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. 2009 Oct;3(4):80-4.
doi: 10.4103/0973-6042.63212.

Dynamic ultrasound assessment in the diagnosis of intra-articular entrapment of the biceps tendon (hourglass biceps): A preliminary investigation

N Pujol  1 , R Hargunani, S Gadikoppula, B Holloway, P M Ahrens
Affiliations

Dynamic ultrasound assessment in the diagnosis of intra-articular entrapment of the biceps tendon (hourglass biceps): A preliminary investigation

N Pujol et al. Int J Shoulder Surg. 2009 Oct.

Abstract

Background: The hourglass biceps, an intra-articular entrapment of the long head of the biceps (LHB), is a possible diagnosis in cases of shoulder pain associated with loss of passive elevation.

Purpose: The objective of this study is to investigate the role of dynamic ultrasound (U/S) in determining the diagnosis of the hourglass biceps lesion.

Materials and methods: A prospective cohort of 16 patients with the clinical suspicion of an hourglass lesion, a preoperative ultrasound, and a confirmed hourglass LHB at surgery, were included in the study. Eight patients had preoperative dynamic ultrasound assessment of the LHB, and eight had standard ultrasound investigations and served as a control group.

Results: Dynamic ultrasound accurately diagnosed an hourglass biceps in three out of eight cases. LHB hypertrophy was demonstrated in five out of eight cases with U/S and three out of eight cases with standard U/S. All patients were treated by excision of the intra-articular portion of the LHB, 15 by bipolar tenotomy, and one by LHB tenodesis.

Conclusions: Dynamic ultrasound shows promise in improving the accuracy in diagnosis of LHB hypertrophy and the Hourglass lesion.

Level of evidence: III (Consecutive case-control study investigating a diagnostic test).

Keywords: Long head of biceps; hourglass; ultrasound.

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Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1
Figure 1
Illustration of a hypertrophic LHB with the arm at the side
Figure 2
Figure 2
Illustration of intra-articular buckling of a hypertrophic LHB with shoulder elevation
Figure 3
Figure 3
Ultrasound image of a longitudinal view of the LHB at rest
Figure 4
Figure 4
Ultrasound image of a longitudinal view of the LHB in abduction, demonstrating increased tendon diameter
Figure 5
Figure 5
Clinical photographs demonstrating the ultrasound probe position, with the arm at the side (a), and on active abduction (b)
Figure 6
Figure 6
Arthroscopic photograph of LHB buckling during an hourglass test
See this image and copyright information in PMC

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