Biceps tendon classifications

1. LHB lesions: Topographical classification
2. Biceps tendon disorders: Yamaguchi and Bindra classification
3. Biceps pulley lesions :Habermeyer, 2004
4. Histological changes in LHB tendon: Murthi
5. Subluxation of long head of biceps: Habermeyer and Walch
6. Dislocation of long head of biceps: Habermeyer and Walch


LHB lesions: Topographical classification

Hedtmann, Verlag, 2002

 Lesions of LHB I
 SLAP lesions I-IV?
Andrews lesions
 Supratubercular lesions  II  Isolated tendinosis / tendinitis
(Partial) tears of LHB?
(Partial) tears of LHB in rotator cuff lesions?
Supratubercular instability (Walch I)
 Sulcus associated lesions  III  Subluxation / dislocation out of the bicipital groove (Walch II) without lesions of posterosuperior rotator cuff but where applicable accompanied with a lesion of the subscapularis tendon (and capsule)
 Lesions below the bicipital groove  IV  Peripheral of proximal LHB (e.g. at tendon-muscle transition zone)

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Biceps tendon disorders: Yamaguchi and Bindra classification
In: Disorders of the Shoulder: Diagnosis and Management, Lippincott Williams and Wilkins, 1999

1. Inflammatory
a. Biceps tendinitis with cuff disease
b. Primary biceps tendinitis

2. Instability
a. Subluxation- anterior
          unstable at proximal groove
          following mal/nonunion of lesser tuberosity
b. Dislocation- extraarticular with partial subscapularis tear
          intraarticular with full thickness subscapularis tear

3. Traumatic

a. Traumatic rupture- partial/ complete
b. SLAP lesions:      Type1- significant fraying
                         Type 2- complete detachment of biceps and labrum
                         Type 3- bucket handle tear of superior labrum
                         Type 4- central superior labral tear with biceps extension

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Pulley lesions (Habermeyer 2004)
Habermeyer et al, JSES, 13:5-12, 2004

Group 1: isolated lesions of the SGHL
Group 2: lesion of the SGHL and partial articular side lesion of the supraspinatus tendon
Group 3: combination of a lesion of the SGHL and deep surface tear of   the subscapularis tendon
Group 4: combination of a lesion of the SGHL and a deep surface tear of the supraspinatus and subscapularis tendon



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Histological changes in LHB tendon: Murthi
Murthi et al, JSES, 9:382-385, 2000

1.Normal
2.Chronic inflammation
3.Fibrosis
4.Mucinous degeneration
5.Vascular congestion
6.Dystrophic calcification
7.Acute inflammation

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Subluxation of long head of biceps: Habermeyer and Walch classification
In: Rotator cuff disorders, edited by Burkead, 142-159, Williams and Wilkins, 1996

Type 1  Superior subluxation with partial or complete tear of the rotator interval sling (the circular sling of the SGHL and coracohumeral ligaments).There may be an associated tear of supraspinatus.
Type II  Subluxation at the groove. The tendon slips over the medial rim of the groove and sits upon the lesser tuberosity, with detachment of the superior portion of subscapularis.
Type III  Malunion or non union of the lesser tuberosity

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Dislocation of long head of biceps: Habermeyer and Walch classification

Type 1
A. Extra-articular dislocation with a partial subscapularis tear
The biceps tendon is completely dislocated and lies over the lesser tuberosity. The deep part of subscapularis remains intact. The SGHL and coraco-humeral ligaments are detached.

B. Extra-articular dislocation with an intact subscapularis tendon

Type 2

Intra-articular dislocation of the long head of biceps combined with a complete tear of subscapularis tendon.
Biceps is widened and flattened. Subscapularis is completely torn from the lesser tuberosity ,biceps dislocates into the joint space infero-medially, associated with a cuff tear.


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