The Ramp Test: An Arthroscopic Technique for Confirming Intra-articular Subluxation and Instability of the Long Head of the Biceps Tendon Within the Shoulder

Motley, Gregory S.; Guengerich, Brad; Schuller, Tracy; Turbyfill, Anna

doi:10.1016/j.eats.2017.09.011

Cited by 12 publications

(7 citation statements)

References 6 publications

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“…The scope was inserted through a posterolateral approach; a standard anterior portal was used for inspection of the intra-articular structures, while additional portals were added depending on the location and size of tendon tear. The first surgical phase was assessment of biceps using a probe both for the labrum and tendon groove inspection, as suggested by Motley et al 17 In case of inflammation, degeneration, or partial tear of the biceps tendon, or if a superior labrum anterior and posterior lesion of type 2 or higher was found, we performed a tenotomy/tenodesis in the bicipital groove using a 4.5-mm titanium double-loaded Healix TI BR (DePuy Synthes) suture anchor, with 2 suture lasso knots—1 knot crossing and 1 knot passing into the biceps tendon. In case of complete rupture of the biceps during CrossFit training with a positive Popeye sign, a mini-open tenodesis as described by Tangari et al 23 was performed after rotator cuff repair.…”

Section: Methodsmentioning

confidence: 99%

High Rate of Return to CrossFit Training After Arthroscopic Management of Rotator Cuff Tear

Carbone¹,

Candela

Gumina

2020

Orthopaedic Journal of Sports Medicine

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Background: CrossFit is a conditioning program involving high-intensity exercises performed in rapid, successive repetitions with limited or no recovery time. The shoulder girdle is highly involved in most basic CrossFit training programs. Hypothesis: CrossFit athletes affected by rotator cuff tear may be successfully treated with arthroscopic surgery with a high rate of early return to CrossFit activities. Study Design: Case series; Level of evidence, 4. Methods: Included in this study were athletes participating regularly in CrossFit training who had undergone arthroscopic rotator cuff repair. At a minimum follow-up of 24 months, we compared pre- and postoperative clinical outcome scores, including the Constant Score (CS), the American Shoulder and Elbow Surgeons (ASES) score, and a visual analog scale (VAS) for pain, as well as imaging results. Participants completed a return-to-CrossFit questionnaire at the final follow-up, and changes in laboratory blood test results from preoperative to final follow-up were evaluated for association with outcomes and questionnaire responses. Results: A total of 22 CrossFit athletes (23 shoulders) completed the 24-month follow-up evaluation. Each athlete had undergone single-row rotator cuff tendon repair with additional procedures such as biceps tenodesis. All (100%) athletes returned to intensive CrossFit training at a mean 8.7 ± 3.4 months after surgery (range, 6-15 months). CS and ASES scores improved between preoperative and final follow-up from 73 to 92 ( P = .037) and from 71 to 95 ( P = .035), respectively; VAS pain score improved from 7.2 preoperatively to 0.8 at final follow-up ( P < .001). Imaging evaluation of the repaired rotator cuff tendon showed complete healing in 18 cases (78%) and incomplete healing in 5 (22%). Of the 5 patients with incomplete healing, 2 had lower clinical scores at follow-up. In their questionnaire responses, 13 (59%) participants indicated return to a higher level of fitness, 7 (32%) returned to the same level, and 2 (9%) returned to a lower level. We found a significant association between patients who indicated return to a higher level of CrossFit fitness and higher levels of creatine phosphokinase and testosterone from preoperative to final follow-up ( P = .029 and .023). Conclusion: Arthroscopic repair of rotator cuff tendons led to 100% return to CrossFit participation at approximately 9 months of follow-up. All athletes had returned to sport by the final follow-up. Nevertheless, 2 patients reported a lower level of performance and showed scapular dyskinesis.

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Section: Methodsmentioning

confidence: 99%

High Rate of Return to CrossFit Training After Arthroscopic Management of Rotator Cuff Tear

Carbone¹,

Candela

Gumina

2020

Orthopaedic Journal of Sports Medicine

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“…1). SSP and SSC injuries are more common among RC injuries (10)(11)(12), since the tendons in them are used as reinforcement of the block system. SSP and SSC damage leads to instability of the LHBT, easily causing LHBT lesions following RC injury.…”

Section: Introductionmentioning

confidence: 99%

Small‑incision open distal subpectoral vs. arthroscopic proximal biceps tenodesis for biceps long head tendon lesions with repair of rotator cuff tears

Yang

Zhang

et al. 2019

Exp Ther Med

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The curative effect of small-incision open distal subpectoral vs. arthroscopic proximal biceps tenodesis for lesions in the long head of the biceps tendon (LHBT) combined with rotator cuff repairs (RCR) has remained controversial. The aim of the present study was to compare the two surgical methods. A total of 71 patients who received surgical treatment for LHBT lesions accompanied by RC tears were analyzed. Following arthroscopic RCR and tendectomy of the affected LHBT, 35 patients underwent small-incision open distal subpectoral tenodesis through a small incision (the subpectoral group), while the remaining 36 patients received arthroscopic proximal tenodesis (the arthroscopic group). The surgery time and intra-operative blood loss were compared between the two groups. In addition, the clinical outcomes were evaluated using scoring systems for the functional assessment of the shoulder joint. The subpectoral group had a shorter surgery time and less intra-operative blood loss than the arthroscopic group (P<0.05). The functional scores of the two groups significantly improved as time passed (P<0.05). The subpectoral group was significantly superior to the arthroscopic group with regard to the American Shoulder and Elbow Surgeons score at 2 weeks post-operatively and visual analog scale score at 2 weeks and 3 months post-operatively (P<0.05). Small-incision open distal subpectoral and arthroscopic proximal tenodesis were demonstrated to effectively improve the function of the shoulder joint and relieve pain caused by LHBT lesions accompanied by RCR. However, small-incision open distal subpectoral tenodesis had the additional advantage of shorter surgery time, less intra-operative bleeding and encouraging early results compared to arthroscopic proximal tenodesis. The study was registered as a clinical trial in the Chinese Trial Registry (no. ChiCTR1800015643).

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“…Pulley lesions and associated intra-articular pathologies CHL and SGHL comprise the pulley system that stabilizes the intra-articular LHBT before entry in the bicipital groove. 5,14 Rotator cuff tears were considered to be associated with the BRP lesions based on their anatomical relationship 2,5 and concurrent prevalence. 3,6,15−18 The fibers of the supraspinatus and subscapularis are interwoven with SGHL which have combined function of chief stabilizer of LHBT, 5 and SGHL lesions are strongly associated with partial tear of the rotator fibers at the articular side.…”

Section: Ramp Testmentioning

confidence: 99%

Biceps tendon instability with or without pulley tears: an arthroscopic diagnostic study

Kao

Chiu

Hsu

et al. 2020

Preprint

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Background To investigate long head of the biceps tendon (LHBT) instability and biceps reflection pulley (BRP) lesions with dynamic arthroscopy in patients with refractory anterior shoulder pain and determine associated intraarticular pathologies. Methods Patients with refractory anterior shoulder pain and arthroscopically-diagnosed LHBT instability were enrolled. LHBT instability was confirmed by either static dislodge from the groove or subluxation induced by the hook probe (ramp test), and the integrity of BRP and concomitant intra-articular lesions were investigated. Demographics and arthroscopic findings were compared between patients with and without BRP tear. Results A total of 40 patients with refractory anterior shoulder pain and arthroscopically-diagnosed LHBT instability identified through review of medical records at a single surgeon’s practice from 2014 to 2017 were enrolled. BRP tear was noted in 25 patients (group A) and superior glenohumeral ligament (SGHL) insufficiency through ramp test, in 15 patients (group B). No significant difference of patient characteristics was observed between the two groups. Concomitant intraarticular pathologies were noted in 27 patients, including 19 in group A (76%) and eight in group B (53%), without significant group-wise difference (P = 0.083). The incidence of articular-side subscapularis tear was significantly higher in group A (P = 0.021), and those of the other intraarticular pathologies were similar between groups A and B. Fraying at the articular side of the subscapularis and supraspinatus tendons was frequent in group B, without difference of incidence as compared to group A (P = 0.5 and P = 0.084, respectively). Conclusions LHBT instability was a common disorder in patients with refractory shoulder pain. In patients with refractory anterior shoulder pain, dynamic assessment of BRP lesions and SGHL insufficiency and meticulous survey of associated intra-articular pathologies, including subscapularis tear are necessary for making accurate diagnosis.

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The Ramp Test: An Arthroscopic Technique for Confirming Intra-articular Subluxation and Instability of the Long Head of the Biceps Tendon Within the Shoulder

Cited by 12 publications

References 6 publications

High Rate of Return to CrossFit Training After Arthroscopic Management of Rotator Cuff Tear

High Rate of Return to CrossFit Training After Arthroscopic Management of Rotator Cuff Tear

Small‑incision open distal subpectoral vs. arthroscopic proximal biceps tenodesis for biceps long head tendon lesions with repair of rotator cuff tears

Biceps tendon instability with or without pulley tears: an arthroscopic diagnostic study

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