Estudo da correlação das lesões na cabeça longa do bíceps e no manguito rotador - exame físico, ressonância magnética e artroscopia

• Ano de defesa: 2018
• Autor(a) principal: Carvalho, Cassiano Diniz [UNIFESP]
• Tipo de documento: Dissertação
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Federal de São Paulo (UNIFESP)
• Palavras-chave em Português: Lesions head of the biceps; Ratator cuff lesion; Magnetic resonance arthroscopic; Ressonância magnética artroscopica; Lesão na cabeça longa do bíceps; Lesão manguito eotador
• Link de acesso: https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=7307268; https://repositorio.unifesp.br/handle/11600/52139

Introduction: The long head of the biceps tendon is an anatomical structure that has been studied extensively over the years and is still subject of much controversy. Its exact role in stabilizing the glenohumeral joint, as well as the cause of shoulder pain and its relation to rotator cuff injuries, is still a source of frequent questions in the medical literature. Objective: To identify the clinical, radiological, and arthroscopic correlation of the long head of the biceps tendon injury and its influence in the patient's complaint of pain when associated with rotator cuff lesion. Method: Between April and December of 2013 56 patients were included in this research. Among them, six were excluded, the magnetic resonance imaging of two was incomplete, three didn’t presented injury of the long head of the biceps tendon at intraoperative, and one patient did not agree to sign the informed consent form. Considering that, 50 patients were evaluated, among which 38 (76%) were female and 12 (24%) were male, with the mean age of 65,1 years. All the patients were operated by the Shoulder and Elbow Group from Sports Medicine Discipline of the Department of Orthopaedics and Traumatology of Federal University of São Paulo. They were submitted to repair of the rotator cuff lesion and had clinical, radiological and/or arthroscopic evidence of injury of the long head of the biceps tendon. The patients were evaluated through a preoperative questionnaire which was completed by the surgeon after the surgical procedure. The analyzes were performed by SPSS® software version 18, adopting the significance level of 5%. Results: There was an significant association between the presence of pain on palpation of the bicipital groove and the partial lesion of a high degree (partial rupture of the tendon affecting more than 50% of the tendon) in arthroscopy (p=0.003). It was observed that 83% of the patients with pain in the biceps groove on palpation, presented a significant lesion of the long head of the biceps tendon, that is, an involvement greater than 50% of the thickness of the tendon. In this perspective, patients with this positive test have a 1.7-fold higher risk of having a significant lesion when compared to patients who present negative test. We also found an association between the high grade lesion of the long head of the biceps tendon and supraspinatus muscle tendon lesion (p<0,05). Each centimeter of the supraspinatus muscle tendon lesion represents a 1.7-fold greater risk for the patient of a high-grade long head of the biceps tendon injury. Conclusion: The pain in the anterior region of the shoulder, verified in the physical examination by means of palpation of the bicipital groove, may be related to the lesions of the long head of the biceps tendon that affect more than 50% of the thickness of the same. The surgeon must be prepared to address the injury intraoperatively if the suspicion is confirmed. Magnetic resonance imaging is a very sensitive exam, but not much specific to the intra-articular injury of the long head of the biceps. Rotator cuff injury and its size are a risk factor for high-grade long head of the biceps tendon injury, considering the age range from 50 to 80 years.