Adhesion of the Long Head of the Biceps Tendon: A Case Series

Chih-Hao Chiu; Yu-Ching Lin; Poyu Chen; Alvin Chao-Yu Chen; Yi-Sheng Chan; Kuo-Yao Hsu; Alexandre Lädermann

doi:10.1016/j.asmr.2020.09.001

Adhesion of the Long Head of the Biceps Tendon: A Case Series

Arthrosc Sports Med Rehabil. 2020 Dec 24;3(1):e79-e87. doi: 10.1016/j.asmr.2020.09.001. eCollection 2021 Feb.

Authors

Chih-Hao Chiu^{1

2}, Yu-Ching Lin³, Poyu Chen^{1

4}, Alvin Chao-Yu Chen^{2

5}, Yi-Sheng Chan^{2

5}, Kuo-Yao Hsu^{2

5}, Alexandre Lädermann^{6

7

8}

Affiliations

¹ Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
² Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan.
³ Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Keelung and Chang Gung University, Taoyuan, Taiwan.
⁴ Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
⁵ Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan.
⁶ Division of Orthopedics and Trauma Surgery, La Tour Hospital, Meyrin, Switzerland.
⁷ Faculty of Medicine, University of Geneva, Geneva, Switzerland.
⁸ Orthopedics and Trauma Service, University Hospitals of Geneva, Geneva, Switzerland.

Abstract

Purpose: To present the clinical and imaging findings and results of treatment in patients with intra-articular long head of the biceps tendon (LHBT) adhesion to the undersurface of the rotator cuff found incidentally during shoulder arthroscopy.

Methods: Patients with intra-articular LHBT adhesion to the undersurface of the rotator cuff found incidentally during arthroscopy were included with a minimal 2-year follow-up. Demographic data, images, and physical examinations were recorded. LHBT release, tenotomy, or tenodesis were performed according to the patient's age and surgeon's preference.

Results: Twelve patients were included in the study. All of them presented with chronic anterior shoulder pain and positive Speed and O'Brien tests. The average age was 46.8 ± 17 years (range 20-79 years) and the pain sustained from 6 to 96 (average 25.5 ± 28.6) months. Before the operation, 6 patients had a positive Jobe's test, 1 had a positive lift-off test, and all had positive O'Brien and Speed tests and tenderness over the LHBT. Three release, 4 tenotomy, and 5 LHBT tenodesis were done in addition to other procedures if needed. All range of motion except external rotation, pain visual analog score, and functional outcome scores showed significant improvement at 6 months after surgery. There were no significant differences in range of motion and functional scores between 6 months and 12 months postoperatively. No difference was found in LHBT scores at 6 and 12 months after the operation. Magnetic resonance imaging revealed thickened coracohumeral ligament overlying the LHBT.

Conclusions: Patients who had intra-articular LHBT adhesion to the undersurface of the rotator cuff and underwent release of the adhesion around LHBT, tenotomy, or tenodesis all had good clinical outcomes. The lesion was observed in 2.2% of all shoulder arthroscopies. Although difficult to diagnose before surgery, surgeons should be aware of this unusual condition in patients with chronic and insidious anterior shoulder pain.

Level of evidence: Level IV, Therapeutic case series.