Traumatic tear of the rotator interval

Huec, J C Le; Schaeverbeke, T.; Moinard, M.; Kind, M.; Diard, F; Dehais, J.; Rebelle, A. Le

doi:10.1016/s1058-2746(96)80029-2

Cited by 75 publications

(35 citation statements)

References 6 publications

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“…) Pathologic changes of the long head of biceps tendon (LHB) are a common pain source. Although medial dislocation, tendonitis, or partial tear of LHB have been investigated extensively, 14,16,23,24,27 the role of lesions of biceps reflection pulley remains unclear. In 1994, Walch et al 25 first described the superior glenohumeral (SGHL) and coracohumeral ligaments (CHL) as a pulley system stabilizing the intraarticular part of the LHB.…”

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confidence: 99%

“…Several authors 4,9,14,16,23,24 described secondary tendinitis or partial tears of the LHB due to instability, but epidemiologic data in relation to pulley lesions are lacking. This might be due to the rarity of isolated SGHL and to difficulties in detection at athroscopy.…”

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confidence: 99%

“…4,9,14 Because little is known about this entity, the purpose of this retrospective study was to determine the incidence, etiology, concomitant pathologies, and clinical outcome of pulley lesions.…”

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confidence: 99%

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Arthroscopic prevalence of pulley lesions in 1007 consecutive patients

Baumann

Genning

Böhm

et al. 2008

Journal of Shoulder and Elbow Surgery

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Arthroscopic prevalence of pulley lesions in 1007 consecutive patients

Baumann

Genning

Böhm

et al. 2008

Journal of Shoulder and Elbow Surgery

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“…Non abbiamo mai osservato una lussazione isolata del CLB, come riportato in alcuni Autori [13,15,22]. La maggioranza degli Autori ritiene che il più importante vincolo alla dislocazione mediale del CLB sia l'integrità della puleggia legamentosa dell'intervallo dei rotatori, che può essere leso con la rottura della cuffia [6,9,11,22,24,26]. Il termine "tendinite del bicipite" è molto generico, mal definito anche se frequentemente utilizzato.…”

Section: Classificazione Delle Lesioni Del Clbunclassified

Pathology of the long head of the biceps

Fama

Angelini

Pozzuoli

2008

LO SCAL

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Cenni di anatomiaIl tendine del capo lungo del bicipite (CLB) s'inserisce al polo superiore della glena a livello del tubercolo sopraglenoideo. Tale inserzione, secondo Habermeyer [1], è variabile e può avvenire al cercine postero-superiore (50% dei casi), a quello anteriore (20% dei casi) e a entrambe le strutture (30% dei casi). Per alcuni Autori invece l'inserzione prossimale del CLB avviene nel 70% dei casi nella porzione posteriore [2]. Per altri può distinguersi in 4 tipi: nel tipo I l'inserzione al cercine è completamente posteriore (22%); nel tipo II la maggior parte dell'inserzione è nel cercine posteriore, e solo con una piccola porzione nella parte anteriore (33%); nel tipo III l'inserzione avviene in maniera uguale al labbro anteriore e posteriore (37%); nel tipo IV la maggior parte delle fibre ha origine dal labbro anteriore e una piccola quota dal labbro posteriore (8%) [3]. Huber e Putz [4] hanno descritto in uno studio anatomico e istologico un sistema di fibre periarticolari che circondano la cavità glenoidea. Essi hanno evidenziato che, oltre all'inserzione al labbro e al tubercolo sovraglenoideo, esistono fibre dal legamento gleno-omerale superiore che si congiungono al CLB. Complessivamente il tendine è lungo circa 9 cm; la sua sezione trasversale varia da 8,5 mm a 7,8 mm all'inserzione glenoidea, per restringersi sino a 4,5-2,8 mm alla giunzione muscolo-tendinea che corrisponde al livello d'inserzione del deltoide [5]. Classicamente il tendine del bicipite si divide in una parte intra-articolare, obliqua in basso e in fuori, e una extraarticolare, situata in uno stretto canale osteo-fibroso nella parte anteriore dell'omero. Tale distinzione peraltro è imprecisa, perché il bicipite scivola sulla doccia omerale ed è la posizione del braccio che determina la percentuale di tendine intra-articolare, che è massima in adduzione ed estensione e minima nella completa abduzione [6]. Il CLB è ricoperto da una riflessione della guaina sinoviale in maniera tale che anche nella sua porzione intra-articolare è extrasinoviale. Il CLB è stabilizzato da una ABSTRACT -PATHOLOGY OF THE LONG HEAD OF THE BICEPSPathological changes of the tendon of the long head of the biceps (LHB) are very frequent in the disorders of the rotator cuff: the incidence of tendonitis varies from 60% in athletes practicing overhead sports to 100% in patients with massive rotator cuff tears. Instability (subluxation and dislocation) of the LHB ranges from 16% to 20% while tears occur in 5%. Clinical diagnosis of the LHB lesions is simple in tendonitis and tears but difficult in presence of instability and SLAP lesion. There are no specific tests for SLAP and instability of the LHB, but clinical symptoms are those of rotator cuff tear. Imaging diagnosis is effective in tendonitis, tear, SLAP and intra-articular dislocation, but not in subluxation and extraarticular dislocation.

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“…of changes 14 5 Data in parentheses show management plan (A, B or C) at preceding stage group, we encountered six false-negative arthrograms of FTRCT, four of which MRI had detected. These demanded further investigation: 3 patients had an interval tear, a recognised blindspot for both arthrography and MRI [20,21]; 1 patient had a FTRCT with an intact synovium confirmed on arthroscopy, a well-recognised pitfall [22,23]; 1 patient had such extensive capsulitis that contrast medium extravasated along the needle track and obscured the underlying tear. The final patient was a true arthrographic false negative, in a patient who had previously undergone open shoulder surgery.…”

Section: Accuracymentioning

confidence: 99%

Diagnostic and therapeutic impact of MRI and arthrography in the investigation of full-thickness rotator cuff tears

et al. 1999

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Investigation of shoulder pain is important before surgical treatment. The presence or absence of a full-thickness rotator cuff tear (FTRCT) may determine the type of surgical treatment. Both MRI and conventional arthrography can be used, but little is known about their relative diagnostic and therapeutic impact. We performed a prospective trial assessing: (a) the influence of MRI and arthrography results on the clinician's diagnostic thinking (diagnostic impact); (b) the influence of the results on the clinician's therapeutic thinking (therapeutic impact); and (c) the diagnostic performance of the two techniques in patients with surgical confirmation. A total of 104 consecutive patients with shoulder problems referred to a specialist orthopaedic shoulder clinic underwent pre-operative investigation with MRI and arthrography. The surgeon's diagnosis, diagnostic confidence and planned treatment were measured before the investigation, and then again after the results of each investigation. Before the presentation of the investigation, results, the patients were randomised into two groups. In one group MRI was presented first; in the other group, arthrography. The MRI results led to fewer changes in diagnostic category (14 of 46, 30%) than arthrography (20 of 54, 37%), but the difference was not significant (P > 0.5). Magnetic resonance imaging led to slightly more changes in planned management (17 of 47, 36%) than arthrography (14 of 55, 25%), but again the difference was not statistically significant (P > 0.3). The results of the second investigation always had less diagnostic and therapeutic impact than the first. The accuracy of MRI for FTRCT in 38 patients with surgical confirmation was 79%, sensitivity 81% and specificity 78%; the accuracy of arthrography was 82%, sensitivity 50% and specificity 96%. The clinical diagnosis and management plan can be adequately defined by a single radiological investigation. Magnetic resonance imaging and arthrography had fairly similar diagnostic and therapeutic impact and comparable accuracy, although MRI was more sensitive and less specific. Magnetic resonance imaging may be the preferred investigation because of its better demonstration of soft tissue anatomy.

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Traumatic tear of the rotator interval

Cited by 75 publications

References 6 publications

Arthroscopic prevalence of pulley lesions in 1007 consecutive patients

Arthroscopic prevalence of pulley lesions in 1007 consecutive patients

Pathology of the long head of the biceps

Diagnostic and therapeutic impact of MRI and arthrography in the investigation of full-thickness rotator cuff tears

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