Visualization of the Extra-Articular Portion of the Long Head of the Biceps Tendon During Intra-Articular Shoulder Arthroscopy

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

“…The results of this study concur with the work of Festa et al, 9 who also showed that arthroscopy in the beachchair position only allows visualization of a short length of the extra-articular portion of the tendon. Our study demonstrates that in the lateral decubitus position, this distance is significantly less.…”

“…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.…”

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

“…Arthroscopy is the gold standard for diagnosing LHBT lesions (59); even under maximum visualization during shoulder arthroscopy (60), the average moving length of the LHBT in the cadaver model is 15-19 mm (61,62), which is ~14 mm in the human body (63). Only 78% of the length from the beginning of LHBT to the lower edge of the tendon of the subscapularis muscle and 55% of the proximal edge of the pectoralis major muscle may be observed, which means that nearly 1/3 of the tendinous parts of the LHBT cannot be observed in the joint (62). Moon et al (64) reported that ~80% of intra-articular tendon tears had hidden lesions extending to the outer part of the distal joint.…”

Commentary on: Accuracy of examination of the long head of the biceps tendon in the clinical setting: A systematic review

“…In 2015, Saithna et al (2) challenged the concept that arthroscopy was an appropriate gold standard for the diagnosis of LHBT pathology and reported, along with other groups, that standard arthroscopic techniques fail to visualize a large proportion of this structure (3)(4)(5)(6). In a subsequent systematic review (7), we evaluated whether the length of tendon that can be seen on arthro scopy allows visualization of areas of predilection of pathology and sought to determine the rates of missed diagnoses at arthroscopy compared with an open ap proach.…”