The role of the biceps tendon instability in the development of rotator cuff arthropathy of the shoulder joint
Background. The long head of the biceps tendon (LHB) plays an important role in the development of lesions of the rotator cuff tendons as its instability leads to the damage to the rotator cuff of the shoulder, in particular the supraspinatus and subscapularis muscles. This condition is distinguished into a separate type of impingement syndrome — anterior-upper type. However, the role of instability of LHB tendon in the development of rotator arthropathy has not been described in the literature. The study aimed to investigate the role of instability of the LHB tendon in the development of rotator arthropathy of the shoulder joint. Materials and methods. We conducted a retrospective comparative analysis of the results of a survey of 49 patients suffering from pain in the shoulder area. The results obtained during MRI were subsequently verified during arthroscopy. Results. The condition of the tendons of the rotator cuff, the LHB tendon and its stabilizing system, articular cartilage was investigated. The areas of the shoulder articular cartilage damage were divided according to the areas damaged. The extent of cartilage damage was distributed according to the Outerbridge classification. During the examination, four groups of patients were identified, with different lesions of the tendon of the supraspinatus, subscapularis muscles and instability of the LHB tendon. Patients of the first group had the damage to the LHB tendon only and its stabilizing system; the second group had a combination of the damage to the tendon of the supraspinatus muscle and instability of the long head of the biceps. The third group had damage to the tendon of the subscapularis muscle and instability of the long biceps head; the fourth group patients had a combination of damage to the tendons of supraspinatus, subscapularis muscles with the instability of the LHB tendon. Conclusions. Comparative analysis of these four groups showed that instability of the LHB tendon with da-mage to even one of the tendons of rotator cuff is an unfavorable prognostic factor for the development of rotatory arthropathy, and is accompanied by the damage to the cartilage of the joint tissues. The LHB tendon instability is proved to be a contributing factor in the development of cartilage lesions (chondromalacia).
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