Gandolfo N, Bianchi S, Martinoli C, Derchi L E
Cattedra di Radiologia R, Università degli Studi, Genova.
Radiol Med. 1998 Jul-Aug;96(1-2):18-22.
Dislocation of the long head of biceps tendon, including subluxation to displacement out of the bicipital groove, is an uncommon cause of shoulder pain. We investigated the role of US in the diagnosis of this condition.
We examined eight patients with dislocation of the long head of biceps tendon: seven had a displaced, and one a subluxated tendon. All patients had early radiographic and US studies of the shoulder; then, three (37%) were submitted to CT-arthrography and two (25%) to MRI. US was performed at 7.5-13 MHz frequency, CT-arthrography with a volumetric acquisition technique and MRI with a surface coil at 1.5 T. Three patients with tendon dislocation had surgical confirmation of the diagnosis.
Dislocation of the long head of biceps tendon was always diagnosed with US in all our eight patients; CT-arthrography and MRI confirmed the US findings. In the patient with subluxation of the long head of biceps tendon, US showed the tendon displaced over the lesser tuberosity whereas, in the 7 cases of complete luxations, the groove was empty and the tendon displaced medially. At CT-arthrography, the tendon was well outlined by contrast medium within its sheath. In dislocations, it was close to the anterior aspect of the humeral head. In two cases of dislocation, MRI showed both the empty bicipital sulcus and the medial tendon displacement. The subscapularis tendon tear was always associated with tendon dislocation; a supraspinatus tendon tear was observed in 6 cases.
When imaging a painful shoulder, we should investigate the integrity and course of the long head of biceps tendon. In clinical practice, dislocation of this tendon can be reliably diagnosed with US. CT-arthrography and MRI should be used only to supplement inconclusive US studies.
肱二头肌长头肌腱脱位，包括从肱二头肌沟半脱位至完全移位，是肩部疼痛的罕见原因。我们研究了超声在该病症诊断中的作用。
我们检查了8例肱二头肌长头肌腱脱位患者：7例肌腱完全移位，1例肌腱半脱位。所有患者均早期接受了肩部X线和超声检查；然后，3例（37%）接受了CT关节造影，2例（25%）接受了MRI检查。超声检查采用7.5 - 13MHz频率，CT关节造影采用容积采集技术，MRI采用1.5T表面线圈。3例肌腱脱位患者经手术确诊。
在我们所有8例患者中，肱二头肌长头肌腱脱位均通过超声诊断；CT关节造影和MRI证实了超声检查结果。在肱二头肌长头肌腱半脱位患者中，超声显示肌腱移位至小结节上方，而在7例完全脱位病例中，沟内空虚，肌腱向内侧移位。在CT关节造影中，肌腱在腱鞘内被造影剂清晰勾勒。在脱位时，它靠近肱骨头的前侧。在2例脱位病例中，MRI显示肱二头肌沟空虚及肌腱向内侧移位。肩胛下肌腱撕裂总是与肌腱脱位相关；6例观察到冈上肌腱撕裂。
对疼痛的肩部进行成像检查时，我们应检查肱二头肌长头肌腱的完整性和走行。在临床实践中，该肌腱脱位可用超声可靠诊断。CT关节造影和MRI仅应用于补充超声检查结果不明确的情况。
