Thorsness Robert J, Romeo Anthony A
Shoulder and Elbow, Sports Medicine, Hinsdale Orthopaedics, Joliet, Illinois.
Instr Course Lect. 2017 Feb 15;66:65-77.
The long head of the biceps tendon (LHBT) is a common source of pathology. The biceps-labral complex (BLC) is the collective anatomic and clinical features shared by the biceps tendon and the superior labrum. LHBT pathology can be caused by inflammation, instability, or trauma. Numerous tests can be performed to determine the existence of biceps tendon and superior labrum anterior to posterior (SLAP) lesions; however, many of these tests do not have high sensitivity and specificity, which limit their clinical utility. Because it is difficult to diagnose both LHBT and SLAP pathology, management strategies are best guided by a strong clinical suspicion and imaging findings on either MRI or ultrasonography. Initial nonsurgical management of LHBT and SLAP pathology includes focused physical therapy, anti-inflammatory medications, and corticosteroid injections. If nonsurgical management fails, surgical techniques for the management of LHBT pathology include biceps anchor reattachment (SLAP repair), biceps tenotomy, and biceps tenodesis. Techniques for biceps tenodesis, which can be performed in either an arthroscopic or open manner, include soft-tissue tenodesis, suprapectoral tenodesis, and subpectoral tenodesis. If appropriately managed, patients with LHBT pathology often have excellent clinical outcomes.
肱二头肌长头肌腱（LHBT）是常见的病变来源。肱二头肌-盂唇复合体（BLC）是肱二头肌肌腱和上盂唇共同的解剖学及临床特征。LHBT病变可由炎症、不稳定或创伤引起。可进行多项检查以确定肱二头肌肌腱及前后上盂唇（SLAP）损伤的存在；然而，其中许多检查的敏感性和特异性不高，限制了它们的临床应用价值。由于LHBT和SLAP病变均难以诊断，管理策略最好以强烈的临床怀疑以及MRI或超声检查的影像学结果为指导。LHBT和SLAP病变的初始非手术治疗包括针对性的物理治疗、抗炎药物及皮质类固醇注射。如果非手术治疗失败，LHBT病变的手术治疗技术包括肱二头肌锚定重新附着（SLAP修复）、肱二头肌肌腱切断术和肱二头肌肌腱固定术。肱二头肌肌腱固定术可通过关节镜或开放方式进行，包括软组织肌腱固定术、胸大肌上肌腱固定术和胸大肌下肌腱固定术。如果得到恰当处理，LHBT病变患者通常会有良好的临床结局。
