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We investigated the function of biceps in 18 patients (19 shoulders) with lesions of the rotator cuff. Their mean age was 59 years. Another series of 18 patients (19 shoulders) with normal rotator cuffs as seen on MRI acted as a control group. Their mean age was 55 years. A brace was used to maintain contraction of biceps during elevation. Anteroposterior radiographs were obtained with the arm elevated at 0°, 45° and 90° with and without contraction of biceps. The distance between the centre of the head of the humerus and the glenoid was compared in the two groups.We found that in the group with tears there was significantly greater proximal migration of the head of the humerus at 0° and 45° of elevation without contraction of biceps but depression of the head of the humerus at 0°, 45° and 90° when biceps was functioning. We conclude that biceps is an active depressor of the head of the humerus in shoulders with lesions of the rotator cuff. Patients and MethodsBetween November 1996 and October 1997 we treated surgically 18 patients (19 shoulders) with tears of the rotator cuff which had been diagnosed by arthrography or MRI. There were 14 men and four women with a mean age of 59 years (44 to 77). Eleven shoulders had full-thickness tears, five of which were large (>3 cm), three medium (1 to 3 cm) and three small (<1 cm). Eight shoulders had partialthickness tears of which seven were medium and one small. The long head of biceps was intact in all of these patients. A control group of 19 shoulders was asymptomatic with normal rotator cuffs as seen on MRI. There were 15 men and four women with a mean age of 55 years (17 to 77). There was no significant difference in age (p = 0.38) and gender (p = 0.99) between the two groups. Anteroposterior radiographs were taken with the arm elevated at 0°, 45° and 90°, the elbow flexed and the forearm supinated, and a brace applied which allowed active contraction of biceps without the other muscles (Fig. 1). The resistant force produced by the band was approximately 1.5 kg. The distance between the centre of the head of the humerus and the glenoid was measured and processed using National Institute of Health software 11 (NIH Image; National Institute of Health, Bethesda, Maryland) (Fig. 2). In four volunteers with a mean age of 30 years (29 to 31) EMG was performed using the brace and activity in the anterior, middle and posterior deltoid, triceps, trapezius and pectoralis major recorded at 0°, 45° and 90° of elevation. We were able to confirm that when using the brace, only biceps was contracting significantly. These activities were measured as percentages of the maximum voluntary contraction (% MVC). 12,13Statistical analysis. The results in the two groups were compared using a one-way between-group analysis of variance (ANOVA), with statistical significance set at the 5% level.

We investigated electromyographic activities of the biceps in 40 shoulders with full-thickness tears of the rotator cuff and 40 asymptomatic shoulders, with a normal rotator cuff on MRI, to determine the role of the biceps in cuff-deficient shoulders. Using surface electrodes, biceps activities were recorded during arm elevation in the scapular plane with and without a 1-kg load. The percentages of integrated electromyograms to the maximum voluntary contraction (%MVC) were obtained at 30 degrees, 60 degrees, 90 degrees, and 120 degrees of elevation. In the normal shoulders, %MVC of the biceps was always less than 10% through the arc of elevation both with and without load. Among 40 shoulders with rotator cuff tears, 14 showed increased activities of the biceps more than 10% in %MVC (p < 0.0001), whereas the remaining 26 shoulders had activities similar to the normal shoulders. The biceps activities in these 14 shoulders increased with load application and at higher angles of elevation. The muscle strength tended to be weaker in shoulders with increased biceps activities than in those without. Our findings suggest a potential supplemental function of the biceps in shoulders with rotator cuff tears.

BackgroundCalcification of the yellow ligament sometimes compresses the spinal cord and can induce myelopathy. Usually, the calcification does not induce acute neck pain. We report a case of a patient with acute neck pain caused by calcium pyrophosphate dihydrate in a calcified cervical yellow ligament.Case presentationA 70-year-old Japanese woman presented with acute neck pain. She had a moderately high fever (37.5 °C), and her neck pain was so severe that she could not move her neck in any direction. Computed tomography showed a high-density area between the C5 and C6 laminae suspicious for calcification of the yellow ligament. Magnetic resonance imaging showed intermediate-signal intensity on T1-weighted imaging and high-signal intensity on T2-weighted imaging surrounding a low-signal region on both T1- and T2-weighted imaging with cord compression. There was a turbid, yellow fluid collection in the yellow ligament at the time of operation. Histologically, calcium pyrophosphate dihydrate crystals were found in the fluid, and she was diagnosed as having a pseudogout attack of the yellow ligament.ConclusionsPseudogout attack of the cervical yellow ligament is rare, but this clinical entity should be added to the differential diagnosis of acute neck pain, especially when calcification of the yellow ligament exists.

Objectives: Rectus sheath hematoma (RSH) can result from bleeding into the rectus abdominis muscle or a direct muscular tear; nontraumatic spontaneous RSH is a rare condition. Here, we report a case of spontaneous RSH associated with warfarin administration for the treatment of chronic thromboembolic pulmonary hypertension (CTEPH).Patient: An 87-year-old woman was referred to our hospital because of abdominal pain, nausea, and vomiting for 3 days. She was receiving warfarin for treating CTEPH. She had a bulging and hard lower abdomen with ecchymosis. Moreover, the bulging portion was highly tender, and a positive Carnett’s sign was also observed. She reported no history of abdominal trauma. Abdominal computed tomography (CT) scan revealed right RSH.Results: She was diagnosed with spontaneous RSH and admitted to our hospital. Warfarin was antagonized with an intravenous injection of vitamin K; hemostatic agents were intravenously administered. Gradually, her abdominal pain improved. She was finally discharged 12 days after the admission. Abdominal CT scan performed 17 days after the discharge revealed a reduction in the size of RSH.Conclusion: Despite not having a history of trauma, it is necessary to consider the possibility of RSH for patients receiving warfarin and complaining of abdominal pain.

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We investigated the function of biceps in 18 patients (19 shoulders) with lesions of the rotator cuff. Their mean age was 59 years. Another series of 18 patients (19 shoulders) with normal rotator cuffs as seen on MRI acted as a control group. Their mean age was 55 years. A brace was used to maintain contraction of biceps during elevation. Anteroposterior radiographs were obtained with the arm elevated at 0 degrees , 45 degrees and 90 degrees with and without contraction of biceps. The distance between the centre of the head of the humerus and the glenoid was compared in the two groups. We found that in the group with tears there was significantly greater proximal migration of the head of the humerus at 0 degrees and 45 degrees of elevation without contraction of biceps but depression of the head of the humerus at 0 degrees, 45 degrees and 90 degrees when biceps was functioning. We conclude that biceps is an active depressor of the head of the humerus in shoulders with lesions of the rotator cuff.