BACKGROUND Posterior shoulder dislocation is a rare injury.It accounts for only 1%-4%of all shoulder dislocation cases.However,this injury is often underdiagnosed.Massive rotator cuff tears associated with posterior s...BACKGROUND Posterior shoulder dislocation is a rare injury.It accounts for only 1%-4%of all shoulder dislocation cases.However,this injury is often underdiagnosed.Massive rotator cuff tears associated with posterior shoulder dislocation are exceptionally rare.Early diagnosis and surgical management are crucial for restoring shoulder function and preventing long-term disability.CASE SUMMARY A 60-year-old male with no previous shoulder injuries presented to our hospital with severe right shoulder pain and immobility after a motorcycle accident.He reported that he braced his fall with his right hand.Initial imaging examination revealed posterior shoulder dislocation with minimal glenoid bone loss.Six days after the injury,the patient exhibited pseudoparalysis and active forward flexion limited to 10°.Two weeks after the injury,magnetic resonance imaging revealed complete tears of the supraspinatus,infraspinatus,and subscapularis muscles as well as dislocation of the long head of the biceps tendon.Arthroscopic rotator cuff repair was performed 6 weeks after injury.The tendon quality was acceptable with minimal fatty infiltration.At the 12-month surgical follow-up,the patient had recovered full strength and complete range of motion.CONCLUSION Early diagnosis and tailored repair of massive rotator cuff tears after dislocation are crucial for restoring shoulder function in older patients.展开更多
BACKGROUND Long head of biceps tendon(LHBT)transposition is a novel technique based on the double-row suture bridge method,utilizing autologous reconstruction to treat massive rotator cuff tears.AIM To evaluate the mi...BACKGROUND Long head of biceps tendon(LHBT)transposition is a novel technique based on the double-row suture bridge method,utilizing autologous reconstruction to treat massive rotator cuff tears.AIM To evaluate the mid-to-long-term clinical outcomes following the double-row repair method for massive rotator cuff tears.METHODS This retrospective analysis included data from 53 patients with massive rotator cuff tears treated at our hospital between 2020 and 2021.The patients were divided into the double-row repair group(conventional group)and the doublerow repair combined with the LHBT transposition group(transposition group).Postoperative pain was assessed using the visual analogue scale at one week,one year,and the final follow-up.Shoulder function was evaluated using the American Shoulder and Elbow Surgeons and Constant-Murley scores at one year and the final follow-up.Rotator cuff healing was assessed postoperatively for one year using the Sugaya classification,which categorizes tendon integrity based on magnetic resonance imaging findings.RESULTS No perioperative complications were observed in any of the patients at any time.There were no significant differences between the groups regarding operative time and intraoperative blood loss.The transposition group had significantly lower visual analogue scale scores than the conventional group at one week postoperatively;however,there were no significant differences between the groups at one year or the final follow-up.At one year postoperatively,the transposition group showed significantly higher American Shoulder and Elbow Surgeons and Constant-Murley scores than the conventional group;no significant differences were observed at the final followup.There were no significant differences in rotator cuff healing between the groups at one year postoperatively.CONCLUSION Compared to double-row repair alone,double-row repair combined with LHBT transposition for treating massive rotator cuff tears more effectively alleviates short-term postoperative pain and improves shoulder function within the first year.展开更多
The long head of the biceps tendon is widely recognized as an important pain generator,especially in anterior shoulder pain and dysfunction with athletes and working individuals.The purpose of this review is to provid...The long head of the biceps tendon is widely recognized as an important pain generator,especially in anterior shoulder pain and dysfunction with athletes and working individuals.The purpose of this review is to provide a current understanding of the long head of the biceps tendon anatomy and its surrounding structures,function,and relevant clinical information such as evaluation,treatment options,and complications in hopes of helping orthopaedic surgeons counsel their patients.An understanding of the long head of the biceps tendon anatomy and its surrounding structures is helpful to determine normal function as well as pathologic injuries that stem proximally.The biceps-labral complex has been identified and broken down into different regions that can further enhance a physician’s knowledge of common anterior shoulder pain etiologies.Although various physical examination maneuvers exist meant to localize the anterior shoulder pain,the lack of specificity requires orthopaedic surgeons to rely on patient history,advanced imaging,and diagnostic injections in order to determine the patient’s next steps.Nonsurgical treatment options such as anti-inflammatory medications,physical therapy,and ultrasound-guided corticosteroid injections should be utilized before entertaining surgical treatment options.If surgery is needed,the three options include biceps tenotomy,biceps tenodesis,or superior labrum anterior to posterior repair.Specifically for biceps tenodesis,recent studies have analyzed open vs arthroscopic techniques,the ideal location of tenodesis with intra-articular,suprapectoral,subpectoral,extra-articular top of groove,and extra-articular bottom of groove approaches,and the best method of fixation using interference screws,suture anchors,or cortical buttons.Orthopaedic surgeons should be aware of the complications of each procedure and respond accordingly for each patient.Once treated,patients often have good to excellent clinical outcomes and low rates of complications.展开更多
BACKGROUND Superior capsular reconstruction(SCR)with long head of biceps tendon(LHBT)transposition was developed to massive and irreparable rotator cuff tears(MIRCTs);however,the outcomes of this technique remain uncl...BACKGROUND Superior capsular reconstruction(SCR)with long head of biceps tendon(LHBT)transposition was developed to massive and irreparable rotator cuff tears(MIRCTs);however,the outcomes of this technique remain unclear.AIM To perform a systematic review of biomechanical outcomes and a meta-analysis of clinical outcomes after LHBT transposition for MIRCTs.METHODS We performed a systematic electronic database search on PubMed,EMBASE,and Cochrane Library.Studies of SCR with LHBT transposition were included according to the inclusion and exclusion criteria.Biomechanical studies were assessed for main results and conclusions.Included clinical studies were evaluated for quality of methodology.Data including study characteristics,cohort demographics,and outcomes were extracted.A meta-analysis was conducted of the clinical outcomes.RESULTS According to our inclusion and exclusion criteria,a total of six biomechanical studies were identified and reported an overall improvement in subacromial contact pressures and prevention of superior humeral migration without limiting range of motion(ROM)after LHBT transposition for MIRCTs.A total of five clinical studies were included in the meta-analysis of LHBT transposition outcomes,consisting of 253 patients.The results indicated that compared to other surgical methods for MIRCTs,LHBT transposition had advantages of more significant improvement in ROM(forward flexion mean difference[MD]=6.54,95%confidence interval[CI]:3.07-10.01;external rotation[MD=5.15,95%CI:1.59-8.17];the acromiohumeral distance[AHD][MD=0.90,95%CI:0.21-1.59])and reducing retear rate(odds ratio=0.27,95%CI:0.15-0.48).No significant difference in American Shoulder and Elbow Surgeons score,visual analogue scale score,and University of California at Los Angles score was demonstrated between these two groups for MIRCTs.CONCLUSION In general,SCR with LHBT transposition was a reliable and economical technique for treating MIRCTs,both in terms of biomechanical and clinical outcomes,with comparable clinical outcomes,improved ROM,AHD,and reduced the retear rates compared to conventional SCR and other established techniques.More high-quality randomized controlled studies on the long-term outcomes of SCR with LHBT transposition are required to further assess.展开更多
The long head of the biceps tendon （LHBT） pathology has been implicated as a common source of shoulder pain. The patients may be more resistant to conservative treatment than those with isolated subacromial impingem...The long head of the biceps tendon （LHBT） pathology has been implicated as a common source of shoulder pain. The patients may be more resistant to conservative treatment than those with isolated subacromial impingement. Even though, the surgical options of this disease remain controversial. It has been reported that tenotomy and tenodesis of the biceps tendon were usually utilized. However, persistent pain, deformity, and muscle cramping were frequently observed. Transfer of the LHBT to the conjoint tendon was originally described by Post and Benca in 1982.4 Verma et all has performed the transfer under arthroscopy since 2004. Eighty percent of their patients reported good results with a minimum 2 years of follow-up. However, there was a steep learning curve to become proficient in their technique. We devised a more convenient transfer compared with O＇Brien＇s technique. Six patients received our modified arthroscopic transfers from May 2006 to May 2007. All of them obtained good results.展开更多
Irreducible anteromedial radial head dislocation(IARHD)caused by transposed biceps tendon is rare.Delayed diagnosis and surgical failure often occur.A 46-year-old fisherman presented with 10 days history of painful sw...Irreducible anteromedial radial head dislocation(IARHD)caused by transposed biceps tendon is rare.Delayed diagnosis and surgical failure often occur.A 46-year-old fisherman presented with 10 days history of painful swelling and restricted movement of his right elbow due to strangulation injury by a fishing boat cable.On examination,the images of the right elbow reveals in a"semi-extended and pronated"elastic fixation position.Radiography and 3-dimensional reconstruction CT reveals an isolated anteromedial radial head dislocation with extreme protonation of the radius and the bicipital tuberosity towards the posterior aspect of the elbow joint,and MRI shows biceps tendon wrapping around the radial neck,similar to umbilical cord wrapping seen in newborns.The Henry approach was applied for the first time to reduce the biceps tendon.The patient achieved a good functional recovery at 26 months,which represents the first reported case of IARHD without fracture caused by biceps tendon in an adult.In treatment of IARHD,attention should be paid to the phenomenon of biceps tendon transposition.Careful clinical examination,comprehensive imaging modalities,and appropriate surgical approach are the keys to successful management.展开更多
We report an unusual case of the long head of the biceps brachii tendon rupture near the musculotendinous junction in a young patient.The injury occurred in a young athlete during sports competition.The clinical prese...We report an unusual case of the long head of the biceps brachii tendon rupture near the musculotendinous junction in a young patient.The injury occurred in a young athlete during sports competition.The clinical presentation,surgical treatment,and technique with tenodesis using a unicortical button of the ruptured tendon were presented.The post-surgical recovery was uneventful,and the patient returned to sports in 6 mo.The treatment approach and surgical technique of the long head of biceps brachii rupture was reviewed and discussed.In conclusion,surgical treatment of the long head of the biceps brachii tendon rupture with unicortical button tenodesis resulted in a favorable outcome in a young athlete.展开更多
A 34⁃year⁃old Australian woman broke the Guinness World Record for the most pull⁃ups performed by a woman in 24 hours by doing 7,079 pull⁃ups.To say Olivia Vinson put the old record for most pull⁃ups by a woman in 24 ...A 34⁃year⁃old Australian woman broke the Guinness World Record for the most pull⁃ups performed by a woman in 24 hours by doing 7,079 pull⁃ups.To say Olivia Vinson put the old record for most pull⁃ups by a woman in 24 hours to shame would be an understatement,considering that the Australian fitness enthusiast nearly doubled it.The achieve⁃ment began as a wild proposition from her husband and coach,and even though initially she just laughed at the idea of challenging a world record,it eventually started to make sense.Olivia trained for three months before taking on the challenge in September of last year,but 12 hours into her attempt,she pulled a bicep tendon(肱二头肌腱),which made her unable to perform pull⁃ups anymore.She had to cancel the whole thing,but after healing for a few months,she was back to breaking the Guinness World Record.展开更多
文摘BACKGROUND Posterior shoulder dislocation is a rare injury.It accounts for only 1%-4%of all shoulder dislocation cases.However,this injury is often underdiagnosed.Massive rotator cuff tears associated with posterior shoulder dislocation are exceptionally rare.Early diagnosis and surgical management are crucial for restoring shoulder function and preventing long-term disability.CASE SUMMARY A 60-year-old male with no previous shoulder injuries presented to our hospital with severe right shoulder pain and immobility after a motorcycle accident.He reported that he braced his fall with his right hand.Initial imaging examination revealed posterior shoulder dislocation with minimal glenoid bone loss.Six days after the injury,the patient exhibited pseudoparalysis and active forward flexion limited to 10°.Two weeks after the injury,magnetic resonance imaging revealed complete tears of the supraspinatus,infraspinatus,and subscapularis muscles as well as dislocation of the long head of the biceps tendon.Arthroscopic rotator cuff repair was performed 6 weeks after injury.The tendon quality was acceptable with minimal fatty infiltration.At the 12-month surgical follow-up,the patient had recovered full strength and complete range of motion.CONCLUSION Early diagnosis and tailored repair of massive rotator cuff tears after dislocation are crucial for restoring shoulder function in older patients.
基金Supported by the General Program of the Hubei Provincial Natural Science Foundation of China Key Project,No.2021CFB520.
文摘BACKGROUND Long head of biceps tendon(LHBT)transposition is a novel technique based on the double-row suture bridge method,utilizing autologous reconstruction to treat massive rotator cuff tears.AIM To evaluate the mid-to-long-term clinical outcomes following the double-row repair method for massive rotator cuff tears.METHODS This retrospective analysis included data from 53 patients with massive rotator cuff tears treated at our hospital between 2020 and 2021.The patients were divided into the double-row repair group(conventional group)and the doublerow repair combined with the LHBT transposition group(transposition group).Postoperative pain was assessed using the visual analogue scale at one week,one year,and the final follow-up.Shoulder function was evaluated using the American Shoulder and Elbow Surgeons and Constant-Murley scores at one year and the final follow-up.Rotator cuff healing was assessed postoperatively for one year using the Sugaya classification,which categorizes tendon integrity based on magnetic resonance imaging findings.RESULTS No perioperative complications were observed in any of the patients at any time.There were no significant differences between the groups regarding operative time and intraoperative blood loss.The transposition group had significantly lower visual analogue scale scores than the conventional group at one week postoperatively;however,there were no significant differences between the groups at one year or the final follow-up.At one year postoperatively,the transposition group showed significantly higher American Shoulder and Elbow Surgeons and Constant-Murley scores than the conventional group;no significant differences were observed at the final followup.There were no significant differences in rotator cuff healing between the groups at one year postoperatively.CONCLUSION Compared to double-row repair alone,double-row repair combined with LHBT transposition for treating massive rotator cuff tears more effectively alleviates short-term postoperative pain and improves shoulder function within the first year.
文摘The long head of the biceps tendon is widely recognized as an important pain generator,especially in anterior shoulder pain and dysfunction with athletes and working individuals.The purpose of this review is to provide a current understanding of the long head of the biceps tendon anatomy and its surrounding structures,function,and relevant clinical information such as evaluation,treatment options,and complications in hopes of helping orthopaedic surgeons counsel their patients.An understanding of the long head of the biceps tendon anatomy and its surrounding structures is helpful to determine normal function as well as pathologic injuries that stem proximally.The biceps-labral complex has been identified and broken down into different regions that can further enhance a physician’s knowledge of common anterior shoulder pain etiologies.Although various physical examination maneuvers exist meant to localize the anterior shoulder pain,the lack of specificity requires orthopaedic surgeons to rely on patient history,advanced imaging,and diagnostic injections in order to determine the patient’s next steps.Nonsurgical treatment options such as anti-inflammatory medications,physical therapy,and ultrasound-guided corticosteroid injections should be utilized before entertaining surgical treatment options.If surgery is needed,the three options include biceps tenotomy,biceps tenodesis,or superior labrum anterior to posterior repair.Specifically for biceps tenodesis,recent studies have analyzed open vs arthroscopic techniques,the ideal location of tenodesis with intra-articular,suprapectoral,subpectoral,extra-articular top of groove,and extra-articular bottom of groove approaches,and the best method of fixation using interference screws,suture anchors,or cortical buttons.Orthopaedic surgeons should be aware of the complications of each procedure and respond accordingly for each patient.Once treated,patients often have good to excellent clinical outcomes and low rates of complications.
基金the National Natural Science Foundation of China,No.81972125 and No.82172510.
文摘BACKGROUND Superior capsular reconstruction(SCR)with long head of biceps tendon(LHBT)transposition was developed to massive and irreparable rotator cuff tears(MIRCTs);however,the outcomes of this technique remain unclear.AIM To perform a systematic review of biomechanical outcomes and a meta-analysis of clinical outcomes after LHBT transposition for MIRCTs.METHODS We performed a systematic electronic database search on PubMed,EMBASE,and Cochrane Library.Studies of SCR with LHBT transposition were included according to the inclusion and exclusion criteria.Biomechanical studies were assessed for main results and conclusions.Included clinical studies were evaluated for quality of methodology.Data including study characteristics,cohort demographics,and outcomes were extracted.A meta-analysis was conducted of the clinical outcomes.RESULTS According to our inclusion and exclusion criteria,a total of six biomechanical studies were identified and reported an overall improvement in subacromial contact pressures and prevention of superior humeral migration without limiting range of motion(ROM)after LHBT transposition for MIRCTs.A total of five clinical studies were included in the meta-analysis of LHBT transposition outcomes,consisting of 253 patients.The results indicated that compared to other surgical methods for MIRCTs,LHBT transposition had advantages of more significant improvement in ROM(forward flexion mean difference[MD]=6.54,95%confidence interval[CI]:3.07-10.01;external rotation[MD=5.15,95%CI:1.59-8.17];the acromiohumeral distance[AHD][MD=0.90,95%CI:0.21-1.59])and reducing retear rate(odds ratio=0.27,95%CI:0.15-0.48).No significant difference in American Shoulder and Elbow Surgeons score,visual analogue scale score,and University of California at Los Angles score was demonstrated between these two groups for MIRCTs.CONCLUSION In general,SCR with LHBT transposition was a reliable and economical technique for treating MIRCTs,both in terms of biomechanical and clinical outcomes,with comparable clinical outcomes,improved ROM,AHD,and reduced the retear rates compared to conventional SCR and other established techniques.More high-quality randomized controlled studies on the long-term outcomes of SCR with LHBT transposition are required to further assess.
文摘The long head of the biceps tendon （LHBT） pathology has been implicated as a common source of shoulder pain. The patients may be more resistant to conservative treatment than those with isolated subacromial impingement. Even though, the surgical options of this disease remain controversial. It has been reported that tenotomy and tenodesis of the biceps tendon were usually utilized. However, persistent pain, deformity, and muscle cramping were frequently observed. Transfer of the LHBT to the conjoint tendon was originally described by Post and Benca in 1982.4 Verma et all has performed the transfer under arthroscopy since 2004. Eighty percent of their patients reported good results with a minimum 2 years of follow-up. However, there was a steep learning curve to become proficient in their technique. We devised a more convenient transfer compared with O＇Brien＇s technique. Six patients received our modified arthroscopic transfers from May 2006 to May 2007. All of them obtained good results.
基金supported by the Basic Research Category Project of Yantai Science and Technology Innovation Development Plan (2022JCYJ037),China.
文摘Irreducible anteromedial radial head dislocation(IARHD)caused by transposed biceps tendon is rare.Delayed diagnosis and surgical failure often occur.A 46-year-old fisherman presented with 10 days history of painful swelling and restricted movement of his right elbow due to strangulation injury by a fishing boat cable.On examination,the images of the right elbow reveals in a"semi-extended and pronated"elastic fixation position.Radiography and 3-dimensional reconstruction CT reveals an isolated anteromedial radial head dislocation with extreme protonation of the radius and the bicipital tuberosity towards the posterior aspect of the elbow joint,and MRI shows biceps tendon wrapping around the radial neck,similar to umbilical cord wrapping seen in newborns.The Henry approach was applied for the first time to reduce the biceps tendon.The patient achieved a good functional recovery at 26 months,which represents the first reported case of IARHD without fracture caused by biceps tendon in an adult.In treatment of IARHD,attention should be paid to the phenomenon of biceps tendon transposition.Careful clinical examination,comprehensive imaging modalities,and appropriate surgical approach are the keys to successful management.
文摘We report an unusual case of the long head of the biceps brachii tendon rupture near the musculotendinous junction in a young patient.The injury occurred in a young athlete during sports competition.The clinical presentation,surgical treatment,and technique with tenodesis using a unicortical button of the ruptured tendon were presented.The post-surgical recovery was uneventful,and the patient returned to sports in 6 mo.The treatment approach and surgical technique of the long head of biceps brachii rupture was reviewed and discussed.In conclusion,surgical treatment of the long head of the biceps brachii tendon rupture with unicortical button tenodesis resulted in a favorable outcome in a young athlete.
文摘A 34⁃year⁃old Australian woman broke the Guinness World Record for the most pull⁃ups performed by a woman in 24 hours by doing 7,079 pull⁃ups.To say Olivia Vinson put the old record for most pull⁃ups by a woman in 24 hours to shame would be an understatement,considering that the Australian fitness enthusiast nearly doubled it.The achieve⁃ment began as a wild proposition from her husband and coach,and even though initially she just laughed at the idea of challenging a world record,it eventually started to make sense.Olivia trained for three months before taking on the challenge in September of last year,but 12 hours into her attempt,she pulled a bicep tendon(肱二头肌腱),which made her unable to perform pull⁃ups anymore.She had to cancel the whole thing,but after healing for a few months,she was back to breaking the Guinness World Record.
