Original Contribution
Ultrasound-Guided Injection for the Biceps Brachii Tendinitis: Results and Experience

https://doi.org/10.1016/j.ultrasmedbio.2011.02.014Get rights and content

Abstract

The purpose of this study was to identify the results of ultrasound-guided injection of corticosteroid for biceps brachii tendinitis. In this randomized and prospective study, we evaluated 45 patients who were treated by free-hand injection without ultrasound guidance (group A) and 53 patients who were treated by ultrasound-guided injection (group B). The mean age was 47 y (range, 28 to 72). The average follow-up was 33 weeks (range, 24 to 56). The visual analog scale score decreased from 7.1 ± 2.3 before injection to 4.2 ± 3.1 at follow-up in group A and from 6.9 ± 2.6 to 2.1 ± 1.9 in group B (p < 0.05). The Constant-Murley score improved from 31.4 ± 11.6 before injection to 73.5 ± 19.2 at follow-up in group A and from 32.5 ± 14.7 to 85.5 ± 10.3 (p < 0.01). The ultrasound-guided injection therefore demonstrated a statistically significantly greater degree of pain relief. However, the outcome of injection was not satisfactory for the patients who demonstrated severely frayed tendons at arthroscopy. There were no complications related to the injection in both groups. Corticosteroid injection under ultrasound guidance is a safe and well-tolerated procedure with a satisfactory rate of symptom relief in patients with biceps brachii tendinitis. (E-mail:[email protected])

Introduction

The tendon of the long head of the biceps brachii is commonly involved in pathological processes and has been a recognized cause of shoulder pain and dysfunction. However, the treatment of biceps brachii tendinitis remains controversial. Some authors believe that treatment of the primary disease may entail biceps tenodesis; others suggest biceps tendinopathy is the result of an ongoing subacromial impingement syndrome. Some authors have reported favorable results from surgeries with tenodesis or tenotomy (Checchia et al., 2005, Gill et al., 2001; Edwards and Walch 2002). There are also reports showing 84% failure rates for tenodesis (Becker and Cofield 1989) and 35% for tenotomy (Kelly et al. 2005). Moreover, tenodesis or tenotomy may produce proximal migration of the humeral head from the loss of the depressing function provided by the intra-articular portion of the biceps brachii tendon (Kumar et al., 1989, Rodosky et al., 1994).

Many nonoperative treatments including local anesthetic and steroid injections have been advocated for the treatment of biceps brachii tendinitis (Morrison et al., 1997, Petri et al., 1987). To achieve maximum benefit, steroid should be injected into the tendon sheath only and intratendinous injection should be avoided. This injection is technically difficult to achieve. Many articles have described that the ultrasound-guided interventions are safe, effective and accurate because of the lack of ionizing radiation and dynamic visualization in multiple planes (Holm 1998).

However, a study comparing ultrasound-guided injection and free-hand injection for the long head of biceps brachii tendonitis has not been performed. In this article, we report our experience in ultrasound-guided injection for patients with biceps brachii tendinitis.

Section snippets

Patients

From February 2008 to March 2010, there were 1532 patients who came to our clinic center with shoulder pain. There were only 98 patients with isolated biceps brachii tendinitis who were included in our study. The criteria for the patients in our study were: (i) History of shoulder or upper extremity pain that lasted for more than three months, (ii) local tenderness over the brachial bicipital groove, (iii) bicipital resistance test and Yergason’s test caused pain in the region of brachial

Results

There was no significant difference between the two groups in age, gender and weight. For the procedure of injection, the mean frequency of puncture (i.e., number of skin punctures at one injection session) was 3.6 times in group A and one time in group B. All of the 98 patients were available for follow-up at an average of 33 weeks (range, 24 to 56). There were 36 patients in group A and 12 patients in group B who underwent repeated injection (p < 0.05) (Table 2).

The mean follow-up time was 31

Discussion

The tendon of the long head of the biceps brachii can be a significant source of morbidity in the diseased shoulder and has drawn increasing attention during shoulder treatment. Long head of biceps brachii pathology can be classified as occurring in isolation or in association with other lesions (Habermeyer and Walch 1996). The precise definition of biceps brachii tendinitis remains elusive. From a purist perspective, primary biceps brachii tendinitis is defined as inflammation of the brachial

References (17)

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