Ali Tufan PEHLİVAN, Esmehan PEHLİVAN, Yunus İMREN, Süleyman Semih DEDEOĞLU, Ali SARI

Are we over-treating biceps tendon disorders?

The aim was to analyse biceps tendon disorders histopathologically in order to get a better understanding of the pathogenesis. A histopathological examination was made of tissue samples taken from 41 patients in subpectoral biceps tenodesis operations applied for a diagnosis of biceps tendinopathy. The mean age of the patients was 53,4 . The mean Constant shoulder score was determined as 32 preoperatively and 84 postoperatively. The VAS (visual analog score) values were determined as mean 8.75 preoperatively and 2.18 postoperatively. As a result of the histopathological examinations, no findings suggestive of an acute or chronic inflammatory event were determined in any case. The histological findings determined were not sufficient to explain the pathophysiology of biceps tendinopathy diseases. The findings strengthened the view that extrinsic factors apart from the tendon could play a significant role in the pathogenesis of the disease. Therefore, we ask whether or not tendon decompression may be considered as a treatment option for biceps tendinopathies as in chronic compression tendinopathies

PDF

___

1. Ikemoto RY, Pileggi PE, Murachovsky J, Nascimento LGP, Serpone RB, Strose E and Oliveira LHA. TenoTomy WiTh or WiThouT Tenodesis of The long head of The bicePs using rePair of The roTaTor cuff. Rev Bras Ortop. 2012;47(6):736-40.

2. Gleason PD, Beall DP, Sanders TG, Bond JL, Ly JQ, Holland LL, Pasque CB. The transverse humeral ligament a separate anatomical structure or a continuation of the osseous attachment of the rotator cuff? Am J Sports Med. 2006;34(1):72-7.

3. Murthi AM, Vosburgh CL, Neviaser TJ. The incidence of pathologic changes of the long head of the biceps tendon. J Shoulder Elbow Surg. 2000;9(5):382-5.

4. Elser F, Braun S, Dewing CB, Giphart JE, Millett PJ. Anatomy, function, injuries, and treatment of the long head of the biceps brachii tendon. Arthroscopy. 2011;27(4):581-92.

5. Sakurai G, Ozaki J, Tomita Y, Nakagawa Y, Kondo T, Tamai S. Morphologic changes in long head of biceps brachii in rotator cuff dysfunction. J Orthop Sci. 1998;3(3):137-42.

6. Beall DP, Williamson EE, Ly JQ, Adkins MC, Emery RL, Jones TP, Rowland CM. Association of biceps tendon tears with rotator cuff abnormalities: degree of correlation with tears of the anterior and superior portions of the rotator cuff. AJR Am J Roentgenol. 2003;180(3):633-9.

7. Patzer T, Habermeyer P, Hurschler C, Bobrowitsch E, Paletta J, Fuchs-Winkelmann S, Schofer MD. Increased glenohumeral translation and biceps load after SLAP lesions with potential influence on glenohumeral chondral lesions: a biomechanical study on human cadavers. Knee Surg Sports Traumatol Arthrosc. 2011;19(10):1780-7.

8. Longo UG, Loppini M, Marineo G, Khan WS, Maffulli N, Denaro V. Tendinopathy of the tendon of the long head of the biceps. Sports Med Arthrosc. 2011;19(4):321-32.

9. Patton WC, McCluskey GM. Biceps tendinitis and subluxation. Clin Sports Med. 2001;20(3):505-29.

10. Arroyo JS, Hershon SJ, Bigliani LU. Special considerations in the athletic throwing shoulder. Orthop Clin North Am. 1997;28(1):69- 78.

11. Gill TJ, McIrvin E, Mair SD, Hawkins RJ. Results of biceps tenotomy for treatment of pathology of the long head of the biceps brachii. J Shoulder Elbow Surg. 2001;10(3):247-9.

12. Walch G, Edwards TB, Boulahia A, Nové-Josserand L, Neyton L, Szabo I. Arthroscopic tenotomy of the long head of the biceps in the treatment of rotator cuff tears: clinical and radiographic results of 307 cases. J Shoulder Elbow Surg. 2005;14(3):238-46.

13. Berlemann U, Bayley I. Tenodesis of the long head of biceps brachii in the painful shoulder: improving results in the long term. Jf Shoulder Elbow Surg. 1995;4(6):429-35.

14. Checchia SL, Doneux PS, Miyazaki AN, Silva LA, Fregoneze M, Ossada A, Tsutida CY, Masiole C. Biceps tenodesis associated with arthroscopic repair of rotator cuff tears. J Shoulder Elbow Surg. 2005;14(2):138-44.

15. Neviaser TJ, Neviaser RJ, Neviaser JS, Neviaser JS. The four-in-one arthroplasty for the painful arc syndrome. Clin Orthop Relat Res. 1982;163:107-12.

16. Williams MM, Snyder SJ, Buford D Jr. The Buford complex--the "cord-like" middle glenohumeral ligament and absent anterosuperior labrum complex: a normal anatomic capsulolabral variant. Arthroscopy. 1994;10(3):241-7.

17. Warren R. Lesions of the long head of the biceps tendon. Instr Course Lect. 1984;34:204-9.

18. Hsu AR, Ghodadra NS, Provencher CMT, Lewis PB, Bach BR. Biceps tenotomy versus tenodesis: a review of clinical outcomes and biomechanical results. J Shoulder Elbow Surg. 2011;20(2):326-32.

19. Kelly AM, Drakos MC, Fealy S, Taylor SA, O’Brien SJ. Arthroscopic release of the long head of the biceps tendon functional outcome and clinical results. Am J Sports Med. 2005;33(2):208-13.

20. Ahrens P, Boileau P. The long head of biceps and associated tendinopathy. J Bone Joint Surg. 2007;89(8):1001-9.

21. Galasso O, Gasparini G, De Benedetto M, Familiari F, Castricini R. Tenotomy versus tenodesis in the treatment of the long head of biceps brachii tendon lesions. BMC Musculoskelet Disord. 2012;13:205.

22. Boileau P, Baqué F, Valerio L, Ahrens P, Chuinard C, Trojani C. Isolated arthroscopic biceps tenotomy or tenodesis improves symptoms in patients with massive irreparable rotator cuff tears. J Bone Joint Surg Am. 2007;89(4):747-57.

23. Gombera MM, Kahlenberg CA, Nair R, Saltzman MD, Terry MA. All-arthroscopic suprapectoral versus open subpectoral tenodesis of the long head of the biceps brachii. Am J Sports Med. 2015;43:1077- 83.

24. Abraham VT, Tan BH, Kumar VP. Systematic Review of Biceps Tenodesis: Arthroscopic Versus Open. Arthroscopy: Arthroscopy 2015;32(2):365-71.

25. Millett PJ, Sanders B, Gobezie R, Braun S, Warner JJ. Interference screw vs. suture anchor fixation for open subpectoral biceps tenodesis: does it matter? BMC musculoskelet disord. 2008;9:121.

26. Streit JJ, Shishani Y, Rodgers M, Gobezie R. Tendinopathy of the long head of the biceps tendon: histopathologic analysis of the extraarticular biceps tendon and tenosynovium. Open Access J Sports Med. 2015;6:63-70

27. Alizadeh K, Tavangar S-M. Histologic findings in idiopathic carpal tunnel syndrome: Report of 209 cases. Arc Iran Med. 2002;5:100.

28. Jafari D, Mazhar FN, Shariatzadeh H, Shahverdi S, Moghimi Z, Mokhtari T. Inflammation and fibrosis of transverse carpal ligament and flexor tenosynovium in severe idiopathic carpal tunnel syndrome. Shafa Orthopedic J. 2014;1(3):9-12.

29. Nakamichi K-i, Tachibana S. Histology of the transverse carpal ligament and flexor tenosynovium in idiopathic carpal tunnel syndrome. J Hand Surg Am. 1998;23:1015-24.

30. Clarke M, Lyall H, Grant J, Matthewson M. The histopathology of de Quervain’s disease. J Hand Surg. 1998;23(6):732-4.

31. Kwon YW, Hurd J, Keith Yeager B, Ishak C, Walker PS, Khan S, Bosco III JA, Jazrawi LM. Proximal Biceps Tendon. Bull NYU hosp Jt Dis. 2009;67(4):337-40.

32. Sanders B, Lavery KP, Pennington S and Warner JJ. Clinical success of biceps tenodesis with and without release of the transverse humeral ligament. J Shoulder Elbow Surg. 2012;21(1):66-71.