Department of Orthopaedic Surgery, Orvit Clinic, Torun, Poland.
Depertment of General Orthopaedics, Musculoskeletal Oncology and Trauma Surgery, Poznan University of Medical Sciences, Poznan, Poland.
Folia Morphol (Warsz). 2020;79(2):395-401. doi: 10.5603/FM.a2019.0072. Epub 2019 Aug 26.
Open or mini-invasive operative procedures are methods of choice in the treatment of the advanced degenerative process of tendinopathy of long head of biceps tendon (LHBT). Cosmetic arm deformity and fatigue are the main complaints after the surgery. Researchers have noticed that in some cases the typical cosmetic deformity is often barely noticeable and the pain is significantly reduced as it occurs after spontaneous LHBT rupture due to extremely advanced tendinopathy.
This study included 41 of 75 patients who underwent LHBT arthroscopy-assisted tenotomy, followed by examination conducted by means of dedicated clinical tests, the American Shoulder and Elbow Surgeons Score (ASES) and ultrasounds.
The average time interval from surgery to follow-up in the cohort was 31 months, the mean outcome measured with the ASES was 87 points and the "Popeye deformity" complication was present in 15 individuals. In the group of 26 patients where the Popeye deformity was absent and the arm contour was similar to that of the opposite arm, sonographic examination revealed the LHBT stump at the level of the intertubercular groove that was hyperechogenic and wider than the part under the groove.
Recent reports about the absence of the cosmetic deformity in the anterior area of the arm after shoulder arthroscopy are based on the autotenodesis phenomenon. The intra-articular part of LHBT is painlessly trapped in the bicipital groove by the surrounding soft tissues, which results in unchanged biceps muscle length; however, it is more probable to happen in patients without massive rotator cuff tears.
开放性或微创手术是治疗长头肱二头肌肌腱病（LHBT）退行性病变的首选方法。手术后，手臂的美容畸形和疲劳是主要抱怨。研究人员注意到，在某些情况下，典型的美容畸形往往几乎不明显，疼痛明显减轻，因为它发生在由于极其先进的腱病导致自发性 LHBT 破裂后。
这项研究包括 75 名接受 LHBT 关节镜辅助肌腱切断术的患者中的 41 名，随后通过专门的临床测试、美国肩肘外科医生评分（ASES）和超声检查进行检查。
该队列中从手术到随访的平均时间间隔为 31 个月，用 ASES 测量的平均结果为 87 分，15 人存在“大力水手畸形”并发症。在 26 名没有大力水手畸形且手臂轮廓与对侧手臂相似的患者中，超声检查显示 LHBT 残端位于结节间沟水平，呈高回声且比沟下部分宽。
最近关于肩关节镜检查后手臂前区无美容畸形的报道是基于自动肌腱松解现象。LHBT 的关节内部分被周围软组织无痛地困在二头肌沟内，导致肱二头肌长度不变；然而，在没有巨大肩袖撕裂的患者中更有可能发生。
