Specialists

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Biceps Instability

Biceps instability takes the form of either frank dislocation or more subtle subluxation. As noted previously, the primary restraining structures holding the LHB in the bicipital groove are the medial sling and subscapularis tendon. Habermayer and Walch divided LHB dislocations into extra-articular or intra-articular. The much less common extra-articular dislocations dislodge from the bicipital groove […]

Biceps Tendinitis

Biceps tendinitis has been partitioned into primary tendinitis versus secondary tendinitis. Primary tendinitis involves inflammation of the tendon within the bicipital groove. To be considered primary, no other pathological findings (such as impingement, bony abnormalities within the groove, or biceps subluxation) should be present. It is considered an uncommon condition and should be thought of […]

Biceps Tendon

Key Points

The long head of the biceps (LHB) originates at and around the supraglenoid tubercle. Although it is intra-articular, it is extrasynovial. Although acute ruptures of the LHB do occur, LHB ruptures are more commonly the result of chronic biceps tendonitis.

There is such a close association between subacromial impingement and biceps tendonitis that […]

Impingement: Secondary

Individuals with shoulder instability or other underlying pathology can develop significant abnormal mechanics that can lead to rotator cuff functional disability, eventual fatigue and loss of humeral head containment. When this occurs, rather than the coracoacromial arch moving toward the cuff, the cuff migrates cephalad as containment is compromised.

In addition to articular-sided internal impingement-type […]

Diagnostic Imaging

Because rotator cuff pathology can represent as a wide spectrum of disease, there is some utility to compartmentalizing the most common entities in an effort to develop algorithms which guide treatment. The management of impingement with or without associated cuff tearing, partial thickness-tears and full-thickness rotator cuff injuries will be the primary topics of this […]

Principles of Instability Surgery

The goal of treatment in both open and arthroscopic instability surgery is twofold: to restore the labrum to its anatomic attachment site and to re-establish the appropriate tension to the inferior capsuloligamentous complex of the joint. Cadaveric studies have shown that both the labrum and the capsule must be injured for a dislocation to occur.

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Technique-SLAP Surgical Techniques

Surgical treatment of symptomatic SLAP lesions consists of shoulder arthroscopy, which frequently demonstrates a positive “drive-through” sign, a displaceable biceps vertex and, in up to 60% of cases, associated rotator cuff pathology, mostly partial-thickness undersurface tears.

If the biceps-labral anchor is avulsed, it is partially debrided and secured back to the glenoid with suture anchors […]

Complications

Surgical complications related to ASAD are similar to those of other shoulder procedures. They can be separated into complications related to inaccurate or incomplete diagnosis and those related to incorrect technique.

An incomplete diagnosis can occur from failure to recognize and address coexisting pathology such as a labral tear or partial rotator cuff tear. These […]

Physical Exam

A thorough physical examination should include careful evaluation of the cervical spine to rule out a neurologic problem such as a herniated cervical disc that can mimic shoulder pathology. This is especially true if a patient presents with bilateral symptoms.

If subacromial impingement is suspected, specific tests should be used and documented. The Neer and […]

Management-Operative Management

If patients fail conservative management of TOS and have severe and persistent symptoms or progressive neurological dysfunction, surgery often is recommended. Surgical intervention bypassing conservative treatment usually is indicated for patients with acute vascular insufficiency.

A variety of surgeries have been recommended for the treatment of TOS; however, because TOS may result from a variety […]