Evaluation of the Relationship between Biceps-Glenoid Angle and Subscapularis Tendon Pathologies in the Biceps Long Head Tendon Subluxation with MRI

Abstract

Objective: The aim of this study was to determine the variability of biceps-glenoid angle in patients with subluxation of the long head of the biceps tendon (LHBT) in magnetic resonance imaging (MRI) and to evaluate the relationship between subscapular tendon pathologies.

Material and Method: Shoulder MRIs taken in Kirikkale University Medical School Radiology Department between January 2014 and March 2018 were reviewed. Thirty patients with subluxation in BUBT and 32 control patients without subluxation were compared. In the T2-weighted oblique-coronal MRI images, the biceps-glenoid angle between the parallel line drawn to the biceps tendon and the tangent line drawn on the glenoid bone roof was measured in the cross-section at the level of supraglenoid tubercle adhesion of BUBT. In addition, subcapularis tendon pathologies were analyzed for normal, partial and full-thickness tear.

Results: There were 12 males and 18 females in the subluxation group in BUBT and the mean age was 61±13.6 years. There were 14 males and 18 females in the non-subluxation group in BUBT and the mean age was 55.9±14 years. The mean biceps-glenoid angle was 84.1º±4.9º in the subluxation group and 92.8º±4.7º in the non-subluxation group, showing a statistically significant difference (p<0.05). Subcapularis tendon pathology was present in 80%of patients with subluxation in BUBT.

Conclusion: In patients with subluxation in BUBT, biceps-glenoid angle values are lower than those with non-subluxation. Biceps-glenoid angle measurement may be helpful in cases where diagnosis of BUBT subluxation is obscure. In addition, subcapularis tendon pathologies frequently accompany BUBT subluxation.

Keywords

• Biceps,subluxation,magnetic resonance imaging,rotator cuff

BİSEPS UZUN BAŞI TENDON SUBLUKSASYONUNDA BİSEPS-GLENOİD AÇISI VE SUBSKAPULARİS TENDON PATOLOJİLERİ ARASINDAKİ İLİŞKİNİN MRG İLE DEĞERLENDİRİLMESİ

Abstract

Amaç: Manyetik rezonans görüntülemede (MRG) biseps uzun başı tendonunda (BUBT) subluksasyon tespit edilen olgularda biseps-glenoid açısındaki değişkenliklerin tespiti ve subskapularis tendon patolojileri ile ilişkisinin değerlendirilmesi amaçlandı.

Gereç ve Yöntem: Ocak 2014-Mart 2018 tarihleri arasında Kırıkkale Üniversitesi Tıp Fakültesi Radyoloji Anabilim Dalı’nda çekilen omuz manyetik rezonans görüntüleri incelendi. BUBT’da subluksasyon olan 30 hasta ve subluksasyon olmayan 32 kontrol hastası karşılaştırıldı. T2 ağırlıklı oblik-koronal MRG görüntülerde, BUBT’un supraglenoid tuberküle yapışma düzeyinden geçen kesitte, biseps tendonuna çizilen paralel çizgi ile glenoid kemik çatıya çizilen teğet çizgi arasındaki biseps glenoid açısı ölçüldü. Ayrıca subskapularis tendon patolojileri normal, parsiyel ve tam kat yırtık açısından analiz edildi. 

Bulgular: BUBT’da subluksasyon olan grupta 12 erkek, 18 kadın olup yaş ortalaması 61.0±13.6 yıl idi. BUBT’da subluksasyon olmayan grupta 14 erkek, 18 kadın olup yaş ortalaması 55.9±14.0 yıl idi. Subluksasyon olan grupta biseps-glenoid açı ortalaması 84.1º±4.9º ve subluksasyon olmayan grupta 92.8º±4.7º idi (p<0.05). BUBT’da subluksasyon olan olguların da %80’inde subskapularis tendon patolojisi mevcuttu.

Sonuç: BUBT’da subluksasyon olan hastalarda, biseps-glenoid açı değerleri, subluksasyon olmayanlara göre düşüktür. BUBT subluksasyonu tanısında arada kalınan olgularda biseps-glenoid açı ölçümü yardımcı olabilir. Ayrıca BUBT subluksasyonuna, subskapularis tendon patolojileri sıklıkla eşlik etmektedir.

Keywords

• Biseps,subluksasyon,manyetik rezonans görüntüleme,rotator manşet

References

1. 1. Chung CB, Steinbach LS. MRI of the upper extremity: shoulder, elbow, wrist and hand: Lippincott Williams & Wilkins. 2009.
2. 2. Koh K-H, Kim SC, Yoo JC. Arthroscopic evaluation of subluxation of the long head of the biceps tendon and its relationship with subscapularis tears. Clinics in orthopedic surgery. 2017;9(3):332-9.
3. 3. Walch G, Nove-Josserand L, Boileau P, Levigne C. Subluxations and dislocations of the tendon of the long head of the biceps. Journal of shoulder and elbow surgery. 1998;7(2):100-8.
4. 4. Ergen FB. Süperiyor Labrum Anteriyor-Posteriyor Lezyonları ve Biseps Tendon Patolojileri. 2014.
5. 5. Gerber C, Sebesta A. Impingement of the deep surface of the subscapularis tendon and the reflection pulley on the anterosuperior glenoid rim: a preliminary report. Journal of shoulder and elbow surgery. 2000;9(6):483-90.
6. 6. Urita A, Funakoshi T, Amano T, Matsui Y, Kawamura D, Kameda Y, et al. Predictive factors of long head of the biceps tendon disorders-the bicipital groove morphology and subscapularis tendon tear. Journal of shoulder and elbow surgery. 2016;25(3):384-9. DOI: 10.1016/j.jse.2015.12.015.
7. 7. Yoo JC, Iyyampillai G, Park D, Koh KH. The influence of bicipital groove morphology on the stability of the long head of the biceps tendon. Journal of orthopaedic surgery (Hong Kong). 2017;25(2):2309499017717195. DOI: 10.1177/2309499017717195.
8. 8. Murthi AM, Vosburgh CL, Neviaser TJ. The incidence of pathologic changes of the long head of the biceps tendon. Journal of shoulder and elbow surgery. 2000;9(5):382-5. DOI: 10.1067/mse.2000.108386.

9. 9. Holtby R, Razmjou H. Accuracy of the Speed's and Yergason's tests in detecting biceps pathology and SLAP lesions: comparison with arthroscopic findings. Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association. 2004;20(3):231-6. DOI: 10.1016/j.arthro.2004.01.008.
10. 10. Motley GS, Guengerich B, Schuller T, Turbyfill A. The Ramp Test: An Arthroscopic Technique for Confirming Intra-articular Subluxation and Instability of the Long Head of the Biceps Tendon Within the Shoulder. Arthroscopy techniques. 2018;7(4):e327-e30. DOI: 10.1016/j.eats.2017.09.011. PMC5981836.
11. 11. Shi LL, Mullen MG, Freehill MT, Lin A, Warner JJ, Higgins LD. Accuracy of long head of the biceps subluxation as a predictor for subscapularis tears. Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association. 2015;31(4):615-9.
12. 12. Chen CH, Hsu KY, Chen WJ, Shih CH. Incidence and severity of biceps long head tendon lesion in patients with complete rotator cuff tears. The Journal of trauma. 2005;58(6):1189-93.
13. 13. Warren RF. Lesions of the long head of the biceps tendon. Instructional course lectures. 1985;34:204-9.