Kelly Brian J, Reynolds Alan W, Schimoler Patrick J, Kharlamov Alexander, Miller Mark Carl, Akhavan Sam
Allegheny General Hospital, Pittsburgh, Pennsylvania, USA.
Orthop J Sports Med. 2021 Jan 21;9(1):2325967120977538. doi: 10.1177/2325967120977538. eCollection 2021 Jan.
Lesions of the long head of the biceps can be successfully treated with biceps tenotomy or tenodesis when surgical management is elected. The advantage of a tenodesis is that it prevents the potential development of a cosmetic deformity or cramping muscle pain. Proponents of a subpectoral tenodesis believe that "groove pain" may remain a problem after suprapectoral tenodesis as a result of persistent motion of the tendon within the bicipital groove.
PURPOSE/HYPOTHESIS: To evaluate the motion of the biceps tendon within the bicipital groove before and after a suprapectoral intra-articular tenodesis. The hypothesis was that there would be minimal to no motion of the biceps tendon within the bicipital groove after tenodesis.
Controlled laboratory study.
Six fresh-frozen cadaveric arms were dissected to expose the long head of the biceps tendon as well as the bicipital groove. Inclinometers and fiducials (optical markers) were used to measure the motions of the scapula, forearm, and biceps tendon through a full range of shoulder and elbow motions. A suprapectoral biceps tenodesis was then performed, and the motions were repeated. The motion of the biceps tendon was quantified as a function of scapular or forearm motion in each plane, both before and after the tenodesis.
There was minimal motion of the native biceps tendon during elbow flexion and extension but significant motion during all planes of scapular motion before tenodesis, with the most motion occurring during shoulder flexion-extension (20.73 ± 8.21 mm). The motion of the biceps tendon after tenodesis was significantly reduced during every plane of scapular motion compared with the native state ( < .01 in all planes of motion), with a maximum motion of only 1.57 mm.
There was a statistically significant reduction in motion of the biceps tendon in all planes of scapular motion after the intra-articular biceps tenodesis. The motion of the biceps tendon within the bicipital groove was essentially eliminated after the suprapectoral biceps tenodesis.
This arthroscopic suprapectoral tenodesis technique can significantly reduce motion of the biceps tendon within the groove in this cadaveric study, possibly reducing the likelihood of groove pain in the clinical setting.
当选择手术治疗时，肱二头肌长头损伤可通过肱二头肌肌腱切断术或肌腱固定术成功治疗。肌腱固定术的优点是可防止出现外观畸形或肌肉痉挛性疼痛。胸大肌下肌腱固定术的支持者认为，由于肌腱在肱二头肌沟内持续活动，胸大肌上肌腱固定术后“沟部疼痛”可能仍然是一个问题。
目的/假设：评估胸大肌上关节内肌腱固定术前、后肱二头肌肌腱在肱二头肌沟内的活动情况。假设是肌腱固定术后肱二头肌肌腱在肱二头肌沟内的活动将极小或无活动。
对照实验室研究。
解剖6只新鲜冷冻尸体手臂，以暴露肱二头肌肌腱长头以及肱二头肌沟。使用倾角仪和基准点（光学标记）通过全范围的肩部和肘部运动来测量肩胛骨、前臂和肱二头肌肌腱的活动。然后进行胸大肌上肱二头肌肌腱固定术，并重复测量活动情况。肱二头肌肌腱的活动在肌腱固定术前、后均根据每个平面内肩胛骨或前臂的运动进行量化。
在肘关节屈伸过程中，天然肱二头肌肌腱的活动极小，但在肌腱固定术前肩胛骨运动的所有平面内活动显著，其中在肩关节屈伸过程中活动最大（20.73±8.21毫米）。与天然状态相比，肌腱固定术后肱二头肌肌腱在肩胛骨运动的每个平面内的活动均显著减少（所有运动平面内P<0.01），最大活动仅为1.57毫米。
关节内肱二头肌肌腱固定术后，肱二头肌肌腱在肩胛骨运动所有平面内的活动在统计学上显著减少。胸大肌上肱二头肌肌腱固定术后，肱二头肌肌腱在肱二头肌沟内的活动基本消除。
在本尸体研究中，这种关节镜下胸大肌上肌腱固定术可显著减少肱二头肌肌腱在沟内的活动，可能降低临床环境中沟部疼痛的可能性。
