“HOUR-GLASS” LONG BICEPS, ANOTHER CAUSE OF SHOULDER PAIN AND BLOCKAGE

Purpose: We report a new pathological entity involving the long head of the biceps tendon (LHBT). In this entity, the hypertrophic LHBT becomes incarcerated in the joint during limb elevation, leading to shoulder pain and blockage.Material and methods: Twenty-one patients were identified. These patients presented hypertrophy of the intra-articular portion of the LHBT with tendon incarceration at limb elevation. The diagnosis was confirmed during open surgery (n=14) or arthroscopy (n=7). All cases were diagnosed in patients with an associated cuff tear. Treatment consisted in resection of the intra-articular portion of the LHBT and appropriate treatment of the cuff.Results: All patients had anterior shoulder pain and deficient anterior flexion because of the incarcerated tendon. An intra-operative dynamic test consisted in raising the arm with the elbow extended, providing objective proof of the tendon trapped in the articulation in all cases. The positive “hour glass” test produce a fold then incarceratio...