Age / Sex : 77 / F

Chief complaint: Right shoulder pain and LOM (D: several years)

1) What is your impression?

Two weeks later, you can see the final diagnosis with a brief discussion of this case.

* Send Application Answers to Jae Hyuck Yi, MD (yijh@knu.ac.kr)
(Quiz는 quiz일 뿐이오니 답안은 한개만 보내주시기 바라오며, 복수의 답안을 보내주시는 분은 정답이 포함되어 있더라도 부득이 semi-correct answer로 처리토록 하겠습니다.)

Courtesy : Jee Young Lee, MD, Dankook University Hospital

Intraarticular dislocation of long head of biceps tendon

Discussion

Findings: Fat-suppressed T2-weighted axial images from superior to inferior (1a->1d) show a thick and dark rope-like structure from the superior glenoid rim to the central area of long head of biceps. Intraarticular dislocation of the long head of biceps tendon may be easily identified by the empty bicipital groove and the intraarticular course of this rope-like structure from the superior glenoid to the biceps. In this case, Intraarticular medial dislocation of biceps tendon from the shallow bicipital groove is associated with disruption of biceps pulley in massive rotator cuff tear; total tear of supraspinatus tendon(Not shown here) and subscapularis tendon(Retracted tendon marin of subscapularis is noted in Fig. 1c, Bennett type 3).

Diagnosis: Intraarticular dislocation of long head of biceps tendon

Discussion: The long head of the biceps tendon (LHBT) arises from the supraglenoid tubercle and the superior glenoid labrum, courses over the top of the humeral head intraarticularly but extrasynovially, and goes down into the bicipital groove between the greater and lesser tuberosities. The LHBT sheath communicates with the synovial joint. The LHBT as it courses from the intraarticular to the extraarticular bicipital groove is retained in its proper position by the combined action of the coracohumeral ligament, superior glenohumeral ligament, anterior portion of supraspinatus tendon and cranial portion of subscapularis tendon, which is forming the “biceps pulley”. The disruption of this “biceps pulley” may result in the intraarticular subluxation or dislocation of biceps tenon. Dislocation or subluxation of the biceps tendon may present as an isolated lesion, but it is usually seen in association with rotator cuff disease, especillay, involving the anterior portion of supraspinatus tendon or cranial portion of subscapularis tendon.