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SLAP Lesion and Injury of the Proximal Portion of Long Head of Biceps Tendon in Elite Amateur Wrestlers

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Abstract

Background

Injuries to the proximal portion of the tendon of the long head of the biceps are challenging, and often only diagnosed at arthroscopy. However, it is important to be able to formulate a preoperative plan based on physical examination and imaging studies, so as to inform patients correctly, plan the likely procedure, and give indication to length and modalities of rehabilitation.

Materials and Methods

Eleven elite wrestlers who suffered their injury between 2008 and 2018 were investigated retrospectively. We aimed to identify an association between the mechanism and the symptoms of the biceps-labral complex injury.

Results

The injury was sustained at a mean age of 20.63 years, and most wrestlers were middle or light weight. All injuries occurred during shoulder movements in closed kinetic chain with the elbow extended, the forearm pronated and the shoulder slightly elevated. The surgical procedures performed were tenodesis in three wrestlers, reinsertion in seven wrestlers, and one tenotomy of the tendon of the long head of the biceps. The postoperative rehabilitation was shorter (1–3 month) in case of tenodesis or tenotomy, and markedly longer after reinsertion (6–9 months).

Conclusions

Injuries to the proximal part of long head of biceps tendon are relatively frequent in elite wrestlers, reflecting the high functional demands imposed on the upper limb. Though necessitating surgery, in these athletes, such injuries are not career ending, and most of our elite athletes returned to high performance levels after surgery.

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Abbreviations

ECh:

European championship

FS:

Freestyle

GR:

Greco-Roman style

LHBT:

Long head biceps tendon

SLAP:

Superior labrum anterior to posterior

WCh:

World championship

References

  1. Bisciotti, G. N., Quaglia, A., Belli, A., Carimati, G., & Volpi, P. (2016). No-holes transpectoral tenodesis technique vs tenotomy of the long head of the biceps brachii. Muscles, Ligaments and Tendons Journal,6(4), 427–432.

    Google Scholar 

  2. Gausden, E. B., Taylor, S. A., Ramkumar, P., Nwachukwu, B. U., Corpus, K., Rebolledo, B. J., et al. (2016). Tenotomy, tenodesis, transfer: a review of treatment options for biceps-labrum complex disease. The American Journal of Orthopedics,45(7), 503–511.

    Google Scholar 

  3. Taylor, S. A., & O’Brien, S. J. (2016). Clinically relevant anatomy and biomechanics of the proximal biceps. Clinics in Sports Medicine,35(1), 1–18.

    Article  CAS  Google Scholar 

  4. Weber, A. E., Kontaxis, A., O’Brien, S. J., & Bedi, A. (2014). The biomechanics of throwing: simplified and cogent. Sports Medicine and Arthroscopy Review,22(2), 72–79.

    Article  Google Scholar 

  5. Ge, H., Zhang, Q., Sun, Y., Li, J., Sun, L., & Cheng, B. (2015). Tenotomy or tenodesis for the long head of biceps lesions in shoulders: a systematic review and meta-analysis. PLoS ONE,10(3), e0121286.

    Article  Google Scholar 

  6. Delle Rose, G., Borroni, M., Silvestro, A., Garofalo, R., Conti, M., De Nittis, P., et al. (2012). The long head of biceps as a source of pain in active population: tenotomy or tenodesis? A comparison of 2 case series with isolated lesions. Musculoskeletal Surgery,96(Suppl 1), S47–S52.

    Article  Google Scholar 

  7. Morse, K. W., Eno, J. J., Altchek, D. W., & Dines, J. S. (2019). Injuries of the biceps and superior labral complex in overhead athletes. Current Reviews in Musculoskeletal Medicine,12(2), 72–79.

    Article  Google Scholar 

  8. Abdul-Rassoul, H., Defazio, M., Curry, E. J., Galvin, J. W., & Li, X. (2019). Return to sport after the surgical treatment of superior labrum anterior to posterior tears: a systematic review. Orthopaedic Journal of Sports Medicine,7(5), 2325967119841892.

    Article  Google Scholar 

  9. Ahmad, C. S. (2018). Editorial commentary: the shoulder biceps tendon and baseball continue their controversial relationship. Arthroscopy,34(3), 752–753.

    Article  Google Scholar 

  10. Li, X., Lin, T. J., Jager, M., Price, M. D., Deangelis, N. A., Busconi, B. D., et al. (2010). Management of type II superior labrum anterior posterior lesions: a review of the literature. Orthopedic Reviews (Pavia),2(1), e6.

    Article  Google Scholar 

  11. Snyder, S. J., Karzel, R. P., Del Pizzo, W., Ferkel, R. D., & Friedman, M. J. (1990). SLAP lesions of the shoulder. Arthroscopy,6(4), 274–279.

    Article  CAS  Google Scholar 

  12. Maffet, M. W., Gartsman, G. M., & Moseley, B. (1995). Superior labrum-biceps tendon complex lesions of the shoulder. American Journal of Sports Medicine,23(1), 93–98.

    Article  CAS  Google Scholar 

  13. Andrews, J. R., Carson, W. G., Jr., & McLeod, W. D. (1985). Glenoid labrum tears related to the long head of the biceps. American Journal of Sports Medicine,13(5), 337–341.

    Article  CAS  Google Scholar 

  14. Burkhart, S. S., & Morgan, C. D. (1998). The peel-back mechanism: its role in producing and extending posterior type II SLAP lesions and its effect on SLAP repair rehabilitation. Arthroscopy,14, 637–640.

    Article  CAS  Google Scholar 

  15. Thomas, R. E., & Zamanpour, K. (2018). Injuries in wrestling: systematic review. The Physician and Sportsmedicine,46(2), 168–196.

    Article  Google Scholar 

  16. Goodman, A. D., Twomey-Kozak, J., DeFroda, S. F., & Owens, B. D. (2018). Epidemiology of shoulder and elbow injuries in National Collegiate Athletic Association wrestlers, 2009–2010 through 2013–2014. The Physician and Sportsmedicine,46(3), 361–366.

    Article  Google Scholar 

  17. Jlid, M. C., Maffulli, N., Elloumi, M., Moalla, W., & Paillard, T. (2013). Rapid weight loss alters muscular performance and perceived exertion as well as postural control in elite wrestlers. Journal of Sports Medicine and Physical Fitness,53(6), 620–627.

    CAS  PubMed  Google Scholar 

  18. Maffulli, N. (1992). Making weight: a case study of two elite wrestlers. British Journal of Sports Medicine,26(2), 107–110.

    Article  CAS  Google Scholar 

  19. Shadgan, B., Molnar, S., Sikmic, S., & Chahi, A. (2017). Wrestling injuries during the 2016 Rio Olympic Games. British Journal of Sports Medicine,51, 387.

    Article  Google Scholar 

  20. Tangari, M., Carbone, S., Gallo, M., & Campi, A. (2011). Long head of the biceps tendon rupture in professional wrestlers: treatment with a mini-open tenodesis. Journal of Shoulder and Elbow Surgery,20(3), 409–413.

    Article  Google Scholar 

  21. Maffulli, N., Longo, U. G., Gougoulias, N., Caine, D., & Denaro, V. (2011). Sport injuries: a review of outcomes. British Medical Bulletin,97, 47–80.

    Article  Google Scholar 

  22. Shadgan, B., Feldman, B. J., & Jafari, S. (2010). Wrestling injuries during the 2008 Beijing Olympic Games. American Journal of Sports Medicine,38(9), 1870–1876.

    Article  Google Scholar 

  23. Myers, R. J., Linakis, S. W., Mello, M. J., & Linakis, J. G. (2010). Competitive wrestling-related injuries in school aged athletes in US emergency departments. Western Journal of Emergency Medicine,11(5), 442–449.

    PubMed  PubMed Central  Google Scholar 

  24. Lorish, T. R., Rizzo, T. D., Jr., Ilstrup, D. M., & Scott, S. G. (1992). Injuries in adolescent and preadolescent boys at two large wrestling tournaments. American Journal of Sports Medicine,20(2), 199–202.

    Article  CAS  Google Scholar 

  25. Osti, L., Soldati, F., Cheli, A., Pari, C., Massari, L., & Maffulli, N. (2012). Biceps instability and Slap type II tear in overhead athletes. Muscles, Ligaments and Tendons Journal,2(4), 258–266.

    PubMed  Google Scholar 

  26. Lepore, L., Lepore, S., & Maffulli, N. (1995). Osteoid osteoma of the clavicle. Bulletin/Hospital for Joint Diseases,54(1), 43–45.

    CAS  Google Scholar 

  27. Stetson, W. B., Polinsky, S., Morgan, S. A., Strawbridge, J., & Carcione, J. (2019). Arthroscopic repair of type II SLAP lesions in overhead athletes. Arthroscopy Techniques,8(7), e781–e792.

    Article  Google Scholar 

  28. Powell, S. E., Nord, K. D., & Ryu, R. K. N. (2012). The diagnosis, classification and treatment of SLAP lesions. Operative Techniques in Sports Medicine,20(1), 46–56.

    Article  Google Scholar 

  29. Bennett, W. F. (1998). Specificity of the Speed’s test: arthroscopic technique for evaluating the biceps tendon at the level of the bicipital groove. Arthroscopy,14(8), 789–796.

    Article  CAS  Google Scholar 

  30. Gill, H. S., El Rassi, G., Bahk, M. S., Castillo, R. C., & McFarland, E. G. (2007). Physical examination for partial tears of the biceps tendon. American Journal of Sports Medicine,35(8), 1334–1340.

    Article  Google Scholar 

  31. Ben Kibler, W., Sciascia, A. D., Hester, P., Dome, D., & Jacobs, C. (2009). Clinical utility of traditional and new tests in the diagnosis of biceps tendon injuries and superior labrum anterior and posterior lesions in the shoulder. American Journal of Sports Medicine,37(9), 1840–1847.

    Article  CAS  Google Scholar 

  32. Dinauer, P. A., Flemming, D. J., Murphy, K. P., & Doukas, W. C. (2007). Diagnosis of superior labral lesions: comparison of noncontrast MRI with indirect MR arthrography in unexercised shoulders. Skeletal Radiology,36(3), 195–202.

    Article  Google Scholar 

  33. Connell, D. A., Potter, H. G., Wickiewicz, T. L., Altchek, D. W., & Warren, R. F. (1999). Noncontrast magnetic resonance imaging of superior labral lesions 102 cases confirmed at arthroscopic surgery. The American Journal of Sports Medicine,27(2), 208–213.

    Article  CAS  Google Scholar 

  34. Holzapfel, K., Waldt, S., Bruegel, M., Paul, J., Heinrich, P., Imhoff, A. B., et al. (2010). Inter- and intraobserver variability of MR arthrography in the detection and classification of superior labral anterior posterior (SLAP) lesions: evaluation in 78 cases with arthroscopic correlation. European Radiology,20(3), 666–673.

    Article  Google Scholar 

  35. Sodha, S., Srikumaran, U., Choi, K., Borade, A. U., & McFarland, E. G. (2017). Clinical assessment of the dynamic labral shear test for superior labrum anterior and posterior lesions. American Journal of Sports Medicine,45(4), 775–781.

    Article  Google Scholar 

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Acknowledgements

Gábor Martin UWW photographer.

Author information

Authors and Affiliations

  1. Department of Traumatology, Medical Centre Hungarian Defence Forces, Budapest, Hungary

    Szabolcs Molnár & Attila Bozsik

  2. University of Physical Education, Budapest, Hungary

    Szabolcs Molnár

  3. Department of Orthopedics, University of Debrecen, Debrecen, Hungary

    Zsolt Hunya

  4. Department of Sports Surgery, National Institute for Sports Medicine, Budapest, Hungary

    Attila Pavlik

  5. Department of Orthopaedics, University of British Columbia, Vancouver, Canada

    Babak Shadgan

  6. Department of Musculoskeletal Disorder, Faculty of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy

    Nicola Maffulli

  7. Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, 275 Bancroft Road, London, E1 4DG, UK

    Nicola Maffulli

  8. School of Pharmacy and Bioengineering, Keele University School of Medicine, Thornburrow Drive, Stoke on Trent, UK

    Nicola Maffulli

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  1. Szabolcs Molnár
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Corresponding author

Correspondence to Nicola Maffulli.

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Ethical Approval

All the procedures described in the present study were approved by our local ethics committee.

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The authors certify that they have obtained all appropriate patient consent forms. In the form the patients have given his/her consent for his/her images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

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Molnár, S., Hunya, Z., Pavlik, A. et al. SLAP Lesion and Injury of the Proximal Portion of Long Head of Biceps Tendon in Elite Amateur Wrestlers. JOIO 54, 310–316 (2020). https://doi.org/10.1007/s43465-020-00041-6

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  • DOI: https://doi.org/10.1007/s43465-020-00041-6

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