Sabzevari Soheil, Khalilipour Roudi Mostafa, Kalawadia Jay, Lin Albert
Department of Orthopaedic Surgery, Division of Shoulder Surgery and Sports Medicine, University of Pittsburgh, UPMC Center for Sports, Pittsburgh, PA, USA.
Department of Orthopaedic Surgery, Razavi Hospital, Mashhad, Iran.
Arch Bone Jt Surg. 2019 Nov;7(6):493-497.
To describe a case series of young adult patients with isolated chronic proximal biceps tendinitis refractory to conservative care found to have anatomic long head biceps tendon (LHBT) origin variations who underwent arthroscopic-assisted subpectoral biceps tenodesis.
Patients were included in this retrospective case series if they met all the following criteria: 1) had an anomalous origin of the LHBT without any pre-operative or concurrent pathologies at the time of surgery, 2) had non-traumatic anterior shoulder pain refractory to conservative care for >6 months, 3) pain relief with ultrasound guided steroid injections into the bicipital tendon sheath, and 4) routine radiographs and MRI-arthrogram demonstrating no pathology. All patients underwent arthroscopic assisted mini-open subpectoral biceps tenodesis. Pre- and post-operative active range of motion (ROM), strength, visual analog scale (VAS) for pain, and subjective shoulder values (SSV) were evaluated. Statistical analysis was done using repeated measure ANOVA.
Seven patients mean age of 18.4 ± 3.5 years old were included in this study. Arthroscopic examination revealed anomalous origins of the LHBT in all patients with the following distribution: medial to superior labrum (x2), proximal insertion to the supraspinatus confluent with the superior labrum (x2), insertion into the superior capsular tissues at the rotator interval (x2), and bifid LHBT (x1). VAS score and SSV were significantly improved at 3 months ( and = 0.024 respectively) and final follow-up.
Anomalous origins of the LHBT may be a predisposing factor for chronic biceps tendinitis refractory to non-operative treatment in young adults. Biceps tenodesis seems to offer improvements in function and pain.
描述一组年轻成年患者的病例系列，这些患者患有孤立性慢性近端二头肌肌腱炎，保守治疗无效，发现其解剖学上的肱二头肌长头肌腱（LHBT）起源变异，接受了关节镜辅助下胸小肌下二头肌固定术。
如果患者符合以下所有标准，则纳入本回顾性病例系列：1）LHBT起源异常，手术时无任何术前或并发疾病；2）非创伤性前肩痛，保守治疗>6个月无效；3）超声引导下向肱二头肌肌腱鞘内注射类固醇后疼痛缓解；4）常规X线片和磁共振关节造影未显示病变。所有患者均接受关节镜辅助下小切口胸小肌下二头肌固定术。评估术前和术后的主动活动范围（ROM）、力量、疼痛视觉模拟量表（VAS）和主观肩关节评分（SSV）。使用重复测量方差分析进行统计分析。
本研究纳入了7例平均年龄为18.4±3.5岁的患者。关节镜检查发现所有患者的LHBT起源异常，分布如下：上盂唇内侧（2例）、近端插入与上盂唇汇合的冈上肌（2例）、插入旋转间隙的上囊组织（2例）和双叉LHBT（1例）。VAS评分和SSV在3个月时（分别为 和 = 0.024）及最终随访时均有显著改善。
LHBT起源异常可能是年轻成年人非手术治疗无效的慢性二头肌肌腱炎的一个易感因素。二头肌固定术似乎能改善功能和缓解疼痛。
