Bicipital groove morphology on MRI has no correlation to intra-articular biceps tendon pathology

Anatomical Analysis of Bicipital Groove and Its Spur Formation Using 3D-CT: A Retrospective Observational Study

Concomitant long head of biceps (LHB) pathologies commonly occur with rotator cuff tears, but LHB problems are often underestimated. There is a lack of studies on the correlation between bicipital groove morphology and biceps pathology, as well as the significance of bony spurs around the groove. This study analyzed the anatomical parameters of the bicipital groove and spur formation using 3D-CT in 111 patients. Biceps spurs were evaluated using 3D and 2D-CT images, and patients were grouped by age (below and above 55 years). The detection rate of biceps spur was higher with 3D-CT (54.0%) than with 2D-CT (42.3%). Spur incidence was significantly greater in older patients (60.3% vs. 45.8%). The average groove width was narrower in older adults (p = 0.006) and larger in men compared to women (p = 0.000). The average spur height was also greater in men (p = 0.039). Lateral spurs were the most common type that was observed. This study highlights the differences in bicipital groove morphology and spur formation by age and gender, with 3D-CT being more effective in detecting biceps spurs.

Is the Tendon-to-Groove Ratio Associated with Elevated Risk for LHB Tendon Disorders?-A New Approach of Preoperative MR-Graphic Analysis for Targeted Diagnosis of Tendinopathy of the Long Head of Biceps

Background: Pathologies of the long head of the biceps (LHB) tendon are a common cause of anterior shoulder pain. While the influence of the anatomical morphology of the intertubercular groove (ITG) on the development of LHB tendon instability has been investigated with ambiguous results, the relationship of the LHB to ITG anatomy has not yet been considered in this context. The objective of this study was to reliably extract the tendon-to-groove ratio from MRI scans of symptomatic patients and examine its potential influence on the occurrence of certain causes for LHB-associated symptoms. Methods: In this retrospective study, preoperative MRI scans of 35 patients (mean age of 46 ± 14 years) presenting with anterior shoulder pain and clinical indications of LHB tendinopathy were analyzed in transversal planes. Long and short diameters of the LHB tendon and ITG were measured, cross-sectional areas of the LHB tendon and ITG were calculated from these measurements, and the ratio of cross-sectional areas (LHB/ITG) was introduced. All measurements were repeated independently by three investigators and inter-rater reliability was assessed using intraclass correlation coefficient (ICC). Thereafter, tendon-to-groove ratios were compared in patients with and without intraoperative signs of LHB tendon instability. Results: All patients exhibited intraoperative signs of LHB tendinitis, with additional findings including pulley lesions and SLAP lesions. Analysis revealed variations in the dimensions of the LHB tendon and ITG cross sections, with the tendon-to-groove ratio decreasing from 37% at the pulley to 31% at the deepest point of the sulcus. Very good inter-rater reliability was observed for all measurements. The tendon-to-groove ratio did not significantly differ (p > 0.05) in patients with or without pulley lesions or SLAP lesions. Conclusions: Our study introduced the novel parameter of the tendon-to-groove ratio of cross-sectional areas as a reproducible parameter for the description of local anatomy in the field of targeted diagnosis of LHB tendon disorders. While our findings do not yet support the predictive value of the tendon-to-groove ratio, they underscore the importance of further research with larger cohorts and control groups to validate these observations.

Examining the Dimensions of the Bicipital Groove: A Human Cadaveric Study

Introduction Understanding the mechanisms and risk factors associated with bicipital groove (BG) morphology is essential for optimizing patient outcomes. Despite interest in the topic of BG morphology, there remains a lack of clarity and consensus on the parameters of BG morphology due to significant methodological limitations in the existing research. The purpose of this study is to explore the dimensions of BG morphology with a methodology rooted in recent research findings to better understand the human anatomy, potentially underpinning various shoulder pathologies.  Methods The right shoulders of seventeen cadavers (nine male and eight female; median age of death: 88.0 years; age of death range: 66.0 - 97.0 years) were included in this cadaveric study. Dissection was done by removing the deltoid musculature and reflecting the long head of the biceps tendon to expose the BG. Measurements for BG morphology included BG width (millimeters, mm), depth (mm), and length (mm). Statistical comparisons were done between male and female measurements using the independent-samples Mann-Whitney U test due to the small sample size.  Results The median width of the BG at the narrowest point was 4.3 mm (mean: 4.7 ± 1.4 mm; range: 3.0 - 7.7 mm) with male cadavers having a significantly wider BG as compared to female cadavers (median: 5.0 mm versus 3.7 mm; p=0.006). The median depth of the BG was 5.1 mm (mean: 5.0 ± 0.7 mm; range: 3.8 - 6.3 mm) with no statistically significant difference between male and female cadavers (median: 4.8 mm versus 5.3 mm; p=0.370). The median length of the BG was 25.1 mm (mean: 25.1 ± 3.3 mm; range: 18.1 - 31.3 mm) with no statistically significant difference between male and female cadavers (median: 25.4 mm versus 23.9 mm; p=0.673). Conclusion The width of the BG at the narrowest point was significantly larger in male cadavers as compared to female cadavers in this study. However, there was no difference between male and female cadavers in terms of depth and length of the BG. This study contributes to the understanding of BG morphology by exploring the dimensions for width, depth, and length of the BG, which may contribute to biceps tendon pathology in clinical practice. Future research should focus on reducing measurement variability and exploring the possible relationship between BG morphology and biceps tendon conditions to further enhance the understanding of this complex relationship.

Radiographic evaluation of the bicipital groove morphology does not predict intraarticular changes in the long head of biceps tendon

INTRODUCTION AND OBJECTIVES

This study aimed to examine the clinical utility of the radiographic evaluation of the bicipital groove in predicting long head of biceps tendon (LHBT) pathology.

MATERIAL AND METHODS

A prospective study was conducted, and sixty consecutive patients proposed to shoulder arthroscopic surgery were selected. Before surgery, a radiographic evaluation was performed with a supine and a Fisk radiograph. Most supine radiographs (>75%) were non-interpretable and were excluded from the study. As some Fisk radiographs (26.7%) were also non-interpretable, that left 44 interpretable radiographs in the study. These were measured for medial opening angle, total opening angle, width and depth of the bicipital groove. The radiographic measurements and the presence of LHBT pathology, as assessed at arthroscopy, were correlated.

RESULTS

Radiographic evaluation of the bicipital groove showed a mean medial opening angle of 53 ± 15° (23-90), a mean total opening angle of 80 ± 26° (30-135), a mean width of 10.3 ± 2.5 mm (6-19) and a mean depth of 4.1 ± 1.5 mm (1-8). Men had higher medial opening angle (60 vs 50°, p = 0.044) and wider grooves (11.9 vs 9.7 mm, p = 0.019). Twenty-five patients (56.8%) were found to have an abnormal LHBT. No correlation was found between the radiographic measurements and LHBT pathology. Only age was correlated with a LHBT lesion (61.8 vs 46.3 years, p < 0.001).

CONCLUSIONS

Our results show that there is no correlation between radiographic morphologic evaluation of the bicipital groove and LHBT pathology.

Bilateral dislocation of the long head of biceps tendon with intact rotator cuff tendon: A case report

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.

Correlation between the morphological features of the biceps groove and injuries to the biceps pulley and the long head tendon of the biceps

PURPOSE

The morphometric features of the biceps groove were measured to investigate their correlation with the injury of the pulley and the long head of the biceps tendon (LHBT).

METHODS

A total of 126 patients undergoing arthroscopic rotator cuff repair surgery had their morphological features of bicipital groove evaluated on a 3D reconstruction model of the humeral head. The groove width, groove depth, opening angle, medial wall angle, and inclination angle of the bicipital groove were measured for each patient. During the surgery, the type of injury to the biceps pulley and the degree of long head of biceps tendon injury were assessed. The correlations of these injury assessments with bicipital groove measurements were analyzed.

RESULTS

The average groove width was(12.3 ± 2.1) mm. The average groove depth was(4.9 ± 1.4) mm. The average groove inclination angle was 26.3° ± 8.1°. The average opening angle was 89.8° ± 18.4°. The average medial groove wall angle was 40.6° ± 7.9°.Sixty six patients had injury of the biceps pulley structure, and their Martetschläger classifications were as follows: type I injury in 12 patients, type II injury in 18 patients, and type III injury in 36 patients. The Lafosse grades of Lesions of LHBT were as follows: 72 cases were grade 0 injury, 30 cases were grade I injury, and 24 cases were grade II injury. We found no significant correlation between the opening width, depth, inclination angle, opening angle, and medial wall angle of the morphological features of bicipital groove and injuries of the pulley and the LHBT. The correlation between pulley structure injury and lesions of LHBT was statistically significant.

CONCLUSION

Lesions of LHBT show strong correlation with pulley injuries.This study does not find a correlation between the injury of the pulley or the LHBT and bicipital groove morphology.

A shallow morphology of the intertubercular groove is associated with medial and bilateral but not lateral pulley lesions

PURPOSE

To investigate the influence of intertubercular groove (IG) morphology on the development of different types of biceps reflection pulley (BRP) injuries.

METHODS

A consecutive cohort of 221 patients with ventral shoulder pain and a preoperative diagnosis suspecting BRP injury, who underwent arthroscopy, was retrospectively reviewed. The presence or absence as well as type of pulley injury (medial, lateral or bilateral) was confirmed arthroscopically. The intertubercular groove was evaluated on MRIs after triplanar reconstruction of the axial plane. IG depth, width, medial wall angle (MWA), lateral wall angle (LWA) and total opening angle (TOA) were measured. IG depth and width were expressed in relation to the humeral head diameter. Measurements were performed by two clinicians independently and averaged.

RESULTS

Of 166 included patients 43 had bilateral, 65 medial and 38 lateral BRP lesions. 20 patients had intact BRPs and represented the control group. The intra-class correlation coefficient of measurements was 0.843-0.955. Patients with a medial or bilateral BRP injury had a flatter MWA (38.8° or 40.0° vs. 47.9°, p < 0.001), wider TOA (96.1° or 96.6° vs. 82.6°, p < 0.001), greater width (12.5 or 12.3 vs. 10.8 mm, p = 0.013) and shallower depth (5.5 or 5.4 vs. 6.2 mm, p < 0.001) than the control group. Conversely, the IG morphology of those with lateral BRP injuries did not differ significantly from the control group. The odds ratio for a medial or bilateral BRP injury when the TOA exceeded 95° was 6.8 (95% confidence interval 3.04-15.2).

CONCLUSION

A dysplastic type of IG morphology with a wide TOA, flat MWA, decreased depth and increased width is associated with the presence of medial and bilateral BRP injuries. A TOA of > 95° increases the likelihood of a medial or bilateral BRP injury 6.8-fold. Lateral BRP injuries are not associated with dysplastic IG morphology. Concomitant LHBT surgery may, therefore, not always be necessary during isolated supraspinatus tendon repair.

LEVEL OF EVIDENCE

Level III.

MRI morphological evaluation of humeral head bone profile inside region of the biceps pulley reflection

OBJECTIVE

Evaluating humeral head bone profile inside biceps reflection pulley area in order to identify possible anatomical variants and any causes predisposing to tendon's instability of the long head of the biceps.

MATERIALS AND METHODS

This retrospective study analyzed 326 patients, 183 males and 143 females (age 15-88 years; average 51.5 years), who underwent MRI examination between 2013 and 2019. Biceps pulley reflection area morphology of 192 right shoulders and 134 left shoulders was assessed analyzing 309 MRI and 17 MR arthrography (MRA) shoulder exams. We investigated age and gender and the frequency of morphological variants among the patient groups.

RESULTS

Four possible morphological variants were identified: 95 with convex shape; 127 with flat shape; 77 with spiculated shape; and 12 with mixed morphology. Fifteen humeral bone profiles were not classifiable.

CONCLUSIONS

MRI was effective in defining humeral head anatomic variants inside the biceps pulley reflection area. The most frequent variants were flat or convex types.

The effect of bicipital groove morphology on the stability of the biceps long head tendon

BACKGROUND

Long head of biceps tendon (LHBT) instability is an important source of pain and disability for the shoulder. Supraspinatus and subscapularis tendons contribute to the formation of the biceps pulley system, which maintains biceps stability during shoulder movements. The aim of this study is to evaluate the effect of morphology of bicipital groove on the stability of LHBT. Also, to evaluate the relationship between bicipital groove morphology and subscapularis rupture and supraspinatus rupture.

MATERIAL AND METHODS

Surgical images and magnetic resonance images of 200 patients who underwent shoulder arthroscopy surgery in our clinic between January 2016 and December 2017 were retrospectively analyzed. The depth of groove, medial wall angle and opening angle values of 200 patients were measured on MRI. The stability of the biceps long head tendon, rotator cuff tear and SLAP lesions was recorded by monitoring the shoulder arthroscopy records in each groups.

RESULTS

There were 200 patients, 131 male and 69 female, with an average age of 40.9 ± 14.2 (range: 17.0-79.0) years. In 69 (34.5%) patients, long head of the biceps tendon (LHBT) instability was detected. The patients were divided into two groups according to LHBT instability.The subscapularis rupture was significantly more frequent in the group with LHBT instability (52.2%) than the group without LHBT instability (4.6%) (p < 0.001). The supraspinatus tear was observed in 72.5% in the group with instability and 56.5% in the non-instability group, which shows a statistical difference between the two groups (p = 0.027). The presence of SLAP was observed in similar rates in both groups (p = 0.053). Mean depth of groove, medial wall angle, and opening angle measurements were similar in both groups (p = 0.568, p = 0.393 and p = 0.598, respectively).

CONCLUSION

To conclude, the morphology of the bicipital groove is not related to the stability of LHBT, and the soft tissue factors above the bicipital groove rather than bone morphology are important in stability. In addition, subscapularis rupture is a pre-disposing factor for LHBT instability; therefore, we recommend a more careful examination of LHBT in patients with subscapularis rupture.

LEVEL OF EVIDENCE

III.

Bicipital groove cross-sectional area on ultrasonography: Does a correlation to intra-articular tendon pathology exist?

BACKGROUND

The etiology and relevance of long head of biceps tendon (LHBT) pathology is debated. As it can have important therapeutic consequences and physical examination can be misleading, various morphologic parameters have been described to try to predict it.

HYPOTHESIS

We hypothesized that bicipital groove cross-sectional area (CSA), as assessed by ultrasonography, could be related to intra-articular tendon pathology.

MATERIAL AND METHODS

Fifty-eight consecutive consenting patients who underwent arthroscopic shoulder surgery at our hospital were selected. Diagnosis consisted mainly of rotator cuff tears, but also of anterior instability and subacromial impingement. Before surgery, ultrasonography was performed to measure width, depth and cross-sectional area of the bicipital groove. LHBT pathology was assessed during arthroscopy and classified as tendinopathy, partial disruption or complete tear and correlated to the ultrasonography measurements.

RESULTS

Bicipital groove width was of 6.7±1.2mm in patients with a normal LHBT and 7.3±1.9mm with patients with an abnormal LHBT (p=0.234). Bicipital groove depth was of 3.5±0.5mm in patients with a normal LHBT and 3.7±1.1mm with patients with an abnormal LHBT (p=0.251). Bicipital groove CSA was of 16.6±4.5 mm² in patients with a normal LHBT and 19.1±7.1 mm² with patients with an abnormal LHBT (p=0.108).

CONCLUSION

Our results do not support any correlation between LHBT pathology and the bicipital groove CSA, even though this measurement, as its width and depth, are somewhat higher in patients with a LHBT injury.

LEVEL OF EVIDENCE

I; diagnostic study.

Radiographic evaluation of the bicipital groove morphology does not predict intraarticular changes in the long head of biceps tendon

INTRODUCTION AND OBJECTIVES

This study aimed to examine the clinical utility of the radiographic evaluation of the bicipital groove in predicting long head of biceps tendon (LHBT) pathology.

MATERIAL AND METHODS

A prospective study was conducted, and sixty consecutive patients proposed to shoulder arthroscopic surgery were selected. Before surgery, a radiographic evaluation was performed with a supine and a Fisk radiograph. Most supine radiographs (>75%) were non-interpretable and were excluded from the study. As some Fisk radiographs (26.7%) were also non-interpretable, that left 44 interpretable radiographs in the study. These were measured for medial opening angle, total opening angle, width and depth of the bicipital groove. The radiographic measurements and the presence of LHBT pathology, as assessed at arthroscopy, were correlated.

RESULTS

Radiographic evaluation of the bicipital groove showed a mean medial opening angle of 53±15o (23 - 90), a mean total opening angle of 80±26o (30 - 135), a mean width of 10.3±2.5mm (6 - 19) and a mean depth of 4.1±1.5mm (1 - 8). Men had higher medial opening angle (60 vs 50o, p=0.044) and wider grooves (11.9 vs 9.7mm, p=0.019). Twenty-five patients (56.8%) were found to have an abnormal LHBT. No correlation was found between the radiographic measurements and LHBT pathology. Only age was correlated with a LHBT lesion (61.8 vs 46.3 years, p <0.001).

CONCLUSIONS

Our results show that there is no correlation between radiographic morphologic evaluation of the bicipital groove and LHBT pathology.

Clinical relevance of the anatomy of the long head bicipital groove, an evidence-based review

Pathology in the bicipital groove can be a source of anterior shoulder pain. Many studies have compared treatment techniques for the long head biceps tendon (LHBT) without showing any clinically significant differences. As the LHBT is closely related to the bicipital groove, anatomical aspects of this groove could also be implicated in surgical outcomes. The aim of this review is to contribute to developing the optimal surgical treatment of LHBT pathology based on clinically relevant aspects of the bicipital groove. Medline/PubMed was systematically searched using key words "bicipital" and "groove" and combinations of their synonyms. Studies reporting on evolution, embryonic development, morphometry, vascularization, innervation, and surgical treatment of the LHBT and the bicipital groove were included. The length of the bicipital groove reported in the included studies ranged from 81.00 mm to 87.33 mm, width from 7.74 mm to 11.60 mm, and depth from 3.70 mm to 6.00 mm. The anatomy of the bicipital groove shows a bottleneck narrowing approximately two-thirds from superior. The transverse humeral ligament can constrain the bicipital groove and could be involved in anterior shoulder pain. When either LHBT tenotomy or tenodesis is performed, routinely releasing the transverse ligament could decrease postoperative anterior shoulder pain, which has frequently been reported in the literature. To avoid the bottle neck narrowing, a location below the bicipital groove may be preferred for biceps tenodesis over a more proximal tenodesis site. Level of evidence: IV.

The influence of bicipital groove morphology on the stability of the long head of the biceps tendon

PURPOSE

We aimed to evaluate the influence of the bony morphology of the bicipital groove on the stability of the long head of the biceps tendon (LHBT).

METHODS

Among the patients who underwent magnetic resonance imaging of the shoulder at our outpatient clinic in 2012, those aged >40 years were included. After excluding cases with complete tear or unclear positioning of the biceps tendon, 464 shoulders were analyzed according to the position of the LHBT with respect to the bicipital groove. Shoulders with subluxation or dislocation of the LHBT were labeled as having unstable LHBT, while those with the LHBT located in the bicipital groove were labeled as having stable LHBT. The bony morphology of the bicipital groove was measured in terms of opening angle, medial wall angle, and depth. A shallow bicipital groove was defined as having an opening angle >94°, concurrent with earlier studies. We compared shoulders with stable and unstable LHBT regarding bicipital bony morphology. We also compared shoulders with normal and shallow grooves regarding tendon stability.

RESULTS

Shoulders with stable and unstable LHBT differed significantly regarding bony morphology. Shoulders with unstable LHBT showed a shallower mean depth (by 0.3 mm; p = 0.008), a smaller mean medial angle (by 2.2°; p = 0.014), and a larger mean opening angle (by 3.7°; p = 0.016). Bony morphology characterized by a shallow groove was significantly associated with increased prevalence of instability defined as LHBT subluxation or dislocation ( p = 0.011).

CONCLUSION

A shallow bicipital groove, identified by the larger opening angle, smaller medial angle, and shallower depth, may represent a predisposing factor for biceps tendon instability.

Diagnostic accuracy of 3T conventional shoulder MRI in the detection of the long head of the biceps tendon tears associated with rotator cuff tendon tears

OBJECTIVE

To evaluate the diagnostic performance (DP) of 3T (3 Tesla field strength) conventional shoulder magnetic resonance imaging (MRI) in detecting the long head of the biceps tendon (LHBT) tears in association with rotator cuff tendon tears.

MATERIALS AND METHODS

This study included 80 consecutive patients who underwent arthroscopic surgery for rotator cuff tendon tears. Two radiologists independently evaluated the preoperative 3T shoulder MRI for the presence of LHBT tears. The DP of MRI was evaluated using the results of arthroscopy as the reference standard. We also evaluated the DP of several MR signs of LHBT in detection of partial LHBT tears.

RESULTS

Arthroscopic examination revealed 35 partial and 5 complete tears. According to the results of evaluation by reviewers 1 and 2, shoulder MRI exhibited sensitivities of 77.14 and 80 % and specificities of 71.11 and 73.33 % in detection of partial LHBT tears and sensitivities of 80 and 100 % and a specificity of 100% (both) in detection of complete LHBT tears. In detecting partial LHBT tears, increased T2 signal intensity of the LHBT exhibited high sensitivities (reviewers 1 and 2; 82.85 and 80 %, respectively) and the presence of intratendinous defects or C-signs exhibited the highest specificities (reviewers 1 and 2; 95.55 and 93.33 %, respectively), followed by abnormalities in shape and outer margins of the LHBT (reviewers 1 and 2; 91.11 and 82 %; 91.11 and 86.66 %, respectively).

CONCLUSION

Non-contrast-enhanced 3T shoulder MRI is potentially highly accurate in detection of complete LHBT tears, but moderately accurate in detection of partial LHBT tears.

Morphometric Study on Bicipital Groove among South Indian Population

INTRODUCTION

The Bicipital Groove (BG) is an indentation between the lesser and greater tubercles of the proximal part of the humerus. It conveys biceps tendon, its synovial sheath and ascending branch of anterior circumflex humeral artery. The knowledge of the morphometry is important for the understanding of the functional aspect of the shoulder region.

AIM

To study the morphometry of bicipital groove of humerus in south Indian population.

MATERIALS AND METHODS

In the present study, 100 adult humeri (50 right and 50 left) were examined. The length of the medial wall, lateral wall, width and depth were measured by using vernier calliper. The humeri were examined for the presence of supratubercular ridge. All the parameters were accurately measured and the data were analysed.

RESULTS

The mean length of BG on right side was 84.79±5.84 mm and 87.33±6.40mm on the left side. The mean width of BG on right side was 6.84±1.01mm and 7.74±1.96mm on the left side. The mean depth of BG on right side was 4.21±0.58 mm and 5.01±1.05mm on the left side. The mean length of the medial and lateral walls on the right side was 24.22±1.02mm and 32.05±2.21mm respectively and that on the left side was 23.31±2.21mm and 31.12±0.24mm respectively. 17% of humeri on the right side and 14% on the left side showed the presence of supratubercular ridge of Meyer in the present study.

CONCLUSION

Bicipital groove is present in the shoulder region where wide range of movements occurs. Osseous spurs and supratubercular ridge may predispose dislocation of tendon of biceps brachii. Hence morphometric knowledge is obligatory and is significant functionally and clinically for better understanding of this region.

Morphology of the Lesser Tuberosity and Intertubercular Groove in Patients With Arthroscopically Confirmed Subscapularis and Biceps Tendon Pathology

PURPOSE

To evaluate for an association between the morphology of the lesser tuberosity and intertubercular groove and subscapularis tendon tears and biceps tendon pathology.

METHODS

Sixty-six patients with arthroscopically confirmed subscapularis tendon tears were compared with 59 demographically matched control patients who underwent magnetic resonance imaging or computed tomography arthrography examination of the shoulder. Measurements of the lesser tuberosity and intertubercular groove included maximum depth of the intertubercular groove, intertubercular groove depth at the midpoint of the glenoid, lesser tuberosity length, length from the top of the humeral head to the point of maximum depth of the intertubercular groove, length from the top of the humeral head to the top of the lesser tuberosity, and medial wall angle and depth.

RESULTS

Patients with subscapularis tears showed a significantly decreased depth of the intertubercular groove at the mid glenoid (P = .01), shorter length of the lesser tuberosity (P = .002), and greater distance from the top of the humeral head to the top of the lesser tuberosity (P = .02). There was a trend toward a decreased medial wall angle (P = .07) and greater distance from the top of the humeral head to the point of maximum intertubercular groove depth (P = .06). Patients with biceps tendon pathology showed a significantly decreased depth of the intertubercular groove at the mid glenoid (P = .001), shorter length of the lesser tuberosity (P = .0003), greater distance from the top of the humeral head to the top of the lesser tuberosity (P = .01), and decreased medial wall angle (P = .01) and depth (P = .03).

CONCLUSIONS

There are several morphologic factors related to the lesser tuberosity and intertubercular groove that are associated with both subscapularis tendon tears and biceps tendon pathology.

LEVEL OF EVIDENCE

Level III, case-control study.

Predictive factors of long head of the biceps tendon disorders-the bicipital groove morphology and subscapularis tendon tear

BACKGROUND

Disorders of the long head of the biceps (LHB) tendon contribute to anterior shoulder pain. Although LHB tendon disorders are associated with rotator cuff disease, distinguishing between biceps and rotator cuff pathology is difficult. The objective was to identify the predictors of LHB tendon disorders associated with a supraspinatus tear.

METHODS

In 55 patients (average age, 65 years) undergoing arthroscopic rotator cuff repair, bicipital groove morphology were assessed using computed tomography, and subscapularis tear and bicipital groove effusion were assessed using magnetic resonance imaging, retrospectively. The LHB tendon was evaluated arthroscopically according to the Lafosse classification. Univariate and multivariate ordinal logistic regression analyses were conducted for injury grade with all covariates.

RESULTS

The arthroscopic evaluation of the LHB tendon showed that there were 23 shoulders classified as grade 0, 15 as grade 1, and 17 as grade 2. Univariate logistic regression analysis showed that the width and depth, a medial spur of the bicipital groove, and a subscapularis tear were significantly associated with LHB tendon disorders. Multivariate ordinal logistic regression analysis identified a medial spur and subscapularis tear as significant predictors of LHB tendon disorders.

CONCLUSIONS

The preoperative computed tomography and magnetic resonance images, notably the presence of a spur on the bicipital groove or a subscapularis tear, were useful for identifying LHB tendon disorders. When these are found in preoperative images, the clinician should evaluate the patient for the presence of an LHB tendon disorder as a pain generator.

Accuracy of preoperative MRI in the diagnosis of disorders of the long head of the biceps tendon

OBJETIVES

To evaluate the accuracy of magnetic resonance imaging (MRI) in the detection of disorders of the long head of the biceps tendon (LHBT). The secondary objective was to investigate predictive factors for tears and instability.

METHODS

This retrospective case series involved patients undergoing shoulder arthroscopy due to rotator cuff injury. MRI was performed in a 1.5T scanner and was evaluated by a musculoskeletal radiologist. The findings were compared with those of arthroscopic inspection.

RESULTS

A total of 90 shoulders were analyzed. Regarding tears, there was 67% sensitivity and 98% specificity. Regarding instabilities, the values were 53% and 72%, respectively. Tears and fatty degeneration of the infraspinatus are predictive factors for tears of the LHBT. Tears of the subscapularis and infraspinatus, retraction of the supraspinatus and infraspinatus equal to or greater than 30mm, and fatty degeneration of the infraspinatus and subscapularis are predictive factors for instability.

CONCLUSION

Compared to arthroscopy, the shoulder MRI has a sensitivity of 67% and a specificity of 98% for the detection of complete tears of the LHBT. For instability, the values are 53% and 72%, respectively.

Diagnostic accuracy in detecting tears in the proximal biceps tendon using standard nonenhancing shoulder MRI

BACKGROUND

There is a paucity of data in the literature evaluating the performance of noncontrast MRI in the diagnosis of partial and complete tears of the proximal portion of the long head of the biceps (LHB) tendon. The objective of this study was to evaluate the accuracy of noncontrast magnetic resonance imaging (MRI) compared to arthroscopy for the diagnosis of pathology involving the intra-articular portion of the LHB tendon.

METHODS

We conducted a retrospective review of 66 patients (mean age 57.8 years, range 43-70 years) who underwent shoulder arthroscopy and evaluation of the LHB tendon after having had a noncontrast MRI of the shoulder. Biceps pathology was classified by both MRI and direct arthroscopic visualization as either normal, partial tearing, or complete rupture, and arthroscopy was considered to be the gold standard. We then determined the sensitivity, specificity, and positive- and negative-predictive values of MRI for the detection of partial and complete LHB tears.

RESULTS

MRI identified 29/66 (43.9%) of patients as having a pathologic lesion of the LHB tendon (19 partial and ten complete tears) while diagnostic arthroscopy identified tears in 59/66 patients (89.4%; 50 partial and 16 complete). The sensitivity and specificity of MRI for detecting partial tearing of the LHB were 27.7% and 84.2%, respectively (positive predictive value =81.2%, negative predictive value =32.0%). The sensitivity and specificity of MRI for complete tears of the LHB were 56.3% and 98.0%, respectively (positive predictive value =90.0%, negative predictive value =87.5%).

CONCLUSION

Standard noncontrast MRI of the shoulder is limited in detecting partial tears and complete ruptures of the intra-articular LHB tendon. Surgeons may encounter pathologic lesions of the LHB tendon during arthroscopy that are not visualized on preoperative MRI.

Review of bicipital groove morphology and its analysis in north Indian population

The variant morphometry of bicipital groove is reported to be associated with pathologies of biceps tendon and is useful in surgical procedures in this region. The pathologies of biceps tendon are frequent causes of shoulder pain. Therefore, under the condition of paucity of data pertaining to north Indians, not only morphometric analysis of bicipital groove and a new definition of narrow/shallow groove to provide logical explanation for dependence of pathologies of biceps tendon on groove morphology is done but also a review of the literature has been carried out. Various dimensions such as lengths of medial and lateral walls, width, depth, medial wall, and opening angles including incidence of supratubercular ridge of bicipital groove from 101 humerii are 23 ± 5, 32 ± 5, 8 ± 2, 6 ± 1, 48.91 ± 10.31, 82.20 ± 22.62, and 37%, respectively. The average height along with average width of biceps tendon and average width along with average depth of bicipital groove from two cadavers are 1.8, 10.5, 11.3, and 5.5 mm, respectively. The knowledge of bicipital groove will be of paramount importance to anatomists for new data, for orthopaedic surgeons in carrying out surgical procedures in this region, and for physicians in the management of anterior shoulder pain in north Indian population.

The rotator interval and long head biceps tendon: anatomy, function, pathology, and magnetic resonance imaging

The rotator interval is an anatomically defined triangular area located between the coracoid process, the superior aspect of the subscapularis, and the anterior aspect of the supraspinatus. It is widely accepted that the rotator interval structures fulfill a role in biomechanics and pathology of the glenohumeral joint and long head biceps tendon. However, there is ongoing debate regarding the biomechanical details and the indications for treatment. A better understanding of rotator interval anatomy and function will lead to improved treatment of rotator interval abnormalities, and guide the indications for imaging and surgical intervention.