LHB split tear or tendinitis

[Dicken Read]

Dear Stephen

This patient attended with a one month history of left shoulder pain on flexion and abduction to 90 degrees only.

I am not sure what to make of the neovascularisation under power doppler within the LHB. There appears to be a bifurcation on the axial view. Tear or tendinitis do you think? Your feedback would be greatly appreciated.

Dicken Read

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[Stephen Bird]

Hi Dicken,

Nice images,

I am not concerned about the integrity of the LHBT here.

It is normal for the tendon to flatten a little and become a bit broader as it approaches the rotator cuff interval in the proximal LHBT. It is also normal for the medial aspect of the LHBT in short axis to be further from the underlying bone than the lateral aspect. This is due to the superior glenohumeral ligament sitting underneath the medial aspect of the tendon. This ligament fuses with the adjacent goracohumeral ligament to make the rotator cuff interval “sling” which prevents medial subluxation of the LHBT.

The vascularity you are seeing is not inside the tendon itself but rather within the synovial sheath of the LHBT. The sheath of the LHBT communicates directly with the glenohumeral joint capsule and while many may call this “biceps tenosynovitis” I would suggest the LHBT is normal here but the glenohumeral joint itself has a degree of synovitis leading to the hyperaemia.

You can add to the scan by looking for flow in the rotator cuff interval structures (coracohumeral ligament and superior glenohumeral ligament) , you can also look at how thick the posterior joint capsule is deep to infra in the posterior shoulder. You can also lay the patient down and place their arm above their head and scan in the axilla. Line up the humeral neck and the humeral head and you will see how thick the inferior glenohumeral ligament is (joint capsule). Compare to the other side.

If there is a global restriction in movement it is in the spectrum of adhesive capsulitis. If range is maintained I would go for GH joint synovitis.

Steve

[Dicken Read]

Thank you Steve, this has been very helpful. Dicken

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