Asociación de la tenodesis sin tenotomía del tendón de larga porción larga del bíceps durante la reparación del manguito rotador con el dolor anterior postoperatorio
La enfermedad del manguito rotador se asocia a mayores de 40 años, 25% de los pacientes mayores de 60 años y 50% de los pacientes mayores de 80 años presentan rupturas del manguito rotador con una distribución casi uniforme cada 10 años con un tendón sin rupturas hasta una ruptura bilateral.(1 las r...
- Autores:
-
Rubiano López, Nicolás Augusto
- Tipo de recurso:
- Fecha de publicación:
- 2024
- Institución:
- Universidad Autónoma de Bucaramanga - UNAB
- Repositorio:
- Repositorio UNAB
- Idioma:
- spa
- OAI Identifier:
- oai:repository.unab.edu.co:20.500.12749/23322
- Acceso en línea:
- http://hdl.handle.net/20.500.12749/23322
- Palabra clave:
- Medical sciences
Health sciences
Rotato cuff
Long head biceps tendon
Massive tear
Muscular system
Demographic characteristics
Postoperative complications
Postoperative pain
Ciencias médicas
Sistema muscular
Características demográficas
Complicaciones postoperatorias
Dolor postoperatorio
Ciencias de la salud
Maguito rotador
Ruptura masiva
Porción larga del tendón del bíceps
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| dc.title.spa.fl_str_mv |
Asociación de la tenodesis sin tenotomía del tendón de larga porción larga del bíceps durante la reparación del manguito rotador con el dolor anterior postoperatorio |
| dc.title.translated.spa.fl_str_mv |
Association of tenodesis without tenotomy of the long head of the biceps tendon during rotator cuff repair with postoperative anterior pain |
| title |
Asociación de la tenodesis sin tenotomía del tendón de larga porción larga del bíceps durante la reparación del manguito rotador con el dolor anterior postoperatorio |
| spellingShingle |
Asociación de la tenodesis sin tenotomía del tendón de larga porción larga del bíceps durante la reparación del manguito rotador con el dolor anterior postoperatorio Medical sciences Health sciences Rotato cuff Long head biceps tendon Massive tear Muscular system Demographic characteristics Postoperative complications Postoperative pain Ciencias médicas Sistema muscular Características demográficas Complicaciones postoperatorias Dolor postoperatorio Ciencias de la salud Maguito rotador Ruptura masiva Porción larga del tendón del bíceps |
| title_short |
Asociación de la tenodesis sin tenotomía del tendón de larga porción larga del bíceps durante la reparación del manguito rotador con el dolor anterior postoperatorio |
| title_full |
Asociación de la tenodesis sin tenotomía del tendón de larga porción larga del bíceps durante la reparación del manguito rotador con el dolor anterior postoperatorio |
| title_fullStr |
Asociación de la tenodesis sin tenotomía del tendón de larga porción larga del bíceps durante la reparación del manguito rotador con el dolor anterior postoperatorio |
| title_full_unstemmed |
Asociación de la tenodesis sin tenotomía del tendón de larga porción larga del bíceps durante la reparación del manguito rotador con el dolor anterior postoperatorio |
| title_sort |
Asociación de la tenodesis sin tenotomía del tendón de larga porción larga del bíceps durante la reparación del manguito rotador con el dolor anterior postoperatorio |
| dc.creator.fl_str_mv |
Rubiano López, Nicolás Augusto |
| dc.contributor.advisor.none.fl_str_mv |
Abril Gaona, Cesar Augusto Serrano Gómez, Sergio |
| dc.contributor.author.none.fl_str_mv |
Rubiano López, Nicolás Augusto |
| dc.contributor.cvlac.spa.fl_str_mv |
Serrano Gómez, Sergio [0001547816] |
| dc.contributor.googlescholar.spa.fl_str_mv |
Serrano Gómez, Sergio [es&oi=ao] |
| dc.contributor.orcid.spa.fl_str_mv |
Abril Gaona, Cesar Augusto [0000-0002-8092-4128] Serrano Gómez, Sergio [0000-0001-6418-7116] |
| dc.contributor.apolounab.spa.fl_str_mv |
Abril Gaona, Cesar Augusto [cesar-augusto-abril-gaona] Serrano Gómez, Sergio [sergio-eduardo-serrano-gómez] |
| dc.subject.keywords.spa.fl_str_mv |
Medical sciences Health sciences Rotato cuff Long head biceps tendon Massive tear Muscular system Demographic characteristics Postoperative complications Postoperative pain |
| topic |
Medical sciences Health sciences Rotato cuff Long head biceps tendon Massive tear Muscular system Demographic characteristics Postoperative complications Postoperative pain Ciencias médicas Sistema muscular Características demográficas Complicaciones postoperatorias Dolor postoperatorio Ciencias de la salud Maguito rotador Ruptura masiva Porción larga del tendón del bíceps |
| dc.subject.lemb.spa.fl_str_mv |
Ciencias médicas Sistema muscular Características demográficas Complicaciones postoperatorias Dolor postoperatorio |
| dc.subject.proposal.spa.fl_str_mv |
Ciencias de la salud Maguito rotador Ruptura masiva Porción larga del tendón del bíceps |
| description |
La enfermedad del manguito rotador se asocia a mayores de 40 años, 25% de los pacientes mayores de 60 años y 50% de los pacientes mayores de 80 años presentan rupturas del manguito rotador con una distribución casi uniforme cada 10 años con un tendón sin rupturas hasta una ruptura bilateral.(1 las rupturas del manguito rotador se encuentran asociadas hasta un 62.5% con una lesión del tendón de la porción larga del bíceps (TPLB) el cual es un factor que genera dolor anterior en el hombro.(2) Su inervación proximal es dada gracias a la rama subacromial lateral del nervio supraescapular el cual también da inervación al labrum superior con un mayor número de neurofilamentos en la región posterior superior.(3) (4) Los pacientes con lesión asociada entre el manguito rotador y TPLB presentan cambios estructurales intra articulares macroscópicos dados por el color amarillo, engrosamiento y tejido mucoide; cambios microscópicos como lo son desorganización en las fibras de colágeno con predominio de colágeno tipo III y presencia de metaloproteinasas 1 y 3, 2 a 6 veces la presencia de glucosaminoglicanos, todos siendo cambios asociados a la degeneración y sobrecarga mecánica con células inflamatorias, neovascularización e inervación neuronal extensa asociado a la inflamación. (5,6) Donde se ha evidenciado la presencia de actividad simpática con presencia de neuropéptidos como la proteína S100 y el neuropéptido Y (7), esta presencia de fibras simpáticas presenta una distribución heterogénea siendo principalmente en su inserción, donde esta distribución no se altera en presencia de enfermedad sin embargo se ve aumento de la diferenciación neuronal con mayor presencia de células estromales.(8) En cuanto a las lesiones del manguito rotador existen lesiones parciales y completas, dentro de las lesiones completas se presentan rupturas masivas descritas como la ruptura de dos o más tendones, en la cual ante la presencia del bíceps este se utiliza en la reparación ya que la presencia de tenocitos potencia ese beneficio de curación. En las reparaciones se puede preservar o resecar esa inserción proximal donde se ha demostrado beneficios en cuanto a dolor, movilidad y escalas funcionales como American Shoulder and Elbow Surgeons (ASES) en ensayos controlados y metaanálisis. (9–11) Se considera que al no realizar la tenotomía se persistirá con la fuente de dolor a nivel proximal, por lo tanto, buscamos evaluar el dolor anterior del hombro originado en el bíceps durante la reparación con aumentación de TPLB sin tenotomía, que busca aumentar la reparación del manguito rotador; con tenodesis más alta y posterior en la tuberosidad mayor buscando el efecto restrictor de la porción humeral. |
| publishDate |
2024 |
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2024-01-30T18:48:43Z |
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2024-01-30T18:48:43Z |
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2024-01-30 |
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info:eu-repo/semantics/masterThesis |
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| dc.relation.references.spa.fl_str_mv |
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Belk JW, Kraeutler MJ, Houck DA, Chrisman AN, Scillia AJ, McCarty EC. Biceps tenodesis versus tenotomy: a systematic review and meta-analysis of level I randomized controlled trials. J Shoulder Elbow Surg. 2021 May 1;30(5):951–60. Belay ES, Wittstein JR, Garrigues GE, Lassiter TE, Scribani M, Goldner RD, et al. Biceps tenotomy has earlier pain relief compared to biceps tenodesis: a randomized prospective study. Knee Surgery, Sports Traumatology, Arthroscopy. 2019 Dec 1;27(12):4032–7. Pavlidis T, Ganten M, Lehner B, Düx M, Loew M, med Loew S, et al. Tenoplastik der langen Bizepssehne bei großem Defekt der Rotatorenmanschette. Z Orthop. 2003;141:177–81. Fandridis E, Zampeli F. Superior Capsular Reconstruction With Double Bundle of Long Head Biceps Tendon Autograft: The “Box” Technique. Arthrosc Tech. 2020 Nov 1;9(11):e1747–57. Rhee YG, Nam SC, Chan TL, Jin WY, Vishvanathan T. Bridging the gap in immobile massive rotator cuff tears: Augmentation using the tenotomized biceps. American Journal of Sports Medicine. 2008 Aug;36(8):1511–8. Veen EJD, Stevens M, Diercks RL. Biceps Autograft Augmentation for Rotator Cuff Repair: A Systematic Review. Vol. 34, Arthroscopy - Journal of Arthroscopic and Related Surgery. W.B. Saunders; 2018. p. 1297–305. Ji JH, Shafi M, Jeong JJ, Park SE. Arthroscopic repair of large and massive rotator cuff tears using the biceps-incorporating technique: mid-term clinical and anatomical results. European Journal of Orthopaedic Surgery and Traumatology. 2014 Nov 22;24(8):1367–74. Kim JH, Lee HJ, Park TY, Lee JU, Kim YS. Preliminary outcomes of arthroscopic biceps rerouting for the treatment of large to massive rotator cuff tears. J Shoulder Elbow Surg. 2021 Jun 1;30(6):1384–92. Franceschi F, Longo UG, Ruzzini L, Papalia R, Rizzello G, Denaro V. To detach the long head of the biceps tendon after tenodesis or not: Outcome analysis at the 4-year follow-up of two different techniques. Int Orthop. 2007 Aug;31(4):537–45. Richards DP, Burkhart SS. Margin convergence of the posterior rotator cuff to the biceps tendon. Arthroscopy. 2004;20(7):771–5. Cho NS, Yi JW, Rhee YG. Arthroscopic Biceps Augmentation for Avoiding Undue Tension in Repair of Massive Rotator Cuff Tears. Arthroscopy - Journal of Arthroscopic and Related Surgery. 2009 Feb;25(2):183–91. Ji JH, Shafi M, Jeong JJ, Park SE. Arthroscopic repair of large and massive rotator cuff tears using the biceps-incorporating technique: mid-term clinical and anatomical results. European Journal of Orthopaedic Surgery and Traumatology. 2014 Nov 22;24(8):1367–74. Boutsiadis A, Chen S, Jiang C, Lenoir H, Delsol P, Barth J. Long Head of the Biceps as a Suitable Available Local Tissue Autograft for Superior Capsular Reconstruction: “The Chinese Way.” Arthrosc Tech. 2017 Oct 1;6(5):e1559–66. Kim YS, Lee HJ, Park I, Sung GY, Kim DJ, Kim JH. Arthroscopic In Situ Superior Capsular Reconstruction Using the Long Head of the Biceps Tendon. Arthrosc Tech. 2018 Feb 1;7(2):e97–103. Park SR, Sun DH, Kim J, Lee HJ, Kim J Bin, Kim YS. Is augmentation with the long head of the biceps tendon helpful in arthroscopic treatment of irreparable rotator cuff tears? J Shoulder Elbow Surg. 2018 Nov 1;27(11):1969–77. Chiang CH, Shaw L, Chih WH, Yeh ML, Su WR. Arthroscopic Rotator Cuff Repair Combined With Modified Superior Capsule Reconstruction as Reinforcement by the Long Head of the Biceps. Arthrosc Tech. 2019 Oct 1;8(10):e1223–31. Kim D, Jang Y, Park J, On M. Arthroscopic Superior Capsular Reconstruction With Biceps Autograft: Snake Technique. Arthrosc Tech. 2019 Oct 1;8(10):e1085–92. Fandridis E, Zampeli F. Superior Capsular Reconstruction With Double Bundle of Long Head Biceps Tendon Autograft: The “Box” Technique. Arthrosc Tech. 2020 Nov 1;9(11):e1747–57. Tang J, Zhao J. Dynamic Biceps Rerouting for Irreparable Posterior-Superior Rotator Cuff Tear. Arthrosc Tech. 2020 Nov 1;9(11):e1709–14. Terra BB, Sassine TJ, Ejnisman B, de Castro Pochini A, Belangero PS. Arthroscopic partial Superior Capsular Reconstruction using the Long Head of the Biceps Tendon–Technique Description. Arthrosc Tech. 2021 Mar 1;10(3):e669–73. Kim JH, Lee HJ, Park TY, Lee JU, Kim YS. Preliminary outcomes of arthroscopic biceps rerouting for the treatment of large to massive rotator cuff tears. J Shoulder Elbow Surg. 2021 Jun 1;30(6):1384–92. Aicale R, Poeta N, Savarese E, Bernardini G, Oliva F, Maffulli N. The use of long head biceps tendon autograft for massive rotator cuff tears: a PRISMA compliant systematic review. Vol. 144, British Medical Bulletin. Oxford University Press; 2022. p. 76–89. McClatchy SG, Parsell DE, Hobgood ER, Field LD. Augmentation of Massive Rotator Cuff Repairs Using Biceps Transposition Without Tenotomy Improves Clinical and Patient-Reported Outcomes: The Biological Superior Capsular Reconstruction Technique. Arthroscopy - Journal of Arthroscopic and Related Surgery. 2023; Pak T, Hwang S, Ardebol J, Ghayyad K, Menendez ME, Gobezie R, et al. Arthroscopic Repair of Massive Rotator Cuff Tears Leads to Functional Improvement in Most Patients at 4-Year Follow-up. Arthrosc Sports Med Rehabil. 2023 Aug 1;5(4). Kawashima I, Sugaya H, Takahashi N, Matsuki K, Tokai M, Ishizuka S, et al. Biceps tenotomy versus soft-tissue tenodesis in females aged 60 years and older with rotator cuff tears. Journal of Orthopaedic Science. 2022 Jul 1;27(4):786–91. Park I, Lee HJ, Choi Y ho, Kim YS. Arthroscopic repair of large to massive rotator cuff tears in patients younger than 60 years. Journal of Orthopaedic Science. 2020 Jan 1;25(1):104–9. Kim JM, Kim MW, Do HJ. Influence of hyperlipidemia on the treatment of supraspinatus tendinopathy with or without tear. Ann Rehabil Med. 2016;40(3):463–9. Neyton L, Godenèche A, Nové-Josserand L, Carrillon Y, Cléchet J, Hardy MB. Arthroscopic suture-bridge repair for small to medium size supraspinatus tear: Healing rate and retear pattern. Arthroscopy - Journal of Arthroscopic and Related Surgery. 2013 Jan;29(1):10–7. Almeida A, Valin MR, Zampieri R, Almeida NC de, Roveda G, Agostini AP. COMPARATIVE ANALYSIS ON THE RESULT FOR ARTHROSCOPIC ROTATOR CUFF SUTURE BETWEEN SMOKING AND NON-SMOKING PATIENTS. Revista Brasileira de Ortopedia (English Edition). 2011 Mar;46(2):172–5. |
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Abril Gaona, Cesar Augusto9774511b-7407-4283-a044-4b5ca1b3f0f7Serrano Gómez, Sergio275cde51-75b0-4ea4-a1aa-90e0999f9ce7Rubiano López, Nicolás Augusto43b3be97-ef59-4040-80ea-3b09d37fecf1Serrano Gómez, Sergio [0001547816]Serrano Gómez, Sergio [es&oi=ao]Abril Gaona, Cesar Augusto [0000-0002-8092-4128]Serrano Gómez, Sergio [0000-0001-6418-7116]Abril Gaona, Cesar Augusto [cesar-augusto-abril-gaona]Serrano Gómez, Sergio [sergio-eduardo-serrano-gómez]Bucaramanga (Santander, Colombia)2020-2023UNAB Campus Bucaramanga2024-01-30T18:48:43Z2024-01-30T18:48:43Z2024-01-30http://hdl.handle.net/20.500.12749/23322instname:Universidad Autónoma de Bucaramanga - UNABreponame:Repositorio Institucional UNABrepourl:https://repository.unab.edu.coLa enfermedad del manguito rotador se asocia a mayores de 40 años, 25% de los pacientes mayores de 60 años y 50% de los pacientes mayores de 80 años presentan rupturas del manguito rotador con una distribución casi uniforme cada 10 años con un tendón sin rupturas hasta una ruptura bilateral.(1 las rupturas del manguito rotador se encuentran asociadas hasta un 62.5% con una lesión del tendón de la porción larga del bíceps (TPLB) el cual es un factor que genera dolor anterior en el hombro.(2) Su inervación proximal es dada gracias a la rama subacromial lateral del nervio supraescapular el cual también da inervación al labrum superior con un mayor número de neurofilamentos en la región posterior superior.(3) (4) Los pacientes con lesión asociada entre el manguito rotador y TPLB presentan cambios estructurales intra articulares macroscópicos dados por el color amarillo, engrosamiento y tejido mucoide; cambios microscópicos como lo son desorganización en las fibras de colágeno con predominio de colágeno tipo III y presencia de metaloproteinasas 1 y 3, 2 a 6 veces la presencia de glucosaminoglicanos, todos siendo cambios asociados a la degeneración y sobrecarga mecánica con células inflamatorias, neovascularización e inervación neuronal extensa asociado a la inflamación. (5,6) Donde se ha evidenciado la presencia de actividad simpática con presencia de neuropéptidos como la proteína S100 y el neuropéptido Y (7), esta presencia de fibras simpáticas presenta una distribución heterogénea siendo principalmente en su inserción, donde esta distribución no se altera en presencia de enfermedad sin embargo se ve aumento de la diferenciación neuronal con mayor presencia de células estromales.(8) En cuanto a las lesiones del manguito rotador existen lesiones parciales y completas, dentro de las lesiones completas se presentan rupturas masivas descritas como la ruptura de dos o más tendones, en la cual ante la presencia del bíceps este se utiliza en la reparación ya que la presencia de tenocitos potencia ese beneficio de curación. En las reparaciones se puede preservar o resecar esa inserción proximal donde se ha demostrado beneficios en cuanto a dolor, movilidad y escalas funcionales como American Shoulder and Elbow Surgeons (ASES) en ensayos controlados y metaanálisis. (9–11) Se considera que al no realizar la tenotomía se persistirá con la fuente de dolor a nivel proximal, por lo tanto, buscamos evaluar el dolor anterior del hombro originado en el bíceps durante la reparación con aumentación de TPLB sin tenotomía, que busca aumentar la reparación del manguito rotador; con tenodesis más alta y posterior en la tuberosidad mayor buscando el efecto restrictor de la porción humeral.Contenido............................................................................................................................................ 2 1. Justificación:................................................................................................................................ 3 2. Marco teórico:............................................................................................................................. 4 3. Estado del Arte:......................................................................................................................... 17 4. Objetivos ................................................................................................................................... 19 4.1. Objetivo General ................................................................................................................... 19 4.2. Objetivos específicos............................................................................................................. 19 5. Metodología .............................................................................................................................. 19 5.1. Tipo de estudio...................................................................................................................... 19 5.2. Población............................................................................................................................... 19 5.3. Criterios de inclusión............................................................................................................. 19 5.4. Criterios de exclusión............................................................................................................ 19 5.5. Cálculo de tamaño de muestra ............................................................................................. 19 5.6. Recolección de la información .............................................................................................. 19 5.7. Variables................................................................................................................................ 19 5.8. Plan de análisis de datos....................................................................................................... 20 5.9. Consideraciones éticas.......................................................................................................... 20 6. Resultados esperados................................................................................................................ 21 6.1. Relacionados con la generación de nuevo conocimiento..................................................... 21 6.2. Conducentes al fortalecimiento de la capacidad científica institucional.............................. 22 6.3 Dirigidos a la apropiación social del conocimiento................................................................. 22 7. Impactos esperados .................................................................................................................. 22 8. Resultados................................................................................................................................. 23 9. Discusión ................................................................................................................................... 29 10. Conclusión ................................................................................................................................. 31 11. Referencias bibliográficas.......................................................................................................... 32 Anexos............................................................................................................................................... 40 Cronograma de actividades............................................................................................................... 43 Presupuesto ...................................................................................................................................... 43EspecializaciónRotator cuff disease is associated with people over 40 years of age, 25% of patients over 60 years of age and 50% of patients over 80 years of age present rotator cuff ruptures with an almost uniform distribution every 10 years with an unruptured tendon. up to a bilateral rupture. (1 Rotator cuff ruptures are associated up to 62.5% with an injury to the long head of the biceps tendon (TPLB), which is a factor that generates anterior pain in the shoulder. (2) Its Proximal innervation is given thanks to the lateral subacromial branch of the suprascapular nerve which also innervates the superior labrum with a greater number of neurofilaments in the superior posterior region.(3) (4) Patients with an associated injury between the rotator cuff and TPLB present macroscopic intra-articular structural changes given by yellow color, thickening and mucoid tissue; microscopic changes such as disorganization in collagen fibers with predominance of type III collagen and presence of metalloproteinases 1 and 3, 2 to 6 times the presence of glycosaminoglycans, all being changes associated with degeneration and mechanical overload with inflammatory cells, neovascularization and Extensive neuronal innervation associated with inflammation. (5.6) Where the presence of sympathetic activity has been evidenced with the presence of neuropeptides such as protein S100 and neuropeptide Y (7), this presence of sympathetic fibers presents a heterogeneous distribution, being mainly in their insertion, where this distribution is not altered in the presence of disease. However, an increase in neuronal differentiation is seen with a greater presence of stromal cells.(8) Regarding rotator cuff injuries, there are partial and complete injuries; within complete injuries, there are massive ruptures described as the rupture of two or more tendons, in which, in the presence of the biceps, this is used in the repair since the presence of tenocytes enhances this healing benefit. In repairs, this proximal insertion can be preserved or resected, where benefits in terms of pain, mobility and functional scales such as the American Shoulder and Elbow Surgeons (ASES) have been demonstrated in controlled trials and meta-analysis. (9–11) It is considered that by not performing the tenotomy the source of pain will persist at a proximal level, therefore, we sought to evaluate the anterior shoulder pain originating in the biceps during the repair with augmentation of TPLB without tenotomy, which seeks to increase the repair of the rotator cuff; with higher and posterior tenodesis in the greater tuberosity seeking the restrictive effect of the humeral portion.Modalidad Presencialapplication/pdfspahttp://creativecommons.org/licenses/by-nc-nd/2.5/co/Abierto (Texto Completo)Atribución-NoComercial-SinDerivadas 2.5 Colombiahttp://purl.org/coar/access_right/c_abf2Asociación de la tenodesis sin tenotomía del tendón de larga porción larga del bíceps durante la reparación del manguito rotador con el dolor anterior postoperatorioAssociation of tenodesis without tenotomy of the long head of the biceps tendon during rotator cuff repair with postoperative anterior painThesisinfo:eu-repo/semantics/masterThesisTesisinfo:eu-repo/semantics/acceptedVersionhttp://purl.org/redcol/resource_type/TMEspecialista en Ortopedia y TraumatologíaUniversidad Autónoma de Bucaramanga UNABFacultad Ciencias de la SaludEspecialización en Ortopedia y TraumatologíaMedical sciencesHealth sciencesRotato cuffLong head biceps tendonMassive tearMuscular systemDemographic characteristicsPostoperative complicationsPostoperative painCiencias médicasSistema muscularCaracterísticas demográficasComplicaciones postoperatoriasDolor postoperatorioCiencias de la saludMaguito rotadorRuptura masivaPorción larga del tendón del bícepsSalazar D, Keener JD. Chapter 4 – What Happens With Cuff Tears?: Natural History and Epidemiology. Disorders of the Rotator Cuff and Biceps Tendon. 2020.Gurnani N, van Deurzen DFP, Janmaat VT, van den Bekerom MPJ. Tenotomy or tenodesis for pathology of the long head of the biceps brachii: a systematic review and meta-analysis. Vol. 24, Knee Surgery, Sports Traumatology, Arthroscopy. Springer Verlag; 2016. p. 3765–71.Harte LM, Rick T, Bisson LJ, Inglis S, Marzo JM. Clinical implications of the distinct anatomy and innervation of the long head biceps tendon. J Anat [Internet]. 2022;241(2):453–60. Available from: https://onlinelibrary.wiley.com/doi/abs/10.1111/joa.13685Boesmueller S, Blumer R, Gesslbauer B, Hirtler L, Fialka C, Mittermayr R. Molecular pattern and density of axons in the long head of the biceps tendon and the superior labrum. J Clin Med. 2019 Dec 1;8(12).Joseph M, Maresh CM, McCarthy MB, Kraemer WJ, Ledgard F, Arciero CL, et al. Histological and molecular analysis of the biceps tendon long head post-tenotomy. Journal of Orthopaedic Research. 2009 Oct;27(10):1379–85.Schmalzl J, Plumhoff P, Gilbert F, Gohlke F, Konrads C, Brunner U, et al. The inflamed biceps tendon as a pain generator in the shoulder: A histological and biomolecular analysis. Journal of Orthopaedic Surgery. 2019 Jan 1;27(1).Tosounidis T, Hadjileontis C, Triantafyllou C, Sidiropoulou V, Kafanas A, Kontakis G. Evidence of sympathetic innervation and α1-adrenergic receptors of the long head of the biceps brachii tendon. Journal of Orthopaedic Science. 2013;18(2):238–44.Boesmueller S, Nógrádi A, Heimel P, Albrecht C, Nürnberger S, Redl H, et al. Neurofilament distribution in the superior labrum and the long head of the biceps tendon. J Orthop Surg Res. 2017 Nov 22;12(1).Llinás PJ, Bailie DS, Sanchez DA, Chica J, Londono JF, Herrera GA. Partial Superior Capsular Reconstruction to Augment Arthroscopic Repair of Massive Rotator Cuff Tears Using Autogenous Biceps Tendon: Effect on Retear Rate. American Journal of Sports Medicine. 2022 Sep 1;50(11):3064–72.Chiang CH, Shaw L, Chih WH, Yeh ML, Ting HH, Lin CH, et al. Modified Superior Capsule Reconstruction Using the Long Head of the Biceps Tendon as Reinforcement to Rotator Cuff Repair Lowers Retear Rate in Large to Massive Reparable Rotator Cuff Tears. Arthroscopy - Journal of Arthroscopic and Related Surgery. 2021 Aug 1;37(8):2420–31.Shang X, Chen J, Chen S. A meta-analysis comparing tenotomy and tenodesis for treating rotator cuff tears combined with long head of the biceps tendon lesions. PLoS One. 2017 Oct 1;12(10).DePalma AF. The classic. Surgical anatomy of the rotator cuff and the natural history of degenerative periarthritis. Surg Clin North Am. 1963;43:1507-1520. Clin Orthop Relat Res. 2008 Mar;466(3):543–51.Dugas JR, Campbell DA, Warren RF, Robie BH, Millett PJ. Anatomy and dimensions of rotator cuff insertions. J Shoulder Elbow Surg. 2002;11(5):498–503.Ricchetti ET, Entezari V, Derwin KA. PART XIII Rotator Cuff Lesions 50 Structure and Function of the Rotator Cuff [Internet]. Available from: www.netterimages.com.Jobe CM, Phipatanakul WP, Petkovic D. Gross Anatomy of the Shoulder. 1990.Taylor SA, O’Brien SJ. Clinically Relevant Anatomy and Biomechanics of the Proximal Biceps. Vol. 35, Clinics in Sports Medicine. W.B. Saunders; 2016. p. 1–18.Taylor SA, Fabricant PD, Bansal M, Khair MM, McLawhorn A, DiCarlo EF, et al. The anatomy and histology of the bicipital tunnel of the shoulder. J Shoulder Elbow Surg. 2015 Apr 1;24(4):511–9.Boesmueller S, Blumer R, Gesslbauer B, Hirtler L, Fialka C, Mittermayr R. Molecular pattern and density of axons in the long head of the biceps tendon and the superior labrum. J Clin Med. 2019 Dec 1;8(12).Akhtar A, Richards J, Monga P. The biomechanics of the rotator cuff in health and disease – A narrative review. J Clin Orthop Trauma. 2021 Jul 1;18:150–6.Saha AK. DYNAMIC STABILITY OF THE GLENOHUMERAL JOINT. Vol. 42, Acta orthop. Scandinav. 1971.Wilk KE, Hooks TR. The Painful Long Head of the Biceps Brachii: Nonoperative Treatment Approaches. Vol. 35, Clinics in Sports Medicine. W.B. Saunders; 2016. p. 75–92.Su Cho N, Kyo Jeong W, McGarry MH, Lee TQ. Chapter 3 – Biomechanics and Clinical Functionof the Rotator Cuff. 2020.Burkhart SS, Esch JC, Jolson RS. The Rotator Crescent and Rotator Cable: An Anatomic Description of the Shoulder’s “Suspension Bridge.” Vol. 9, Arthroscopy: The Journal of Arthroscopic and Related Surgery. 1993.Huri G, Kaymakoglu M, Garbis N. Rotator cable and rotator interval: Anatomy, biomechanics and clinical importance. EFORT Open Rev. 2018;4(2):56–62.Schmidt CC, Spicer CS, Papadopoulos D v., Delserro SM, Tomizuka Y, Zink TR, et al. The Rotator Cable Does Not Stress Shield the Crescent Area during Shoulder Abduction. Journal of Bone and Joint Surgery. 2022 Jul 20;104(14):1292–300.Sistermann R. The biceps tendon footprint. Acta Orthop. 2005 Apr;76(2):237–40.Panico L, Roy T, Namdari S. Long Head of the Biceps Tendon Ruptures: Biomechanics, Clinical Ramifications, and Management. JBJS Rev. 2021 Oct 25;9(10).Peltz CD, Perry SM, Getz CL, Soslowsky LJ. Mechanical properties of the long-head of the biceps tendon are altered in the presence of rotator cuff tears in a rat model. Journal of Orthopaedic Research. 2009 Mar;27(3):416–20.Neer CS. Impingement Lesions.Ellman H. Diagnosis and Treatment of Incomplete Rotator Cuff Tears.Kuhn JE, Dunn WR, Ma B, Wright RW, Jones G, Spencer EE, et al. Interobserver agreement in the classification of rotator cuff tears. American Journal of Sports Medicine. 2007 Mar;35(3):437–41.Davidson J, Burkhart SS. 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