Diagnostic Glenohumeral Arthroscopy Fails to Fully Evaluate the Biceps-Labral Complex

Taylor, Samuel A.; Khair, M. Michael; Gulotta, Lawrence V.; Pearle, Andrew D.; Baret, Nikolas J.; Newman, Ashley; Dy, Christopher J.; O’Brien, Stephen J.

doi:10.1016/j.arthro.2014.10.017

Cited by 83 publications

(100 citation statements)

References 42 publications

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“…However, this manoeuvre appears insufficient based on the findings in the current study as medial sidewall lesions would be missed. Several recent researches have called into question whether arthroscopy provides an adequate view of the LHBT and bicipital groove [20, 26, 27]. Consequently, when a subscapularis tear is suspected and the SGHL/CHL complex appears normal during arthroscopic assessment, the LHBT in its intertubercular groove and the medial wall of the groove must be checked.…”

Section: Discussionmentioning

confidence: 99%

Relationship between subscapularis tears and injuries to the biceps pulley

Godenèche

Nové-Josserand

Audebert³

et al. 2016

Knee Surg Sports Traumatol Arthrosc

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Purpose The purpose of this study was to analyse the relationship between long head of the biceps brachii (LHBT) lesions and subscapularis tears. The hypothesis was that a bicipital pulley might remain intact, even in the case of a subscapularis tear.MethodsBetween 2010 and 2011, all patients who had a primary arthroscopic repair of a subscapularis tear were potentially included in this prospective study. The outcome of interest was the prevalence and type of arthroscopic lesions of the LHBT and bicipital pulley. Furthermore, the supposed pathomechanics of injury and the treatment proposed (conservative, pulley repair, tenodesis, tenotomy, etc.) was recorded. The following baseline characteristics were assessed: age, sex, shoulder side, and limb dominance.Results Of the 218 patients, the superior glenohumeral ligament/coracohumeral ligament (SGHL/CHL) complex was normal in 54 patients (25%), stretched in 84 patients (39%), and absent in 77 patients (35%). Below the SGHL/CHL complex in the bicipital groove, the medial wall of the LHBT sheath was normal in 25%, partially torn in 39%, and completely torn in 35%. In 25 of the 218 patients (11%), a pathologic LHBT with an intact SGHL/CHL complex was observed. In these cases, the medial wall of the bicipital sheath was torn in 92%.ConclusionsThe biceps pulley system, including the SGHL/CHL complex and subscapularis tendon, merits recognition as an important anatomical structure, and its lesions contribute to shoulder pathology. The subscapularis tendon is very important for the stability of the LHBT and should be included in the pulley system. In cases of a tear associated with a lesion of the SGHL/CHL complex, the LHBT is nearly always unstable and pathologic.Level of evidenceII.

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Section: Discussionmentioning

confidence: 99%

Relationship between subscapularis tears and injuries to the biceps pulley

Godenèche

Nové-Josserand

Audebert³

et al. 2016

Knee Surg Sports Traumatol Arthrosc

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“…Inability to visualize this region is an important cause of missed diagnoses, which are reported to occur at a rate of 30% to 50%. 9,11,16,22 This also implies that published figures for sensitivities and specificities of common physical examination tests and imaging modalities based on arthroscopy as a gold standard are invalid. [1][2][3]10,13 It would therefore be appropriate for further research to revisit these values based on open exploration to obtain valid data.…”

Section: Discussionmentioning

confidence: 99%

“…This is an important limitation of previous studies as not only is this technique not used in clinical practice but it also overestimates the amount of tendon that is normally visualized. 11,22 To our knowledge, there is only 1 published report of an atraumatic grasper technique. Parada et al 18 described using an Allis clamp and rotating the tendon around its closed jaws.…”

Section: Discussionmentioning

confidence: 99%

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Shoulder arthroscopy does not adequately visualize pathology of the long head of biceps tendon

Old

Saithna

Longo

et al. 2017

Journal of Shoulder and Elbow Surgery

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“…Taylor et al 50 conducted a cadaveric study demonstrating diagnostic glenohumeral arthroscopy reveals only 55% of the length of the LHBT tendon. Sheean et al 10 further explored this issue using both cadaveric and in vivo components to demonstrate that a 70° arthroscope significantly improves visualisation of the bicipital groove in the lateral decubitus position compared with a standard 30° arthroscope (18 mm vs 11 mm).…”

Section: Introductionmentioning

confidence: 99%