Clinics in Shoulder and Elbow

Korean Shoulder and Elbow Society (대한견·주관절의학회)
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Posterior Shoulder Instability in the Patients with Bilateral Congenital Absence of Long Head of Biceps Tendon: A Case Report

  • Yoon, Sung-Hyun (Department of Orthopedic Surgery, Dankook University College of Medicine) ;
  • Heo, Kang (Department of Orthopedic Surgery, Dankook University College of Medicine) ;
  • Yoo, Jae-Sung (Department of Orthopedic Surgery, Dankook University College of Medicine) ;
  • Kim, Sung-Joon (Department of Orthopedic Surgery, Dankook University College of Medicine) ;
  • Seo, Joong-Bae (Department of Orthopedic Surgery, Dankook University College of Medicine)
  • Received : 2018.06.06
  • Accepted : 2018.07.30
  • Published : 2018.12.01
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Abstract

Rare cases of a congenital absence of the long head of the biceps tendon (LHBT) have been reported, and its incidence is unknown. In a literature review of the congenital absence of the LHBT, only 1 case was associated with posterior shoulder instability and severe posterior glenoid dysplasia. This paper reports the first case of a patient with a bilateral congenital absence of the LHBT with posterior shoulder instability without glenoid dysplasia or posterior glenoid tilt. The patient experienced a traffic accident while holding the gear stick with his right hand. After the accident, a posteroinferior labral tear with paralabral cysts was detected on the magnetic resonance images. The congenital absence of the LHBT was assumed to have affected the posterior instability that possibly increased the susceptibility to a subsequent traumatic posterior inferior labral tear. This case was identified as a posterior inferior tear caused by a traumatic 'gear stick injury'.

Keywords

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Fig. 3. Both ultrasonography shows no long head of the biceps tendon and shallow, smooth bicipital groove. RT: right, LT: left.

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Fig. 6. T2 weighted axial magnetic resonance imagings of the left shoulder. Intraarticular lesion including a labral tear was not detected in uninjured shoulder, even though the left shoulder also had a shallow, smooth bicipital groove with an absence of the long head of the biceps tendon.

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Fig. 1. (A) Lateral view photograph of the driver catching the gear stick. (B) Photograph that is pushing the gear stick in a reflexive manner when a traffic accident occurs.

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Fig. 2. (A) Magnetic resonance arthrography demonstrated an absence of the long head of the biceps tendon and the shallow, smooth bicipital groove. (B) Magnetic resonance arthrography demonstrated a posteroinferior labral tear with a paralabral cyst.

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Fig. 4. (A) Arthroscopic view of the rotator interval with the shoulder in the beach chair position. Complete absence of the foramen for the long head of the biceps tendon (LHBT) is noted. (B) Arthroscopic view of the labrum with the shoulder in the beach chair position. Complete absence of the LHBT is noted.

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Fig. 5. (A) Arthroscopic view of the inferior aspect of the glenoid with the shoulder in the beach chair position. Posteroinferior (5–9 o’clock) labral tear is noted. (B) Arthroscopic view of the posteroinferior aspect of the glenoid. The labral was repaired with a suture juggerknot 1.5 mm (Biomet, Warsaw, IN, USA).

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Fig. 7. (A) Photographs of the shoulder position taken from the above when the driver pushed the gear stick reflexively in a traffic accident. (B) The drawing depicts the axial view of the transverse ligament, LHBT, humeral head at the level of bicipital groove. The transverse ligament located in front of the LHBT prevents LHBT from being dislocated in the future by pressing the LHBT, thereby preventing the posterior dislocation of the humeral head. G: glenoid, HH: humeral head, LHBT: long head of the biceps tendon, GT: greater tuberosity, LT: lesser tuberosity.

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