In general, the long head of the biceps brachii originates from the superior glenoid labrum and the supraglenoid tubercle, crosses the rotator cuff interval, and extends into the bicipital groove. However, rare anatomic variations of the origins of the long head have been reported in the past. In this report, we review the clinical history, radiologic findings, and arthroscopic identifications of 3 anatomic variants of the biceps tendon long head. As the detection of long head of biceps tendon pathology during preoperative radiologic assessment can be difficult without prior knowledge, surgeons should be aware of such possible anatomic variations.
Anatomic Variation ; Head* ; Pathology ; Rotator Cuff ; Shoulder ; Tendons

Ultrasonography is a powerful and useful method for the examination of the various shoulder diseases. The use of high-resolution transducer and technical evolution allowed the improvement of the accuracy of detection of the rotator cuff disease. In addition to diagnostic tool, ultrasonography can be applied as an optimal guidance in many intervention therapy around shoulder. However, its limitation is that there is marked disparity between the operators' experience levels. This article describes stepwise methods for evaluating shoulder conditions, ultrasonographic findings of various shoulder pathology, and guidance techniques for intervention therapy.
Pathology ; Rotator Cuff ; Shoulder Pain* ; Shoulder* ; Transducers ; Ultrasonography*

The ultrasonography (US) is an important modality in evaluating shoulder disease. It is accurate in diagnosing the various shoulder diseases including tendinosis, calcific tendinitis, and subacromial bursitis as well as rotator cuff tears. This article presents a pictorial review of US anatomy of the shoulder, the technical aspects of shoulder US, major types of shoulder pathology, and interventional procedure under US guidance.
Bursitis ; Pathology ; Rotator Cuff* ; Shoulder ; Tendinopathy ; Tendons ; Ultrasonography*

In general, the long head of the biceps brachii originates from the superior glenoid labrum and the supraglenoid tubercle, crosses the rotator cuff interval, and extends into the bicipital groove. However, rare anatomic variations of the origins of the long head have been reported in the past. In this report, we review the clinical history, radiologic findings, and arthroscopic identifications of 3 anatomic variants of the biceps tendon long head. As the detection of long head of biceps tendon pathology during preoperative radiologic assessment can be difficult without prior knowledge, surgeons should be aware of such possible anatomic variations.
Anatomic Variation ; Head ; Pathology ; Rotator Cuff ; Shoulder ; Tendons

Biologic augmentation could promote rotator cuff tendon healing and improve the mechanical properties as well as reduce postoperative adhesion. Biologic augmentations play a vital role in rotator cuff repair and healing. However, most of the studies were performed on animals and clinical outcomes were short-term follow-up. The therapeutic effects should be assessed in multicenter prospective trials.
Animals ; Humans ; Intercellular Signaling Peptides and Proteins ; metabolism ; therapeutic use ; Rotator Cuff ; metabolism ; pathology ; transplantation ; Rotator Cuff Injuries ; Transplantation ; Wound Healing

Adult ; Aged ; Arthroscopy ; methods ; Female ; Humans ; Male ; Middle Aged ; Prospective Studies ; Rotator Cuff ; pathology ; surgery ; Rotator Cuff Injuries ; pathology ; surgery ; Tendon Injuries ; surgery ; Young Adult

Rotator cuff injury comprises a continual spectrum of lesions ranging from tendinopathy, which may progress to partial- or full-thickness tear. This progression may be influenced by the interplay of extrinsic and intrinsic factors. We describe the case of a 29-year-man who presented with right shoulder pain for one year. His initial magnetic resonance (MR) arthrogram showed supraspinatus tendinopathy. Subsequent MR arthrogram, obtained after a road traffic accident, showed a bursal-sided partial-thickness tear of the supraspinatus tendon. In view of his worsening clinical symptoms, surgery was performed ten months later, revealing a full-thickness rotator cuff tear near the tendon insertion, with a tight subacromial space and bony protuberance of the humeral head. The pathogenesis of rotator cuff injuries, the roles of different imaging modalities in the diagnosis of rotator cuff injuries, as well as the advantages and limitations of various radiological modalities, are discussed.
Adult ; Arthroscopy ; Diagnosis, Differential ; Humans ; Magnetic Resonance Imaging ; methods ; Male ; Rotator Cuff ; pathology ; Rotator Cuff Injuries ; Rupture ; Shoulder Joint ; injuries ; pathology ; Tendon Injuries ; diagnosis

OBJECTIVESTo establish the animal model of acute rotator cuff tear in rabbits, and study the effect of timing of surgical repair on healing of tendon-bone interface, formation and distribution of collagens in the supraspinatus tendon insertion and biomechanical properties of supraspinatus.

METHODSSupraspinatus tenotomy was performed in the right shoulder of 90 skeletally matured male New Zealand white rabbits to establish the animal model of acute rotator cuff tear. The rabbits were randomly divided into 3 groups : group of early repair, repaired at 1 week after tenotomy; group of late repair, repaired at 4 weeks after tenotomy; and group without repair, used as control. At 2 weeks, 4 weeks and 8 weeks after repair, healing of tendon-bone interface was observed by HE staining. Collagens were observed by Sirius Red F 3B (SR) in saturated carbazotic acid staining. The areas of type I and III collagens were measured by using imaging analysis software and the ratio of type I and III collagens were calculated. Failure loads of supraspinatus on both sides were measured. The percentage of failure loads of the surgical side was calculated and contralateral supraspinatus were uninjured.

RESULTSThere was no obvious fatty infiltration and muscle atrophy in supraspinatus in all groups. At 8 weeks, the formation of a new enthesis of supraspinatus in groups of early and late repair were observed. In groups of early and late repair, the ratio of areas of type I and III collagens at 8 weeks (2.02 ± 0.77 and 2.06 ± 0.58) was larger than that at 2 weeks (1.10 ± 0.24 and 1.14 ± 0.50, t = 3.082, 3.655, P < 0.01). At 2, 4 and 8 weeks, the percentages of failure loads of the surgical side and uninjured contralateral supraspinatus in group of early repair(38% ± 11%, 66% ± 7%, 89% ± 4%) and group of late repair (41% ± 16%, 63% ± 7%, 89% ± 9%) were both higher than that in group without repair (14% ± 6%, 32% ± 4%, 56% ± 12%); the differences were all statistically significant (group of early repair: t = 3.311, 8.549, 5.719; group of late repair: t = 3.713, 8.063, 6.044; P < 0.01). The percentage of failure loads of the surgical side and uninjured contralateral supraspinatus at 8 weeks was higher than those at 4 weeks (t = 3.878 - 4.613, P < 0.01) and 2 weeks (t = 7.158 - 10.024, P < 0.01) in all groups.

CONCLUSIONSSurgical repair within 4 weeks of acute rotator cuff tear lead to formation of a new enthesis of supraspinatus, improvement of both ratio of type I collagen in the supraspinatus tendon insertion and biomechanical properties of supraspinatus.

Animals ; Biomechanical Phenomena ; Collagen Type I ; metabolism ; Collagen Type III ; metabolism ; Disease Models, Animal ; Male ; Rabbits ; Rotator Cuff ; pathology ; surgery ; Rotator Cuff Injuries ; Time Factors

BACKGROUNDThe supraspinatus tendon is the most commonly affected tendon in rotator cuff tears. Early detection of a supraspinatus tear using an accurate physical examination is, therefore, important. However, the currently used physical tests for detecting supraspinatus tears are poor diagnostic indicators and involve a wide range of sensitivity and specificity values. Therefore, the aim of this study was to establish a new physical test for the diagnosis of supraspinatus tears and evaluate its accuracy in comparison with conventional tests.

METHODSBetween November 2012 and January 2014, 200 consecutive patients undergoing shoulder arthroscopy were prospectively evaluated preoperatively. The hug-up test, empty can (EC) test, full can (FC) test, Neer impingement sign, and Hawkins-Kennedy impingement sign were used and compared statistically for their accuracy in terms of supraspinatus tears, with arthroscopic findings as the gold standard. Muscle strength was precisely quantified using an electronic digital tensiometer.

RESULTSThe prevalence of supraspinatus tears was 76.5%. The hug-up test demonstrated the highest sensitivity (94.1%), with a low negative likelihood ratio (NLR, 0.08) and comparable specificity (76.6%) compared with the other four tests. The area under the receiver operating characteristic curve for the hug-up test was 0.854, with no statistical difference compared with the EC test (z = 1.438, P = 0.075) or the FC test (z = 1.498, P = 0.067). The hug-up test showed no statistical difference in terms of detecting different tear patterns according to the position (χ2 = 0.578, P = 0.898) and size (Fisher's exact test, P > 0.999) compared with the arthroscopic examination. The interobserver reproducibility of the hug-up test was high, with a kappa coefficient of 0.823.

CONCLUSIONSThe hug-up test can accurately detect supraspinatus tears with a high sensitivity, comparable specificity, and low NLR compared with the conventional clinical tests and could, therefore, improve the diagnosis of supraspinatus tears in clinical settings.

Adolescent ; Adult ; Aged ; Diagnostic Tests, Routine ; methods ; Female ; Humans ; Male ; Middle Aged ; Rotator Cuff ; pathology ; Rotator Cuff Injuries ; diagnosis ; Tendon Injuries ; diagnosis ; Young Adult

PURPOSE: This study compared the SLAP lesions caused by a sports-induced injury with those caused by a nonsports-induced injury. MATERIALS AND METHODS: The study was performed on 54 patients who had undergone arthroscopic surgery for a SLAP lesion. There were 21 sports-induced-injury patients (group I) and 36 non-sports-induced injury patients (group II). The mean age of the men was 36 years and that of the women was 48 years. In both groups, the frequency of a concomitant injury and the clinical outcomes at the last follow-up was evaluated using the UCLA score, Rowe score, and the ASES score. RESULTS: According to their injury mechanism, , there were 14 cases (67%) of repeated microtrauma injury in group I and 25 cases (75%) of compression injury type in group II. As a concomitant pathology, there was 11 cases of shoulder instability and 5 cases of a rotator cuff tear in group I, and 23 cases of rotator cuff tears and 14 cases of shoulder instability in group II. At the last follow up, group I showed slightly better clinical satisfaction (P>0.05). CONCLUSION: The possibility of a SLAP lesion accompanying other diseases is high. Therefore, an accurate assessment of concomitant injury lesions before surgery is important for the treatment outcome.
Arthroscopy ; Female ; Follow-Up Studies ; Humans ; Male ; Pathology ; Rotator Cuff ; Shoulder ; Sports* ; Treatment Outcome