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 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:Tenodesis of the long head of the biceps(LHB)is commonly undertaken during arthroscopic rotator cuff repair.We assessed the clinical and structural outcomes after high arthroscopic tenodesis(HAT)or mini-ope...Background:Tenodesis of the long head of the biceps(LHB)is commonly undertaken during arthroscopic rotator cuff repair.We assessed the clinical and structural outcomes after high arthroscopic tenodesis(HAT)or mini-open subpectoral tenodesis(ST).We hypothesized that the clinical and structural results after HAT and ST are similar.Methods:We included 40 patients with rotator cuff tear and LHB tendinopathy.Twenty patients(7 women and 13 men;mean age:57.9 years;range:56-63 years)were treated using HAT,and 20 patients(8 women and 12 men;mean age:58.5 years;range:55-64 years)were treated using ST.Functional evaluation was performed preoperatively and at 6 weeks,6 months,and 1 year after surgery,using the Constant Murley Score and Simple Shoulder Test scores;the LHB was evaluated using the LHB score.A Visual Analogue Scale was administered to all patients preoperatively and 2 days after surgery.Results:The postoperative total and pain subscale’s Constant scores were significantly higher in the ST group.Moreover,2 LHB score values were significantly different between the groups.The postoperative LHB total score in the ST and HAT groups averaged 86.9±4.1(mean±SD)points and 73.3±6.4 points,respectively.The Pain/Cramps subscale in the ST and HAT groups averaged 47.1±5.9 and 33.2±4.6 points,respectively.The 2 groups showed no difference in Visual Analogue Scale values(5.5 in the HAT group;5.8 in the ST group)postoperatively.One patient in the HAT group reported a secondary onset of Popeye deformity.Conclusion:Both high arthroscopic and mini-open ST of the LHB tendon produced reliably good functional results,but the ST group was associated with better postoperative clinical outcomes.展开更多
BACKGROUND Dislocation of the long head of biceps tendon(LHBT)usually involves rotator cuff injury,and isolated dislocation with an intact rotator cuff is rare.Some cases of isolated dislocation have been reported.How...BACKGROUND Dislocation of the long head of biceps tendon(LHBT)usually involves rotator cuff injury,and isolated dislocation with an intact rotator cuff is rare.Some cases of isolated dislocation have been reported.However,to the best of our knowledge,there has been no report of bilateral dislocation of the LHBT without rotator cuff pathology.CASE SUMMARY A 23-year-old male presented to our outpatient clinic with left side dominant pain in both shoulders.The patient had no history of trauma or overuse.The patient underwent intra-articular injection and physical therapy,but his symptoms aggravated.Based on preoperative imaging,the diagnosis was bilateral dislocation of the LHBT.Dysplasia of the bicipital groove was detected in both shoulders.Active dislocation of the biceps tendon over an intact subscapularis tendon was identified by diagnostic arthroscopy.Staged biceps tenodesis was performed and continuous passive motion therapy was administered immediately after surgery.The patient’s pain was resolved,and full functional recovery was achieved,and he was satisfied with the condition of his shoulders.CONCLUSION This study describes a rare case of bilateral dislocations of the LHBT without rotator cuff injury due to dysplasia of the bicipital groove.展开更多
The time window for repair of the lower trunk is shorter than that of the upper trunk in patients with obstetric brachial plexus palsy. The denervated intrinsic muscles of the hand become irreversibly atrophic much fa...The time window for repair of the lower trunk is shorter than that of the upper trunk in patients with obstetric brachial plexus palsy. The denervated intrinsic muscles of the hand become irreversibly atrophic much faster than the denervated biceps. However, it is unclear whether the motor endplates of the denervated interosseous muscles degenerate more rapidly than those of the denervated biceps. In this study, we used a rat model of obstetric brachial plexus palsy of the right upper limb. C5–6 was lacerated distal to the intervertebral foramina, with concurrent avulsion of C7–8 and T1, with the left upper limb used as the control. Bilateral interossei and biceps were collected at 5 and 7 weeks. Immunofluorescence was used to assess the morphology of the motor endplates. Real-time quantitative polymerase chain reaction and western blot assay were used to assess mRNA and protein expression levels of acetylcholine receptor subunits(α, β and δ), rapsyn and β-catenin. Immunofluorescence microscopy showed that motor endplates in the denervated interossei were fragmented, while those in the denervated biceps were morphologically intact with little fragmentation. The number and area of motor endplates, relative to the control side, were significantly lower in the denervated interossei compared with the denervated biceps. mRNA and protein expression levels of acetylcholine receptor subunits(α, β and δ) were significantly lower, whereas β-catenin protein expression was higher, in the denervated interossei compared with the denervated biceps. The protein expression of rapsyn was higher in the denervated biceps than in the denervated interossei at 7 weeks. Our findings demonstrate that motor endplates of interossei are destabilized, whereas those of the biceps remain stable, in the rat model of obstetric brachial plexus palsy. All procedures were approved by the Experimental Animal Ethics Committee of Fudan University, China(approval No. DF-187) in January 2016.展开更多
AIM: To demonstrate that long head of the biceps tendon(LHBT) tenodesis is possible more than 3 mo after rupture. METHODS: From September 2009 to January 2012 we performed tenodesis of the LHBT in 11 individuals(avera...AIM: To demonstrate that long head of the biceps tendon(LHBT) tenodesis is possible more than 3 mo after rupture. METHODS: From September 2009 to January 2012 we performed tenodesis of the LHBT in 11 individuals(average age 56.9 years, range 42 to 73) more than 3 mo after rupture. All patients were evaluated by Disabilites of the Arm Shoulder and Hand(DASH) and Mayo outcome scores at an average follow-up of 19.1 mo. We similarly evaluated 5 patients(average age 58.2 years, range 45 to 64) over the same time treated within 3 mo of rupture with an average follow-up of 22.5 mo.RESULTS: Tenodesis with an interference screw was possible in all patients more than 3 mo after rupture and 90% had good to excellent outcomes but two had recurrent rupture. All of those who had tenodesis less than 3 mo after rupture had good to excellent outcomes and none had recurrent rupture. No statistical difference was found for DASH and Mayo outcome scores between the two groups(P <0.05). CONCLUSION: Tenodesis of LHBT more than 3 mo following rupture had outcomes similar to tenodesis done within 3 mo of rupture but recurrent rupture occurred in 20%.展开更多
AIM: To evaluate the clinical and functional results after repair of distal biceps tendon tears, following the Morrey's modified double-incision approach.METHODS: We retrospectively reviewed 47 patients with dista...AIM: To evaluate the clinical and functional results after repair of distal biceps tendon tears, following the Morrey's modified double-incision approach.METHODS: We retrospectively reviewed 47 patients with distal rupture of biceps brachii treated between2003 and 2012 in our Orthopedic Department with muscle-splitting double-incision technique. Outcome measures included the Mayo elbow performance, the DASH questionnaire, patient's satisfaction, elbow and forearm motion, grip strength and complications occurrence.RESULTS: At an average 18 mo follow-up(range, 7 mo-10 years) the average Mayo elbow performance and DASH score were respectively 97.2 and 4.8. The elbow flexion range was 94%, extension was-2°, supination was 93% and pronation 96% compared with the uninjured limb. The mean grip strength, expressed as percentage of respective contralateral limb, was 83%. The average patient satisfaction rating on a Likert scale(from 0 to 10) was 9.4. The following complications were observed: 3 cases of heterotopic ossification(6.4%), one(2.1%) re-rupture of the tendon at the site of reattachment and 2 cases(4.3%) of posterior interosseous nerve palsy. No complication required further surgical treatment.CONCLUSION: This technique allows an anatomic reattachment of distal biceps tendon at the radial tuberosity providing full functional recovery with low complication rate.展开更多
In treating patients with obstetric brachial plexus palsy,we noticed that denervated intrinsic muscles of the hand become irreversibly atrophic at a faster than denervated biceps.In a rat model of obstetric brachial p...In treating patients with obstetric brachial plexus palsy,we noticed that denervated intrinsic muscles of the hand become irreversibly atrophic at a faster than denervated biceps.In a rat model of obstetric brachial plexus palsy,denervated intrinsic musculature of the forepaw entered the irreversible atrophy far earlier than denervated biceps.In this study,isobaric tags for relative and absolute quantitation were examined in the intrinsic musculature of forepaw and biceps on denervated and normal sides at 3 and 5 weeks to identify dysregulated proteins.Enrichment of pathways mapped by those proteins was analyzed by Kyoto Encyclopedia of Genes and Genomes analysis.At 3 weeks,119 dysregulated proteins in denervated intrinsic musculature of the forepaw were mapped to nine pathways for muscle regulation,while 67 dysregulated proteins were mapped to three such pathways at 5 weeks.At 3 weeks,27 upregulated proteins were mapped to five pathways involving inflammation and apoptosis,while two upregulated proteins were mapped to one such pathway at 5 weeks.At 3 and 5 weeks,53 proteins from pathways involving regrowth and differentiation were downregulated.At 3 weeks,64 dysregulated proteins in denervated biceps were mapped to five pathways involving muscle regulation,while,five dysregulated proteins were mapped to three such pathways at 5 weeks.One protein mapped to inflammation and apoptotic pathways was upregulated from one pathway at 3 weeks,while three proteins were downregulated from two other pathways at 5 weeks.Four proteins mapped to regrowth and differentiation pathways were upregulated from three pathways at 3 weeks,while two proteins were downregulated in another pathway at 5 weeks.These results implicated inflammation and apoptosis as critical factors aggravating atrophy of denervated intrinsic muscles of the hand during obstetric brachial plexus palsy.All experimental procedures and protocols were approved by the Experimental Animal Ethics Committee of Fudan University,China(approval No.DF-325)in January 2015.展开更多
The preferred treatment of distal biceps tendon ruptures is by operative repair. However, the best approach for repair(single vs double incision) is still subject of debate. Grewal and colleagues recently presented th...The preferred treatment of distal biceps tendon ruptures is by operative repair. However, the best approach for repair(single vs double incision) is still subject of debate. Grewal and colleagues recently presented the results of a randomized clinical trial evaluating two different surgical approaches for the repair of distal biceps tendon ruptures. Despite the fact that this article currently presents the highest level of evidence for the surgical repair of distal biceps tendon ruptures, we have some comments on the study that might be interesting to discuss. We think that some of the results and conclusions presented in this study need to be interpreted in the light of these comments.展开更多
Objectives: This study compared the effect of Kinesio Taping (KT) with local Methyl Prednisolone injection in patients with biceps tendonitis based on visual analog scale (VAS) and range of motion (ROM). Methods: Thir...Objectives: This study compared the effect of Kinesio Taping (KT) with local Methyl Prednisolone injection in patients with biceps tendonitis based on visual analog scale (VAS) and range of motion (ROM). Methods: Thirty-eight patients (15 females and 23 males;mean age: 29.87 ± 6.31, years) with biceps tendonitis were participated in this study during 2014-2015. The patients were randomly assigned into two groups: 19 patients in KT group and 19 patients in injection group. In the first group, KT was used three times for 24 hours sequentially with four-day intervals;in the second group, one dose of Methyl Prednisolone (40 mg) plus 1% lidocaine was injected in the bicipital fissure around the long head of the biceps muscle. The injections and KT therapy were performed by the same physician. The patients were investigated for VAS and ROM in the first, second, seventh and twelfth days. Results: VAS and ROM indices were significantly improved in the second and seventh days (p 0.05). Conclusion: Regarding the more immediate effect of KT on ROM and VAS and the fast restoring of the patient to normal life, it could be used as a noninvasive alternative to injection and as the first line of treatment specially in patients who need the immediate effect of treatment.展开更多
An Irreducible dislocation of the shoulder is an uncommon event. When it does occur, blocks to reduction can include bone, labrum, rotator cuff musculature or tendon. Patients older than 40 at the time of initial disl...An Irreducible dislocation of the shoulder is an uncommon event. When it does occur, blocks to reduction can include bone, labrum, rotator cuff musculature or tendon. Patients older than 40 at the time of initial dislocation are at increased risk of sustaining a concomitant rotator cuff tear. We present a case of an irreducible anterior shoulder dislocation due to interposition of both subscapularis tendon and a posteriorly dislocated long head of biceps. Both Computed Tomography (CT) and magnetic resonance imaging (MRI), along with intraoperative findings are discussed. Conclusion: We would advocate maintaining a low threshold for MR imaging post shoulder dislocation in the older population, when there is radiological or clinical concern regarding the integrity of the rotator cuff, and also to evaluate whether a concentric reduction of the shoulder joint has been achieved.展开更多
Distal biceps tendon rupture accounts for only 3% - 10% of all biceps tendon injuries. The majority of distal biceps tendon injuries are from complete rupture. It is especially rare to diagnose partial rupture of the ...Distal biceps tendon rupture accounts for only 3% - 10% of all biceps tendon injuries. The majority of distal biceps tendon injuries are from complete rupture. It is especially rare to diagnose partial rupture of the distal biceps tendon. Our case profiles a chronic partial tear of the distal biceps tendon in a pediatric patient.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
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
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
The study made an observation of electromyograph changes of biceps femoris muscle during contraction with different loads and at different speeds. The results indicated: the IEMG during fast contraction (one elbow fle...The study made an observation of electromyograph changes of biceps femoris muscle during contraction with different loads and at different speeds. The results indicated: the IEMG during fast contraction (one elbow flexion each second) and slow contraction (one elbow flexion every two seconds) with three loads (5kg, 10kg, 15kg) didnot show significant difference whether be fore or after fatiguel the MPF of fast contraction be fore fatigue was larger than that of slow contraction: the IEMG during dynamic contraction to fatigue (5kg, 10kg) was significantly larger than that before fatigue; with the loading of 15kg the IEMG after fatigue significantly decreased;the MPF decreased during contraction to fatigue at all loadings.展开更多
Targeted muscle reinnervation has been proposed for reconstruction of neuromuscular function in amputees.However,it is unknown whether performing delayed targeted muscle reinnervation after nerve injury will affect re...Targeted muscle reinnervation has been proposed for reconstruction of neuromuscular function in amputees.However,it is unknown whether performing delayed targeted muscle reinnervation after nerve injury will affect restoration of function.In this rat nerve injury study,the median and musculocutaneous nerves of the forelimb were transected.The proximal median nerve stump was sutured to the distal musculocutaneous nerve stump immediately and 2 and 4 weeks after surgery to reinnervate the biceps brachii.After targeted muscle reinnervation,intramuscular myoelectric signals from the biceps brachii were recorded.Signal amplitude gradually increased with time.Biceps brachii myoelectric signals and muscle fiber morphology and grooming behavior did not significantly differ among rats subjected to delayed target muscle innervation for different periods.Targeted muscle reinnervation delayed for 4 weeks can acquire the same nerve function restoration effect as that of immediate reinnervation.展开更多
Surgical treatment of superior labral anterior posterior(SLAP) lesion becomes more and more frequent which is the consequence of evolving progress in both,imaging and surgical technique as well as implants.The first c...Surgical treatment of superior labral anterior posterior(SLAP) lesion becomes more and more frequent which is the consequence of evolving progress in both,imaging and surgical technique as well as implants.The first classification of SLAP lesions was described in 1990, a subdivision in four types existed. The rising comprehension of pathology and pathophysiology in SLAP lesions contributed to increase the types in SLAP classification to ten. Concerning the causative mechanism of SLAP lesions, acute trauma has to be differed from chronic degeneration. Overhead athletes tend to develop a glenohumeral internal rotation deficit which forms the basis for two controversial discussed potential mechanisms of pathophysiology in SLAP lesions: Internal impingement and peel-back mechanism. Clinical examination often remains unspecific whereas soft tissue imaging such as direct or indirect magnetic resonance arthrography has technically improved and is regarded to be indispensable in detection of SLAP lesions. Concomitant pathologies as Bankart lesions, rotator cuff tears or perilabral cysts should be taken into consideration when planning a personalized therapeutic strategy. In addition, normal variants such as sublabral recess, sublabral hole, Buford complex and other less common variants have to be distinguished. The most frequent SLAP type Ⅱ needs a sophisticated approach when surgical teatment comes into consideration. While SLAP repair is considered to be the standard operative option, overhead athletes benefit from a biceps tenodesis because improved patient-reported satisfaction and higher rate of return to pre-injury level of sports has been reported.展开更多
Background:Muscular strength can be conceptually determined by two components:muscle activation and size.Muscle activation by the central nervous system can be measured by surface electromyography(sEMG).Muscular size ...Background:Muscular strength can be conceptually determined by two components:muscle activation and size.Muscle activation by the central nervous system can be measured by surface electromyography(sEMG).Muscular size reflects the amount of contractile protein within a skeletal muscle and can be estimated by anthropometric measurements.The purpose of this study was to determine the relative contributions of size parameters and muscle activation to the prediction of maximal voluntary isometric elbow flexion strength. Methods:A series of anthropometric measurements were taken from 96 participants.Torque and root-mean-square(RMS) of the sEMG from the biceps brachii were averaged across three maximal voluntary isometric contractions.A multiple linear regression analysis was performed based on a Pearson's correlation matrix. Results:Body weight(BW) accounted for 39.1% and 27.3% in males and females,respectively,and was the strongest predictor of strength for males.Forearm length(L3) was the strongest predictor of strength in females(partial R^2 = 0.391).Elbow circumference(ELB) accounted for a significant(p < 0.05) amount of variance in males but not females.The addition of sEMG RMS as a third variable accounted for an average of 10.1% of the variance excluding the equation of BW and L3 in females.The strongest prediction equation included BW,L3,and ELB accounting for 55.6% and 58.5% of the variance in males and females,respectively. Conclusion:Anthropometrics provide a strong prediction equation for the estimation of isometric elbow flexion strength.Muscle activation,as measured by sEMG activity,accounted for a significant(p < 0.05) amount of variance in most prediction equations,however,its contribution was comparable to an additional anthropometric variable.展开更多
Noninvasive techniques,surface electromyography(sEMG)in particular,are being increasingly employed for assessing muscle activity.In these studies,local oxygen consumption and muscle metabolism are of great interest.Me...Noninvasive techniques,surface electromyography(sEMG)in particular,are being increasingly employed for assessing muscle activity.In these studies,local oxygen consumption and muscle metabolism are of great interest.Measurements can be performed noninvasively using optics-based methods such as near-infrared spectroscopy(NIRS).By combining energy con-sumption data provided by NIRS with muscle level activation data from sEMG,we may gain an insight into the metabolic and functional characteristics of muscle tissue.However,muscle mo-tion may induce artifacts into EMG and NIRS.Thus,the inclusion of simultaneous motion measurements using accelerometers(ACMs)enhances possibilities to perceive the effects of motion on NIRS and EMG signals.This paper reviews the current state of noninvasive EMG and NIRS-based methods used to study muscle function.In addition,we built a combined sEMG/NIRS/ACM sensor to perform simultaneous measurements for static and dynamic exercises of a biceps brachii muscle.Further,we discuss the effect of muscle motion in response of NIRS and EMG when measured noninva-sively.Based on our preliminary studies,both NIRS and EMG supply specific information on muscle activation,but their signal responses also showed similarities with acceleration signals which,in this case,were supposed to be solely sensitive to motions.展开更多
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 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.
文摘Background:Tenodesis of the long head of the biceps(LHB)is commonly undertaken during arthroscopic rotator cuff repair.We assessed the clinical and structural outcomes after high arthroscopic tenodesis(HAT)or mini-open subpectoral tenodesis(ST).We hypothesized that the clinical and structural results after HAT and ST are similar.Methods:We included 40 patients with rotator cuff tear and LHB tendinopathy.Twenty patients(7 women and 13 men;mean age:57.9 years;range:56-63 years)were treated using HAT,and 20 patients(8 women and 12 men;mean age:58.5 years;range:55-64 years)were treated using ST.Functional evaluation was performed preoperatively and at 6 weeks,6 months,and 1 year after surgery,using the Constant Murley Score and Simple Shoulder Test scores;the LHB was evaluated using the LHB score.A Visual Analogue Scale was administered to all patients preoperatively and 2 days after surgery.Results:The postoperative total and pain subscale’s Constant scores were significantly higher in the ST group.Moreover,2 LHB score values were significantly different between the groups.The postoperative LHB total score in the ST and HAT groups averaged 86.9±4.1(mean±SD)points and 73.3±6.4 points,respectively.The Pain/Cramps subscale in the ST and HAT groups averaged 47.1±5.9 and 33.2±4.6 points,respectively.The 2 groups showed no difference in Visual Analogue Scale values(5.5 in the HAT group;5.8 in the ST group)postoperatively.One patient in the HAT group reported a secondary onset of Popeye deformity.Conclusion:Both high arthroscopic and mini-open ST of the LHB tendon produced reliably good functional results,but the ST group was associated with better postoperative clinical outcomes.
文摘BACKGROUND Dislocation of the long head of biceps tendon(LHBT)usually involves rotator cuff injury,and isolated dislocation with an intact rotator cuff is rare.Some cases of isolated dislocation have been reported.However,to the best of our knowledge,there has been no report of bilateral dislocation of the LHBT without rotator cuff pathology.CASE SUMMARY A 23-year-old male presented to our outpatient clinic with left side dominant pain in both shoulders.The patient had no history of trauma or overuse.The patient underwent intra-articular injection and physical therapy,but his symptoms aggravated.Based on preoperative imaging,the diagnosis was bilateral dislocation of the LHBT.Dysplasia of the bicipital groove was detected in both shoulders.Active dislocation of the biceps tendon over an intact subscapularis tendon was identified by diagnostic arthroscopy.Staged biceps tenodesis was performed and continuous passive motion therapy was administered immediately after surgery.The patient’s pain was resolved,and full functional recovery was achieved,and he was satisfied with the condition of his shoulders.CONCLUSION This study describes a rare case of bilateral dislocations of the LHBT without rotator cuff injury due to dysplasia of the bicipital groove.
基金supported by the National Natural Science Foundation of China,No.81672240(to LC)
文摘The time window for repair of the lower trunk is shorter than that of the upper trunk in patients with obstetric brachial plexus palsy. The denervated intrinsic muscles of the hand become irreversibly atrophic much faster than the denervated biceps. However, it is unclear whether the motor endplates of the denervated interosseous muscles degenerate more rapidly than those of the denervated biceps. In this study, we used a rat model of obstetric brachial plexus palsy of the right upper limb. C5–6 was lacerated distal to the intervertebral foramina, with concurrent avulsion of C7–8 and T1, with the left upper limb used as the control. Bilateral interossei and biceps were collected at 5 and 7 weeks. Immunofluorescence was used to assess the morphology of the motor endplates. Real-time quantitative polymerase chain reaction and western blot assay were used to assess mRNA and protein expression levels of acetylcholine receptor subunits(α, β and δ), rapsyn and β-catenin. Immunofluorescence microscopy showed that motor endplates in the denervated interossei were fragmented, while those in the denervated biceps were morphologically intact with little fragmentation. The number and area of motor endplates, relative to the control side, were significantly lower in the denervated interossei compared with the denervated biceps. mRNA and protein expression levels of acetylcholine receptor subunits(α, β and δ) were significantly lower, whereas β-catenin protein expression was higher, in the denervated interossei compared with the denervated biceps. The protein expression of rapsyn was higher in the denervated biceps than in the denervated interossei at 7 weeks. Our findings demonstrate that motor endplates of interossei are destabilized, whereas those of the biceps remain stable, in the rat model of obstetric brachial plexus palsy. All procedures were approved by the Experimental Animal Ethics Committee of Fudan University, China(approval No. DF-187) in January 2016.
文摘AIM: To demonstrate that long head of the biceps tendon(LHBT) tenodesis is possible more than 3 mo after rupture. METHODS: From September 2009 to January 2012 we performed tenodesis of the LHBT in 11 individuals(average age 56.9 years, range 42 to 73) more than 3 mo after rupture. All patients were evaluated by Disabilites of the Arm Shoulder and Hand(DASH) and Mayo outcome scores at an average follow-up of 19.1 mo. We similarly evaluated 5 patients(average age 58.2 years, range 45 to 64) over the same time treated within 3 mo of rupture with an average follow-up of 22.5 mo.RESULTS: Tenodesis with an interference screw was possible in all patients more than 3 mo after rupture and 90% had good to excellent outcomes but two had recurrent rupture. All of those who had tenodesis less than 3 mo after rupture had good to excellent outcomes and none had recurrent rupture. No statistical difference was found for DASH and Mayo outcome scores between the two groups(P <0.05). CONCLUSION: Tenodesis of LHBT more than 3 mo following rupture had outcomes similar to tenodesis done within 3 mo of rupture but recurrent rupture occurred in 20%.
文摘AIM: To evaluate the clinical and functional results after repair of distal biceps tendon tears, following the Morrey's modified double-incision approach.METHODS: We retrospectively reviewed 47 patients with distal rupture of biceps brachii treated between2003 and 2012 in our Orthopedic Department with muscle-splitting double-incision technique. Outcome measures included the Mayo elbow performance, the DASH questionnaire, patient's satisfaction, elbow and forearm motion, grip strength and complications occurrence.RESULTS: At an average 18 mo follow-up(range, 7 mo-10 years) the average Mayo elbow performance and DASH score were respectively 97.2 and 4.8. The elbow flexion range was 94%, extension was-2°, supination was 93% and pronation 96% compared with the uninjured limb. The mean grip strength, expressed as percentage of respective contralateral limb, was 83%. The average patient satisfaction rating on a Likert scale(from 0 to 10) was 9.4. The following complications were observed: 3 cases of heterotopic ossification(6.4%), one(2.1%) re-rupture of the tendon at the site of reattachment and 2 cases(4.3%) of posterior interosseous nerve palsy. No complication required further surgical treatment.CONCLUSION: This technique allows an anatomic reattachment of distal biceps tendon at the radial tuberosity providing full functional recovery with low complication rate.
基金supported by the National Natural Science Foundation of China,No.816019591003263(to JXW)the National Basic Research Program of China(973 Program),No.2014CB542203(to LC)
文摘In treating patients with obstetric brachial plexus palsy,we noticed that denervated intrinsic muscles of the hand become irreversibly atrophic at a faster than denervated biceps.In a rat model of obstetric brachial plexus palsy,denervated intrinsic musculature of the forepaw entered the irreversible atrophy far earlier than denervated biceps.In this study,isobaric tags for relative and absolute quantitation were examined in the intrinsic musculature of forepaw and biceps on denervated and normal sides at 3 and 5 weeks to identify dysregulated proteins.Enrichment of pathways mapped by those proteins was analyzed by Kyoto Encyclopedia of Genes and Genomes analysis.At 3 weeks,119 dysregulated proteins in denervated intrinsic musculature of the forepaw were mapped to nine pathways for muscle regulation,while 67 dysregulated proteins were mapped to three such pathways at 5 weeks.At 3 weeks,27 upregulated proteins were mapped to five pathways involving inflammation and apoptosis,while two upregulated proteins were mapped to one such pathway at 5 weeks.At 3 and 5 weeks,53 proteins from pathways involving regrowth and differentiation were downregulated.At 3 weeks,64 dysregulated proteins in denervated biceps were mapped to five pathways involving muscle regulation,while,five dysregulated proteins were mapped to three such pathways at 5 weeks.One protein mapped to inflammation and apoptotic pathways was upregulated from one pathway at 3 weeks,while three proteins were downregulated from two other pathways at 5 weeks.Four proteins mapped to regrowth and differentiation pathways were upregulated from three pathways at 3 weeks,while two proteins were downregulated in another pathway at 5 weeks.These results implicated inflammation and apoptosis as critical factors aggravating atrophy of denervated intrinsic muscles of the hand during obstetric brachial plexus palsy.All experimental procedures and protocols were approved by the Experimental Animal Ethics Committee of Fudan University,China(approval No.DF-325)in January 2015.
文摘The preferred treatment of distal biceps tendon ruptures is by operative repair. However, the best approach for repair(single vs double incision) is still subject of debate. Grewal and colleagues recently presented the results of a randomized clinical trial evaluating two different surgical approaches for the repair of distal biceps tendon ruptures. Despite the fact that this article currently presents the highest level of evidence for the surgical repair of distal biceps tendon ruptures, we have some comments on the study that might be interesting to discuss. We think that some of the results and conclusions presented in this study need to be interpreted in the light of these comments.
文摘Objectives: This study compared the effect of Kinesio Taping (KT) with local Methyl Prednisolone injection in patients with biceps tendonitis based on visual analog scale (VAS) and range of motion (ROM). Methods: Thirty-eight patients (15 females and 23 males;mean age: 29.87 ± 6.31, years) with biceps tendonitis were participated in this study during 2014-2015. The patients were randomly assigned into two groups: 19 patients in KT group and 19 patients in injection group. In the first group, KT was used three times for 24 hours sequentially with four-day intervals;in the second group, one dose of Methyl Prednisolone (40 mg) plus 1% lidocaine was injected in the bicipital fissure around the long head of the biceps muscle. The injections and KT therapy were performed by the same physician. The patients were investigated for VAS and ROM in the first, second, seventh and twelfth days. Results: VAS and ROM indices were significantly improved in the second and seventh days (p 0.05). Conclusion: Regarding the more immediate effect of KT on ROM and VAS and the fast restoring of the patient to normal life, it could be used as a noninvasive alternative to injection and as the first line of treatment specially in patients who need the immediate effect of treatment.
文摘An Irreducible dislocation of the shoulder is an uncommon event. When it does occur, blocks to reduction can include bone, labrum, rotator cuff musculature or tendon. Patients older than 40 at the time of initial dislocation are at increased risk of sustaining a concomitant rotator cuff tear. We present a case of an irreducible anterior shoulder dislocation due to interposition of both subscapularis tendon and a posteriorly dislocated long head of biceps. Both Computed Tomography (CT) and magnetic resonance imaging (MRI), along with intraoperative findings are discussed. Conclusion: We would advocate maintaining a low threshold for MR imaging post shoulder dislocation in the older population, when there is radiological or clinical concern regarding the integrity of the rotator cuff, and also to evaluate whether a concentric reduction of the shoulder joint has been achieved.
文摘Distal biceps tendon rupture accounts for only 3% - 10% of all biceps tendon injuries. The majority of distal biceps tendon injuries are from complete rupture. It is especially rare to diagnose partial rupture of the distal biceps tendon. Our case profiles a chronic partial tear of the distal biceps tendon in a pediatric patient.
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.
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.
文摘The study made an observation of electromyograph changes of biceps femoris muscle during contraction with different loads and at different speeds. The results indicated: the IEMG during fast contraction (one elbow flexion each second) and slow contraction (one elbow flexion every two seconds) with three loads (5kg, 10kg, 15kg) didnot show significant difference whether be fore or after fatiguel the MPF of fast contraction be fore fatigue was larger than that of slow contraction: the IEMG during dynamic contraction to fatigue (5kg, 10kg) was significantly larger than that before fatigue; with the loading of 15kg the IEMG after fatigue significantly decreased;the MPF decreased during contraction to fatigue at all loadings.
基金supported in part by the National Natural Science Foundation of China,Nos.U1913601,81927804the Key-Area Research and Development Program of Guangdong Province,No.2020B0909020004(GL)the National Natural Science Foundation of China,Nos.81960419,82260456(both to LY)。
文摘Targeted muscle reinnervation has been proposed for reconstruction of neuromuscular function in amputees.However,it is unknown whether performing delayed targeted muscle reinnervation after nerve injury will affect restoration of function.In this rat nerve injury study,the median and musculocutaneous nerves of the forelimb were transected.The proximal median nerve stump was sutured to the distal musculocutaneous nerve stump immediately and 2 and 4 weeks after surgery to reinnervate the biceps brachii.After targeted muscle reinnervation,intramuscular myoelectric signals from the biceps brachii were recorded.Signal amplitude gradually increased with time.Biceps brachii myoelectric signals and muscle fiber morphology and grooming behavior did not significantly differ among rats subjected to delayed target muscle innervation for different periods.Targeted muscle reinnervation delayed for 4 weeks can acquire the same nerve function restoration effect as that of immediate reinnervation.
文摘Surgical treatment of superior labral anterior posterior(SLAP) lesion becomes more and more frequent which is the consequence of evolving progress in both,imaging and surgical technique as well as implants.The first classification of SLAP lesions was described in 1990, a subdivision in four types existed. The rising comprehension of pathology and pathophysiology in SLAP lesions contributed to increase the types in SLAP classification to ten. Concerning the causative mechanism of SLAP lesions, acute trauma has to be differed from chronic degeneration. Overhead athletes tend to develop a glenohumeral internal rotation deficit which forms the basis for two controversial discussed potential mechanisms of pathophysiology in SLAP lesions: Internal impingement and peel-back mechanism. Clinical examination often remains unspecific whereas soft tissue imaging such as direct or indirect magnetic resonance arthrography has technically improved and is regarded to be indispensable in detection of SLAP lesions. Concomitant pathologies as Bankart lesions, rotator cuff tears or perilabral cysts should be taken into consideration when planning a personalized therapeutic strategy. In addition, normal variants such as sublabral recess, sublabral hole, Buford complex and other less common variants have to be distinguished. The most frequent SLAP type Ⅱ needs a sophisticated approach when surgical teatment comes into consideration. While SLAP repair is considered to be the standard operative option, overhead athletes benefit from a biceps tenodesis because improved patient-reported satisfaction and higher rate of return to pre-injury level of sports has been reported.
基金supported by the Natural Sciences and Engineering Research Council of Canada
文摘Background:Muscular strength can be conceptually determined by two components:muscle activation and size.Muscle activation by the central nervous system can be measured by surface electromyography(sEMG).Muscular size reflects the amount of contractile protein within a skeletal muscle and can be estimated by anthropometric measurements.The purpose of this study was to determine the relative contributions of size parameters and muscle activation to the prediction of maximal voluntary isometric elbow flexion strength. Methods:A series of anthropometric measurements were taken from 96 participants.Torque and root-mean-square(RMS) of the sEMG from the biceps brachii were averaged across three maximal voluntary isometric contractions.A multiple linear regression analysis was performed based on a Pearson's correlation matrix. Results:Body weight(BW) accounted for 39.1% and 27.3% in males and females,respectively,and was the strongest predictor of strength for males.Forearm length(L3) was the strongest predictor of strength in females(partial R^2 = 0.391).Elbow circumference(ELB) accounted for a significant(p < 0.05) amount of variance in males but not females.The addition of sEMG RMS as a third variable accounted for an average of 10.1% of the variance excluding the equation of BW and L3 in females.The strongest prediction equation included BW,L3,and ELB accounting for 55.6% and 58.5% of the variance in males and females,respectively. Conclusion:Anthropometrics provide a strong prediction equation for the estimation of isometric elbow flexion strength.Muscle activation,as measured by sEMG activity,accounted for a significant(p < 0.05) amount of variance in most prediction equations,however,its contribution was comparable to an additional anthropometric variable.
文摘Noninvasive techniques,surface electromyography(sEMG)in particular,are being increasingly employed for assessing muscle activity.In these studies,local oxygen consumption and muscle metabolism are of great interest.Measurements can be performed noninvasively using optics-based methods such as near-infrared spectroscopy(NIRS).By combining energy con-sumption data provided by NIRS with muscle level activation data from sEMG,we may gain an insight into the metabolic and functional characteristics of muscle tissue.However,muscle mo-tion may induce artifacts into EMG and NIRS.Thus,the inclusion of simultaneous motion measurements using accelerometers(ACMs)enhances possibilities to perceive the effects of motion on NIRS and EMG signals.This paper reviews the current state of noninvasive EMG and NIRS-based methods used to study muscle function.In addition,we built a combined sEMG/NIRS/ACM sensor to perform simultaneous measurements for static and dynamic exercises of a biceps brachii muscle.Further,we discuss the effect of muscle motion in response of NIRS and EMG when measured noninva-sively.Based on our preliminary studies,both NIRS and EMG supply specific information on muscle activation,but their signal responses also showed similarities with acceleration signals which,in this case,were supposed to be solely sensitive to motions.