title: Sentinel sign: a sign of biceps tendon which indicates the presence of subscapularis tendon rupture.
abstract: OBJECTIVE
  Subscapularis tendon ruptures, which are small in size, can be missed on CT or MRI imaging and are also difficult to diagnose by arthroscopy. Here we discuss a new sign of biceps tendon, which may point towards rupture of the subscapularis tendon. The biceps tendon may have scuffing, abrasion or partial tear of its anterior portion. We have named this as sentinel sign as it signals the presence of a coexisting subscapularis rupture.
  
  
  METHODS
  This study was a retrospective analysis of available arthroscopic rotator cuff repair surgery videos of 2009-2010. The videos were studied, and data recorded for number of cases showing the presence of sentinel sign and coexisting subscapularis rupture. Sensitivity, positive predictive value of the sign, was calculated.
  
  
  RESULTS
  Out of 330 available videos, 79 showed the presence of subscapularis rupture. Ten patients had a positive sentinel sign, but an intact biceps pulley that obscured the visualisation of the subscapularis tendon tear. This tear became apparent after removal of anterior part of biceps sling.
  
  
  CONCLUSIONS
  The presence of sentinel sign of the biceps tendon indicates the presence of a coexistent subscapularis rupture. If the rupture is not apparent, obscuring parts of the biceps sling should be removed to see the upper fibres of subscapularis tendon.
  
  
  METHODS
  Study of diagnostic test, Level III.
authors.affiliation: Mumbai Shoulder Institute, Mumbai, India. dip.it@me.com.
authors.forename: Dipit
authors.initials: D
authors.lastname: Sahu
authors.affiliation: Center for Shoulder, Elbow and Hand Surgery, Alps Surgery Institute, Clinique Generale, Annecy, France.
authors.forename: Robert
authors.initials: R
authors.lastname: Fullick
authors.affiliation: Center for Shoulder, Elbow and Hand Surgery, Alps Surgery Institute, Clinique Generale, Annecy, France.
authors.forename: Antonios
authors.initials: A
authors.lastname: Giannakos
authors.affiliation: Center for Shoulder, Elbow and Hand Surgery, Alps Surgery Institute, Clinique Generale, Annecy, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Lafosse
mesh_terms: D000328:Adult; D000368:Aged; D001182:Arthroscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D017006:Rotator Cuff / Q000601:surgery; D000070636:Rotator Cuff Injuries / Q000175:diagnosis* / Q000601:surgery; D012785:Shoulder Joint / Q000601:surgery; D014743:Videotape Recording
keywords: Arthroscopic sign; Biceps lesion; Sentinel sign; Subscapularis tear