Correlation between superior humeral head migration and proximal long head of biceps tendon pathology in patients with and without rotator cuff tears using magnetic resonance imaging and radiography

Rattee, Josh; Sims, Laura A.; Leswick, David A.; Obaid, Haron

doi:10.1016/j.jseint.2022.06.003

Cited by 5 publications

(5 citation statements)

References 21 publications

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“…Whilst the LHBT predominantly affects elbow function, 10% of shoulder abduction strength in external rotation can be attributed to the LHBT [ 29 ]. Additionally, it has been shown that LHBT surgery or pathology causes an upward migration of the humeral head, suggesting a depressing function of the LHBT [ 6 , 8 , 25 ]. Functional results after RC repair with retained anatomical insertion of the LHBT have been shown to be superior when compared to cases with additional LHBT surgery [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

A shallow morphology of the intertubercular groove is associated with medial and bilateral but not lateral pulley lesions

Kleim

Carbonel

Hinz

et al. 2023

Knee Surg Sports Traumatol Arthrosc

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Purpose To investigate the influence of intertubercular groove (IG) morphology on the development of different types of biceps reflection pulley (BRP) injuries. Methods A consecutive cohort of 221 patients with ventral shoulder pain and a preoperative diagnosis suspecting BRP injury, who underwent arthroscopy, was retrospectively reviewed. The presence or absence as well as type of pulley injury (medial, lateral or bilateral) was confirmed arthroscopically. The intertubercular groove was evaluated on MRIs after triplanar reconstruction of the axial plane. IG depth, width, medial wall angle (MWA), lateral wall angle (LWA) and total opening angle (TOA) were measured. IG depth and width were expressed in relation to the humeral head diameter. Measurements were performed by two clinicians independently and averaged. Results Of 166 included patients 43 had bilateral, 65 medial and 38 lateral BRP lesions. 20 patients had intact BRPs and represented the control group. The intra-class correlation coefficient of measurements was 0.843–0.955. Patients with a medial or bilateral BRP injury had a flatter MWA (38.8° or 40.0° vs. 47.9°, p < 0.001), wider TOA (96.1° or 96.6° vs. 82.6°, p < 0.001), greater width (12.5 or 12.3 vs. 10.8 mm, p = 0.013) and shallower depth (5.5 or 5.4 vs. 6.2 mm, p < 0.001) than the control group. Conversely, the IG morphology of those with lateral BRP injuries did not differ significantly from the control group. The odds ratio for a medial or bilateral BRP injury when the TOA exceeded 95° was 6.8 (95% confidence interval 3.04–15.2). Conclusion A dysplastic type of IG morphology with a wide TOA, flat MWA, decreased depth and increased width is associated with the presence of medial and bilateral BRP injuries. A TOA of > 95° increases the likelihood of a medial or bilateral BRP injury 6.8-fold. Lateral BRP injuries are not associated with dysplastic IG morphology. Concomitant LHBT surgery may, therefore, not always be necessary during isolated supraspinatus tendon repair. Level of evidence Level III.

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Section: Discussionmentioning

confidence: 99%

A shallow morphology of the intertubercular groove is associated with medial and bilateral but not lateral pulley lesions

Kleim

Carbonel

Hinz

et al. 2023

Knee Surg Sports Traumatol Arthrosc

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 99%

“…Although the function of the LHBT continues to be discussed in the literature, many studies shows that the long head of the biceps tendon is effective in glenohumeral stability and prevents superior humeral migration. [20,21] The head-suppressing effect of the rotator cuff is frequently mentioned in the literature; [22] in our study, we wanted to question the effect of variable long head of biceps lesions on the humeral head position in patients with posterior superior rotator cuff tears in addition to the literature. Our study was able to answer this question; the superior humeral migration was higher, and the CD was significantly reduced in the totally ruptured biceps group compared to other groups, which clinically proves that the LHBT, of which biomechanical role is controversial, has an important function in preventing the anterior and SMHH.…”

Section: Discussionmentioning

confidence: 99%

Radiological and clinical evaluation of long head of biceps tendon function in the glenohumeral joint

Duman

Özer

2022

Jt Dis Relat Surg

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Objectives The aim of the study was to investigate the relationship between biceps pathologies and radiological measurements in massive rotator cuff tears treated arthroscopically. Patients and methods Between December 2015 and December 2018, a total of 145 patients (56 males, 89 females; mean age: 62.2±9.7 years; range, 28 to 87 years) with supraspinatus and/or infraspinatus full-thickness tear larger than 3 cm and who underwent arthroscopic rotator cuff repair were retrospectively analyzed. Biceps pathologies detected during arthroscopy were divided into four groups. Group 1: biceps tendinitis or without biceps pathology; Group 2: biceps partial/degeneration tear; Group 3: biceps dislocation/instability; Group 4: complete biceps head rupture. Radiological measurements were calculated from the preoperative magnetic resonance imaging and anteroposterior X-ray images of the patients. Results A total of 65.5% of the lesions were on the right arm and 34.5% were on the left arm. All patients had posterior superior rotator cuff tears which could be surgically repaired. A total of 22.1% of the patients had no biceps tendinitis/biceps pathology, 20.7% had biceps instability/dislocation, 28.3% had biceps degeneration/partial rupture, and 29% of patients had biceps total rupture. Patients in Group 4 had a statistically significantly higher superior migration of the humeral head distance (p=0.012) than Group 2, and patients in Group 2 had a statistically significantly higher coracohumeral distance (p=0.042) than patients in Group 4. There was no significant difference in the other measurements among the groups. Conclusion The long head of the biceps, of which function has not yet been clearly elucidated, is one of the superior and anterior stabilizing forces of the humeral head.

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“…A recent study found that biceps pathology reduced AHD. They also showed that this decrease was greater in patients with RC tears [19]. Superior migration of the humeral head after RC tear was first described by Golding in 1962 [7].…”

Section: Introductionmentioning

confidence: 86%

“…A recent study found that biceps pathology reduced AHD. They also showed that this decrease was greater in patients with RC tears [ 19 ].…”

Section: Introductionmentioning

confidence: 99%

The effect of biceps tenotomy on humeral migration and clinical outcomes in arthroscopic rotator cuff repair

Çakar

Güney

et al. 2022

J EXP ORTOP

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Purpose To evaluate the effect of biceps tenotomy on humeral migration and clinical outcomes in patients who underwent arthroscopic rotator cuff (RC) repair. Methods This is a retrospective study of 60 patients who underwent arthroscopic RC repair. Patients were divided into two groups, whether they underwent concomitant biceps tenotomy or not. The group underwent concomitant biceps tenotomy, tenotomy ( +), or not, tenotomy (-). Clinical and functional outcomes were performed using the American Shoulder and Elbow Surgeons (ASES), the University of California-Los Angeles (UCLA) scoring system. Radiological evaluation was performed in X-rays and magnetic resonance imaging (MRI), measuring the acromiohumeral distance (AHD), humeral migration (HM) and upper migration index (UMI). Results There was no significant difference between the groups in terms of patient characteristics. The follow-up period was 30.9 ± 8.7 months in the tenotomy ( +) group and 34.9 ± 8.2 months in the tenotomy (-) group with no significant difference. Postoperative ASES score improved significantly in the tenotomy ( +) group compared to the tenotomy (-) group (91.2 ± 4.7, 80.8 ± 18.7, respectively, p = 0.005). There was a significant difference in postoperative AHD, HM and UMI values (MRI; p = 0.003, p = 0.017, p = 0.025; X-ray; p = 0.049, p = 0.002, p = 0.010, respectively). The post–pre difference increase of AHD [MRI for tenotomy( +): 0.14 ± 0.86 and tenotomy(-): 0.91 ± 0.85, p = 0.001; X-ray for tenotomy( +): 0.61 ± 0.43 and tenotomy(-): 1.12 ± 0.7, p = 0.001] and UMI [MRI for tenotomy( +): 0.005 ± 0.05 and tenotomy(-): 0.04 ± 0.06, p = 0.006; X-ray for tenotomy( +): 0.01 ± .064 and tenotomy(-): 0.12 ± 0.37, p = 0.110] values were higher in the tenotomy (-) group compared to the tenotomy ( +) group while HM values decreased more in the tenotomy (-) group. [MRI for tenotomy ( +): -0.19 ± 1.07 and tenotomy (-): -0.79 ± 1.52, p = 0.079; X-ray for tenotomy ( +): -0.27 ± 0.54 and tenotomy (-): -1.006 ± 1.83, p = 0.040]. Conclusion After short-term follow-up, the humeral head was positioned higher in patients who underwent LHBT tenotomy compared to patients without tenotomy. However, it seems to affect clinical outcomes during this period positively. Level of Evidence Level 3

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Correlation between superior humeral head migration and proximal long head of biceps tendon pathology in patients with and without rotator cuff tears using magnetic resonance imaging and radiography

Cited by 5 publications

References 21 publications

A shallow morphology of the intertubercular groove is associated with medial and bilateral but not lateral pulley lesions

A shallow morphology of the intertubercular groove is associated with medial and bilateral but not lateral pulley lesions

Radiological and clinical evaluation of long head of biceps tendon function in the glenohumeral joint

The effect of biceps tenotomy on humeral migration and clinical outcomes in arthroscopic rotator cuff repair

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