title: Shoulder Arthroscopy Does Not Adequately Visualize Pathology of the Long Head of Biceps Tendon.
abstract: BACKGROUND
  Pulling the long head of the biceps tendon into the joint at arthroscopy is a common method for evaluation of tendinopathic lesions. However, the rate of missed diagnoses when using this technique is reported to be as high as 30% to 50%.
  
  
  OBJECTIVE
  Tendon excursion achieved using a standard arthroscopic probe does not allow adequate visualization of extra-articular sites of predilection of tendinopathy.
  
  
  METHODS
  Descriptive laboratory study.
  
  
  METHODS
  Seven forequarter amputation cadaveric specimens were evaluated. The biceps tendon was tagged to mark the intra-articular length and the maximum excursions achieved using a probe and a grasper in both beach-chair and lateral positions. Statistical analyses were performed using analysis of variance to compare means.
  
  
  RESULTS
  The mean intra-articular and extra-articular lengths of the tendons were 23.9 and 82.3 mm, respectively. The length of tendon that could be visualized by pulling it into the joint with a probe through the anterior midglenoid portal was not significantly different when using either lateral decubitus (mean ± SD, 29.9 ± 3.89 mm; 95% CI, 25.7-34 mm) or beach-chair positions (32.7 ± 4.23 mm; 95% CI, 28.6-36.8 mm). The maximum length of the overall tendon visualized in any specimen using a standard technique was 37 mm. Although there was a trend to greater excursion using a grasper through the same portal, this was not statistically significant. However, using a grasper through the anterosuperior portal gave a significantly greater mean excursion than any other technique (46.7 ± 4.31 mm; 95% CI, 42.6-50.8 mm), but this still failed to allow evaluation of Denard zone C.
  
  
  CONCLUSIONS
  Pulling the tendon into the joint with a probe via an anterior portal does not allow visualization of distal sites of predilection of pathology. Surgeons should be aware that this technique is inadequate and can result in missed diagnoses.
  
  
  CONCLUSIONS
  This study demonstrates that glenohumeral arthroscopy does not allow visualization of common areas of pathology of the long head of the biceps tendon.
authors.affiliation: The Pam Am Clinic Foundation, Winnipeg, Manitoba, Canada.; Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada.; Southport and Ormskirk Hospitals NHS Trust, Lancashire, UK.
authors.forename: Adnan
authors.initials: A
authors.lastname: Saithna
authors.affiliation: The Pam Am Clinic Foundation, Winnipeg, Manitoba, Canada.
authors.forename: Alison
authors.initials: A
authors.lastname: Longo
authors.affiliation: The Pam Am Clinic Foundation, Winnipeg, Manitoba, Canada.; Southport and Ormskirk Hospitals NHS Trust, Lancashire, UK.
authors.forename: Jeff
authors.initials: J
authors.lastname: Leiter
authors.affiliation: The Pam Am Clinic Foundation, Winnipeg, Manitoba, Canada.
authors.forename: Jason
authors.initials: J
authors.lastname: Old
authors.affiliation: The Pam Am Clinic Foundation, Winnipeg, Manitoba, Canada.; Southport and Ormskirk Hospitals NHS Trust, Lancashire, UK.
authors.forename: Peter M
authors.initials: PM
authors.lastname: MacDonald
keywords: arthroscopic evaluation; biceps tendon; shoulder