MR arthrography study shows a tear of the lateral aspect of the biceps pulley (medial and lateral band of the coracohumeral ligament and superior glenohumeral ligament), and mild tendinosis of the superior aspect of the subscapularis tendon.
Coronal T1-fat-suppressed MR arthrography images depict intrasubstance degenerative changes and fraying of the superior labrum.
Arthroscopic examination confirms an isolated tear of the lateral BP (arrows) and incompetence with dynamic instability of the intraarticular long head of the biceps tendon. Note also degenerative changes of the superior labrum and biceps-labral complex with irregularity and fraying (asterisks).
Diagram and arthroscopic images and video illustrating the the surgical procedure performed, consisting of biceps tenodesis by arthroscopic transfer of the long head of the biceps tendon to the anterior aspect of the lateral conjoint tendon (short head of the biceps and coracobrachialis) using the subdeltoid space.
Normal anatomy of the biceps pulley (BP). Arthroscopic and sagittal T1-weighted MR arthrography images of the lateral pulley. The BP is a capsuloligamentous complex that acts to stabilize the long head of the biceps tendon in the bicipital groove and protecting of the LHB tendon against anterior shearing stress.
Isolated injury of the lateral biceps pulley (Habermeyer type 1). Anterosuperior impingement
Isolated lesions of the shoulder biceps pulley (BP) are a rare condition. These injuries are commonly associated with other injuries, mainly tears of the subscapularis tendon. BP injuries have the potential to prevent patients from engaging in sports activities.
Accurate diagnosis and treatment of BP pathology remains a controversial and challenging subject.
MR arthrography is the imaging modality of choice for demonstrating both the normal anatomy and associated lesions of the BP. Oblique sagittal images and axial images obtained are the most valuable for identifying individual components of the pulley system. However, arthroscopic examination remains the gold standard in BP injuries diagnosis.
Because of the infrequent occurrence, surgical management of isolated BP injuries is controversial. When conservative treatment fails, surgical options include BP repair, debridement, tenotomy, or tenodesis.
Biceps tenodesis by arthroscopic transfer of the long head of the biceps tendon to the anterior aspect of the lateral conjoint tendon using the subdeltoid space is a technique that offers excellent results, and high return to sport activity in athletic patients with a symptomatic isolated BP. The soft tissue transfer closely reproduces the native axis of pull of the biceps.
Fantastic case, thank you.
ReplyDeleteWe will be featuring MSK imaging of Team Handball injuries at the ESSR 2020 meeting in Stockholm, Schweden next year!
The 2019 World Cup was hosted by Denmark and Germany. See here the highlights of this fascinating sport:
https://www.youtube.com/watch?v=x9_x4H5sqBA
Thank you! Here in Spain, handball is not really a big sport. However, in our city (Santander), there is a huge handball tradition. It is the third most important sport, after football and tennis. I´m really looking forward to seeing your work about World cup handball injuries in next year´s in Sweden.
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Very nice correlation. We can learn so much from these intraoperative images. I wonder how many rads are in that lucky situation and able to do that on a regular basis and have a standard workflow for that to be practical without chasing each individual case.
ReplyDeleteThank you! It is true, It´s very difficult for us radiologists to keep permanent correlation of our cases and at the same time deal with our really busy agenda. However we try to maintain a permanent correlation with three important groups of arthroscopy and wrist surgery in our town. We hold a weekly session with this groups and we try to assist to special surgeries. I think this correlation and mutual exchange is key to our practice.
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