Quantitative Ultrasound Facilitates the Exploration of Morphological Association of the Long Head Biceps Tendon with Supraspinatus Tendon Full Thickness Tear

Abstract

BackgroundsPathology of the long head biceps tendon (LHBT) is associated with rotator cuff tears but whether the LHBT texture changes following supraspinatus tendon full thickness tear (SSFT) can be detected at the extra-articular segment remains unknown. This cross-sectional study aimed to explore the morphological differences of the LHBT in shoulders with and without deficient rotator cuffs by using quantitative ultrasound.Materials and MethodsWe selected 145 cases with SSFT and 145 age-and- gender-matched controls. The width, thickness, flattening ratio, cross-sectional area, and echogenicity ratio of the LHBT were measured and a general linear model was used to clarify the relationship between rotator cuff pathology and LHBT morphology. The receiver operating characteristic curves of each parameter were constructed for SSFT discrimination and the maximal Youden indexes were used to define the best cut-off points.ResultsWe found increased thickness and cross-sectional area but decreased flattening ratio in shoulders with SSFT, and no between-group differences in the width and echogenicity ratio. The LHBT appearance was modified by biceps peritendinous effusion and medial subluxation, but not by the size of SSFT. The flattening ratio was the best discriminator for SSFT with an area under curve of 0.81 (95% confidence interval, 0.76–0.86). The cut-off values to differentiate between the non-tear and tear groups were 2.00 mm of the thickness, 1.73 of the flattening ratio and 10.53 mm2 of the cross-sectional area.ConclusionQuantitative ultrasound facilitated the detection of the LHBT morphological changes following SSFT and demonstrated its potential utility in discriminating rotator cuff deficiency.

Can Quantification of Biceps Peritendinous Effusion Predict Rotator Cuff Pathologies?

“…4 Because the LHBT at the bicipital groove is the first structure scanned during a standard US imaging of the shoulder, BPE acts as an initial alerting sign for the rest of the examination. 5 Previous studies used a hypoechoic area of more than 2 to 3 mm around the LHBT as the diagnostic criterion for biceps tendinopathy or tenosynovitis. 6,7 The relationship between peritendinous effusion of more than 2 mm (as the diagnostic standard) and physical examination findings of LHBT lesions has been investigated.…”

Association of Bicipital Peritendinous Effusion with Subacromial Impingement: A Dynamic Ultrasonographic Study of 337 Shoulders

“…The software Image J (National Institutes of Health, 9000 Rockville Pike, Bethesda, MD 20892) was used to conduct the measurements. Several previous researchers showed that using this method to quantify BPE, the correlation coefficients of inter- and intra-observer reliability can be up to 0.93 and 0.76, respectively891013. One previous study showed that effusion thickness more than 1 mm was associated with various sonographic pathologies of the shoulder10.…”

“…The supraspinatus tendon and subscapularis bursa were scanned by placing the arm behind the back to shift the tendon away from the coverage of the acromion. The hand was put on the contralateral shoulder during the examination of the infraspinatus tendon and the posterior shoulder recess891013. Regarding the dynamic subdeltoid imaging test; the arm was rested beside the trunk with the transducer placed lateral to the acromion along the scapular axis.…”

“…Subluxation of the biceps tendon was diagnosed if part of the tendon was displaced from the bicipital groove, whereas dislocation was diagnosed if the whole tendon was outside the groove. A full-thickness tear of the rotator cuff tendons was defined as an intra-tendinous gap extending from the bursal to the articular aspect, while a partial thickness tear was defined as a gap on either side or inside the tendon89101315. One antecedent study indicated that simultaneous presentation of BPE with subdeltoid bursa effusion usually coexisted with rotator cuff tendon tears16.…”

“…The short axis view of the biceps tendon (with light touch of the probe) was used for measurement of the BPE, which was visualized as an anechoic compressible fluid collection surrounding the LHBT891013. A point on the border of the biceps tendon with the greatest effusion thickness was determined visually.…”