Detaillierte Beitrags-Information
| Beitragstitel | Intraoperative estimation of Popeye deformity appearance by electrical stimulation of the musculocutaneous nerve |
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| Beitragscode | P010 |
| Autoren | |
| Präsentationsform | Poster |
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| Abstract |
Background: Although the need for tenodesis after a tenotomy of the long head of biceps brachii muscle is controversial, some of in particular younger patients require tenodesis in order to reduce the probability of Popeye deformity occurrence. In addition to the cosmetically unfavorable appearance, Popeye deformity is also associated with poor functional outcome and more pain. The aim of this study was to investigate a new technique to intraoperatively estimate the risk of Popeye deformity development with electrical stimulation of the biceps brachii muscle. Methods: Electrical stimulation of the musculocutaneous nerve was applied to assess the risk of Popeye deformity after biceps tendinopathy has been affirmed. Simultaneously to the maximal motor response, the contraction of the biceps tendon inside the joint, following the rhythm of the stimulator, was visible. Biceps tenotomy was then performed. The contraction of the long proximal biceps tendon was arthroscopically documented. The risk of a possible postoperative Popeye deformity was estimated by the surgeon based on the movement amplitude of the long biceps tendon. Results: 12 consecutive patients (5 females, 7 males, mean age 53 years, SD 9.5, 9/12 dominant shoulders) underwent either biceps tenotomy (n=7) or biceps tenodesis (n=5). After a mean follow-up period of 20 months (SD 3.4), no Popeye deformity has been documented in any of the 7 patients with biceps tenotomy. In 3 out of 5 patients where biceps deformity has been anticipated intraoperatively, Popeye sign was observed postoperative. The Constant Shoulder Score improved by an average of 12 points (SD 7.2) with an average Constant Shoulder Score of 93 (SD 7.9) after 20 months. Both the preoperative pain level (Visual Analogue Scale = VAS, mean 4.6, SD 2.3) and the preoperative Subjective Shoulder Value (SSV, mean 64%, SD 16.6) showed a significant improvement (pVAS=0.002, pSSV=0.008) (VAS 1.4, SD 1.6 respectively SSV 83%, SD 12.9). No damage of musculocutaneous nerve was observed. Conclusion: The intraoperative use of biceps brachii muscle stimulation device is a valuable, safe and patient specific technique to help the surgeon estimate the need for biceps tenodesis. |