Skip to main content
SpringerLink
Log in

Long head biceps tendon instability: diagnostic performance of known and new MRI diagnostic signs

  • Scientific Article
  • Published:
Skeletal Radiology Aims and scope Submit manuscript

Abstract

Objective

The aim of this work was to evaluate the inter-observer agreement and diagnostic performance values of 7 MRI signs (3 known and 4 new) of long head biceps tendon instability.

Materials and methods

MRI of 86 patients were retrospectively evaluated. Inter-observer agreement and diagnostic performance of each diagnostic sign and of all combined signs (with the exception of detour sign) were tested for identification of biceps tendon instability, with arthroscopy as the reference standard.

Results

Agreement between expert operators was moderate to good. Sensitivity, specificity, and sign accuracy showed a variation respectively of the following: humeral chondral print 72–80%, 62–68%, and 70–76%; subchondral bone edema 24–31%, 84–97%, and 50%; biceps tendon angle 60–71%, 97–100%, and 74–81%, biceps tendon-groove distance 31–47%, 90–100%, and 56–64%; long head biceps subluxation/dislocation on axial plane 49–53%, 97–100%, and 66–70%; displacement sign 74–80%, 74–100%, and 74–87%; detour sign 51–64%, 58–81%, and 62–64%; and all signs 98–100%, 32–61%, and 75–86%.

Conclusion

These diagnostic signs, both known and new, individually and/or in combination, provide a valid tool in the MRI diagnosis of long head biceps tendon instability.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Lafosse L, Reiland Y, Baier GP, Toussaint B, Jost B. Anterior and posterior instability of the long head of the biceps tendon in rotator cuff tears: a new classification based on arthroscopic observations. Arthrosc J Arthrosc Relat Surg Elsevier. 2007;23:73–80.

    Article  Google Scholar 

  2. Cervilla V, Schweitzer ME, Ho C, Motta A, Kerr R, Resnick D. Medial dislocation of the biceps brachii tendon: appearance at MR imaging. Radiology. 1991;180:523–6.

    Article  CAS  Google Scholar 

  3. Anbar A, Emad Y, Zeinhom F, Ragab Y. Shoulder arthroscopy remains superior to direct MR arthrography for diagnosis of subtle rotator interval lesions. Eur J Orthop Surg Traumatol Springer. 2015;25:689–97.

    Article  Google Scholar 

  4. Kang Y, Lee JW, Ahn JM, Lee E, Kang HS. Instability of the long head of the biceps tendon in patients with rotator cuff tear: evaluation on magnetic resonance arthrography of the shoulder with arthroscopic correlation. Skeletal Radiol Springer. 2017;46:1335–42.

    Article  Google Scholar 

  5. Khil EK, Cha JG, Yi JS, Kim H-J, Min KD, Yoon YC, et al. Detour sign in the diagnosis of subluxation of the long head of the biceps tendon with arthroscopic correlation. Br J Radiol The British Institute of Radiology. 2017;90:20160375.

    Article  Google Scholar 

  6. De Maeseneer M, Boulet C, Pouliart N, Kichouh M, Buls N, Verhelle F, et al. Assessment of the long head of the biceps tendon of the shoulder with 3T magnetic resonance arthrography and CT arthrography. Eur J Radiol Elsevier. 2012;81:934–9.

    Article  Google Scholar 

  7. Spritzer CE, Collins AJ, Cooperman A, Speer KP. Assessment of instability of the long head of the biceps tendon by MRI. Skeletal Radiol Springer. 2001;30:199–207.

    Article  CAS  Google Scholar 

  8. Baptista E, Malavolta EA, Gracitelli MEC, Alvarenga D, Bordalo-Rodrigues M, Neto AAF, et al. Diagnostic accuracy of MRI for detection of tears and instability of proximal long head of biceps tendon: an evaluation of 100 shoulders compared with arthroscopy. Skeletal Radiol Springer. 2019;48:1723–33.

    Article  Google Scholar 

  9. Weishaupt D, Zanetti M, Tanner A, Gerber C, Hodler J. Lesions of the reflection pulley of the long biceps tendon: MR arthrographic findings. Invest Radiol LWW. 1999;34:463.

    Article  CAS  Google Scholar 

  10. Barile A, Lanni G, Conti L, Mariani S, Calvisi V, Castagna A, et al. Lesions of the biceps pulley as cause of anterosuperior impingement of the shoulder in the athlete: potentials and limits of MR arthrography compared with arthroscopy. Radiol Med. 2013;118:112–22.

    Article  CAS  Google Scholar 

  11. Schaeffeler C, Waldt S, Holzapfel K, Kirchhoff C, Jungmann PM, Wolf P, et al. Lesions of the biceps pulley: diagnostic accuracy of MR arthrography of the shoulder and evaluation of previously described and new diagnostic signs. Radiology. 2012;264:504–13.

    Article  Google Scholar 

  12. Walch G, Nové-Josserand L, Boileau P, Levigne C. Subluxations and dislocations of the tendon of the long head of the biceps. J Shoulder Elb Surg. 7:100–8.

  13. Lafosse L, Jost B, Reiland Y, Audebert S, Toussaint B, Gobezie R. Structural integrity and clinical outcomes after arthroscopic repair of isolated subscapularis tears. JBJS LWW. 2007;89:1184–93.

    Article  Google Scholar 

  14. Castagna A, Mouhsine E, Conti M, Vinci E, Borroni M, Giardella A, et al. Chondral print on humeral head: an indirect sign of long head biceps tendon instability. Knee Surgery, Sport Traumatol Arthrosc. 2007;15:645–8.

    Article  Google Scholar 

  15. Zappia M, Carfora M, Romano AM, Reginelli A, Brunese L, Rotondo A, et al. Sonography of chondral print on humeral head. Skelet Radiol. 2016;45:35–40.

    Article  Google Scholar 

  16. Buck FM, Dietrich TJ, Resnick D, Jost B, Pfi Rrmann CWA, Surgery O. Long biceps tendon : normal position, shape, and orientation in its groove in neutral position and external and internal rotation 1. Radiol n Radiol. 2011;261.

  17. Domos P, Neogi DS, Longo UG, Ahrens PM. The chondral print sign: what does it really mean? J shoulder Elb Surg. Elsevier. 2017;26:e188–92.

    Google Scholar 

  18. Patzer T, Lichtenberg S, Kircher J, Magosch P, Habermeyer P. Influence of SLAP lesions on chondral lesions of the glenohumeral joint. Knee Surgery, sport Traumatol Arthrosc. Springer. 2010;18:982–7.

    Google Scholar 

  19. Patzer T, Habermeyer P, Hurschler C, Bobrowitsch E, Paletta JR, Fuchs-Winkelmann S, et al. Increased glenohumeral translation and biceps load after SLAP lesions with potential influence on glenohumeral chondral lesions: a biomechanical study on human cadavers. Knee Surgery, Sport Traumatol Arthrosc Springer. 2011;19:1780–7.

    Article  CAS  Google Scholar 

  20. Koh K-H, Kim SC, Yoo JC. Arthroscopic evaluation of subluxation of the long head of the biceps tendon and its relationship with subscapularis tears. Clin Orthop Surg. 2017;9:332–9.

    Article  Google Scholar 

  21. Braun S, Horan MP, Elser F, Millett PJ. Lesions of the biceps pulley. Am J Sports Med Sage Publications Sage CA: Los Angeles, CA. 2011;39:790–5.

    Google Scholar 

  22. Malavolta EA, Assunção JH, Guglielmetti CLB, de Souza FF, Gracitelli MEC, Neto AAF. Accuracy of preoperative MRI in the diagnosis of disorders of the long head of the biceps tendon. Eur J Radiol Elsevier. 2015;84:2250–4.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy

    Marcello Zappia & Luca Brunese

  2. Musculoskeletal Radiology Unit, Varelli Institute, Naples, Italy

    Marcello Zappia

  3. Department of Radiology, Campolongo Hospital, Eboli, SA, Italy

    Marcello Zappia

  4. Department of Shoulder Surgery, Campolongo Hospital, Eboli, SA, Italy

    Francesco Ascione & Alfonso M. Romano

  5. Department of Orthopaedic and Traumatology Surgery, Ospedale Buon Consiglio Fatebenefratelli, Naples, Italy

    Francesco Ascione & Alfonso M. Romano

  6. Department of Radiology, Pineta Grande Hospital, Castel Volturno, CE, Italy

    Francesco Di Pietto

  7. Department of Radiology, University of Foggia, Foggia, Italy

    Michele Fischetti

  8. Humanitas Clinical and Research Center – IRCCS, Rozzano, MI, Italy

    Alessandro Castagna

  9. Department of Biomedical Sciences, Pieve Emanuele, Humanitas University, Milan, Italy

    Alessandro Castagna

Authors
  1. Marcello Zappia
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Francesco Ascione
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Francesco Di Pietto
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Michele Fischetti
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Alfonso M. Romano
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Alessandro Castagna
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Luca Brunese
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Marcello Zappia.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest. Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

The Local Institutional Review Board approved this retrospective study, and the need for patients’ informed consent was waived.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zappia, M., Ascione, F., Di Pietto, F. et al. Long head biceps tendon instability: diagnostic performance of known and new MRI diagnostic signs. Skeletal Radiol 50, 1863–1871 (2021). https://doi.org/10.1007/s00256-021-03710-1

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00256-021-03710-1

Keywords

Search

Navigation