Journal of Orthopaedic Science

, Volume 18, Issue 2, pp 238–244 | Cite as

Evidence of sympathetic innervation and α1-adrenergic receptors of the long head of the biceps brachii tendon

  • Theodoros Tosounidis
  • Constantine Hadjileontis
  • Christos Triantafyllou
  • Varvara Sidiropoulou
  • Antonios Kafanas
  • George Kontakis
Original Article



The primary purpose of this study was to investigate the sympathetic innervation of the long head of the biceps brachii tendon LHB via immunohistochemical staining for protein S-100 and neuropeptide Y (NPY) in patients with complex proximal humerus fractures, in individuals with chronic biceps tendinosis in the setting of large rotator cuff tears (RC), and in cadaveric samples with no previously reported shoulder pathology.


We investigated the presence of sympathetic innervation and α1-adrenergic receptors of the long head of the biceps brachii tendon (LHB) in patients with complex proximal humerus fractures and individuals with chronic biceps tendinosis in the setting of large rotator cuff tears (RC). The correlation of morphological features with immunohistochemical evidence of neural element presence was also investigated. Forty-one LHB tendon specimens were examined. Seventeen were harvested from patients who underwent hemiarthroplasty for proximal humerus fractures, 14 were from individuals with biceps tendinosis in the context of a large RC tear, and ten were from cadaveric controls with no previous shoulder pathology. Histologic examination was performed using hematoxylin and eosin. Immunohistochemistry was used to detect the expression of the protein S-100, neuropeptide Y, and α1-adrenergic receptors, as well as to characterize the potential neural differentiation of tendon cells.


A strong correlation between the expression of NPY/S-100, α1-adrenergic/S-100, and α1-adrenergic/NPY was found. The LHB tendon has sympathetic innervation and α1-adrenergic receptors in acute and chronic pathological conditions.


Our results provide useful guidance on the management of tendinosis and the handling of the LHB in hemiarthroplasties for fractures.


Rotator Cuff Sympathetic Innervation Proximal Humerus Fracture Tendon Tissue Tendon Cell 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



The authors, their immediate families, and any research foundations with which they are affiliated have not received any financial payments or other benefits from any commercial entity related to the subject of this article. The ethics committee of Iraklio University Hospital approved this study (protocol number 13541, 18/12/2007).


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Copyright information

© The Japanese Orthopaedic Association 2012

Authors and Affiliations

  • Theodoros Tosounidis
    • 1
  • Constantine Hadjileontis
    • 2
  • Christos Triantafyllou
    • 3
  • Varvara Sidiropoulou
    • 1
  • Antonios Kafanas
    • 2
  • George Kontakis
    • 1
  1. 1.University Hospital of HeraklionHeraklionGreece
  2. 2.Serres General HospitalSerresGreece
  3. 3.Informatics Centre of Secondary EducationSerresGreece

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