Original articleEntrapment of the long head of the biceps tendon: the hourglass biceps—a cause of pain and locking of the shoulder
Section snippets
Materials and methods
A retrospective review was performed at our institution of all patients with a preoperative diagnostic suspicion or diagnostic confirmation at operation of an hourglass biceps. Between June 2000 and April 2002, 21 patients were identified as having a confirmed diagnosis at operation. There were 7 women and 14 men; the mean age was 62 years (range, 47-69 years). The dominant arm was affected in 18 patients. Eleven patients were engaged in manual professions involving regular overhead activity
Operative and arthroscopic findings
A so-called hourglass biceps was identified in 14 cases during open surgery and in 7 during arthroscopic surgery. All cases occurred in the presence of a full-thickness rotator cuff rupture, except for one with a partial deep tear of the supraspinatus. Three cases were associated with a small isolated supraspinatus tear. The cuff lesions are detailed in Table I.
The intraarticular portion of the biceps was hypertrophic in all cases. The mean diameter of the intraarticular biceps tendon, measured
Discussion
Although enlargement of the LHB tendon has been described previously, mainly in association with massive rotator cuff tears, to our knowledge, no author has reported that entrapment of the biceps tendon inside the joint could be a cause of pain and dysfunction of the shoulder. We present a previously unrecognized mechanical condition affecting the LHB tendon, in which entrapment of the tendon within the joint causes shoulder pain and limited elevation. In these patients, hypertrophy of the
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