Lesão do Tendão Biceptal

Question 1

Quais são os locais de lesão proximal do tendão biceptal?

Answer 1

The injury site or sites may include the attachment to the supraglenoid tubercle, SLAP, the tendon (intraarticular or extraarticular), and the bicipital arch.

Question 2

Quais estruturas formam o arco biceptal?

Answer 2

The bicipital arch consists of the conglomerate of the superior glenohumeral ligament and the coracohumeral ligament attachment at the superior bicipital groove. The ligaments are reinforced anteriorly by the subscapular tendon attachment and posteriorly by the supraspinatus attachment.

Question 3

Como Lafosse descreveu o exame para avaliar a instabilidade do tendão biceptal?

Answer 3

Lafosse et al. suggested internal and external rotation of the humerus in 0 to 30 degrees abduction for dynamic evaluation of the biceps followed by probing to evaluate for static stability.

Question 4

Quais são as opções de tratamento para a instabilidade do tendão biceptal?

Answer 4

The treatment is arthroscopic tendon debulking or tenodesis. In patients who have chronic impingement and persistent biceps tendinitis with more than 50% of the biceps tendon disrupted, or with biceps tendon subluxation as described by Lafosse et al., Habermeyer et al., and Bennett, an arthroscopic or mini-open tenodesis may be performed.

Question 5

Quais são as propostas cirúrgicas para pacientes com instabilidade do tendão biceptal de acordo com sua idade?

Answer 5

For middle-aged patients, a soft tissue tenodesis may be adequate. In older patients with prior informed consent, the best results are achieved with simple tendon release and stump débridement. Indications for biceps tenotomy included age older than 50 years and no heavy work activities.

Question 6

Desfechos insatisfatórios estão relacionados com quais achados anatômicos ao redor do ombro do paciente?

Answer 6

A poor outcome was often associated with the preoperative findings of a high-riding humerus and associated fatty infiltration of the rotator cuff.

Question 7

Como é a classificação de Bennett para instabilidade/subluxação do tendão biceptal?

Answer 7

Type 1, with tears of subscapularis without involvement of medial head of coracohumeral ligament;
Type 2, without tears of subscapularis with involvement of medial head of coracohumeral ligament;
Type 3, with tears of subscapularis and with involvement of medial head of coracohumeral ligament.
Type 4, with tears of supraspinatus and lateral head of coracohumeral ligament.
Type 5, with tears of subscapularis, with medial and lateral head of coracohumeral ligament including leading edge of supraspinatus tendon.

Question 8

Na técnica de Mazzocca para tenodese da parte proximal do tendão biceptal, quanto de tendão é excisado? Quanto de tendão sobra aproximadamente?

Answer 8

20 mm of diseased portion of tendon is excised. Sobra aproximadamente 15 mm.

Question 9

Qual local mais prevalente de lesão dos tendões biceptais?

Answer 9

More than half of all ruptures involving the biceps brachii muscle occur through the tendon of its long head. The rupture usually is more or less transverse and is located either within the shoulder joint or within the proximal part of the intertubercular groove.

Question 10

Qual a epidemiologia das lesões proximais do biceps?

Answer 10

The injury is most common in individuals 40 to 60 years of age and often is due to impingement or chronic microtrauma on the tendon, but it may occur in younger individuals during heavy weightlifting or other sports activities (e.g., football, rugby, soccer, snowboarding) or in a traumatic fall.

Question 11

Qual a porcentagem de perda da força de flexão do cotovelo e abdução do ombro nas lesões proximais do tendão biceptal?

Answer 11

Acute rupture of the proximal biceps tendon is associated with a 20% decrease in elbow flexion power, and the power of shoulder abduction with the arm in external rotation is about 17% less that of the opposite side.

Question 12

Quais os achados de exame físico podem ser encontrados em uma lesão aguda do tendão biceptal?

Answer 12

With an acute injury, ecchymosis and a lump may be noted on the lateral side of the arm from retraction of the tendon.

Question 13

Quais outras patologias podem estar associadas a lesões proximais dos tendões biceptais?

Answer 13

One dificulty in the diagnosis of rupture of the proximal biceps tendon is determining if the rupture is associated with concomitant rotator cuff tears or instability.

Question 14

Quais são as opções de tratamento para lesões proximais dos tendões biceptais?

Answer 14

Ruptures of the proximal biceps tendon traditionally have been treated nonoperatively because they rarely cause significant functional impairment. We prefer operative repair of acute proximal biceps tendon rupture in young, active patients who are unwilling to accept the deformity or slight weakness of supination. Occasionally, repair is indicated in a middle-aged patient whose profession, such as carpentry, requires full supination strength if the patient believes the time out of work is outweighed by the slight increase in supination power gained by operation.

Question 15

Qual a epidemiologia e o mecanismo de lesão da parte distal do tendão biceptal?

Answer 15

Distal rupture of the biceps tendon typically occurs in middle-aged men during heavy lifting with the elbow flexed 90 degrees, or when the biceps muscle contracts against unexpected resistance.

Question 16

Quais são os movimentos afetados pela lesão distal do tendão biceptal?

Answer 16

Initially, there is weakness with flexion and supination.

Question 17

Como é realizado o squeeze test para o biceps?

Answer 17

The test is done with the patient seated and the elbow flexed 60 to 80 degrees. This amount of flexion minimizes tension on the brachialis and helps isolate the biceps to forearm supination. The forearm is slightly pronated to place tension on the biceps brachii tendon. The examiner stands on the same side as the extremity being tested. The biceps brachii is squeezed firmly with both hands, one hand at the distal myotendinous junction and the other around the muscle belly. As the biceps is squeezed, the muscle belly is drawn away from the underlying humerus, eliciting an anterior bow of the muscle. Lack of forearm supination with this maneuver is considered a positive text, indicating rupture of the biceps brachii tendon or muscle belly.

Question 18

Quais são os valor preditivo positivo e sensibilidade do squeeze test para lesão distal do biceps braquial?

Answer 18

The reported positive predictive value of this test is 95%, with a sensitivity of 100%.

Question 19

Como realizar o teste do gancho para lesão distal do tendão do biceps?

Answer 19

The hook test can be used for the diagnosis of complete biceps tendon avulsions: with the elbow actively flexed and supinated, the examiner should be able to “hook” an index finger under a cordlike structure in the antecubital fossa if the tendon is intact. This test was reported to have 100% sensitivity and specificity; however, the examiner must be sure to hook the lateral edge of the biceps tendon, not the medial edge, because the lacertus fibrosus might be mistaken for an intact biceps tendon.

Question 20

Qual estrutura pode ser comprimida nas lesões parciais distais do tendão do biceps?

Answer 20

Median nerve compression in the proximal forearm may result from a partial rupture.

Question 21

Qual a posição o membro superior na realização da RNM para se conseguir uma imagem longitudinal do tendão biceptal distal?

Answer 21

A flexed, abducted and supinated (FABS) position (90 degrees of elbow flexion, 180 degrees of shoulder abduction, and forearm supination) has been recommended to obtain a true longitudinal view of the tendon.

Question 22

Em qual local o tendão distal do biceps deve ser colocado no reparo cirurgico?

Answer 22

Most authors agree that theoretically it should be reattached at its normal position on the radial tuberosity to restore the power of supination of the biceps muscle.

Question 23

Quais as tecnicas disponiveis para reinserção do tendão distal do biceps?

Answer 23

Surgical treatment of distal biceps tendon ruptures can be accomplished through a single-incision or two-incision technique. The two-incision technique of Boyd and Anderson restores the power of supination to the biceps but avoids the dangers of deep dissection in the antecubital fossa. An endoscopic procedure has been described, but we do not recommend this technique. A “mini-open” two-incision technique has been described using a small (≤2 mm) transverse incision in the flexion crease of the antecubital fossa and a 3-cm postero-lateral incision for transosseous fixation.

Question 24

Quais complicações podem acompanhar o tratamento cirurgico com 2 incisões para reinserção do tendão distal do biceps?

Answer 24

There has been some concern about heterotopic ossification formation or radioulnar synostosis using the Boyd and Anderson approach.

Question 25

Quais são as vantagens e desvantagens da técnica de reinserção do tendão biceptal distal por via única?

Answer 25

Reported advantages of the single-incision techniques include limited exposure of the radial tuberosity, better cosmetic result, and decreased risk of heterotopic ossification. Disadvantages include increased costs (expensive hardware), possibility of less secure fixation, and no bony trough for tendon revascularization. In general, nerve injuries are more frequent with single-incision techniques and heterotopic ossification is more common after two-incision techniques.

Question 26

Quais são as causas de lesão do tendão biceptal?

Answer 26

Biceps tendon lesions may be inflammatory, degenerative, or traumatic as a result of repetitive microtrauma or macrotrauma.