PurposeTo evaluate the diagnostic efficacy of indirect signs for proximal articular‐positioned, partial (< 50%), subscapularis tendon tears (facet 1 tears) via conventional magnetic resonance imaging (MRI). MethodsA retrospective study was conducted on 67 patients of Yoo’s type 1 or 2A tears. Forty‐five arthroscopic subacromial decompression and acromioclavicular resection cases served as controls. Indirect signs indicating a facet 1 tear included small defects, superior subscapularis recess (SSR), long head of the biceps (LHBT) configurations, bone edema or cyst formation on lesser tuberosity (LTBEC), and fatty infiltration of subscapularis muscle. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were checked. ResultsSSR was the most sensitive sign (90%). The sensitivities and NPV of LHBT configurations and LTBEC were low (sensitivity: 42.9% and 17.9%, NPV: 56.4% and 44.4%, respectively). The specificities of all indirect signs were relatively high (> 90%). The Chi‐squared test and multinomial logistic regression confirmed the significance of small defects, SSRs, and fatty infiltrations for facet 1 tears (p ≤ 0.014). The combined sensitivity and specificity were up to 97.7% and 92.3%, respectively, in the presence of either a small defect or an SSR. ConclusionsConventional MRI alone can detect facet 1 tears through indirect signs (small defects, SSR, and fatty infiltrations of the subscapularis muscle), predicting unspecified anterior shoulder pain due to concealed biceps instability, and facilitating preoperative diagnosis for a facet 1 tear. Level of evidenceIII.
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.
Background Traumatic distal triceps tendon rupture results in substantial disability in the absence of an appropriate diagnosis and treatment. To the best of our knowledge, differences in the degree of injury according to the injury mechanisms and associated lesions are not well known. Questions/purposes In this study, we asked: (1) What differences are seen in triceps tear patterns between indirect injuries (fall on an outstretched hand) and direct injuries? (2) What are the associated elbow and soft tissue injuries seen in indirect and direct triceps ruptures? Methods Between 2006 and 2017, one center treated 73 elbows of 72 patients for distal triceps tendon rupture. Of those, 70% (51 of 73 elbows) was excluded from this study; 8% (6 of 73) were related to systemic diseases, 59% (43 of 73) sustained open injuries, and 3% (2 of 73) were related to local steroid injections. We retrospectively collected data on traumatic distal triceps tendon rupture in 30% (22 of 73) of elbows at a single trauma center during a 10-year period. A fall on an outstretched hand was the cause of injury in 15 patients and direct blow by object or contusion were the cause in seven. MRI and surgery were performed in all patients. Traumatic distal triceps tendon rupture was classified by the Giannicola method, which is classified according to the depth and degree of the lesion based on MRI and surgical findings. Associated fractures and bone contusions on MRI were characterized. Ligament injuries on MRI was divided into partial and complete rupture. Agreement between the MRI and intraoperative findings for the presence of a traumatic distal triceps tendon rupture was perfect, and the Giannicola classification of traumatic distal triceps tendon rupture was good (kappa = 0.713). Results In the indirect injury group (fall on an outstretched hand), 15 of 15 patients had injuries that involved only the tendinous portion of the distal triceps, but these injuries were not full-thickness tears, whereas in the direct injury group, three of seven patients had a full-thickness rupture (odds ratio [OR] 1.75 [95% CI 0.92 to 3.32]; p = 0.02). The direct injury group had no associated ligamentous injuries while 14 of 15 patients with indirect injuries had ligamentous injuries (OR 0.13 [95% CI 0.02 to 0.78]; p < 0.001; associated injuries in the indirect group: anterior medial collateral ligament [14 of 15], posterior medial collateral ligament [7 of 15], and lateral collateral ligament complex [2 of 15]). Similarly, one of seven patients in the direct injury group had a bone injury (capitellar contusion), whereas 15 of 15 patients with indirect ruptures had associated fractures or bone contusions (OR 16.0 [95% CI 2.4 to 106.7]; p < 0.001). Conclusion A fall on an outstretched hand may result in an injury mostly to the lateral and long head of distal triceps tendon and an intact medial head tendon; however, direct injuries can involve full-thickness ruptures. Although a traumatic distal triceps tendon rupture occurs after a fall on an outstretched hand, radial neck, capitellar, and medial collateral ligament injury can occur because of valgus load and remnant extensor mechanisms. Based on our finding, the clinician encountering a distal triceps tendon rupture due to a fall on an outstretched hand should be aware of the possibility of remaining elbow extensor mechanism by intact medial head tendon portion, and associated injuries, which may induce latent complications. Level of Evidence Level III, prognostic study.
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