Biceps tendon instability with or without pulley tears: an arthroscopic diagnostic study

Background To investigate long head of the biceps tendon (LHBT) instability and biceps reflection pulley (BRP) lesions with dynamic arthroscopy in patients with refractory anterior shoulder pain and determine associated intraarticular pathologies. Methods Patients with refractory anterior shoulder pain and arthroscopically-diagnosed LHBT instability were enrolled. LHBT instability was confirmed by either static dislodge from the groove or subluxation induced by the hook probe (ramp test), and the integrity of BRP and concomitant intra-articular lesions were investigated. Demographics and arthroscopic findings were compared between patients with and without BRP tear. Results A total of 40 patients with refractory anterior shoulder pain and arthroscopically-diagnosed LHBT instability identified through review of medical records at a single surgeon’s practice from 2014 to 2017 were enrolled. BRP tear was noted in 25 patients (group A) and superior glenohumeral ligament (SGHL) insufficiency through ramp test, in 15 patients (group B). No significant difference of patient characteristics was observed between the two groups. Concomitant intraarticular pathologies were noted in 27 patients, including 19 in group A (76%) and eight in group B (53%), without significant group-wise difference (P = 0.083). The incidence of articular-side subscapularis tear was significantly higher in group A (P = 0.021), and those of the other intraarticular pathologies were similar between groups A and B. Fraying at the articular side of the subscapularis and supraspinatus tendons was frequent in group B, without difference of incidence as compared to group A (P = 0.5 and P = 0.084, respectively). Conclusions LHBT instability was a common disorder in patients with refractory shoulder pain. In patients with refractory anterior shoulder pain, dynamic assessment of BRP lesions and SGHL insufficiency and meticulous survey of associated intra-articular pathologies, including subscapularis tear are necessary for making accurate diagnosis.

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