Clin Orthop Surg.  2017 Sep;9(3):332-339. 10.4055/cios.2017.9.3.332.

Arthroscopic Evaluation of Subluxation of the Long Head of the Biceps Tendon and Its Relationship with Subscapularis Tears

• Koh KH
• Kim SC
• Yoo JC

• KMID: 2412270
• DOI: http://doi.org/10.4055/cios.2017.9.3.332

Abstract

BACKGROUND
The purpose of this study was to evaluate the angle between the long head of the biceps tendon (LHBT) and the glenoid during arthroscopic surgery and its correlation with biceps subluxation on magnetic resonance imaging (MRI). Furthermore, we evaluated the relationship of this angle with subscapularis tears and biceps pathologies.
METHODS
MRI and arthroscopic images of 270 consecutive patients who had undergone arthroscopic surgery were retrospectively evaluated. On MRI, 60 shoulders with biceps subluxation and 210 shoulders without subluxation were identified. On the arthroscopic view from the posterior portal, the angle between the LHBT and the glenoid (biceps-glenoid angle) was measured. The biceps-glenoid angle, tears of the LHBT, degenerative superior labrum anterior to posterior (SLAP) lesions, and presence of a subscapularis tear were compared according to the presence of biceps subluxation on MRI.
RESULTS
In the subluxation group, 51 (85%) had a subscapularis tendon tear and all shoulders showed biceps tendon pathologies. In the non-subluxation group, 116 (55.2%) had a subscapularis tendon tear, 125 (60%) had tears in the biceps tendon, and 191 (91%) had degenerative SLAP lesions. The incidences of subscapularis tears (p < 0.001) and biceps pathologies (p < 0.001) showed significant differences. The mean biceps-glenoid angle was 87.0° (standard deviation [SD], 11.4°) in the subluxation group and 90.0° (SD, 9.6°) in the non-subluxation group, showing a statistically significant difference (p = 0.037).
CONCLUSIONS
Shoulders with subluxation of the biceps tendon on the preoperative MRI revealed more pathologies in the subscapularis tendon and biceps tendon during arthroscopy. However, the arthroscopically measured biceps-glenoid angle did not have clinical relevance to the determination of subluxation of the LHBT from the bicipital groove.

Keyword

Biceps long head tendon; Subluxation; Biceps-glenoid angle; Subscapularis tear

MeSH Terms

Female
Humans
Magnetic Resonance Imaging
Male
Middle Aged
Muscle, Skeletal/diagnostic imaging/injuries
Retrospective Studies
Shoulder Injuries/*diagnosis/diagnostic imaging/surgery
Tendon Injuries/*diagnosis/diagnostic imaging/surgery
Tendons/diagnostic imaging/surgery

Figure

• 

  Fig. 1 T1 axial magnetic resonance imaging scans of a 57-year-old female patient without subluxation of the long head of the biceps tendon (A) and a 50-year-old male patient with subluxation (B).

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  Fig. 2 (A and B) Measurements of the biceps-glenoid angle (red angle) on the arthroscopic view from the posterior portal in the right shoulder without any biceps pathology. The arrows indicate the line connecting superior half of the anterior glenoid. Arthroscopic images of a 63-year-old female patient with subluxation of the long head of the biceps tendon (C) and a 52-year-old female patient without subluxation (D).

• 

  Fig. 3 Schematic images of a normal long head of the biceps tendon (A) and subluxated long head of the biceps tendon (B). The biceps-glenoid angle (arrow) in a shoulder with subluxation of the long head of the biceps tendon is steeper than that in a shoulder without subluxation.

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