Kelly Anne M, Drakos Mark C, Fealy Stephen, Taylor Samuel A, O'Brien Stephen J
Sports Medicine and Shoulder Service, Hospital for Special Surgery, Cornell Medical Center, New York, New York, USA.
Am J Sports Med. 2005 Feb;33(2):208-13. doi: 10.1177/0363546504269555.
Treatment of chronic, refractory biceps tendinitis remains controversial. The authors sought to evaluate clinical and functional outcomes of arthroscopic release of the long head of the biceps tendon.
In specific cases of refractory biceps tendinitis, site-specific release of the long head of the biceps tendon may yield relief of pain and symptoms.
Case series; Level of evidence, 4.
Fifty-four patients diagnosed with biceps tendinitis underwent arthroscopic release of the long head of the biceps tendon as an isolated procedure or as part of a concomitant shoulder procedure over a 2-year period. Patients were not excluded for concomitant shoulder abnormality, including degenerative joint disease, rotator cuff tears, Bankart lesions, or instability. Nine of 40 patients had an isolated arthroscopic release of the biceps tendon. At a minimum of 2 years, the American Shoulder and Elbow Surgeons; the University of California, Los Angeles; and the L'Insalata shoulder questionnaires as well as ipsilateral and contralateral metrics were used for evaluation.
The L'Insalata; University of California, Los Angeles; and American Shoulder and Elbow Surgeons scores were 77.6, 27.6, and 75.6, respectively. Seventy percent had a Popeye sign at rest or during active elbow flexion; 82.7% of men and 36.5% of women had a positive Popeye sign (P < .05); 68% were rated as good, very good, or excellent. No patient reported arm pain at rest distally or proximally; 38% of patients complained of fatigue discomfort (soreness) isolated to the biceps muscle after resisted elbow flexion.
Arthroscopic release of the long head of the biceps tendon is an appropriate and reliable intervention for patients with chronic, refractory biceps tendinitis. Cosmetic deformity presenting as a positive Popeye sign and fatigue discomfort were the primary complaints.
Although tenotomy is not the ideal intervention for patients of all ages with various shoulder abnormalities, data suggest that it may be an acceptable surgical intervention for a specifically selected cohort of individuals.
慢性、难治性肱二头肌肌腱炎的治疗仍存在争议。作者旨在评估关节镜下肱二头肌长头松解术的临床和功能结果。
在难治性肱二头肌肌腱炎的特定病例中，肱二头肌长头的部位特异性松解可能会缓解疼痛和症状。
病例系列；证据等级，4级。
在2年期间，54例被诊断为肱二头肌肌腱炎的患者接受了关节镜下肱二头肌长头松解术，该手术可作为单独手术或作为同期肩部手术的一部分。患者不因其存在包括退行性关节病、肩袖撕裂、Bankart损伤或不稳定在内的同期肩部异常而被排除。40例患者中有9例接受了单独的关节镜下肱二头肌松解术。至少随访2年，采用美国肩肘外科医师协会、加利福尼亚大学洛杉矶分校和L'Insalata肩部问卷以及同侧和对侧指标进行评估。
L'Insalata、加利福尼亚大学洛杉矶分校和美国肩肘外科医师协会的评分分别为77.6、27.6和75.6。70%的患者在休息时或主动屈肘时出现“大力水手”征；82.7%的男性和36.5%的女性有阳性“大力水手”征（P <.05）；68%的患者被评为良好、非常好或优秀。没有患者报告在休息时手臂近端或远端疼痛；38%的患者在抗阻屈肘后抱怨肱二头肌肌肉出现疲劳不适（酸痛）。
关节镜下肱二头肌长头松解术是慢性、难治性肱二头肌肌腱炎患者的一种合适且可靠的干预措施。表现为阳性“大力水手”征的美容畸形和疲劳不适是主要的主诉。
尽管腱切断术并非所有年龄伴有各种肩部异常患者的理想干预措施，但数据表明，对于特定选择的个体群体，它可能是一种可接受的手术干预方法。
