Refuting the lipstick sign

Grassbaugh, Jason A.; Bean, Betsey R.; Greenhouse, Alyssa; Yu, Henry H.; Arrington, Edward D.; Friedman, Richard J.; Eichinger, Josef K.

doi:10.1016/j.jse.2017.01.009

Cited by 11 publications

(13 citation statements)

References 16 publications

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“…Eleven patients (40.7%) underwent surgery ≤ 6 months after the onset of pain. The decision for LHBT resection was made by surgeons intraoperatively, based on arthroscopic findings including tenosynovitis (like ‘lip stick lesion’), 16 hypertrophy, and partial rupture of the tendon ( Figure 1 ). The criteria were standardized in two hospitals and patients who had at least one of the previously mentioned findings underwent arthroscopic tenotomy or mini-open supra-pectoral tenodesis of the LHBT.…”

Section: Methodsmentioning

confidence: 99%

Expression of Substance P and Nerve Growth Factor in Degenerative Long Head of Biceps Tendon in Patients with Painful Rotator Cuff Tear

Izumi¹,

Harada²,

Kajita³

et al. 2021

JPR

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Purpose Degenerative long head of biceps tendon (LHBT) has been recognized as a notable pain source in patients with rotator cuff tear (RCT). Tenotomy or tenodesis of LHBT is frequently indicated together with arthroscopic rotator cuff repair (ARCR) aiming for complete pain relief; however, it has not been fully investigated whether resected LHBT is really a source of pain. The purpose of this study was to investigate expression levels of pain-associated mediators in LHBT and its association with preoperative pain profiles. Methods Twenty-seven RCT patients who underwent ARCR with LHBT resection were included. Each LHBT was resected due to its abnormal arthroscopic findings including tenosynovitis, hypertrophy, and partial tear. Worst macroscopic lesion of the LHBT was obtained, and expression levels of substance P (SP) and nerve growth factor (NGF) were evaluated using enzyme-linked immunosorbent assay (ELISA). Ten healthy knee flexor tendons were analyzed as non-degenerative samples. Preoperatively, subjective shoulder pain VAS and pain duration were investigated. Conventional LHBT pain provocation tests (Speed, Yergason, O’Brien) were performed. Pressure pain threshold (PPT) of bilateral LHBT on the groove was recorded. Results Levels of SP and NGF expression were significantly higher compared with non-degenerative tendons (P<0.01). Shoulder pain VAS and pain duration were not directly associated with SP and NGF expression level. Patients with positive O’Brien test expressed greater SP than negative patients (P=0.001). Significant negative correlation between the PPT ratio (ipsilateral/contralateral) and SP expression level was observed (r=−0.453, P=0.034). Conclusion Greater expression of SP and NGF in degenerative LHBT supported our hypothesis that it would be a pain source in RCT patients. SP was likely to be expressed highly in patients with localized pressure pain hypersensitivity and positive O’Brien test (ie, altered mechanistic pain profile of LHBT), which may help when considering simultaneous LHBT resection during ARCR. Clinical Registration UMIN000023943.

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Section: Methodsmentioning

confidence: 99%

Expression of Substance P and Nerve Growth Factor in Degenerative Long Head of Biceps Tendon in Patients with Painful Rotator Cuff Tear

Izumi¹,

Harada²,

Kajita³

et al. 2021

JPR

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“… 29 Arthroscopic examination of the intra-articular appearance of the biceps tendon was not used in the diagnosis of biceps tendinopathy because intra-articular inflammatory changes have not been shown to be reliable indicators of the clinical entity. 30 However, for patients with substantial preoperative Zone 2 biceps tenderness, we performed a preoperative ultrasound-guided biceps groove diagnostic injection of a combined mixture of local anesthetic and steroid. If patients had substantial pain relief following this injection, it confirmed the diagnosis, and those patients underwent concomitant biceps tenodesis.…”

Section: Methodsmentioning

confidence: 99%

High Incidence of Anterior Shoulder Pain in Young Athletes Undergoing Arthroscopic Posterior Labral Repair for Posterior Shoulder Instability

Galvin

Slevin

et al. 2021

Arthroscopy, Sports Medicine, and Rehabilitation

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The purposes of this study were to determine the incidence of anterior shoulder pain in young athletes undergoing arthroscopic posterior labral repair for symptomatic unidirectional posterior shoulder instability and in patients with preoperative anterior shoulder pain treated without biceps tenodesis at the time of arthroscopic posterior labral repair who underwent a revision biceps tenodesis procedure at short-term follow up. Methods: A retrospective review was performed at a single institution over a 24-month period. The study included young patients who underwent an arthroscopic posterior labral repair for symptomatic unidirectional posterior shoulder instability. The electronic medical record, magnetic resonance arthrograms, and arthroscopic images were reviewed to exclude patients with posterior labral tears with anterior labral tear or SLAP (superior labrum anterior-to-posterior) tear extension on advanced imaging and arthroscopic examination. Data collected included the presence of preoperative tenderness to palpation of the biceps tendon in the groove, the results of a preoperative Speed test, postoperative Subjective Shoulder Value, the presence of postoperative anterior shoulder pain, and the need for a secondary biceps tenodesis. Results: We identified 65 patients who underwent arthroscopic labral repair for posterior shoulder instability. From this cohort, 26 patients with symptomatic unidirectional posterior shoulder instability underwent an arthroscopic posterior labral repair. The incidence of preoperative anterior shoulder pain with Zone 2 biceps groove tenderness and a positive Speed test was identified in 20 of 26 patients (76.9%). Of 26 patients, 5 (19%) had concomitant biceps tenodesis. The median postoperative Subjective Shoulder Value was 80 (interquartile range, 60-90) at median follow-up of 2.1 years. Of the 20 patients with preoperative anterior shoulder pain, 8 of 20 (40%) reported persistent anterior pain. One patient (4.7%) underwent a secondary biceps tenodesis. Conclusions: There is a high incidence of anterior shoulder pain and Zone 2 biceps groove tenderness in patients undergoing isolated arthroscopic posterior labral repair for unidirectional posterior shoulder instability. At shortterm follow-up, few patients required a secondary biceps tenodesis procedure; however, 30% of patients had persistent anterior shoulder pain. Level of Evidence: Level IV, retrospective diagnostic case series.

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“…In 2010, we started debridement of the subscapularis tendon involving less than 50% of a footprint (less than 6‐mm width) in the articular side and repair for more than 50% of the footprint. Thus, debridement of the subscapularis tendon and biceps tenotomy or tenodesis were performed in the cases of type 1 or type 2A subscapularis tendon [14, 26].…”

Section: Methodsmentioning

confidence: 99%

Prediction of the anterior shoulder pain source by detecting indirect signs for partial articular subscapularis tendon tears through conventional magnetic resonance imaging

Lee

Rhyou

Ahn

2020

Knee Surg Sports Traumatol Arthrosc

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PurposeTo evaluate the diagnostic efficacy of indirect signs for proximal articular‐positioned, partial (< 50%), subscapularis tendon tears (facet 1 tears) via conventional magnetic resonance imaging (MRI). MethodsA retrospective study was conducted on 67 patients of Yoo’s type 1 or 2A tears. Forty‐five arthroscopic subacromial decompression and acromioclavicular resection cases served as controls. Indirect signs indicating a facet 1 tear included small defects, superior subscapularis recess (SSR), long head of the biceps (LHBT) configurations, bone edema or cyst formation on lesser tuberosity (LTBEC), and fatty infiltration of subscapularis muscle. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were checked. ResultsSSR was the most sensitive sign (90%). The sensitivities and NPV of LHBT configurations and LTBEC were low (sensitivity: 42.9% and 17.9%, NPV: 56.4% and 44.4%, respectively). The specificities of all indirect signs were relatively high (> 90%). The Chi‐squared test and multinomial logistic regression confirmed the significance of small defects, SSRs, and fatty infiltrations for facet 1 tears (p ≤ 0.014). The combined sensitivity and specificity were up to 97.7% and 92.3%, respectively, in the presence of either a small defect or an SSR. ConclusionsConventional MRI alone can detect facet 1 tears through indirect signs (small defects, SSR, and fatty infiltrations of the subscapularis muscle), predicting unspecified anterior shoulder pain due to concealed biceps instability, and facilitating preoperative diagnosis for a facet 1 tear. Level of evidenceIII.

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Refuting the lipstick sign

Cited by 11 publications

References 16 publications

Expression of Substance P and Nerve Growth Factor in Degenerative Long Head of Biceps Tendon in Patients with Painful Rotator Cuff Tear

Expression of Substance P and Nerve Growth Factor in Degenerative Long Head of Biceps Tendon in Patients with Painful Rotator Cuff Tear

High Incidence of Anterior Shoulder Pain in Young Athletes Undergoing Arthroscopic Posterior Labral Repair for Posterior Shoulder Instability

Prediction of the anterior shoulder pain source by detecting indirect signs for partial articular subscapularis tendon tears through conventional magnetic resonance imaging

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