Variant origin of the bifurcated long head of biceps tendon - the case for supraspinatus.

Transcription

1 Variant origin of the bifurcated long head of biceps tendon - the case for supraspinatus. Poster No.: P-0066 Congress: ESSR 2015 Type: Authors: Keywords: DOI: Scientific Poster H. Madani 1, C. G. Boulet 2, M. Kichouh 2, M. Shahabpour 2, M. De Maeseneer 2 ; 1 London/UK, 2 Brussels/BE Education and training, Decision analysis, MR, Musculoskeletal system, Musculoskeletal soft tissue, Musculoskeletal joint /essr2015/P-0066 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Page 1 of 14

2 Purpose The application of magnetic resonance imaging (MRI) (including 3T MR arthrography and 3D reconstruction Gradient Echo sequences) to identify variant anatomy of the bifurcate long head of the biceps tendon (LHBT) from the supraspinatus. Page 2 of 14

3 Images for this section: Fig. 1: Illustrative diagram showing the normal configuration of the biceps tendons (light blue) including the normal attachment of the long head of biceps tendon (LHBT, origin from superior labrum and supra glenoid tubercle (dark blue), and normal short head (SHBT). Radiology, Royal Free Hospital - London/UK Page 3 of 14

4 Fig. 2: Illustrative diagram showing an example of the abnormal configuration of a bifid long head of biceps tendon (LHBT) and normal short head of biceps tendon (SHBT). Radiology, Royal Free Hospital - London/UK Page 4 of 14

5 Methods and Materials A retrospective electronic database search within a 3-year period was conducted through the radiology information system (RIS) of the department with specific search terms targeted at identify shoulder MRI and MR Arthrograms with bifurcate long head of the biceps (LHBT) within the reports. The terms included "bifid LHBT, double head of long head of bicep, double LHB and bifurcate long head". The shortlisted cases were independently reviewed in random order by three musculoskeletal consultant radiologists, specifically tasked to describe the nature and origin of the long head of biceps and any variant anatomy noticed. Any correlation and agreement between all three consultants were noted, including any comments pertaining to the supraspinatus as a likely origin of the tendon. Page 5 of 14

6 Results In the three year period, 12 cases of MRI shoulder (5 MRI and 7 MR arthrograms) containing bifurcate long head of the biceps tendon were identified. In 25% of cases (4 out of 12) there was 100% correlation that the minor cord of the bifurcate tendons originated from the supraspinatus. Other variant anatomy identified included capsular origins. Page 6 of 14

7 Images for this section: Fig. 3: Sequential coronal T1 fat-saturated arthrogram images of the shoulder showing a bifurcate long head of biceps tendon (LHBT) with a major (solid arrow head) and minor (hollow arrow head) components. The more lateral limb was considered to originate from the supraspinatus. Radiology Department, Universitair Ziekenhuis Brussel, Belgium Page 7 of 14

8 Fig. 5: Coronal T1 fat-saturated arthrogram images of the shoulder showing a bifurcate long head of biceps tendon (LHBT) arrow. Radiology Department, Universitair Ziekenhuis Brussels, Belgium Page 8 of 14

9 Fig. 6: Sequential axial T1 PD arthrogram images of the shoulder showing a bifurcate long head of biceps tendon (LHBT) (circle) with a major and minor limbs. The minor limb was considered to originate from the supraspinatus. Radiology Department, Universitair Ziekenhuis Brussels, Belgium Page 9 of 14

10 Fig. 7: Axial 3D high resolution (1mm) Gradient Echo, showing bifurcate long head of biceps tendons (LHBT) (arrow). The minor limbs were considered to fuse with and originate from the superspinatous (not shown) in 25% of cases. Radiology Department, Universitair Ziekenhuis Brussels, Belgium Page 10 of 14

11 Fig. 4: Axial T1 fat-saturated arthrogram, showing bifurcate long head of biceps tendons (LHBT) (arrow) of the shoulder. Radiology Department, Universitair Ziekenhuis Brussels, Belgium Page 11 of 14

12 Conclusion Understanding the full spectrum of possible anatomical findings is crucial in correct interpretation of shoulder imaging; avoiding misdiagnosis and unnecessary surgery. [1,2] Variations in the origin of the long head of the biceps tendon (LHBT) are well known; including intra-articular, extra-articular origins or congenital absence. [1,2] Incidence as high as 9.1% to 22.9% of accessory heads of long head of the biceps have been reported. [3] Described variant origins included from the pectoralis major tendon [4] and separate attachments to the supraglenoid tubercle and posterosuperior capsule and labrum. [5-6] In this small case series we highlight persuasive imaging evidence that the supraspinatus should also be considered as an alternative origin in variant anatomy. Further anatomical correlation is required but this finding may begin to explain the basis of increasing anecdotal evidence that these variants can be the cause of rotator cuff pain, degeneration or impingement. [7-9] Page 12 of 14

13 References 1. Wittstein J, Lassiter T Jr, Taylor D. Aberrant origin of the long head of the biceps: a case series. J shoulder Elbow Surg Mar;21(3): Cook TS, Syein JM, Simonson S, Kim W. Normal and variant anatomy of the shoulder on MRI. Magn Reson Imaging CLin N Am Aug;19(3):5 3. Sargon MF, Tuncali D, Celik HH. An unusual origin for the accessory head of biceps brachii muscle. Clin Anat. 1996; 9: Enad JG. Bifurcate origin of the long head of the biceps tendon. Arthroscopy. 2004;20: DePalma AF, Callery G, Bennett GA, authors. Shoulder joint: Variational anatomy and degenerative lesions of the shoulder joint. Instr Course Lect. 1949;6: Vangsness CT Jr, Jorgenson SS, Watson T, Johnson DL. The origin of the long head of the biceps from the scapula and glenoid labrum. An anatomical study of 100 shoulders. J Bone Joint Surg Br. 1994;76: Borghei P, Tehranzadeh, J. Bifurcation of the long head of the biceps brachii. Applied Radiology Radiolocal Case. October Accessed via website Vivek Pandey, Simon Nurettin van Laarhoven, Gaurav Arora, Sripathi Rao. Bifurcated intra-articular long head of biceps tendon. J Orthop Jul- Aug; 48(4): Samik Banerjee, Vipul R Patel. Anomalous biceps origin from the rotator cuff. Indian J Orthop Jan-Feb; 49(1): Page 13 of 14

14 Personal Information Dr Hardi madani is a 4th year specialist radiology registrar based at the London Deanery. This work was completed during a visiting MSK scholarship awarded by the ESR/ESOR in association with the ESSR. Page 14 of 14