Liessi G, Cesari S, Dell'Antonio C, Spaliviero B, Avventi P, Butini R, Pavanello M
ULSS 8, Servizio di Radiologia, Ospedale Civile, Castelfranco Veneto Treviso.
Radiol Med. 1995 Oct;90(4):374-7.
The medial intraarticular dislocation of the biceps tendon of the shoulder is a rare pathologic condition and its diagnosis before surgery is very important to properly repair the tears of rotator cuff tendons, the rotator cuff being nearly always involved. We report our experience in 8 patients (1.8%) with biceps tendon dislocation observed in a series of 432 patients submitted to MR studies to address several diagnostic issues. The MR patterns of biceps tendon dislocation and the related physiopathologic mechanisms are discussed. The MR images were retrospectively reviewed by two of the authors and dislocations were diagnosed in a subgroup of 34 patients (7.8%), associated with full-thickness tears of the tendon of supraspinatus muscle; all patients also presented a full-thickness tear of the subscapularis tendon. A dislocated biceps tendon can follow a variety of courses depending on the pattern of subscapularis tendon tear. We always found a complete dislocation of the biceps tendon; other dislocation patterns reported in the literature, and particularly oblique and superficial dislocations, were never observed in our series. Dislocation is visible on axial images, where the tendon appears completely displaced from the bicipital groove, but also sagittal and coronal images can depict the more medial position of the tendon. In our patients this abnormality was correctly identified in 4 patients during the first observation and in the extant patients during the retrospective review. The dislocation of the biceps tendon of the shoulder was frequently associated with a complete tear of the supraspinatus tendon (23.5%). All patients exhibited severe joint effusion and in two patients the dislodged tendon was also inflamed.
肩关节肱二头肌肌腱关节内脱位是一种罕见的病理状况，术前诊断对于正确修复肩袖肌腱撕裂非常重要，因为肩袖几乎总是受累。我们报告了在432例接受磁共振成像（MR）检查的患者系列中观察到的8例（1.8%）肱二头肌肌腱脱位患者的经验，以探讨几个诊断问题。讨论了肱二头肌肌腱脱位的MR表现及相关病理生理机制。两位作者对MR图像进行了回顾性分析，在34例患者（7.8%）的亚组中诊断出脱位，这些患者伴有冈上肌肌腱全层撕裂；所有患者还存在肩胛下肌肌腱全层撕裂。肱二头肌肌腱脱位可因肩胛下肌肌腱撕裂模式的不同而有多种走行。我们总是发现肱二头肌肌腱完全脱位；文献中报道的其他脱位模式，尤其是斜行和浅表脱位，在我们的系列中从未观察到。轴向图像上可见脱位，此时肌腱似乎完全从肱二头肌沟移位，但矢状面和冠状面图像也可显示肌腱更靠内侧的位置。在我们的患者中，4例患者在首次观察时正确识别了这种异常，其余患者在回顾性分析时得以确诊。肩关节肱二头肌肌腱脱位常与冈上肌肌腱完全撕裂相关（23.5%）。所有患者均表现为严重的关节积液，并在2例患者中，脱位的肌腱也有炎症。
