Compensatory Movement Patterns Are Based on Abnormal Activity of the Biceps Brachii and Posterior Deltoid Muscles in Patients with Symptomatic Rotator Cuff Tears

Veen, Egbert J.D.; Koorevaar, Cornelis T.; Verdonschot, Koen H M; Sluijter, Tim E; Groot, Tom de; Hoeven, Johannes H. van der; Diercks, Ron L.; Stevens, Martin

doi:10.1097/corr.0000000000001555

Cited by 12 publications

(12 citation statements)

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“…Four studies used fine wire electromyography (fwEMG) to record biceps brachii muscle activity [ 20 , 23 , 25 , 51 ]. Seven studies used a combination of both sEMG and fwEMG for recording activity of the biceps brachii and other shoulder muscles, such as the rotator cuff and deltoid muscles [ 40 , 46 , 52 , 101 , 102 , 120 , 228 ].…”

Section: Functionmentioning

confidence: 99%

“…A single study reported a significant delay in anticipatory muscle activation in subjects with rotator cuff tears during a ball drop task [ 213 ]. A recent study demonstrated both hyperactivity and pre-activation of the biceps brachii in patients with rotator cuff tears during reaching tests [ 228 ]. In support of biceps activity during throwing, two studies reported significant hyperactivity of the biceps brachii during simulated pitching and cocking phases of throwing in subjects with anterior shoulder instability vs. controls [ 25 , 51 ].…”

Section: Pathologymentioning

confidence: 99%

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The long head of biceps at the shoulder: a scoping review

Diplock

Hing

Marks

2023

BMC Musculoskelet Disord

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Background This review aimed to explore the available literature to update our understanding of the long head of biceps (LHB) at the shoulder. Synthesise our findings to identify emergent themes and knowledge gaps to inform future research and management directions. Methods PubMed, Embase, Cinahl, SportDiscus, CENTRAL, and Web of Science were searched from inception to 31st December 2021. Articles were included if they referenced adult participants > 18 years of age and were written in English. Results 214 articles were included in the final analysis, and results were categorised into six emergent themes: (1) Anatomy - Normal anatomical variation of the biceps from aberrant origins, third and fourth accessory heads, and an absence of the LHB tendon (LHBT) are not necessarily benign, with shoulder pain and instability a commonly reported theme. (2) Function - Bicep’s role in glenohumeral elevation and stability in healthy shoulders is minimal. In contrast, LHB has a more significant role in shoulder stability and humeral head depression in subjects with rotator cuff failure or an absent LHBT. (3) Pathology - There is an association between LHB tendinopathy, rotator cuff disease, LHBT instability and occult rotator cuff tears. Early recruitment and hyperactivity of the LHB in subjects with symptomatic rotator cuff tears and instability suggest a potential compensatory role. (4) Assessment - The limited diagnostic utility of special orthopaedic tests in assessing LHBT pathology was a consistent theme. The utility of magnetic resonance imaging and ultrasound to identify full-thickness tendon tears and instability of the LHBT was moderate to high. However, the utility of clinical tests and imaging may be underestimated due to arthroscopy’s limitations in fully visualising the proximal LHBT. (5) Non-Surgical Management - Ultrasound-guided injections into the biceps sheath show greater accuracy and patient outcomes than blinded injections; however, the entry of injectate into the intraarticular glenohumeral joint may have unwanted complications. (6) Surgical management - For the surgical management of biceps pathology with or without rotator cuff pathology, both biceps tenodesis and tenotomy report similar improvements in pain without any significant adverse effect on strength or function. Tenodesis favoured higher overall constant scores and a lower incidence of Popeye deformity and cramping arm pain, with tenotomy trending to be more cost and time effective. For patients with a healthy LHBT, rotator cuff repair with adjunctive tenodesis or tenotomy fails to provide additional clinical improvements compared to rotator cuff repair in isolation. Conclusions The scoping review highlights the variability of biceps anatomy, which is not necessarily benign and suggests a minimal role of the LHB in shoulder elevation and stability in healthy individuals. In contrast, individuals with rotator cuff tears experience proximal humeral migration and demonstrate hyperactivity of the LHB, suggesting a potential compensation role. The observed prevalence of LHBT pathology with rotator cuff tears is well established; however, the cause-and-effect relationship between LHBT pathology and rotator cuff disease is undetermined. The diagnostic utility of clinical tests and imaging to exclude LHBT pathology may be understated due to the limitations of arthroscopy to visualise the proximal LHBT fully. Rehabilitation programs for the LHB are understudied. Similar post-surgical clinical outcomes are observed for tenodesis and tenotomy for biceps and rotator cuff-related shoulder pain. Subjects undergoing biceps tenodesis are less likely to have cramping arm pain and a Popeye deformity than patients undergoing biceps tenotomy. The significance of routine surgical removal of the LHBT and sequelae on rotator cuff tear progression to failure and long-term shoulder function is unknown, and further research is required. Pre-registration OSF: https://osf.io/erh9m

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Section: Functionmentioning

confidence: 99%

Section: Pathologymentioning

confidence: 99%

The long head of biceps at the shoulder: a scoping review

Diplock

Hing

Marks

2023

BMC Musculoskelet Disord

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“…However, symptomatic rotator cuff tears have less activity of the deltoid muscle during shoulder elevation compared with asymptomatic tears [ 23 ]. Moreover, muscle activity of only the posterior deltoid and biceps brachii was higher in symptomatic rotator cuff tears than in age-matched healthy controls [ 19 ].…”

Section: Introductionmentioning

confidence: 99%

Load-induced increase in muscle activity during 30° abduction in patients with rotator cuff tears and control subjects

Croci,

Warmuth,

Baum

et al. 2023

J Orthop Traumatol

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Background Rotator cuff muscles stabilise the glenohumeral joint and contribute to the initial abduction phase with other shoulder muscles. This study aimed to determine if the load-induced increase in shoulder muscle activity during a 30° abduction test is influenced by asymptomatic or symptomatic rotator cuff pathologies. Materials and Methods Twenty-five patients with unilateral rotator cuff tears (age, 64.3 ± 10.2 years), 25 older control subjects (55.4 ± 8.2 years) and 25 younger control subjects (26.1 ± 2.3 years) participated in this study. Participants performed a bilateral 30° arm abduction and adduction movement in the scapular plane with handheld weights (0–4 kg). Activity of the deltoid, infraspinatus, biceps brachii, pectoralis major, latissimus dorsi and upper trapezius muscles was analysed at maximum abduction angle after normalisation to maximum voluntary contraction. Shoulders were classified into rotator cuff tendinopathy, asymptomatic and symptomatic rotator cuff tears, and healthy based on magnetic resonance images. A linear mixed model (loads, shoulder types) with random effects (shoulder identification) was applied to the log-transformed muscle activities. Results Muscle activity increased with increasing load in all muscles and shoulder types (P < 0.001), and 1-kg increments in additional weights were significant (P < 0.001). Significant effects of rotator cuff pathologies were found for all muscles analysed (P < 0.05). In all muscles, activity was at least 20% higher in symptomatic rotator cuff tears than in healthy shoulders (P < 0.001). Symptomatic rotator cuff tears showed 20–32% higher posterior deltoid (P < 0.05) and 19–25% higher pectoralis major (P < 0.01) activity when compared with asymptomatic tears. Conclusions Rotator cuff pathologies are associated with greater relative activity of shoulder muscles, even with low levels of additional load. Therefore, the inclusion of loaded shoulder tests in the diagnosis and rehabilitation of rotator cuff pathologies can provide important insight into the functional status of shoulders and can be used to guide treatment decisions. Level of evidence: Level 2. Trial registration: Ethical approval was obtained from the regional ethics committee (Ethics Committee Northwest Switzerland EKNZ 2021-00182), and the study was registered at clinicaltrials.gov on 29 March 2021 (trial registration number NCT04819724, https://clinicaltrials.gov/ct2/show/NCT04819724).

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“…Clinically fasciocutaneous, musculocutaneous, or muscular deltoid and posterior deltoid flaps are especially used in tetraplegia (by a transfer to triceps) [28], posterior shoulder instability [29] and radionecrotic defects situated over the glenohumeral joint [30]. In addition, patients with a symptomatic rotator cuff tear show compensatory movement patterns based on the abnormal activity of the biceps brachii and posterior deltoid muscles [31]. Considering the clinical relevance, gross anatomy of the deltoid muscle and anatomical variants should be considered to improve success of management strategies and treatments to avoid injury.…”

Section: Introductionmentioning

confidence: 99%

A Variant of the Deltoid Muscle and Its Clinical Implications: A Cadaveric Study

et al. 2022

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Background: The deltoid is the muscle that forms the rounded contour of the shoulder. Anatomically, it seems to be made up of three different sets of fibers. The three anatomical portions in which the deltoid muscle are typically divided into the anterior (clavicular), the mean (acromial), and the posterior (spinal). Different variations of the deltoid muscle have been described in the literature. The analysis and knowledge of these anomalies are essential for surgeons and anatomists. Methods: A total of 21 specimens (12 women and 9 men) were used with a 10% formaldehyde solution. All specimens were dissected bilaterally (the classical dissection methodology was used). Results: In one corpse, an additional bilateral belly of the deltoid muscle was found. It was observed that this additional muscular belly was related to the fascial tissue of the deltoid muscle and its muscle fibers take origin from the middle third of the inferomedial bands of infraspinatus fascia. In addition, the belly attaches to the posterior belly of the deltoid muscle. The deltoid muscle and the additional belly were innervated by the axillar nerve, which is a lateral terminal bouquet of the posterior fascicle of the brachial plexus. Conclusions: This new variation of the deltoid muscle must be considered by surgeons, as well as abnormal conditions in terms of compartment syndrome involving the shoulder. Therefore, consideration of this variant is necessary for the correct diagnosis and treatment of trauma or other shoulder pathology that may be refractory to standard treatments.

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Compensatory Movement Patterns Are Based on Abnormal Activity of the Biceps Brachii and Posterior Deltoid Muscles in Patients with Symptomatic Rotator Cuff Tears

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Cited by 12 publications

References 32 publications

The long head of biceps at the shoulder: a scoping review

The long head of biceps at the shoulder: a scoping review

Load-induced increase in muscle activity during 30° abduction in patients with rotator cuff tears and control subjects

A Variant of the Deltoid Muscle and Its Clinical Implications: A Cadaveric Study

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