Diagnosis of long head of biceps tendinopathy in rotator cuff tear patients: correlation of imaging and arthroscopy data
The goal of this prospective study was to assess the reliability of pre-operative cross-sectional imaging for the diagnosis of long head of biceps (LHB) tendinopathy in patients with a rotator cuff tear.
Cross-sectional imaging with MRI or CT arthrography data from 25 patients operated upon because of a rotator cuff tear between 1 October 2015 and 1 April 2016 was analysed by one experienced orthopaedic surgeon, one experienced radiologist and one orthopaedic resident. The analysis consisted of determining whether the LHB was present, the extrinsic tendon abnormalities (dislocation, tendon coverage) and intrinsic abnormalities (fraying, inflammation, degeneration). These findings were then compared to intra-operative arthroscopy findings, which were used as the benchmark. The interobserver correlation between the three different examiners for the cross-sectional imaging analysis as well as the correlation between the imaging and arthroscopy data were determined.
The correlation between the imaging and arthroscopy data was the highest (80%) for the determination of LHB dislocation from the bicipital groove. The other diagnostic elements (subluxation, coverage and tendon degeneration) were difficult to discern with preoperative imaging, and correlated poorly with the arthroscopy findings (45% to 65%). The interobserver correlation was moderate to strong for the diagnosis of extrinsic tendon abnormalities. It was low to moderate for intrinsic abnormalities.
Except for LHB dislocation, pre-operative imaging is not sufficient to make a reliable diagnosis of LHB tendinopathy. Arthroscopy remains the gold standard for the management of LHB tendinopathy, as diagnosed intra-operatively.
KeywordsLong head of biceps Rotator cuff tear Cross-sectional imaging Arthroscopy
The authors are grateful to Joanne Archambault, PhD for her editorial assistance.
Compliance with ethical standards
Conflict of interest
Morgane Rol and Julien Berhouet: none.
Luc Favard: Tornier® consultant.
- 2.Jordan RW, Saithna A (2015) Physical examination tests and imaging studies based on arthroscopic assessment of the long head of biceps tendon are invalid. Knee Surg Sports Traumatol Arthrosc. https://doi.org/https://doi.org/10.1007/s00167-015-3862-7
- 3.Taylor SA, Newman AM, Nguyen J, Fabricant PD, Baret NJ, Shorey M, Ramkumar P, O'Brien SJ (2016) Magnetic resonance imaging currently fails to fully evaluate the biceps-Labrum complex and Bicipital tunnel. Arthroscopy 32(2):238–244. https://doi.org/10.1016/j.arthro.2015.08.008 CrossRefPubMedGoogle Scholar
- 7.De Maeseneer M, Boulet C, Pouliart N, Kichouh M, Buls N, Verhelle F, De Mey J, Shahabpour M (2012) Assessment of the long head of the biceps tendon of the shoulder with 3T magnetic resonance arthrography and CT arthrography. Eur J Radiol 81(5):934–939. https://doi.org/10.1016/j.ejrad.2011.01.121 CrossRefPubMedGoogle Scholar
- 9.Teefey SA, Rubin DA, Middleton WD, Hildebolt CF, Leibold RA, Yamaguchi K (2004) Detection and quantification of rotator cuff tears. Comparison of ultrasonographic, magnetic resonance imaging, and arthroscopic findings in seventy-one consecutive cases. J Bone Joint Surg Am 86-A(4):708–716CrossRefPubMedGoogle Scholar
- 13.Mohtadi NG, Vellet AD, Clark ML, Hollinshead RM, Sasyniuk TM, Fick GH, Burton PJ (2004) A prospective, double-blind comparison of magnetic resonance imaging and arthroscopy in the evaluation of patients presenting with shoulder pain. J Shoulder Elb Surg 13(3):258–265. https://doi.org/10.1016/S1058274604000205 CrossRefGoogle Scholar
- 16.Razmjou H, Fournier-Gosselin S, Christakis M, Pennings A, ElMaraghy A, Holtby R (2016) Accuracy of magnetic resonance imaging in detecting biceps pathology in patients with rotator cuff disorders: comparison with arthroscopy. J Shoulder Elb Surg 25(1):38–44. https://doi.org/10.1016/j.jse.2015.06.020 CrossRefGoogle Scholar
- 21.Rosas S, Krill MK, Amoo-Achampong K, Kwon K, Nwachukwu BU, McCormick F (2017) A practical, evidence-based, comprehensive (PEC) physical examination for diagnosing pathology of the long head of the biceps. J Shoulder Elb Surg 26(8):1484–1492. https://doi.org/10.1016/j.jse.2017.03.002 CrossRefGoogle Scholar
- 22.Taylor SA, Newman AM, Dawson C, Gallagher KA, Bowers A, Nguyen J, Fabricant PD, O'Brien SJ (2017) The "3-pack" examination is critical for comprehensive evaluation of the biceps-Labrum complex and the Bicipital tunnel: a prospective study. Arthroscopy 33(1):28–38. https://doi.org/10.1016/j.arthro.2016.05.015 CrossRefPubMedGoogle Scholar
- 23.Sandrey MA (2013) Special physical examination tests for superior labrum anterior-posterior shoulder tears: an examination of clinical usefulness. J Athl Train 48(6):856–858. https://doi.org/https://doi.org/10.4085/1062-6050-48.3.14