long head of biceps tendon pathology

Rupture

Epidemiology

·      accounts for 50% of ruptures of biceps muscle

·      occurs in two groups

1.   young patients

·      often with sudden or unexpected lifting

2.   older patients

·      usually middle-aged or elderly

·      associated with impingement

·      occurs with minimal or no trauma

CLINICAL

·      sudden pain with lifting

·      characteristic bulging contour of arm

·      Popeye muscle

·      some initial weakness after pain settles

·      20% loss of flexion power

·      no significant weakness with time

·      normal flexion

·      10% loss of supination power

treatment
Nonoperative

·      indicated in most patients

Operative

·      in form of tenodesis

Indications

·      young active patients with recent rupture who do not accept deformity or slight weakness

·      older patients as part of treatment of impingement

Technique

·      deltopectoral approach

·      expose intertubercular groove

·      divide transverse humeral ligament

·      remove intraglenoid poftion of tendon

·      make keyhole in floor of groove

·      upper round portion 1 cm dia

·      lower portion 0.5 cm dia

·      roll or knot and suture biceps tendon

·      insert end into keyole

·      close periosteum over it

·      restrict elbow extension for 4 weeks postoperatively

Dislocation

·      medial dislocation of biceps tendon from intertubecular groove

aetiology

·      attrition rupture of transverse humeral ligament

·      with or without associated rotator cuff tear

·      acute traumatic rupture of transverse humeral ligament

clinical
History

·      pain in anterior shoulder

·      on dislocation

·      with abduction and external rotation

·      snapping sensation

·      reflex dropping of arm

·      subsequent relocation of tendon

Examination

·      may be tenderness in groove

radiology

·      best diagnosed on arthrography

differential diagnosis

·      recurrent anterior subluxation of shoulder

treatment

·      tenodesis if troublesome

Tenosynovitis

aetiology

·      part of impingement with

·      rotator cuff tendinitis

·      subacromial bursitis

clinical
History

·      pain in anterior shoulder

·      worse with overhead motion

·      pain at night esp. lying on affected side

Examination

·      tendon tender in groove

·      anterior pain on external rotation

·      Speed’s test

·      shoulder flexed to 90o

·      elbow extended and forearm supinated

·      pain on resisted elevation

radiology
Plain x-ray

·      changes of impingement

·      bicipital groove

·      shallow groove

·      medial an lateral osteophytes

Arthrography

·      narrowed attenuated tendon or vacuolation of tendon

·      elevation of biceps from groove or origin

·      by inflamed synovium

·      poor or no filling of sheath

treatment

·      as for impingement

·      initially nonoperative

·      if fails to respond, operative

·      include tenodesis of biceps tendon