Rotator cuff tears (RCT) and instability are the most common surgically treated shoulder pathologies. The concept of augmentation using the long head of the biceps tendon (LHBT) autograft was created to improve the results of surgical treatment of these pathologies, especially in cases of chronic and massive injuries. The popularity of using the LHBT for augmentation is evidenced by the significant number of publications on this topic published in the last 3 years; however, only one systematic review has been published regarding only LHBT augmentation for massive RCTs. Several studies comparing partial repair with partial repair and additional LHBT augmentation for RCT showed superior clinical outcomes and lower re-tear rates when LHBT augmentation was performed. There is a rising popularity of using LHBT as an autograft to perform superior capsule reconstruction (SCR) in case of irreparable rotator cuff tears. In recent years, shoulder stabilization by arthroscopic Bankart repair with biceps augmentation has been promoted with very promising short-term results. The evidence provided by studies appears to be sufficient to recommend the use of LHBT for augmentation whenever necessary; however, larger studies with long-term follow-up are needed.

BACKGROUND: The presence of subjective mechanical symptoms, such as clicking or popping, is common in patients presenting for shoulder pain and dysfunction, with unclear clinical significance. The primary objective of this study was to assess whether subjective mechanical symptoms in the affected shoulder were associated with full-thickness rotator cuff tearing in a consecutive, prospective cohort of patients undergoing shoulder magnetic resonance imaging (MRI) for suspected rotator cuff pathology.
METHODS: A prospective cohort study was performed of 100 consecutive patients with suspected rotator cuff tendinopathy and/or tearing who underwent shoulder MRI. The presence of subjective shoulder mechanical symptoms, including clicking or popping, was documented prior to MRI. Indications for MRI included weakness on isolated testing of rotator cuff muscle(s) or symptoms refractory to conservative treatment including at least a 6-week course of physical therapy. The primary outcome variable was the presence of full-thickness rotator cuff tearing; secondary outcome variables included any (full-thickness or partial-thickness) rotator cuff tearing and biceps long head subluxation. Radiographic parameters, including critical shoulder angle, Goutallier grade, tear retraction, and tear size were quantified. One patient was lost to follow-up, and 99 patients completed MRI imaging.
RESULTS: In our cohort, 60% of patients reported subjective mechanical symptoms in the affected shoulder. Full-thickness rotator cuff tearing was identified in 42% of patients, any rotator cuff tearing in 69% of patients, and biceps long head subluxation in 14% of patients. Subjective mechanical symptoms were not associated with full-thickness rotator cuff tearing, any rotator cuff tearing, biceps long head subluxation, critical shoulder angle, Goutallier grade, tear size, or tear retraction. Older age was associated with full-thickness and any rotator cuff tearing. As a diagnostic test for full-thickness rotator cuff tearing, subjective shoulder mechanical symptoms has a sensitivity of 64%, a specificity of 44%, and Youden\'s index of 0.08, consistent with poor diagnostic accuracy.
CONCLUSIONS: Subjective mechanical symptoms in the affected shoulder are a common complaint in patients with suspected rotator cuff pathology. Patients may be reassured that a sensation of clicking or popping alone does not necessarily entail structural shoulder derangement.

Introduction Pre-operative diagnosis of subscapularis tears remains a difficult challenge. Ultrasound has been shown to be ineffective at directly detecting subscapularis tears. It has been widely accepted that medial subluxation of the long head of biceps tendon (LHBT) is associated with full-thickness subscapularis tears. The aims of this study are to assess whether LHBT subluxation on ultrasound scanning has any predictive value for subscapularis tears and to determine the relationship between LHBT subluxation and subscapularis tears at arthroscopy. Methods Pre-operative ultrasound and arthroscopic findings for patients undergoing arthroscopic rotator cuff repair at our institution between March 2011 and January 2016 were analysed. The accuracy of LHBT subluxation on ultrasound and at arthroscopy as a predictor of subscapularis tears at arthroscopy was calculated. The correlation between LHBT subluxation and subscapularis tears was determined. A standardised technique was used for ultrasound scans, and the grade of the sonographer was recorded. Results Three hundred fifty-nine rotator cuff repairs were performed. Twenty-four patients had a subluxed LHBT. Ultrasound was poorly sensitive (50%), and a subluxed LHBT on ultrasound only correlated very weakly with subscapularis tears at arthroscopy (R = 0.268, p<0.001). At arthroscopy, 92 patients had full-thickness subscapularis tears. Of these, only 16 patients (17%) had a subluxed/dislocated LHBT. Of the 24 patients with a subluxed LHBT, eight had no subscapularis tears. Thus, LHBT subluxation/dislocation only correlated weakly with full-thickness subscapularis tears (R=0.252, p<0.001). Conclusion Due to their close anatomical relationship, traditional teaching suggests subscapularis tears are associated with medial LHBT subluxation. Our data indicate that, contrary to popular belief, the two are only weakly correlated. In our series, the majority of patients with subscapularis tears (83%) had their LHBT in-groove. The authors therefore recommend high vigilance during arthroscopy for the diagnosis and repair of subscapularis tears, regardless of pre-operative ultrasound findings and the intra-operative position of the LHBT.

UNASSIGNED: Biceps tenodesis is an effective surgical procedure that can address pathologies of the long head of the biceps tendon. The purpose of this study was to evaluate clinical outcomes following two different biceps tenodesis techniques: Loop \'N\' Tack biceps tenodesis and subpectoral biceps tenodesis.
UNASSIGNED: Patients undergoing both the subpectoral biceps tenodesis and Loop \'N\' Tack biceps tenodesis will have improvements in patient-reported outcomes.
UNASSIGNED: Hundred and sixty five consecutive patients who underwent biceps tenodesis were retrospectively identified and contacted by phone to collect visual analog scale pain scores, University of California, Los Angeles shoulder scores, Simple Shoulder Test scores, Single Assessment Numeric Evaluation scores, and American Shoulder and Elbow Surgeons scores. Range of motion, elbow flexion strength, and incidence of bicipital groove pain and Popeye deformity were recorded.
UNASSIGNED: One Hundred and forty five patients were included in the study (55 subpectoral, 90 Loop \'N\' Tack). Patients in both groups reported high American Shoulder and Elbow Surgeons, Simple Shoulder Test, University of California, Los Angeles, Single Assessment Numeric Evaluation shoulder function scores, low visual analog scale pain scores, and had a minimal risk of complications when measured one year postoperatively.
UNASSIGNED: Loop \'N\' Tack biceps tenodesis and subpectoral biceps tenodesis techniques are reliable and effective procedures that can reduce pain scores and restore shoulder function when patients require surgical intervention.

Delayed hypersensitivity reactions (DHRs) have been reported in association with COVID-19 vaccines, particularly those that are mRNA-based. Classic DHRs result in induration, erythema, tenderness, and urticaria. However, soft tissue mass is an uncommon complication of a COVID-19 vaccination-associated DHR and is rarely reported in the literature. We present a case of a 49-year-old male who recognized a mildly painful, firm soft tissue mass within the biceps mimicking neoplasm six months after receiving the booster dose of the Moderna vaccine. Non-operative conservative treatment modalities, including heating pads, ice packs, acetaminophen, and ibuprofen, failed to improve the patient\'s mass. The mass, which proved histologically to be an inflammatory pseudo-tumor, did not recur after complete excision. While there have been many reported cases of DHRs following COVID-19 vaccinations, we present this case to raise awareness of the development of pseudo-tumors as a possible, yet rare, clinical manifestation of DHRs following vaccination.

BACKGROUND: in the treatment the long head of the biceps tendon (LHBT) pathology, the «relaxed tenodesis» is an arthroscopic articular suprapectoral tenodesis that seeks to lower the tension on the LHBT, and therefore, theoretically avoid persistent pain.
OBJECTIVE: to assess clinical and radiological results of «relaxed» tenodesis in a prospective cohort of patient with work related illness.
METHODS: prospective cohort, 54 shoulders with «relaxed» tenodesis performed with an intra-articular interference screw by the same surgeon, from October 2014 to 2018, in a level 1 trauma center. Demographic, clinical, functional and radiologic results were analyzed. On 6 months follow-up, a sonographic and clinical assessment was performed.
RESULTS: mean age 49 ± 9, mean follow-up 16 ± 4 months. The main diagnosis was a rotator cuff tear in 79%, primary biceps pathology in 10% and other pathologies in 11%. At the end of follow-up, the cohort showed active anterior elevation 157.7 ± 22.7, external rotation 47 ± 16.6, median internal rotation T12, Constant Score 83 ± 12.05 points, subjective shoulder value 83 ± 12.97% and pain visual analogue scale 1.4 ± 1.7 points. One patient had a biceps tear and two had cosmetic arm asymmetry. On ultrasound 98% had the LHBT in situ and 10% had inflammatory changes on the bicipital groove. There were complications in 21% of the sample.
CONCLUSIONS: «relaxed biceps tenodesis» is a technique that shows good clinical, functional and sonographic results, with low failure rate.
UNASSIGNED: en el tratamiento de la patología del tendón de la cabeza larga del bíceps (TCLB) la tenodesis «relajada» es una tenodesis artroscópica suprapectoral alta, que busca disminuir la tensión del TCLB y, por tanto, el dolor persistente.
OBJECTIVE: evaluar resultados clínicos y radiológicos de la tenodesis «relajada» en una serie prospectiva de sujetos sometidos a compensación laboral.
UNASSIGNED: cohorte prospectiva de 54 hombros con tenodesis «relajada» con tornillo interferencial intraarticular, mismo cirujano, Octubre de 2014 a 2018, centro de trauma nivel 1. Se analizaron datos demográficos, resultados clínicos, funcionales y radiográficos. A los seis meses se realizó una ecografía de control y se evaluaron complicaciones.
RESULTS: edad media 49 ± 9 años, seguimiento promedio 16 ± 4 meses. El diagnóstico primario fue rotura del manguito rotador en 79%, patología primaria del bíceps en 10% y otras patologías en 11%. Al término del seguimiento, la elevación anterior activa fue 157.7 ± 22.7, rotación externa 47 ± 16.6, rotación interna mediana T12, Constant Score 83 ± 12.05 puntos, valoración subjetiva del hombro 83 ± 12.97% y escala visual análoga del dolor 1.4 ± 1.7 puntos. Un paciente sufrió una rotura del bíceps y dos casos una asimetría estética del brazo. En ecografía, en 98% se visualizó el TCLB in situ y en 10% se objetivaron cambios inflamatorios en la corredera bicipital. Reportamos 21% de complicaciones.
CONCLUSIONS: la tenodesis «relajada» presenta resultados clínicos, funcionales e imagenológicos satisfactorios, con baja tasa de fallo.

The present study was designed to examine the effect of trans-spinal magnetic stimulation on bilateral respiratory and forelimb muscles in healthy subjects. Two wings of a figure-of-eight magnetic coil were placed on the dorsal vertebrae, from the fifth cervical to the second thoracic dorsal vertebra with a center at the seventh cervical vertebra. The surface electromyograms of bilateral diaphragm and biceps were recorded in response to trans-spinal magnetic stimulation with 20%-100% maximum output of the stimulatory device in male (n = 12) and female participants (n = 8). Trans-spinal magnetic stimulation can induce a co-activation of bilateral diaphragm and biceps when the stimulation intensity is above 60%. The onset latency was comparable between the left and right sides of the muscles, suggesting bilateral muscles could be simultaneously activated by trans-spinal magnetic stimulation. In addition, the intensity-response curve of the biceps was shifted upward compared with that of the diaphragm in males, indicating that the responsiveness of the biceps was greater than that of the diaphragm. This study demonstrated the feasibility of utilizing trans-spinal magnetic stimulation to co-activate the bilateral diaphragm and biceps. We proposed that this stimulatory configuration can be an efficient approach to activate both respiratory and forelimb muscles.

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OBJECTIVE: To assess the feasibility, operative time, clinical outcomes, possible complications, and failure rates of all-through arthroscopic biceps tenodesis using press-fit bony plug technique.
METHODS: This prospective case series study involved 30 skeletally mature patients with long head of biceps pathology (tendinitis after failure of conservative treatment, subluxation, dislocation, or tendon tears). All patients were followed up for 24 months at least.
RESULTS: Twenty-nine patients regained full shoulder and elbow range of motion; one case suffered from reflex sympathetic dystrophy. There was a significant improvement in the constant, ASES, and VAS scores when comparing the pre-operative and post-operative values. The average biceps strength was 96% compared to the opposite healthy side. No cases were complicated by neuro-vascular deficits or failure of the tenodesis.
CONCLUSIONS: Press-fit biceps tenodesis is safe and accessible with low economic demands. We recommend this technique to be used more often when addressing patients with long head of biceps pathologies.
UNASSIGNED: Registration number: N-1562023. Registration date: June 2022 \"Retrospectively registered\".

OBJECTIVE: The purpose of this study is to systematically review the comparative studies in the literature to ascertain if biceps tenodesis or superior-labrum anterior to posterior (SLAP) repair results in superior clinical outcomes in the treatment of type II SLAP tears in patients under 40.
METHODS: A systematic search of articles in Pubmed, EMBASE and The Cochrane Library databases was carried out according to the PRISMA guidelines. Cohort studies comparing biceps tenodesis to repair in type II SLAP tears in patients under 40 were included. Clinical outcomes were extracted including return to play, reoperations, ASES, and VAS for pain. All statistical analysis was performed using Review Manager. A p-value of <0.05 was considered to be statistically significant.
RESULTS: Five studies were included. Biceps tenodesis resulted in comparable rates of return to play compared to SLAP repair (78.5% vs 67.7%, p ​= ​0.33), and there was no significant difference in return to play in overhead athletes (83.6% vs 74%, p ​= ​0.82). There was no significant difference in ASES score (87.2 vs 86.2, p ​= ​0.27) or VAS score for pain (1.8 vs 2.1, p ​= ​0.48). There was no significant difference in re-operation rates (2.9% vs 10.8%, p ​= ​0.22).
CONCLUSIONS: This study found that biceps tenodesis has no significant difference in rates of return to play in athletes, as well as in functional outcome scores and rates of revision surgery in younger patients compared to SLAP repair.
METHODS: Level III, Systematic review of Level III studies.