上腕二頭筋長頭腱の破格を伴う棘上筋腱腱内断裂の 1 例
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We report a patient with capsular origin of the long head of the biceps brachii tendon (LHB).<BR>A 45-year-old woman presented with approximately one month of right shoulder pain after a fall. Physical examination showed tenderness at the greater tuberosity and positive impingement sign. Active shoulder ROM of flexion, abduction, external rotation (arm at side/ 90°abd.), and internal rotation were 160°, 145°(with positive painful arc sign), 60°/ 90°, and L1 level respectively. Obvious weakness of cuff muscles was not recognized, but it slightly painful during muscle contraction. Both Speed's test and Yergason's test were negative. MRI showed intratendinous tear of the supraspinatus tendon (SSP). With a diagnosis of intratendinous tear of the SSP, three months of conservative treatment was not successful, and we performed arthroscopic surgery. Arthroscopic examination revealed an absence of origin of LHB on the supraglenoid tuberculum. The LHB was detected at the entrance into the intertubercular sulcus, which was incorporated into the capsule of the undersurface of the SSP adjacent to 1.5 cm proximaly to the entrance. We judged this LHB to be an anomaly but did not intervene, followed by arthroscopic subacromial decompression and rotator cuff repair. Our case was rare in literature and arthroscopic examination was useful for detection. Because of uncharacteristic attachment of this LHB, at the time of injury the eccentric force of the biceps brachii muscle worked as a shearing force to the SSP, and might have produced an intratendinous tear.
- 日本肩関節学会の論文
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