Long Head of Biceps Interposition as a cause of Persistent Pain and Subluxation following Acute Anterior Shoulder Dislocation
Acta of Shoulder and Elbow Surgery | Volume 5 | Issue 1 | January-June 2021 | Page — | Robert J. Burton, Anna LR Porter, Yusuf Michla
Authors: Robert J. Burton , Anna LR Porter , Yusuf Michla 
 Department of Orthopaedics, Sunderland Royal Hospital, Sunderland, UK.
Address of Correspondence
Dr. Anna LR Porter
Sunderland Royal Hospital, Kayll Road, Sunderland, UK.
A 65 year old gentleman presented with persistent severe pain and joint incongruity on plain radiographs following a first time traumatic anterior shoulder dislocation without concurrent fracture to the tuberosities. Further investigation with MRI scan demonstrated interposition of the long head of biceps tendon within the glenohumeral joint, causing persistent pain and the subtle incongruity seen on AP and Axillary radiographs. Under arthroscopy the tendon was grossly tendinopathic at it’s insertion into the labrum, and reduction into the inter-tubucular groove was not possible. Tenotomy was performed, which immediately resolved the patients symptoms. Repeated radiographs demonstrated that the joint congruity had been restored. This case demonstrates that long head of biceps displacement is possible without concurrent fracture, and is a rare but important cause for persistent disproportionate pain post-reduction. Radiographs should be examined carefully for any evidence of joint in-congruity, and ultrasound or MR scanning will adequately demonstrate interposition of the long head of biceps within the glenohumeral joint.
Key Words: Anterior shoulder dislocation; Biceps tendon interposition; Glenohumeral-subluxation.
1. Allard J, Bancroft J. Irreducible posterior dislocation of the shoulder; MR and CT findings. Journal of computer assisted tomography. 1991;15 (4); 694-696. https://pubmed.ncbi.nlm.nih.gov/2061493/
2. Goldman A, Sherman O, Price A, Minkoff J. Posterior fracture-dislocation of the shoulder with biceps tendon interposition. The Journal of Trauma; Injury, Infection and Critical Care.1987; 27(9):1083-1086. https://pubmed.ncbi.nlm.nih.gov/3656473/
3. Gudena R, Iyengar K, Nadkuri J, Loh W. Irreducible shoulder dislocation – a word of caution. Orthopaedics & Traumatology, Surgery and Research. 2011; 97(4): 451-453. 10.1016/j.otsr.2011.02.004. https://pubmed.ncbi.nlm.nih.gov/21511554/
4. Seradge H, Orme G. Acute Irreducible Anterior Dislocation of the Shoulder. The Journal of Trauma: Injury, Infection and Critical Care. 1982;22(4):330-332. https://pubmed.ncbi.nlm.nih.gov/7077691/
5. Velghe A, Humblet P, Lesire M, Liselele D. Fresh posterior luxation of the shoulder: irreducibility due to interposition of the long biceps. Ap-ropos of 2 cases. Revue de chirurgie orthopaedique et reparatrice de l’appareil moteur. 1998;74(8):782-785. https://pubmed.ncbi.nlm.nih.gov/3253850/
6. Wyatt A, Porrino J, Shah S, Hsu J. Irreducible superolateral dislocation of the glenohumeral joint. Skeletal Radiology. 2015:44(9);1387-1391. 10.1007/s00256-015-2183-8. https://pubmed.ncbi.nlm.nih.gov/26051805/
|How to Cite this article: Burton RJ, Porter ALR, Michla Y | Long Head of Biceps Interposition as a cause of Persistent Pain and Subluxation following Acute Anterior Shoulder Dislocation | Acta of Shoulder and Elbow Surgery | January-June 2021; 5(1): —-.|
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