Rupture of the triceps muscle at its attachments.
A case of rupture of the triceps muscle at both the origin and insertion is presented and no similar case has been reported in the literature, to the best of our knowledge.
Elbow Joint↗
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Imaging the long head of biceps tendon--a pictorial essay emphasizing magnetic resonance.
Lesions of the long head of the bicepstendon (BT) are seen in association with tears of the rotator-cuff, particularly lesions of the subscapularis tendon and the rotator-interval. The frequency of positive MR-findings at the BT is approximately 25%. The pathologic alterations include complete medial luxation, subluxation and entrapment by the subscapularis tendon, tendinitis or tendovaginitis and lesions at the origin of the tendon at the superior labrum (superior labrum anterior to posterior (SLAP)--lesions). The imaging signs of BT pathology on MR include an abnormal course and position of the tendon, alterations in shape and changes in signal-intensity (SI), obliteration and thickening of the tendon-sheath. In long standing intra-articular BT rupture, neo-insertion of the tendon in the bicipital sulcus may ensue. The long BT needs to be visualized in transaxial, coronal oblique and sagittal oblique projections. Besides serving as stabilizer of the long head of biceps muscle, the BT is also an important stabilizer of the anterior joint capsule.
Humans↗
How would you treat the partially torn biceps tendon?
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Arthroscopy↗
[Functional adaptation processes of gliding tendons].
Structure and blood supply of the inserting tendons of supraspinatus and biceps brachii as well as the biceps brachii long head tendon are analyzed in respect of tendon rupture. Due to their course the three tendons investigated are gliding tendons. The part of the tendon adjacent to the pulley consists of fibrocartilage, the part looking away from the pulley having the structure of a traction tendon. The occurrence of fibrocartilage inside the investigated tendons is physiological and not a pathological finding. Development of fibrocartilage is a functional adaptation to pressure and shearing forces acting on the tendon at the pulley. In the investigated samples injection techniques and immunohistochemical methods show an avascular area in the part of the tendon that is adjacent to the pulley. The size of this area is identical with the fibrocartilage. The avascular zone in gliding tendons is due to structure, fibrocartilage is usually avascular. Localisation of rupture and fibrocartilage is nearly identical in the investigated tendons. Unphysiologically increased tensile stress which is inadequate for gliding tendons and occurs in certain kinds of sport may be responsible for the development of ruptures of the tendons of supraspinatus and biceps brachii.
Adaptation, Physiological↗
[The sonography of rotator cuff ruptures. The correlation of the sonographic, arthrographic and intraoperative findings in rotator cuff ruptures].
We have compared the findings of sonography, arthrography and at surgery in 66 cases of rotator cuff rupture in order to clarify the sonographic and radiological signs. Preoperative sonography was better than arthrography at demonstrating a partial rupture and at showing the extent of the lesion.
Adolescent↗
[Surgical therapy and results in rupture of the rotator cuff].
Follow up evaluations of 57 patients with surgically treated rotator cuff tears are presented and valued with regard to the literature. A short anterior exposure and cuff anchorage to the humerus is the method of choice. Anterior acromioplasty should not be a routine. Attention should be paid to adhesions of the sub-coracoidal space, they should be separated if necessary. Patients being of older age, with a short history and a long time interval between operation and final evaluation do have the best results.
Aged↗
[Sonography as a new diagnostic procedure for resolving shoulder problems].
Eighty-one sonographic examinations of patients with complaints relating to the shoulder joint have shown that this is the method next in value to radiological examination. So far, lesions of the rotator cuff and of the long head of the biceps could only be demonstrated by invasive procedures such as arthrography or arthroscopy. In these situations, sonography attains a similar accuracy. Diffuse lesions can also be diagnosed correctly, making arthrography and arthroscopy unnecessary. In addition, sonography can demonstrate inflammatory and degenerative changes and incomplete sub-acromial and intermediary tears of the rotator cuff, unlike conventional diagnostic methods. In future, arthrography and arthroscopy will only be necessary as additional diagnostic methods if sonography remains inconclusive.
Adult↗
Slip of the lip--tears of the superior glenoid labrum-anterior to posterior (SLAP) syndrome. A report of four cases.
The shoulder's unique wide range of motion is largely restrained by the articular capsule and the external ligaments of the glenohumeral joint. Internally, the long head of the biceps tendon passes within the capsule and inserts on the superior lip of the glenoid labrum. Trauma distracting this tendon can tear the superior glenoid labrum, producing the superior labrum anterior to posterior (SLAP) syndrome. Four patients, two of whom were female, presented with complaints of acute shoulder pain associated with weakness in abduction and forward flexion. Routine shoulder roentgenograms were normal. Magnetic resonance imaging (MRI) studies revealed a superior glenoid labral tear consistent with a SLAP syndrome. The superior labrum, unlike the firmly bound inferior portion, is loosely attached to the glenoid fossa. This inherent mobility predisposes it to disruption. To routine ultrasonography and arthrogram, the superior labrum may be obscured by superimposed structures. Shoulder arthroscopy, computed tomography, arthrography, and MRI have relatively equal sensitivity in visualizing these labral tears. The SLAP lesion accompanies 16% of all rotator cuff tears, occurring more often than heretofore recognized. When clinically suspected, they can be readily visualized by a noninvasive MRI examination.
Adult↗
Subchondral mineralization patterns of the glenoid after tear of the supraspinatus.
Clinical experience has shown that in many cases of rupture of the supraspinatus tendon the head of the humerus shifts upward against the acromion. This implicates alterations in the stress acting on the joint surface. Accordingly, this should be reflected by changes in the distribution of the subchondral mineralization on the glenoid. Computed tomography osteoabsorptiometry was used to evaluate the distribution patterns on the subchondral bone plate of the glenoid in 67 human shoulders. The position of the two most frequent density maxima was determined by a standard procedure. In macroscopically normal specimens (n = 24) every case had an anterosuperior density maximum and the majority (75%) also had a posterior positioned maximum. In some instances a third maximum, placed centrally (17%) or in an anteroinferior position (4%) was seen. In shoulders with a torn supraspinatus tendon (n = 43) a third density maximum frequently appeared in the center of the glenoid (42%); however, most notable was a significant change of the posterior maximum position toward central and superior. With increasing size of the tendon defect an extension of the shift of the posterior maximum (superiorly and centrally) was observed in contrast to the constant anterior maximum. The changes in the distribution of glenoid subchondral bone mineralization in shoulders with a supraspinatus tear must be regarded as a morphologic parameter for the altered long-term stress acting on the joint surface.
Aged↗
Medial displacement of the tendon of origin of the biceps brachii muscle in 10 greyhounds.
The history, clinical signs and treatment of 10 greyhounds with medial displacement of the tendon of origin of the biceps brachii muscle secondary to rupture of the transverse humeral ligament are described. The aetiology of the condition and the prognosis for return to racing are discussed.
Animals↗
Tendon to bone healing: differences in biomechanical, structural, and compositional properties due to a range of activity levels.
Little knowledge exists about the healing process of the tendon to bone insertion, and hence little can be done to improve tissue healing. The goal of this study is to describe the healing of the supraspinatus tendon to its bony insertion under a variety of loading conditions. Tendons were surgically detached and repaired in rats. Rat shoulders were then immobilized, allowed cage activity, or exercised. Shoulders that were immobilized demonstrated superior structural (significantly higher collagen orientation), compositional (expression of extracellular matrix genes similar to the uninjured insertion), and quasilinear viscoelastic properties (A = 0.30 +/- 0.10 MPa vs. 0.16 +/- 0.08 MPa, B = 17.4 +/- 2.9 vs. 15.1 +/- 0.9, and tau 2 = 344 +/- 161 s vs. 233 +/- 40 s) compared to those that were exercised, contrary to expectations. With this knowledge of the healing response, treatment modalities for rotator cuff tears can be developed.
Animals↗
Glenohumeral instability: evaluation with MR arthrography.
Magnetic resonance arthrography is superior to other imaging techniques in evaluation of the glenohumeral joint. Normal variants that can be diagnostic pitfalls include the anterosuperior sublabral foramen, the Buford complex, and hyaline cartilage under the labrum. Anteroinferior dislocation is the most frequent cause of anterior glenohumeral instability and produces a constellation of lesions (anteroinferior labral tear, classic and osseous Bankart lesions, Hill-Sachs lesion). Variants of anteroinferior labral tears include anterior labroligamentous periosteal sleeve avulsion and glenoid labral articular disruption. Anterior glenohumeral instability can also involve tears of the anterior or anterosuperior labrum or the glenohumeral ligaments. Posterior glenohumeral instability can involve a posterior labral tear, posterior capsular stripping or laxity; fracture, erosion, or sclerosis and ectopic ossification of the posterior glenoid fossa; reverse Hill-Sachs lesion; McLaughlin fracture; or posterosuperior glenoid impingement. Superior labral anterior and posterior lesions involve the superior labrum with varying degrees of biceps tendon involvement.
Humans↗
Ultrasonography of the rotator cuff.
The authors suggest that sonography may be the best screening study for the diagnosis of rotator cuff tears.
Humans↗
Rotator cuff lesions of the shoulder: evaluation by direct sagittal CT arthrography.
Direct sagittal computed tomographic scanning (DSCT) of the shoulder was performed in 42 symptomatic patients, six healthy volunteers, and two cadaver shoulders. Axial CT scanning and double-contrast arthrography with plain radiographs were performed in 41 patients for comparison. DSCT enabled correct identification of 27 of 29 lesions in 24 patients. Seventeen patients had normal shoulders. Axial CT scanning and DSCT together enabled correct identification of all lesions and were markedly superior to plain-film arthrography. DSCT enabled diagnosis of all cases of complete rotator cuff tear plus three cases of incomplete tear and three of rotator cuff atrophy not identified by the other techniques. Axial CT scanning was better than DSCT for diagnosis of Bankart lesions.
Adolescent↗
Rotator cuff disruption: diagnosis with digital arthrography.
Shoulder arthrography is a reliable technique for use in the diagnosis of tears of the rotator cuff, although delineation of the precise site and size of tears requires meticulous double-contrast technique and considerable examiner expertise. The authors initiated a prospective evaluation of digital arthrography of the glenohumeral joint in 28 patients with clinical manifestations suggesting rotator cuff tear because they believed that examination with this technique would allow more accurate definition of the precise status of the cuff. Fifteen patients had normal studies. Ten complete and three partial rotator cuff tears were demonstrated with digital technique, and the precise site of the tear was demonstrated in all of these cases. The results indicate that digital arthrography of the glenohumeral joint may have some advantages over standard arthrography in the delineation of complete and partial tears of the rotator cuff, particularly in defining the exact site of tears.
Adult↗
Rotator cuff tears: correlation of sonographic and surgical findings.
High-resolution, real-time sonography of the rotator cuff was performed in 51 shoulders, and the results were correlated with findings obtained during subsequent surgery. Prospective sensitivity of sonography in detection of a tear was 100%; specificity, 75%; and accuracy, 92%. Retrospective estimation of tear size on sonograms correlated well with the intraoperative measurements for small and moderate lesions. Large lesions were often underestimated sonographically. Retrospectively, partial tears were correctly diagnosed in seven patients, and bursal thickening was recognized in 17 patients. Sonography of the shoulder proved to be an accurate, noninvasive method for the diagnosis of complete rotator cuff tears. It is useful for estimating tear size and location and may be useful in recognizing partial tears.
Adult↗
Status of rotator cuff sonography.
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Humans↗