Warren R F
Instr Course Lect. 1985;34:204-9.
Lesions of the long head of the biceps tendon are generally a component of a diffuse degenerative process involving the subacromial space including the rotator cuff, bursa, biceps tendon, and possibly the acromioclavicular joint. As such, surgical approaches should be designed to treat each component not restricting the surgery to a biceps tenodesis. On occasion bony injury directly to the bicipital groove may result in an inflammatory process in the tendon or even dislocation of the tendon if there was damage to the lesser tuberosity and subscapularis tendon. In these patients biceps tenodesis and coracoacromial ligament excision is advised. The entity of a "subluxating biceps tendon" without damage to the lesser tuberosity or subscapularis is a diagnosis that we are unable to reliably arrive at. It appears that most patients with biceps instability have combined tuberosity or rotator cuff injury allowing the tendon to migrate medially. Ruptures of the long head of the biceps are generally associated with rotator cuff disease, but a localized process secondary to trauma or injections may account for some ruptures. Nearly all are managed conservatively, but the patient is followed closely and forewarned regarding possible rotator cuff degeneration. In young patients a more aggressive approach including shoulder arthrography and early repair, if a cuff tear is noticed, would be recommended if one would hopefully arrest the degenerative process.
肱二头肌长头腱损伤通常是涉及肩峰下间隙的弥漫性退变过程的一部分，该间隙包括肩袖、滑囊、肱二头肌肌腱，可能还包括肩锁关节。因此，手术方法应设计为治疗每个组成部分，而不是将手术局限于肱二头肌固定术。偶尔，直接对肱二头肌沟的骨损伤可能导致肌腱的炎症过程，如果小结节和肩胛下肌腱受损，甚至可能导致肌腱脱位。对于这些患者，建议进行肱二头肌固定术和喙肩韧带切除术。对于没有小结节或肩胛下肌损伤的“半脱位肱二头肌肌腱”这一实体，我们无法可靠地做出诊断。似乎大多数肱二头肌不稳定的患者都合并有结节或肩袖损伤，从而使肌腱向内侧移位。肱二头肌长头腱断裂通常与肩袖疾病相关，但创伤或注射引起的局部病变也可能导致一些断裂。几乎所有病例都采用保守治疗，但会密切随访患者，并提前告知其可能发生的肩袖退变。对于年轻患者，如果发现肩袖撕裂，更积极的方法包括肩关节造影和早期修复，有望阻止退变过程。
