scholarly journals Molecular Pattern and Density of Axons in the Long Head of the Biceps Tendon and the Superior Labrum

2019 ◽  
Vol 8 (12) ◽  
pp. 2129
Author(s):  
Sandra Boesmueller ◽  
Roland Blumer ◽  
Bernhard Gesslbauer ◽  
Lena Hirtler ◽  
Christian Fialka ◽  
...  
Keyword(s):  
Biceps Tendon ◽  
Total Shoulder Arthroplasty ◽  
Absolute Number ◽  
Nociceptive Transmission ◽  
Superior Labrum ◽  
Molecular Pattern ◽  
Slap Repair ◽  
Nociceptive Fibers ◽  
Long Head ◽  
Reverse Total Shoulder

The type II superior labrum anterior to posterior (SLAP) repair is a viable option in young and demanding patients, although a prolonged period of pain after surgery is described in the literature. The reason for this fact remains unknown. Thus, the purpose of this study was to investigate the molecular pattern of the biceps tendon anchor, where the sutures for repair are placed. The long head of the biceps tendon (LHBT), including the superior labrum, was dissected in the setting of reverse total shoulder arthroplasty. Immunohistochemical staining was performed using neurofilament (NF) and protein gene product (PGP) 9.5 as general markers for axons and calcitonin gene-related peptide (CGRP) and substance P for nociceptive transmission. A quantitative assessment was performed according to the two regions of interest (ROIs), i.e., the anterosuperior (ROI I) and the posterosuperior labrum (ROI II). Eleven LHBTs with a mean age of 73 years (range: 66–87 years) were harvested intraoperatively. Six LHBTs were gained in osteoarthrosis and five in fractures. We found an inhomogeneous distribution of axons in the anterosuperior and posterosuperior parts of the labrum in all the specimens irrespective of the age, gender, and baseline situation. There was a significantly higher number (p < 0.01) as well as density (p < 0.001) of NF-positive axons in ROI I compared to ROI II. Nociceptive fibers were always found along the NF-positive axons. Thus, our results indicate that the biceps tendon anchor itself is a highly innervated region comprising different nerve qualities. The anterosuperior labrum contains a higher absolute number and density of axons compared to the posterosuperior parts. Furthermore, we were able to prove the presence of nociceptive fibers in the superior labrum. The results obtained in this study could contribute to the variability of pain after SLAP repair.

Dynamic Ultrasonography of the Intra-Articular Long Head Biceps Tendon and Superior Labrum

2016 ◽  
Vol 95 (11) ◽  
pp. e183-e184 ◽  
Author(s):  
Ming-Yen Hsiao ◽  
Chen-Yu Hung ◽  
Ke-Vin Chang ◽  
Levent Özçakar
Keyword(s):  
Biceps Tendon ◽  
Superior Labrum ◽  
Long Head Biceps Tendon ◽  
Long Head ◽  
Long Head Biceps

scholarly journals Structural and molecular characteristics of axons in the long head of the biceps tendon

2019 ◽  
Vol 380 (1) ◽  
pp. 43-57
Author(s):  
Roland Blumer ◽  
Sandra Boesmueller ◽  
Bernhard Gesslbauer ◽  
Lena Hirtler ◽  
Daniel Bormann ◽  
...  
Keyword(s):  
Sympathetic Nerve ◽  
Biceps Tendon ◽  
Nerve Fibers ◽  
Molecular Characteristics ◽  
Neuronal Markers ◽  
Sympathetic Nerve Fibers ◽  
Molecular Features ◽  
Unmyelinated Axons ◽  
Nociceptive Fibers ◽  
Long Head

AbstractThe innervation of the long head of the biceps tendon (LHBT) is not sufficiently documented. This is a drawback since pathologies of the LHBT are a major source of shoulder pain. Thus, the study aimed to characterize structurally and molecularly nervous elements of the LHBT. The proximal part of 11 LHBTs was harvested intraoperatively. There were 8 female and 3 male specimens. Age ranged from 66 to 86 years. For structural analyses, nervous elements were viewed in the transmission electron microscope. For molecular characterization, we used general neuronal markers including antibodies against neurofilament and protein gene product 9.5 (PGP9.5) as well as specific neuronal markers including antibodies against myelin basic protein (MBP), calcitonin gene-related product (CGRP), substance P (SP), tyrosine hydroxylase (TH), and growth-associated protein 43 (GAP43). Anti-neurofilament and anti-PGP9.5 visualized the overall innervation. Anti-MBP visualized myelination, anti-CGRP and anti-SP nociceptive fibers, anti-TH sympathetic nerve fibers, and anti-GAP43 nerve fibers during development and regeneration. Immunolabeled sections were analyzed in the confocal laser scanning microscope. We show that the LHBT contains unmyelinated as well as myelinated nerve fibers which group in nerve fascicles and follow blood vessels. Manny myelinated and unmyelinated axons exhibit molecular features of nociceptive nerve fibers. Another subpopulation of unmyelinated axons exhibits molecular characteristics of sympathetic nerve fibers. Unmyelinated sympathetic fibers and unmyelinated nociceptive fibers express proteins that are found during development and regeneration. Present findings support the hypothesis that ingrowth of nociceptive fibers are the source of chronic tendon pain.

Heterotopic ossification of the long head of the triceps after reverse total shoulder arthroplasty

2016 ◽  
Vol 25 (11) ◽  
pp. 1810-1815 ◽  
Author(s):  
Jia-Wei Kevin Ko ◽  
Jeffrey D. Tompson ◽  
Daniel S. Sholder ◽  
Eric M. Black ◽  
Joseph A. Abboud
Keyword(s):  
Heterotopic Ossification ◽  
Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty ◽  
Reverse Total Shoulder Arthroplasty ◽  
Long Head ◽  
Reverse Total Shoulder

scholarly journals Superior labrum almost always tears following subscapularis injuries

2017 ◽  
Vol 5 (2_suppl2) ◽  
pp. 2325967117S0006
Author(s):  
Mehmet Çetinkaya ◽  
Muhammet Baybars Ataoğlu ◽  
Mustafa Özer ◽  
Tacettin Ayanoğlu ◽  
Ahmet Yiğit Kaptan ◽  
...  
Keyword(s):  
Shoulder Arthroscopy ◽  
Biceps Tendon ◽  
Slap Lesion ◽  
Subscapularis Tendon ◽  
Strongly Correlated ◽  
Subscapularis Tear ◽  
Slap Lesions ◽  
Superior Labrum ◽  
Medial Support ◽  
Long Head

Purpose and Hypothesis: The subscapularis tendon is the major medial support of the long head of biceps tendon (LHBT). Thus, tears of subscapularis may cause biceps tendon subluxation or dislocation. A subluxated biceps tendon may cause a superior labrum injury because of the changed direction of the biceps tendon pulling vector. The purpose of this study is to express the frequency of superior labrum anterior posterior (SLAP) lesions accompanying subscapularis tears. Methods: The digital files of 2010 patients who underwent shoulder arthroscopy were reviewed retrospectively. 141 videos of 141 patients with subscapularis tear were examined in terms of superior labrum and biceps tendon injuries by one of the authors in this study. The results were compared with those of all the 2010 patients who underwent shoulder arthroscopy for any reason. The statistical analysis was made with a statistics programme by the Independent Samples T-Test. Results: There were 113 videos on which the superior labrum and LHBT could be examined precisely. Mean age was 57.8 and 66% of the patients were female. 96.4% of the 113 patients were having a SLAP lesion. 10.6% of those were SLAP I and 89.4% were SLAP II lesion. Out of 2010 patients, the SLAP lesion ratio was 32.2% of which 4.9% were SLAP I. That difference between the patients with and without subscapularis tear was statistically significant. Conclusions: Following the loss of medial support, the LHBT and its pulling vector subluxate anteriorly resulting in a tear of the superior labrum from anterior to posterior. In this study, SLAP lesions were strongly correlated with subscapularis tears as well. Furthermore, the synovial hypertrophy initiated after a superior labrum pathology at superior aspect of the glenoid spreads over the LHBT. An inflamed LHBT firstly degenerates, and then ruptures. According to this study, tears of subscapularis should be repaired when encountered in order to prevent the upcoming secondary intra-articular disorders. [Figure: see text]

scholarly journals Neurofilament distribution in the superior labrum and the long head of the biceps tendon

2017 ◽  
Vol 12 (1) ◽  
Author(s):  
Sandra Boesmueller ◽  
Antal Nógrádi ◽  
Patrick Heimel ◽  
Christian Albrecht ◽  
Sylvia Nürnberger ◽  
...  
Keyword(s):  
Biceps Tendon ◽  
Superior Labrum ◽  
Long Head

scholarly journals Treatment of SLAP Lesions

2018 ◽  
Vol 12 (1) ◽  
pp. 288-294
Author(s):  
Apostolos Stathellis ◽  
Emmanouil Brilakis ◽  
Jim-Dimitris Georgoulis ◽  
Emmanouil Antonogiannakis ◽  
Anastasios Georgoulis
Keyword(s):  
Biceps Tendon ◽  
Surgical Techniques ◽  
Slap Lesion ◽  
Everyday Clinical Practice ◽  
Postoperative Rehabilitation ◽  
Excellent Outcome ◽  
Slap Lesions ◽  
Superior Labrum ◽  
The Everyday ◽  
Long Head

Background: The surgical treatment of a Superior Labrum Anterior and Posterior (SLAP) lesion becomes more and more frequent as the surgical techniques, the implants and the postoperative rehabilitation of the patient are improved and provide in most cases an excellent outcome. Objective: However, a standard therapy of SLAP lesions in the shoulder surgery has not been established yet. An algorithm on how to treat SLAP lesions according to their type and data on the factors that influence the surgical outcome is essential for the everyday clinical practice. Method: In this article, a retrospective evaluation of patients with SLAP lesion, treated surgically in our orthopaedic clinic was conducted. Results: According to the clinical outcome and our experience with the surgical therapy of SLAP lesions we demonstrate an algorithm on the proper therapeutic approach. Conclusion: SLAP I lesions are treated with debridement. Most controversies concern patients with SLAP II lesions, whose therapy is either fixation of the superior labrum or tenotomy/tenodesis of the long head of the biceps tendon. For patients with SLAP III or IV lesions the most commonly accepted approach is tenotomy or tenodesis of the long head of biceps tendon.

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