Ayoubi Rami, Darwish Mohammad, Nassour Nour, Aouad Dany, Maalouly Joseph, Kanj Vladimir, El Rassi Georges
Saint George Hospital University Medical Center, Achrafieh, St Georges Street, Beirut, Lebanon.
Asia Pac J Sports Med Arthrosc Rehabil Technol. 2020 Dec 11;23:18-21. doi: 10.1016/j.asmart.2020.09.001. eCollection 2021 Jan.
The long head of the biceps tendon is stabilized in the intertubercular groove by several anatomical structures. Dislocation or identification of the biceps tendon into or within the subscapularis tendon is very rarely mentioned in the literature. This is the first reported case of bilateral identification of the long head of the biceps tendons within the lateral subscapularis tendon. This report presents the case of a 51-year-old male patient who presented for bilateral shoulder pain. After failure of conservative treatment, MRIs were done which identified bilateral biceps tendons within the subscapularis tendons, with a concomitant supraspinatus tear on the right side. He underwent right shoulder arthroscopic biceps tenotomy, with supraspinatus repair. The symptoms of the left shoulder diminished as a result of the continuation of conservative treatment. The long head of the biceps tendon normally travels through the intertubercular groove and is stabilized by soft tissue and bony structures. Medial dislocation of the tendon is affected by the medial wall angle and by the integrity of the soft tissue stabilizers; most importantly the coracohumeral ligament in the proximal part of the groove. Dislocation of the biceps tendon into the substance of the subscapularis has been rarely mentioned in the literature; and as far as we know, bilateral occurrence without any identifiable subscapularis tears has never been previously mentioned. The bilateral occurrence with the absence of subscapularis lesions indicates that this is a congenital anomaly.
肱二头肌长头肌腱通过多种解剖结构在结节间沟内保持稳定。肱二头肌肌腱脱位或进入肩胛下肌腱内或在肩胛下肌腱内的情况在文献中很少被提及。这是首例双侧肱二头肌长头肌腱进入肩胛下肌腱外侧的报道病例。本报告介绍了一名51岁男性患者，因双侧肩部疼痛前来就诊。保守治疗失败后，进行了磁共振成像检查，发现双侧肱二头肌肌腱位于肩胛下肌腱内，同时右侧伴有冈上肌撕裂。他接受了右肩关节镜下肱二头肌肌腱切断术，并修复了冈上肌。由于继续进行保守治疗，左肩症状有所减轻。肱二头肌长头肌腱通常穿过结节间沟，并由软组织和骨性结构稳定。肌腱的内侧脱位受内侧壁角度和软组织稳定器完整性的影响；最重要的是沟近端的喙肱韧带。肱二头肌肌腱脱位进入肩胛下肌实质在文献中很少被提及；据我们所知，此前从未提及过双侧发生且无任何可识别的肩胛下肌撕裂的情况。双侧发生且无肩胛下肌病变表明这是一种先天性异常。
