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The management of glenohumeral arthritis in young patients is a challenge given the higher demand for use of the arms, need for longer implant survivorship, and higher postoperative expectations in this patient population. Shoulder arthroplasty is an excellent treatment option for elderly patients with glenohumeral arthritis because this patient population does not have demands as high as those of younger patients with glenohumeral arthritis. Common causes of glenohumeral arthritis in young patients include chondrolysis, inflammatory arthropathies, chronic instability, osteonecrosis, glenoid dysplasia, and early-onset osteoarthritis. Options for the surgical management of glenohumeral arthritis in young patients include arthroscopic débridement with or without capsular release, biceps tenodesis, chondroplasty, and/or subacromial decompression; soft-tissue resurfacing; humeral head resurfacing; anatomic total shoulder arthroplasty; reverse total shoulder arthroplasty; and glenohumeral arthrodesis. Shoulder arthroplasty is the preferred treatment for young patients with glenohumeral arthritis; however, surgeons must counsel patients on treatment options, surgical goals, postoperative functional expectations, and the potential for future surgery to increase the likelihood of good outcomes.

The fourth generation of humeral components currently are being used in anatomic shoulder arthroplasty. Anatomic shoulder arthroplasty implants have evolved to better re-create anatomy, improve fixation, preserve bone, and facilitate revision surgery. Most of the design changes for shoulder arthroplasty implants have centered on the humeral stem, with a transition to shorter, metaphyseal humeral stems. Many of these humeral component design changes may be beneficial; however, long-term studies are necessary to determine if the results of anatomic shoulder arthroplasty with the use of newer humeral components can match those of older humeral components.

Management of failed rotator cuff repair may be very difficult, especially in young patients. Various nonmodifiable and modifiable patient factors, including age, tendon quality, rotator cuff tear characteristics, acute or chronic rotator cuff tear, bone quality, tobacco use, and medications, affect rotator cuff repair healing. Surgical variables, such as the technique, timing, tension on the repair, the biomechanical construct, and fixation, as well as the postoperative rehabilitation strategy also affect rotator cuff repair healing. Variable outcomes have been reported in patients who undergo revision rotator cuff repair; however, a systematic surgical approach may increase the likelihood of a successful outcome. Numerous cellular and mechanical biologic augments, including platelet-rich plasma, platelet-rich fibrin matrix, mesenchymal stem cells, and acellular dermal matrix grafts, have been used in rotator cuff repair; however, conflicting or inconclusive outcomes have been reported in patients who undergo revision rotator cuff repair with the use of these augments. A variety of tendon transfer options, including latissimus dorsi, teres major, lower trapezius, pectoralis minor, pectoralis major, combined pectoralis major and latissimus dorsi, and combined latissimus dorsi and teres major, are available for the management of massive irreparable rotator cuff tears. Ultimately, the optimization of surgical techniques and the use of appropriate biologic/tendon transfer techniques, if indicated, is the best method for the management of failed rotator cuff repair.

Background: The bicipital aponeurosis, or lacertus fibrosus, can potentially be used as a reconstruction graft in chronic distal biceps tendon tears., Purpose: To evaluate construct stiffness, load to failure, and failure mechanism with lacertus fibrosus versus Achilles allograft for distal biceps tendon reconstruction., Study Design: Controlled laboratory study., Methods: Ten fresh-frozen matched cadaveric pairs of elbows were used. Three centimeters of the distal biceps tendon was resected. Specimens were randomized to the lacertus fibrosus or Achilles tendon group. In one group, the lacertus fibrosus was released from its distal attachment and then tubularized and repaired intraosseously to the radius. In the other group, an Achilles tendon graft was sutured to the biceps muscle and repaired to the ulna. The prepared radii were rigidly mounted at a 45° angle on a load frame. The proximal biceps muscle was secured in a custom-fabricated cryogenic grip. Displacement was measured using a differential variable reluctance transducer mounted at the radius-soft tissue junction and in the muscle- or muscle allograft-tissue junction proximal to the repair. Specimens were loaded at 20 mm/min until failure, defined as a 3-mm displacement at the radius-soft tissue junction., Results: No significant difference was found in mean load to failure between the lacertus fibrosus and Achilles tendon group (mean ± SD, 20.2 ± 5.5 N vs 16.89 ± 4.54 N; P = .18). Stiffness also did not differ significantly between the lacertus fibrosus and Achilles tendon group (12.3 ± 7.1 kPa vs 10.5 ± 5.7 kPa; P = .34). The primary mode of failure in the lacertus fibrosus group was suture pullout from the tissue at the musculotendinous junction (7 of 10). In the Achilles group, failures were observed at the muscle-allograft interface (3) and the allograft-bone (radial tuberosity) interface (3), and 3 suture failures were observed. The button fixation did not fail in any specimens., Conclusion: The mean stiffness and load-to-failure values were not significantly different between a lacertus fibrosus construct and Achilles tendon allograft., Clinical Relevance: Use of the lacertus fibrosus may be a potential alternative to Achilles tendon allograft reconstruction of chronic distal biceps tears when primary repair is not possible.

The fourth generation of humeral components currently are being used in anatomic shoulder arthroplasty. Anatomic shoulder arthroplasty implants have evolved to better re-create anatomy, improve fixation, preserve bone, and facilitate revision surgery. Most of the design changes for shoulder arthroplasty implants have centered on the humeral stem, with a transition to shorter, metaphyseal humeral stems. Many of these humeral component design changes may be beneficial; however, long-term studies are necessary to determine if the results of anatomic shoulder arthroplasty with the use of newer humeral components can match those of anatomic shoulder arthroplasty with the use of older humeral components.

Despite recent technologic advances, total elbow arthroplasty has complication rates higher than that of total joint arthroplasty in other joints. With new antirheumatic treatments, the population receiving total elbow arthroplasty has shifted from patients with rheumatoid arthritis to those with posttraumatic arthritis, further compounding the high complication rate. The most common reasons for revision include infection, aseptic loosening, fracture, and component failure. Common mechanisms of total elbow arthroplasty failure include infection, aseptic loosening, fracture, component failure, and instability. Tension band fixation, allograft struts with cerclage wire, and/or plate and screw constructs can be used for fracture stabilization.

Background: We evaluated effects of botulinum toxin A (Botox) and cast immobilization on tendon healing in a rat model. Injection of Botox into rat supraspinatus was hypothesized to reduce muscle active force and improved healing., Methods: Eighty-four supraspinatus tendons were surgically transected and repaired in 42 Sprague-Dawley rats (transosseous technique). After repair, supraspinatus muscle was injected with saline or Botox (3 or 6 U/kg). Half the shoulders were cast-immobilized for the entire postoperative period; half were allowed free cage activity. Histology was examined at 2, 4, 8, and 12 weeks. A healing zone cross-sectional area was measured, and biomechanical testing of repair strength and tendon viscoelastic properties was conducted at 4 and 12 weeks., Results: Botox alone and cast immobilization alone exhibited increased ultimate load compared with controls (saline injection, no immobilization) at 4 weeks. No difference in ultimate load occurred between Botox-only and cast-only groups. At 12 weeks, the Botox (6 U/kg) plus cast immobilization group was significantly weakest (p < 0.05). A trend was shown toward decreased healing zone cross-sectional areas in casted groups., Conclusions: Supraspinatus Botox injection after rotator cuff repair might help protect the repair. However, cast immobilization plus Botox administration is harmful to rotator cuff healing in a rat tendon model.

Total shoulder arthroplasty (TSA) provides an effective solution for the treatment of glenohumeral arthritis. However, long-term outcomes have been limited by glenoid component aseptic loosening and polyethylene (PE) wear. Previous attempts to improve glenoid fixation with metal-backed glenoids resulted in inferior results. Newer component designs that contain porous metal allow for biological ingrowth of the prosthesis, potentially improving longevity and overall outcomes. Porous metal can also improve humeral component fixation, obviating the need for cement and simplifying revision surgery. Advances such as highly cross-linked polyethylene (HXLPE), vitamin E-doped HXLPE, and alternate bearing surfaces like ceramics and pyrolytic carbon have proven to provide superior wear characteristics in other joint replacements and may prove beneficial in the shoulder as well.

Background: We hypothesized that transfer of the olecranon tip for simulated type III coronoid fracture would restore posterior ulnohumeral translation to a level not different from that in the intact state., Methods: The collateral ligaments were left intact in 12 fresh-frozen cadaveric elbows, and all other soft tissues were removed. The entire coronoid process was osteotomized flush with the ventral aspect of the ulna and was reconstructed using the tip of the olecranon process. Specimens were tested with an axial load of 100 N at 0.25 mm/s in 15° increments from 15 to 120° of flexion. Intact, osteotomized, and reconstructed posterior ulnohumeral displacement was measured., Results: The bony reconstruction did not obstruct range of motion of the elbow. Intact translation (mean ± SD) ranged from 0.3 ± 0.1 to 1.1 ± 0.6 mm, and translation in the osteotomized state ranged from 1.3 ± 1.0 to 2.0 ± 1.0 mm. Resection of the coronoid resulted in a significant increase in posterior ulnar translation compared with intact at all flexion angles (p < 0.05) except at 75°. Reconstruction decreased translation versus the osteotomized state at all flexion angles, significantly at 60 and 120°. No significant difference in translation was found between reconstructed and intact states at five of eight positions tested., Conclusions: In this biomechanical study of irreparable coronoid fracture, autograft olecranon tip transfer restored posterior elbow stability to a level not significantly different from the intact elbow in five of eight elbow positions tested.

Varus posteromedial instability of the elbow is a result of traumatic injury to the medial facet of the coronoid and usually the lateral collateral ligament. Treatment of these fractures is usually surgical; poor outcomes have been described with nonoperative treatment. Surgical management consists of coronoid fracture fixation with plates, screws, or sutures and radial collateral ligament repair. Outcomes of these injuries are mixed, but most series report fair to good objective scores. The purpose of this article is to describe the pathophysiology of varus posteromedial instability, discuss the management of this injury, and report the outcomes of treatment., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Case: A sixteen-year-old high school varsity quarterback was referred to us for evaluation of right shoulder pain two months after an injury sustained during a football tackle. The patient reported being substantially limited in his ability to perform vigorous activity because of pain and the sensation that his shoulder was about to dislocate. Evaluation showed a Bankart tear and a focal full-thickness glenoid osteochondral defect. The tear was treated with Bankart repair, and the osteochondral defect was filled arthroscopically with particulated juvenile cartilage graft. The patient returned to full sports activity without restriction at nine months after surgery and, at two years of follow-up, remained pain free with full range of motion and strength and no symptoms of instability., Conclusion: The current case suggests that particulated juvenile cartilage may be effective in the treatment of osteochondral lesions of the glenoid.

Background: The biologic factors associated with shoulder osteoarthritis (OA) have not been elucidated. The purpose of this study was to investigate osteoarthritic biomarkers of the shoulder. To our knowledge, this is the first study to analyze shoulder cartilage for OA-associated genes and to examine human shoulder cartilage for a possible biomarker, connexin 43 (Cx43)., Materials and Methods: Cartilage from 16 osteoarthritic and 10 nonosteoarthritic humeral heads was assessed for expression of the following genes by real-time polymerase chain reaction: types I, II, and X collagen; matrix metalloproteinases (MMPs); tissue inhibitors of MMP (TIMPs); interleukins; versican; cyclooxygenase 2 (Cox-2); inducible nitric oxide synthase (iNOS); tumor necrosis factor α (TNF-α); aggrecanase 2 (ADAMTS5); and Cx43., Results: In osteoarthritic shoulders, Cx43, Cox-2, versican, collagen type I, ADAMTS5, MMP-3, and TNF-α expressions were significantly increased compared with controls. TIMP-3 and iNOS trended toward significance, with robust expression in osteoarthritic shoulders and low expression in nonosteoarthritic shoulders. In osteoarthritic shoulders, gene expression of Cx43, ADAMTS5, collagen type I, Cox-2, versican, and TIMP-3 showed predominance (85-, 33-, 13-, 12-, 11.5-, and 3-fold increases, respectively) relative to nonosteoarthritic controls. Spearman correlation analysis showed significant correlations between Cx43 and collagen (types I, II, and X), MMP-9, TIMP-2 and TIMP-3, versican, Cox-2, iNOS, and ADAMTS5., Conclusions: Certain genes are markedly upregulated in osteoarthritic shoulders compared with nonosteoarthritic shoulders, with Cx43, Cox-2, versican, collagen type I, ADAMTS5, MMP-3, and TNF-α expression being significantly increased. These genes might be useful biomarkers for examining shoulder OA., Clinical Relevance: Identification of osteoarthritic biomarkers can help us better understand shoulder OA and build the foundation for future research on disease progression and treatments., (Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

The number of shoulder arthroplasty procedures performed in the United States is steadily increasing as a result of an expansion in implant options, clinical indications, and surgical experience. Available options include stemmed implants, short-stemmed or stemless prostheses, fracture-specific designs, resurfacing implants, partial surface replacement, metal-backed or polyethylene glenoid components designed for cementation or bone ingrowth, and reverse total shoulder arthroplasty. Efforts to re-create anatomy, improve outcomes, and avoid complications have resulted in many changes in prosthesis design. Despite these changes, failures still occur, and revision surgery is sometimes necessary. A thorough knowledge of current arthroplasty options, indications, and the principles of implantation is necessary to optimize outcomes after shoulder arthroplasty.

It is not known whether significant differences in the glenohumeral center of pressure and contact pressure exist between surface replacement arthroplasty and hemiarthroplasty compared with the native joint. Twelve fresh-frozen cadaveric shoulders were dissected free of soft tissue, and the joint capsule was removed. The scapula was potted with the glenoid parallel to the ground. A pressure-sensitive sensor was placed in the glenohumeral joint, and each specimen was tested in sequence: intact, surface replacement, and hemiarthroplasty. Loading was done with a 440-N compression load at 0.5 Hz with the shoulder in 4 different positions. The center of pressure and contact pressure were measured at each position. The glenohumeral contact pressure with surface replacement was not different from intact pressure in 2 arm positions. Pressure with hemiarthroplasty was significantly different compared with the intact shoulder at all 4 arm positions and compared with the surface replacement group at 2 arm positions (P≤.05). Change in the anterior-posterior center of pressure from intact was significantly smaller with surface replacement compared with hemiarthroplasty with the humerus at 0° flexion/0° abduction and at 0° flexion/90° abduction (1.11±0.89 mm vs 2.38±1.62 mm, P=.02, and 0.68±0.50 mm vs 2.37±2.0 mm, P=.01, respectively). Change in the superior-inferior center of pressure was significantly smaller with surface replacement vs hemiarthroplasty at 0° flexion/0° abduction and at 90° flexion/90° abduction (0.98±1.16 mm vs 2.33±1.38 mm, P=.02, and 1.50±1.28 mm vs 2.90±1.92 mm, P=.04, respectively). Compared with hemiarthroplasty, surface replacement arthroplasty more closely replicated the contact pressure and center of pressure in the intact glenohumeral joint., (Copyright 2014, SLACK Incorporated.)

Based on the available literature, we believe that reverse shoulder arthroplasty is a reasonable treatment modality in patients with CTA and massive irreparable cuff tears. RSA has been shown to increase patient function and decrease pain. There are still a high number of complications related to this procedure; however, with stringent patient selection criteria and meticulous technique, high patient satisfaction scores are typically achieved in these patients, at least in the short term. Further studies are required to evaluate the efficacy these devices in the long term., (Copyright © 2012 Elsevier Inc. All rights reserved.)

The elbow is a difficult joint to treat because of the subtle nuances involved in pathology, examination, and treatment. Patients experiencing the sequelae of recurrent elbow instability can lose substantial function in the affected upper extremity. Elbow instability comprises a wide spectrum of diseases, ranging from valgus instability in the throwing athlete to traumatic recurrent rotatory instability to iatrogenic damage. For the orthopaedic surgeon to develop a systematic algorithm for treating elbow instability disorders, it is necessary to understand the basic elbow biomechanics and the alterations that occur in the unstable elbow. A thorough knowledge of the history, physical examination techniques, and imaging studies necessary to diagnose these injury patterns is also needed. Cutting-edge advances in the surgical reconstruction of the unstable elbow will allow those caring for patients with these difficult injuries to make the proper management decisions.

Patients with multiple traumatic injuries can be difficult to treat, especially when a head injury is involved. In these cases, orthopedic injuries can be missed or ignored. In patients who recover, the orthopedic injuries can be more difficult to manage at a later date. We report the case of a patient whose Monteggia fracture was unmanaged while his head injury was addressed, resulting in a malunited ulna, chronically dislocated radial head, and radioulnar synostosis.

Although distal humeral fractures are well described in the literature, concomitant distal triceps avulsion has not previously been reported. One population that warrants a high index of suspicion for tendon injury after trauma is patients with renal disease. Clinical tests on such patients may yield equivocal results, and in that setting, magnetic resonance imaging may be useful in the diagnosis of concomitant tendon injury. Postoperative rehabilitation is a challenge considering that the old standard of care for isolated triceps avulsions is several weeks of immobilization and that early motion is recommended for open reduction and internal fixation of distal humeral fractures. More recent literature supports early active-assisted range-of-motion (ROM) elbow exercises after triceps tendon repair, and our case supports those recommendations.A 48-year-old, right-hand-dominant man, who was a living-related kidney transplant recipient 3 years previously, presented with radiographic evidence of an intra-articular distal humeral fracture. The patient was rejecting his kidney at the time of injury and was receiving 50 mg of prednisone daily. The patient underwent open reduction and internal fixation of the distal humeral fracture and concomitant triceps repair. Postoperatively, active-assisted and passive ROM elbow exercises were begun. At 3-year follow-up, the patient had 10 degrees to 120 degrees of motion at the elbow, with full supination and pronation., (Copyright 2010, SLACK Incorporated.)

Iatrogenic deltoid injury can result in severe shoulder dysfunction and pain. We used an augmentation patch (porcine submucosa) concomitantly to assist in deltoid repair. We prospectively studied 14 patients (mean age, 57.9 years). All underwent deltoidplasty for postoperative deltoid dehiscence with the orthobiologic patch placed around the detached deltoid and subsequent transosseous repair to the acromion (mean follow-up, 30 months [range, 24-62 months]). Ten patients underwent concomitant revision rotator cuff repair. All patients had undergone at least 1 previous operation. All improved postoperatively with regard to pain, function, or both. The mean pain level (out of 10) decreased (from 5.4 to 1.2); strength (out of 5) improved (from 3.2 to 4.4), forward elevation increased (from 93.1 degrees to 132.5 degrees), external rotation improved (from 30.8 degrees to 54.3 degrees), and internal rotation improved (from L1 to T9). Improvements were found for the mean Simple Shoulder Test score (out of 12) (from 3.6 to 7.1), Disabilities of the Arm, Shoulder and Hand score (from 68.8 to 28.8), and American Shoulder and Elbow Surgeons score (from 38.3 to 69.4). Recurrent deltoid dehiscence occurred in 2 patients (14%). Deltoid dehiscence remains an unsolved issue associated with shoulder reconstruction. Augmenting deltoid repair can improve function and diminishes pain after failed rotator cuff surgery. Careful revision surgical technique and rehabilitation might provide quality outcomes in this patient population.

Many procedures described for operative management of acromioclavicular joint separations entail transfer of the coracoacromial ligament. We sought to describe the anatomy and morphology of the pectoralis minor tendon better, to assess its anatomic potential as a substitute for sacrificing the coracoacromial ligament, and to compare the ultimate tensile strength of the pectoralis minor with that of the coracoacromial ligament and detached coracoclavicular ligament. The morphology of the pectoralis minor tendon was carefully delineated and compared with that of the coracoacromial ligament, and 10 paired fresh-frozen cadaveric shoulders were tested to failure by applying a single uniaxial tensile load. Anatomic study of the pectoralis minor tendon confirmed its adequacy as a source of local autograft tissue in acromioclavicular joint reconstruction. We hypothesize that, in cases of acromioclavicular joint separation necessitating operative intervention, the use of the pectoralis minor tendon as a potential source of autograft tissue is anatomically feasible and it is slightly stronger than the coracoacromial ligament.

The purpose of this study was to compare the strength and stiffness of distal biceps tendon ruptures repaired with either a Bio-Tenodesis screw or suture anchor technique in a cadaveric model. Ten matched pairs of cadaveric arms underwent simulated distal biceps tendon ruptures and were repaired with either a Bio-Tenodesis screw or suture anchor technique. We analyzed pullout strength, stiffness, and mode of failure for each construct. The mean pullout strength of the repair with a Bio-Tenodesis screw was significantly higher (192 N [SD, 42.5 N] vs 147 N [SD, 29.5 N], P < .013). Use of the Bio-Tenodesis screw is an effective means of repairing distal biceps tendon ruptures. It provides significantly more initial pullout strength compared with suture anchors. This could potentially allow more aggressive rehabilitation and faster return to function.

Objective: Measure stiffness of the glenohumeral joint during clinical laxity testing with and without muscular contraction of the Internal rotators., Design: Cross-sectional study of normal shoulders., Background: Clinical examination for shoulder instability is based on subjective impression, and is only performed passively. Our study presents a method for quantitative clinical examination of the shoulder under both passive and active muscle contraction conditions. We hypothesized that in a normal shoulder, contraction of the internal rotators will increase the stiffness of the glenohumeral joint, effectively constraining the head of the humerus against anterior directed forces., Methods: Ten subjects were instrumented with electromagnetic sensors to record glenohumeral linear displacements. A mini-force transducer recorded forces applied to subjects during anterior drawer testing (forced anterior glenohumeral displacement), which was performed passively, and during isometric contraction of internal rotators., Results: Only mild contraction of the internal rotators is needed to significantly increase the stiffness to anterior directed forces. Greater muscular activation does not result in further increased stiffness., Conclusion: Objective measurement of glenohumeral stiffness during passive and active muscular contraction may be useful for evaluating the capacity of rotator cuff muscles to stabilize the shoulder. The concept of more strength is better, for rotator cuff strengthen programs is questioned.

Objective: To evaluate the radiographic and clinical outcomes of patients with displaced proximal humerus fractures (two-part and three-part) treated with nonabsorbable rotator cuff-incorporating sutures., Design: Retrospective., Setting: University hospital., Patients: There were 27 patients (28 shoulders) with displaced proximal humerus fractures. There were 13 greater tuberosity (GT) and 9 surgical neck (SN) two-part fractures and 6 GT/SN three-part fractures. The average age was 64 years (range 38 to 84 years). The average follow-up was 4.4 years (range 1.0 to 11.5 years)., Intervention: All patients were surgically treated solely with heavy polyester nonabsorbable sutures., Main Outcome Measurements: Functional assessment was obtained using the American Shoulder and Elbow Surgeons (ASES) score and Neer's criteria, which grade outcomes as excellent, satisfactory, or unsatisfactory., Results: Overall, there were 22 (78%) excellent, 3 (11%) satisfactory, and 3 (11%) unsatisfactory results, and the average ASES score was 87.1 (range 35.0 to 100.0). All shoulders healed radiographically without evidence of avascular necrosis of the humeral head. Twenty-four shoulders (86%) had anatomic alignment on postoperative radiographs. Of four shoulders with nonanatomic alignment, three had ASES scores of >/=90, with excellent Neer scores. When comparing patients with isolated two-part GT fractures (n = 13) with patients having two-part SN or three-part SN/GT fractures (n = 15), there were no statistically significant differences with respect to range of motion (P > 0.05) and outcome measures (P > 0.05). All patients who had unsatisfactory outcomes were noncompliant with physical therapy, with ASES scores averaging 39.4 (range 35.0 to 43.3)., Conclusion: Two-part and three-part GT and SN fractures can be treated satisfactorily with heavy nonabsorbable rotator cuff-incorporating sutures, particularly in elderly patients. Hardware-associated complications are obviated. Patients with SN fractures treated with sutures can have outcomes similar to patients with two-part GT fractures. Although the goal is to reconstruct a "one-part" fracture pattern, some residual deformity does not preclude an excellent outcome. A compliant patient is crucial for a successful result.

Charles Neer designed his original prosthesis in 1951. It was made of cast cobalt chrome alloy and was only press-fit. There was not any significant loosening in his original series, but patients complained of easy fatigability. This finding was attributed to glenoid issues and a cemented glenoid replacement was introduced in 1973. High rates of lucencies were reported and raised issues regarding fixation. Cementless glenoid components have been found to have fewer lucencies but require metal backing. Higher failure rates have been reported for the cementless design versus the cemented glenoids. With humeral fixation, symptomatic loosening is not a problem with cement or coated press-fit fixation. Long-term outcome studies with cemented and uncemented stems have shown the incidence of humeral loosening to be low. Fixation of humeral components should be based on bone quality, patient age, prosthetic design, and surgeon preference., (Copyright 2002, Elsevier Science (USA).)

The incidence of primary and secondary bicipital tendinitis remains unknown. In our prospective study, 200 consecutive shoulders underwent arthroscopic subacromial decompression for impingement syndrome. A biceps tenodesis was performed in 80 shoulders (40%) featuring macroscopic degeneration of the long head of the biceps; rotator cuff tears were apparent in 91% of these shoulders, the mean patient age being 55 years. In each of 120 shoulders (60%), an extraarticular tenosynovectomy was performed, and histopathologic studies revealed chronic inflammation in 63% and fibrotic degeneration in 13% of the specimens; rotator cuff tears were evident in 70% (23% full thickness) of these cases, the mean patient age being 47 years. In addition, when glenohumeral arthritis was present, it was uniformly associated with pathologic biceps tenosynovium. In summary, the high incidence of chronic inflammation of the long head of the biceps in shoulders with benign-appearing intraarticular portions viewed arthroscopically is significant, and long head of the biceps disease should also be considered in patients with painful rotator cuff disease and arthritic shoulder conditions.