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Visualization of the Extra-Articular Portion of the Long Head of the Biceps Tendon During Intra-Articular Shoulder Arthroscopy

Published:September 04, 2014DOI:https://doi.org/10.1016/j.arthro.2014.05.044

      Purpose

      To quantify the amount of the extra-articular long head of the biceps tendon (LHBT) seen during intra-articular shoulder arthroscopy by pulling the tendon into the joint with a probe through an anterior portal while viewing through a standard posterior portal.

      Methods

      Intra-articular shoulder arthroscopy was performed on 10 forequarter cadaveric specimens. The extra-articular portion of the LHBT was evaluated by pulling the tendon into the joint with an arthroscopic probe inserted through an anterior portal. The tendon was marked at the pulley insertion on the humerus with a vascular clip before and after the tendon was pulled into the joint. An open deltopectoral approach was performed, and the amount of extra-articular tendon visualized was calculated as an absolute amount and in relation to nearby anatomic structures.

      Results

      An additional 1.9 cm (range, 1.4 to 2.6 cm) of extra-articular LHBT was viewed by pulling the tendon into the joint with an arthroscopic probe through an anterior portal during shoulder arthroscopy. This represented 30.8% of the extra-articular portion of the tendon, 47.7% of tendon in the bicipital groove, and 76.3% of the tendon that lies under the area from the pulley insertion to the distal edge of the transverse humeral ligament.

      Conclusions

      During intra-articular shoulder arthroscopy, the extra-articular portion of the LHBT is incompletely visualized by pulling the tendon into the joint with a probe placed through an anterior portal while viewing through a standard posterior portal.

      Clinical Relevance

      An additional extra-articular portion of the LHBT may be viewed by pulling the tendon into the joint with an arthroscopic probe during shoulder arthroscopy.
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      References

        • Becker D.A.
        • Cofield R.H.
        Tenodesis of the long head of the biceps brachii for chronic bicipital tendinitis. Long-term results.
        J Bone Joint Surg Am. 1989; 71: 376-381
        • Mazzocca A.D.
        • McCarthy M.B.
        • Ledgard F.A.
        • et al.
        Histomorphologic changes of the long head of the biceps tendon in common shoulder pathologies.
        Arthroscopy. 2013; 29: 972-981
        • Denard P.J.
        • Dai X.
        • Hanypsiak B.T.
        • Burkhart S.S.
        Anatomy of the biceps tendon: Implications for restoring physiological length-tension relation during biceps tenodesis with interference screw fixation.
        Arthroscopy. 2012; 28: 1352-1358
        • Kanatli U.
        • Ozturk B.Y.
        • Esen E.
        • Bolukbasi S.
        Intra-articular variations of the long head of the biceps tendon.
        Knee Surg Sports Traumatol Arthrosc. 2011; 19: 1576-1581
        • Barber A.
        • Field L.D.
        • Ryu R.
        Biceps tendon and superior labrum injuries: Decision-marking.
        J Bone Joint Surg Am. 2007; 89: 1844-1855
        • Sethi N.
        • Wright R.
        • Yamaguchi K.
        Disorders of the long head of the biceps tendon.
        J Shoulder Elbow Surg. 1999; 8: 644-654
        • Edwards T.B.
        • Walch G.
        • Sirveaux F.
        • et al.
        Repair of tears of the subscapularis.
        J Bone Joint Surg Am. 2005; 87: 725-730
        • Habermeyer P.
        • Magosch P.
        • Pritsch M.
        • Scheibel M.T.
        • Lichtenberg S.
        Anterosuperior impingement of the shoulder as a result of pulley lesions: A prospective arthroscopic study.
        J Shoulder Elbow Surg. 2004; 13: 5-12
        • Rockwood C.A.
        • Lyons F.R.
        Shoulder impingement syndrome: Diagnosis, radiographic evaluation, and treatment with a modified Neer acromioplasty.
        J Bone Joint Surg Am. 1993; 75: 409-424
        • Walch G.
        • Nove-Josserand L.
        • Boileau P.
        • Levigne C.
        Subluxations and dislocations of the tendon of the long head of the biceps.
        J Shoulder Elbow Surg. 1998; 7: 100-108
        • Bennett W.F.
        Specificity of the Speed’s test: Arthroscopic technique for evaluating the biceps tendon at the level of the bicipital groove.
        Arthroscopy. 1998; 14: 789-796
        • Gill H.S.
        • El Rassi G.
        • Bahk M.S.
        • Castillo R.C.
        • McFarland E.G.
        Physical examination for partial tears of the biceps tendon.
        Am J Sports Med. 2007; 35: 1334-1340
        • Hegedus E.J.
        • Goode A.
        • Campbell S.
        • et al.
        Physical examination tests of the shoulder: A systematic review with meta-analysis of individual tests.
        Br J Sports Med. 2008; 42 (discussion 92): 80-92
        • Holtby R.
        • Razmjou H.
        Accuracy of the Speed’s and Yergason’s tests in detecting biceps pathology and SLAP lesions: Comparison with arthroscopic findings.
        Arthroscopy. 2004; 20: 231-236
        • Dierickx C.
        • Ceccarelli E.
        • Conti M.
        • Vanlommel J.
        • Castagna A.
        Variations of the intra-articular portion of the long head of the biceps tendon: A classification of embryologically explained variations.
        J Shoulder Elbow Surg. 2009; 18: 556-565
        • Favorito P.J.
        • Harding III, W.G.
        • Heidt Jr., R.S.
        Complete arthroscopic examination of the long head of the biceps tendon.
        Arthroscopy. 2001; 17: 430-432
        • Murthi A.M.
        • Vosburgh C.L.
        • Neviaser T.J.
        The incidence of pathologic changes of the long head of the biceps tendon.
        J Shoulder Elbow Surg. 2000; 9: 382-385
        • Snyder S.J.
        Shoulder arthroscopy.
        Ed 2. Lippincott, Williams & Wilkins, Philadelphia2003
        • Yamaguchi K.
        • Galatz L.M.
        Disorders of the biceps tendon.
        in: Iannotti J.P. Williams Jr., G.R. Disorders of the shoulder: Diagnosis and management. Ed 2. Lippincott, Williams & Wilkins, Philadelphia2007: 249-250
        • Williams Jr., G.R.
        Painful shoulder after surgery for rotator cuff disease.
        J Am Acad Orthop Surg. 1997; 5: 97-108
        • Bhatia D.N.
        • van Rooyen K.S.
        • de Beer J.F.
        Direct arthroscopy of the bicipital groove: A new approach to evaluation and treatment of bicipital groove and biceps tendon pathology.
        Arthroscopy. 2008; 24 (Available online at www.arthroscopyjournal.org): 368.e1-368.e6
        • Hart N.D.
        • Golish S.R.
        • Dragoo J.L.
        Effects of arm position on maximizing intra-articular visualization of the biceps tendon: A cadaveric study.
        Arthroscopy. 2012; 28: 481-485