anterior to posterior (SLAP) lesions, and presence of a subscapularis tear were compared according to the presence of biceps subluxation on MRI. Results: In the subluxation group, 51 (85%) had a subscapularis tendon tear and all shoulders showed biceps tendon pathologies. In the non-subluxation group, 116 (55.2%) had a subscapularis tendon tear, 125 (60%) had tears in the biceps tendon, and 191 (91%) had degenerative SLAP lesions. The incidences of subscapularis tears (p < 0.001) and biceps pathologies (p < 0.001) showed significant differences. The mean biceps-glenoid angle was 87.0° (standard deviation [SD], 11.4°) in the subluxation group and 90.0° (SD, 9.6°) in the non-subluxation group, showing a statistically significant difference (p = 0.037). Conclusions: Shoulders with subluxation of the biceps tendon on the preoperative MRI revealed more pathologies in the subscapularis tendon and biceps tendon during arthroscopy. However, the arthroscopically measured biceps-glenoid angle did not have clinical relevance to the determination of subluxation of the LHBT from the bicipital groove.

Distal biceps tendon injection

Jacqueline van der Vis,Stein J. Janssen,Ronald L.A.W. Bleys,Denise Eygendaal,Michel P.J. van de Bekerom 대한견주관절의학회 2021 대한견주관절의학회지 Vol.24 No.2

Background: Injection therapy around the distal biceps tendon insertion is challenging. This therapy may be indicated in patients with a partial distal biceps tendon tear, bicipitoradial bursitis and tendinopathy. The primary goal of this study was to determine the accuracy of manually performed injections without ultrasound guidance around the biceps tendon. Methods: Seven upper limb specialists, two general orthopedic specialists, and three orthopedic surgical residents manually injected a cadaver elbow with acrylic dye using an anterior and a lateral infiltration approach. After infiltration the cadaveric elbows were dissected to determine the location of the acrylic dye. Results: In total, 79% of the injections were localized near the biceps tendon. Of these injections, 20% were localized on the radius near the bicipitoradial bursa. In total, 53% of the performed infiltrations were injected by anterior and 47% by lateral approaches. Of the injections near the distal biceps (79%), 47% were injected by an anterior and 53% by a lateral approach. Of the injections on the radius (20%), 33% were injected by anterior and 67% by lateral approach. Of the inaccurate injections (21%), 75% were injected anterior and 25% lateral. Conclusions: Manual infiltration without ultrasound guidance for distal biceps pathology lacks accuracy. We therefore recommend ultrasound guidance for more accurate infiltration.

동적 초음파를 이용하여 진단한 견관절 상완 이두건 장두의 아탈구

박상은(Sang-Eun Park),정재중(Jae-Jung Jung),이연수(Yeon-Soo Lee),김영율(Young-Yul Kim),김명진(Myung-Jin Kim),지종훈(Jong-Hun Ji) 대한견주관절의학회 2011 대한견주관절학회지 Vol.14 No.2

목적: 이학적 검사나 단순 방사선, 정적 초음파, 자기공명영상 등의 검사를 통해 진단하기 어려운 상완 이두건 장두 아탈구의 진단 시 동적 초음파의 유용성에 대해 보고하고자 한다. 대상 및 방법: 동적 초음파를 이용해 상완 이두건 장두 아탈구로 진단된 2명의 남자환자에 대해 관절경을 이용한 연부조직 상완 이두건 장두 고정술을 시행하고 증상 및 기능적 회복 정도를 평가하였다. 결과: 동적 초음파를 이용해 상완 이두건 아탈구를 쉽게 진단할 수 있었으며 수술 후 증상 및 기능적 평가에서도 향상을 나타내었다. 수술 후 특이한 합병증은 발생하지 않았다. 결론: 진단이 어려운 상완 이두건 장두 아탈구의 진단 시 동적 초음파의 이용은 유용한 방법으로 판단된다. Purpose: To report the usefulness of dynamic ultrasonography in subluxation of the long head of the biceps tendon, which is difficult to detect with static imaging such as plain radiography, static sonography, MRI and in a subtle physical examination. Materials and Methods: Two male patients suffered from subluxation of the long head of the biceps. This difficult diagnosis? was managed by surgery (biceps soft tissue tenodesis) with the aid of dynamic ultrasonography. At final follow up, we evaluated patients’ symptoms and functional outcomes using KSS, UCLA and ASES scores. Results: We diagnosed and treated subluxation of the long head of the biceps easily using dynamic ultrasonography. At the final follow up, both patients’ symptoms and functional outcomes were improved. There were no significant complications. Conclusion: Dynamic ultrasonography is a useful method in the difficult and subtle diagnosis of subluxation of the long head of the biceps .

Exploring the Effects of 630 nm Wavelength of Light-Emitting Diode Irradiation on the Proliferation and Migration Ability of Human Biceps Tendon Fibroblast Cells

Ji Hyeon Ryu,Jisu Park,Ji Won Kim,Yong-Il Shin,Sang Don Lee,Young Kwang Oh,Suk-Woong Kang 대한정형외과학회 2023 Clinics in Orthopedic Surgery Vol.15 No.1

Background: Light-emitting diode (LED)-based photobiomodulation is used as an inducer of cell regeneration. Although numerous in vitro and in vivo orthopedic studies have been conducted, the ideal LED wavelength range for tendon healing has not yet been determined. This study, thus, focused on the effects of LED of a 630 nm wavelength on the cell viability, proliferation, and migration of human biceps tendon fibroblast cells. Methods: Human tendon fibroblast cell culture was performed using the biceps tendon of patients who had undergone biceps tenodesis. Human biceps tendon fibroblasts from two patients (male, aged 42 and 69 years) were isolated and cultured. The cell type was confirmed by a morphological analysis and using tendon and fibroblast specific markers. They were then split into three groups, with each receiving a different irradiation treatment: no LED treatment (control), 630 nm LED, and 630 nm + 880 nm LED for 20 minutes each. After the LED treatment, cell viability, proliferation, and migration assays were performed, and the results were compared between the groups. Results: Twenty-four hours after LED treatment, cell viability and proliferation were significantly increased in the 630 nm LED and 630 nm + 880 nm LED treatment groups compared to that in the control group (p < 0.05). Under the same conditions, compared with the control group, the 630 nm LED alone treatment group showed a 3.06 ± 0.21 times higher cell migration rate (p < 0.05), and the 630 nm + 880 nm LED combination treatment group showed a 2.88 ± 0.20 times higher cell migration rate (p < 0.05) in threedimensional migration assay. Conclusions: In human tendon fibroblast cells, 20 minutes of LED treatment at 630 nm and 630 nm + 880 nm exhibited significant effects on cell proliferation and migration. Our findings suggest the potential of LED therapy as an adjuvant treatment for tendon healing, and hence, further research is warranted to standardize the various parameters to further develop and establish this as a reliable treatment regimen.

회전근 개 파열과 동반된 상완 이두 건 장두의 병변

김영규(Young Kyu Kim),김동욱(Dong-Wook Kim),이종훈(Jong Hun Lee) 대한견주관절의학회 2010 대한견주관절의학회지 Vol.13 No.1

목적: 회전근 개 파열과 동반되어진 상완 이두 건의 병변 및 치료 결과를 알아보고자 하였다. 대상 및 방법: 회전근 개 파열로 수술적 치료를 받고 후향적으로 상완 이두 건의 병변 여부를 확인할 수 있었던 92예를 대상으로 2년 이상 추시하였다. 상완 이두 건 병변은 건막염, 건의 마모 또는 비대, 파열, 불안정성의 4형태로 구분하였다. 회전근 개는 광범위 파열 중 4예를 제외하고는 모두 봉합하였으며 상완 이두 건 병변에 대해서는 변연 절제 30예, 건 절단 10예, 건 고정 8예, 재배치 4예를 시행하였다. 결과는 UCLA 평가 지수를 이용하였다. 결과: 상완 이두 건 병변을 보인 예가 70예 (76%)로 건막염은 19예, 건의 마모 또는 비대 22예, 파열 21예, 불안정성 8예의 병변을 보였다. 회전근 개 파열의 크기에 따라서 중범위 이하에서는 63%, 대범위 이상에서는 88%의 상완 이두 건 병변을 보였다. 치료 결과는 상완 이두 건 병변이 없었던 22예에서는 29.6점, 병변이 있었던 예 중 회전근 개 봉합을 시행하였던 66예에서는 28.3점이었다. 동반된 상완 이두 건을 절단하거나 재고정을 시행한 예에서는 28.2점이었다. 결론: 회전근 개 파열의 크기가 클수록 상완 이두 건 병변이 더 많이 발생하였고 형태도 보다 심하게 나타났다. 따라서 상완 이두 건 병변의 원인이 회전근 개 파열을 유발시키는 원인과 연관될 수 있다고 추측되었다. 동반된 상완 이두 건 병변의 치료로 건 절단이나 건 고정이 동통 완화에 효과적일 수 있다고 사료되었다. Purpose: To evaluate pathologic patterns and outcomes of treatment of a biceps tendon lesion associated with a rotator cuff tear. Materials and Methods: We reviewed 92 patients (i) who underwent surgery for a cuff tear, (ii) for whom the biceps lesion could be observed retrospectively, and (iii) had a minimum follow-up of 2 years. The pathology of biceps tendon was classified into 4 types: tenosynovitis, fraying or hypertrophy, tear, and instability. All but the 4 with massive cuff tears were repaired. The biceps lesions were treated with debridement in 30, tenotomy in 10, tenodesis in 8, and recentering in 4. UCLA scoring was used for clinical results. Results: Seventy patients had a biceps lesion, 19 tenosynovitis, 22 fraying or hypertrophy, 21 a tear, and 8 instability. A biceps lesion was observed in 63% of cases of cuff tears below the medium size, and in 88% of cases with cuff tears above the large size. UCLA scores according to the pathology of the biceps lesion were 29.6 in the absence of a biceps lesion, and 28.3 in its presence. UCLA scores in patients with tenotomy or tenodesis for associated biceps tendon lesions were 28.2. Conclusion: There is a greater incidence and severity of a biceps lesion with a larger cuff tear. Therefore, the cause of a biceps lesion might be related to the cause of the cuff tear. Among the several options of treatment for biceps lesion, tenotomy or tenodesis may be particularly effective in providing pain relief.

A Case Series of Symptomatic Distal Biceps Tendinopathy

Jung Hyun Lee,Kyung Chul Kim,Ji-Ho Lee,Kee Baek Ahn,In Hyeok Rhyou 대한견주관절의학회 2018 대한견주관절의학회지 Vol.21 No.4

Background: The study of conservative and surgical treatment of distal biceps tendinopathy and associated biceps tendon partial rupture. Methods: Twenty-one cases with distal biceps tendonitis and partial ruptures were studied who visited Pohang Semyeong Christianity Hospital from June 2010 to August 2017. The mean age was 57.1 years (39–69 years), 14 males and 7 females. The mean duration of symptom at the time of first visit was 4.9 months (0.2–14 months). Ultrasonography and magnetic resonance imaging were performed for patients with severe symptoms. According to the severity of the symptoms, splint immobilization, oral nonsteroidal anti-inflammatory drugs, and ultrasound-guided steroid injection were performed. Surgical treatment was performed if the patient did not respond to conservative treatment for 3 to 6 months or longer. Results: There were 9 cases of partial rupture of the distal biceps tendon associated with distal biceps tendinopathy on imaging studies. Conservative treatment showed symptomatic improvement in 16 of 21 cases. In 4 cases with a relatively mild symptom, anti-inflammatory analgesics and intermittent splinting showed good result. In 12 cases, symptoms improved after ultrasonography-guided steroid injection. Surgical treatment was performed on 5 cases that did not respond to conservative treatment. Conclusions: Conservative treatment of distal biceps tendinopathy may promise good results. However, in case of partial tear of the distal biceps tendon and refractory to conservative treatment, surgical treatment may be needed.

The Correlation between Modified Ashworth Scale and Biceps T-reflex and Inter-rater and Intra-rater Reliability of Biceps T-reflex

민지홍,신용일,좌경림,고성화,신명준,장재혁,고현윤 대한재활의학회 2012 Annals of Rehabilitation Medicine Vol.36 No.4

Objective To establish a correlation between the modified Ashworth scale (MAS) and amplitude and latency of T-reflex and to demonstrate inter-rater and intra-rater reliability of the T-reflex of the biceps muscle for assessing spasticity after stroke. Method A total of 21 patients with hemiplegia and spasticity after ischemic stroke were enrolled for this study. The spasticity of biceps muscle was evaluated by an occupational therapist using the MAS. The mean value of manual muscle test of biceps muscles was 2.3±0.79. Latency and amplitude of T-reflex were recorded from biceps muscles by two physicians. The onset latency and peak to peak amplitude of the mean of 5 big T-reflex were measured. The examinations were carried out by two physicians at the same time to evaluate the inter-rater reliability. Further, one of the physicians performed the examination again after one week to evaluate the intra-rater reliability. The correlations between MAS and T-reflex, and the intra- and inter-rater reliability of biceps T-reflex were established by calculating the Spearman correlation coefficients and the intra-class correlation coefficients (ICCs).Results Amplitude of the biceps T-reflex increased with increasing level of MAS (rs=0.464 and 0.573, respectively, p<0.01). ICCs of latency and amplitude of biceps T-reflex were 0.914 and 0.822. The Spearman correlation coefficients of latency and amplitude of biceps T-reflex were 0.937 and 0.635, respectively (p<0.01). Conclusion Biceps T-reflex demonstrates a good quantitative measurement and correlation tool with MAS for spasticity, and also shows acceptable inter- and intra-rater reliability, which can be used for patients with spasticity after stroke.

Musculocutaneous Nerve Entrapment after Biceps Long Head Tendon Rupture

이동주,류동진 대한정형외과학회 2014 대한정형외과학회지 Vol.49 No.1

Biceps long head tendon rupture is relatively common and requires approximately four weeks of splintage as a general treatment. Musculocutaneous nerve entrapment is commonly caused by excessive exercise or direct external force. Musculocutaneous nerve syndrome has barely been reported; however, association of biceps long head tendon rupture and musculocutaneous nerve entrapment syndrome has never been reported. The authors experienced a 70-year-old male patient, who suffered a traffic accident and was hospitalized due to shoulder joint pain caused by direct external force, delayed forearm lateral aspect hypoesthesia and elbow flexion weakness. For identification of the cause, magnetic resonance imaging, electromyography, and surgical opinion were synthesized, resulting in diagnosis of delayed musculocutaneous nerve entrapment syndrome occurring after biceps long head tendon rupture. With surgical treatment, pain, sense, and elbow flexion weakness were recovered, a showing successful treatment result.

Biceps femoris tendon and lateral collateral ligament: analysis of insertion pattern using MRI

신윤경,류경남,박지선,이정은,진욱,박소영,윤소희,이경렬 대한자기공명의과학회 2014 Investigative Magnetic Resonance Imaging Vol.18 No.3

Purpose : The biceps femoris tendon (BFT) and lateral collateral ligament (LCL) in the knee were formerly known to form aconjoined tendon at the fibular attachment site. However, the BFT and LCL are attached into the fibular head in variouspatterns. We classified insertion patterns of the BFT and LCL using MR imaging, and analyzed whether the LCL attaches tothe fibular head or not. Materials and Methods: A total of 494 consecutive knee MRIs of 470 patients taken between July 2012 and December2012 were retrospectively reviewed. There were 224 males and 246 females, and patient age varied from 10 to 88(mean, 48.6). The exclusion criteria were previous surgery and poor image quality. Using 3T fat-suppressed proton density-weighted axial images, the fibular insertion patterns of the BFT and LCL were classified into following types: type I (theLCL passes between the anterior arm and direct arm of the BFT’s long head), type II (the LCL joins with anterior arm of thelong head of the BFT), type III (the BFT and LCL join to form a conjoined tendon), type IV (the LCL passes laterally aroundthe anterior margin of the BFT), and type V (the LCL passes posteriorly to the direct arm of the BFT’s long head). Results: Among the 494 cases of the knee MRI, there were 433 (87.65%) type I cases, 21 (4.25%) type II cases, 2 (0.4%)type III cases, 16 (3.23%) type IV cases, and 22 (4.45%) type V cases. There were 26 cases (5.26%) in which the LCL andBFT were not attached into the fibular head. Conclusion: The fibular attachment pattern of the BFT and LCL shows diverse types in MR imaging. The LCL does notadhere to the head in some patients.

간섭나사를 이용한 관절경적 상완 이두건 대흉근 상부 건 고정술의 임상적 결과

최상수(Sang Su Choi),강홍제(Hong Je Kang),김정우(Jeong Woo Kim),김종윤(Jong Yun Kim),김동문(Dong Moon Kim),김광미(Kwang Mee Kim) 대한견주관절의학회 2013 대한견주관절의학회지 Vol.16 No.2

목적: 간섭나사(interference screw)를 이용한 관절경적 상완 이두건 대흉근 상부 건 고정술의 임상적 결과를 분석하고자 하였다. 대상 및 방법: 2008년 1월부터 2010년 1월까지 간섭나사를 이용한 관절경적 상완 이두건 장두의 대흉근 상부 건 고정술을 시행한 환자를 대상으로 하였고, 이 중 최소 1년 이상 추시 가능하였던 30예를 대상으로 하였다. 그 중 회전근 개 파열을 동반한 경우는 20예였다. 결과는 VAS, ASES, 상완 이두건 구의 통증, 고정실패 및 변형 정도로 판단하였다. 결과: 최종 추시에서 모든 환자에서 수술 전에 비해 VAS, ASES점수는 의미 있게 호전되었으나(p<0.05), 5예(17%)에서 견관절 전방 통증 및 상완 이두건 구의 압통이 존재하였고, 3예(10%)에서 고정실패로 인한 Popeye 변형이 존재하였다. 또한, 회전근 개 파열을 동반하지 않는 군에서 파열을 동반한 군보다 좋은 결과를 얻을 수 있었다(p<0.05). 결론: 상완 이두건 근위부 병변에 의한 통증이 있는 환자에서 간섭나사를 이용한 관절경적 상완 이두건 장두의 대흉근 상부 건 고정술은 좋은 결과를 얻을 수 있어 유용한 치료방법으로 사료되나, 17%에서 상완 이두건 구에 압통이 존재해 이에 대한 추가적 연구가 필요할 것으로 사료된다. Purpose: The purpose of this study is to evaluate the clinical results of arthroscopic biceps long head suprapectoral tenodesis using an interference screw. Materials and Methods: We reviewed the cases of 30 patients who underwent arthroscopic biceps long head suprapectoral tenodesis using an interference screw between January 2008 and January 2010. The minimum follow up period was one year. Twenty patients had rotator cuff tears. The results were analyzed by VAS, ASES, tenderness in the bicipital groove, fixation failure, and the degree of deformity. Results: VAS, ASES scores showed a statistically significant increase during the final observation in all patients, compared with those before surgery. However, five patients (17%) had anterior shoulder pain and tenderness in the biceps groove, and three patients (10%) had Popeye deformity. Better results were achieved in patients without rotator cuff tear than in patients with rotator cuff tear (p<0.05). Conclusion: Arthroscopic biceps long head tenodesis above the pectoralis major using an interference screw in patients with a pathologic lesion of the proximal biceps tendon showed good results at the last follow up. However, further study for tenderness in the biceps groove in 17% of patients is needed.