pathologies
Shoulder
Biceps tendon (tendinitis and SLAP lesion)
treatment
The treatment of these injuries is complex. It takes into account the type of lesion, the patient's age, sporting activity, occupation and the existence of associated lesions. Initially, anti-inflammatory drugs, physiotherapy sessions or the infiltration of cortisone-based products are considered.
If, despite treatment, the shoulder is still painful, we consider arthroscopic surgery, often during a very short hospital stay (day hospital).
Several processes are described.
Tenotomy is the release of the intra-articular insertion of the biceps by a tendon section. After a tenotomy, this bicipital tendon can be fixed further down, on the humerus. This is called tenodesis.
In some patients (depending on age, type of injury, sporting activity, etc.), the injury is repaired by suturing with bone anchors fitted with sutures.
Post-operative follow-up is straightforward, with rehabilitation starting after one week.
diagnosis
The tests carried out during the patient's examination will help evoke this diagnosis. There are several tests available, but in my opinion, the O'Brien test is most often positive when there is a lesion.
Additional examinations will be carried out afin to confirm the diagnosis (arthroscanner, MRI or ultrasound of the shoulder). For me, arthroscanner remains the gold standard, even if only around 60% of lesions are visualized.
symptoms
Patients' main complaint is pain. It is located on the external anterior surface of the shoulder, radiating to the anterior part of the arm.
Contrary contraction manoeuvres are positive. The patient can no longer sleep on the painful shoulder, and any movement of the arm becomes painful because of the pain.
Over time, joint amplitude gradually decreases, increasing pain and often leading to retractile capsulitis. One of the first painful gestures is stapling a bra, or reaching for an object in the back seat of the car while seated in the driver's seat.
Definition
The biceps is the muscle on the front of the arm. It has two tendons. One tendon attaches to the promontory of the scapula (coracoid bone), while the second tendon crosses the shoulder joint to attach to the articular part (glenoid) of the scapula.
This second tendon is called the long portion of the biceps (LPB). This tendon can present inflammation (tendinitis) or lesions (rupture, disinsertion).
Tendonitis is particularly common among athletes (golfers, tennis players, javelin throwers, baseball players, etc.).
The management of these lesions is complex and often multidisciplinary.
Tendon disinsertion or rupture lesions, can appear after major sports or physical effort, following a fall (with the arm extended forward), or occur spontaneously in patients with pathological coiffe tendon damage. Bead disinsertions have a name - the SLAP lesion.