title: Diagnostic glenohumeral arthroscopy fails to fully evaluate the biceps-labral complex.
abstract: OBJECTIVE
  The purpose of this study was to define the limits of diagnostic glenohumeral arthroscopy and determine the prevalence and frequency of hidden extra-articular "bicipital tunnel" lesions among chronically symptomatic patients.
  
  
  METHODS
  Eight fresh-frozen cadaveric specimens underwent diagnostic glenohumeral arthroscopy with percutaneous tagging of the long head of the biceps tendon (LHBT) during maximal tendon excursion. The percentage of visualized LHBT was calculated relative to the distal margin of subscapularis tendon and the proximal margin of the pectoralis major tendon. Then, a retrospective review of 277 patients who underwent subdeltoid transfer of the LHBT to the conjoint tendon were retrospectively analyzed for lesions of the biceps-labral complex. Lesions were categorized by anatomic location (inside, junctional, or bicipital tunnel). Inside lesions were labral tears. Junctional lesions were LHBT tears visualized during glenohumeral arthroscopy. Bicipital tunnel lesions were extra-articular lesions hidden from view during standard glenohumeral arthroscopy.
  
  
  RESULTS
  Seventy-eight percent of LHBT were visualized relative to the distal margin of the subscapularis tendon and only 55% relative to the proximal margin of the pectoralis major tendon. No portion of the LHBT inferior to the subscapularis tendon was visualized. Forty-seven percent of patients had hidden bicipital tunnel lesions. Scarring was most common and accounted for 48% of all such lesions. Thirty-seven percent of patients had multiple lesion locations. Forty-five percent of patients with junctional lesions also had hidden bicipital tunnel lesions. The only offending lesion was in the bicipital tunnel for 18% of patients.
  
  
  CONCLUSIONS
  Diagnostic glenohumeral arthroscopy fails to fully evaluate the biceps-labral complex because it visualizes only 55% of the LHBT relative to the proximal margin of the pectoralis major tendon and did not identify extra-articular bicipital tunnel lesions present in 47% of chronically symptomatic patients.
  
  
  METHODS
  Level IV, therapeutic case series and cadaveric study.
authors.affiliation: Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York, U.S.A.. Electronic address: samueltaylor.md@gmail.com.
authors.forename: Samuel A
authors.initials: SA
authors.lastname: Taylor
authors.affiliation: Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York, U.S.A.
authors.forename: M Michael
authors.initials: MM
authors.lastname: Khair
authors.affiliation: Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York, U.S.A.
authors.forename: Lawrence V
authors.initials: LV
authors.lastname: Gulotta
authors.affiliation: Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York, U.S.A.
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Pearle
authors.affiliation: Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York, U.S.A.
authors.forename: Nikolas J
authors.initials: NJ
authors.lastname: Baret
authors.affiliation: Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York, U.S.A.
authors.forename: Ashley M
authors.initials: AM
authors.lastname: Newman
authors.affiliation: Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York, U.S.A.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Dy
authors.affiliation: Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York, U.S.A.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: O'Brien
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001182:Arthroscopy; D002102:Cadaver; D003951:Diagnostic Errors; D051445:Fibrocartilage / Q000473:pathology* / Q000601:surgery; D006801:Humans; D012189:Retrospective Studies; D012785:Shoulder Joint / Q000473:pathology* / Q000601:surgery*; D013710:Tendons / Q000473:pathology / Q000601:surgery