Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 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.

PubMed Disclaimer

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

References

    1. Kumar VP, Satku K. Tenodesis of the long head of the biceps brachii for chronic bicipital tendinitis: Long-term results. J Bone Joint Surg Am. 1990;72:789–90. - PubMed
    1. Toshiaki A, Itoi E, Minagawa H, Yamamoto N, Tuoheti Y, Seki N, et al. Cross-sectional area of the tendon and the muscle of the biceps brachii in shoulders with rotator cuff tears: A study of 14 cadaveric shoulders. Acta Orthop. 2005;76:509–12. - PubMed
    1. Walch G, Nové-Josserand L, Boileau P, Levigne C. Subluxations and dislocations of the tendon of the long head of the biceps. J Shoulder Elbow Surg. 1998;7:100–8. - PubMed
    1. Boileau P, Ahrens PM, Hatzidakis AM. Entrapment of the long head of the biceps tendon: The hourglass biceps: A cause of pain and locking of the shoulder. J Shoulder Elbow Surg. 2004;13:249–57. - PubMed
    1. Lee HS, Joo KB, Park CK, Kim YS, Jeong WK, Kim YS, et al. Sonography of the shoulder after arthrography (arthrosonography): Preliminary results. J Clin Ultrasound. 2002;30:23–32. - PubMed

LinkOut - more resources