Dynamic ultrasound assessment in the diagnosis of intra-articular entrapment of the biceps tendon (hourglass biceps): A preliminary investigation

BACKGROUND: The hourglass biceps, an intra-articular entrapment of the long head of the biceps (LHB), is a possible diagnosis in cases of shoulder pain associated with loss of passive elevation. PURPOSE: The objective of this study is to investigate the role of dynamic ultrasound (U/S) in determining the diagnosis of the hourglass biceps lesion. MATERIALS AND METHODS: A prospective cohort of 16 patients with the clinical suspicion of an hourglass lesion, a preoperative ultrasound, and a confirmed hourglass LHB at surgery, were included in the study. Eight patients had preoperative dynamic ultrasound assessment of the LHB, and eight had standard ultrasound investigations and served as a control group. RESULTS: Dynamic ultrasound accurately diagnosed an hourglass biceps in three out of eight cases. LHB hypertrophy was demonstrated in five out of eight cases with U/S and three out of eight cases with standard U/S. All patients were treated by excision of the intra-articular portion of the LHB, 15 by bipolar tenotomy, and one by LHB tenodesis. CONCLUSIONS: Dynamic ultrasound shows promise in improving the accuracy in diagnosis of LHB hypertrophy and the Hourglass lesion. LEVEL OF EVIDENCE: III (Consecutive case-control study investigating a diagnostic test).