The forelock sign: A new arthroscopic finding in partial subscapularis tears

Cetinkaya, Mehmet; Ataoğlu, Baybars; Ayanoğlu, Tacettin; BOLUKBASI, SELCUK; özer, mustafa; Kanatlı, Ulunay

doi:10.5606/ehc.2019.66814

The forelock sign: A new arthroscopic finding in partial subscapularis tears

Mehmet ÇETİNKAYA, (Erzincan Üniversitesi, Mengücek Gazi Eğitim ve Araştırma Hastanesi, Ortopedi ve Travmatoloji Anabilim Dalı, Erzincan, Türkiye)

Ulunay KANATLI, (Gazi Üniversitesi, Tıp Fakültesi, Ortopedi ve Travmatoloji Anabilim Dalı, Ankara, Türkiye)

Muhammet Baybars ATAOĞLU, (Gazi Üniversitesi, Tıp Fakültesi, Ortopedi ve Travmatoloji Anabilim Dalı, Ankara, Türkiye)

Mustafa ÖZER, (Necmettin Erbakan Üniversitesi, Meram Tıp Fakültesi, Ortopedi ve Travmatoloji Anabilim Dalı, Konya, Türkiye)

Tacettin AYANOĞLU, (Gazi Üniversitesi, Tıp Fakültesi, Ortopedi ve Travmatoloji Anabilim Dalı, Ankara, Türkiye)

Selçuk BÖLÜKBAŞI (Gazi Üniversitesi, Tıp Fakültesi, Ortopedi ve Travmatoloji Anabilim Dalı, Ankara, Türkiye)

Eklem Hastalıkları ve Cerrahisi Dergisi (Eski Adı: Artroplasti Artroskopik Cerrahi Derg.)

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Yıl: 2019 Cilt: 30 Sayı: 3 Sayfa Aralığı: 185 - 192 Metin Dili: İngilizce DOI: 10.5606/ehc.2019.66814 İndeks Tarihi: 20-11-2020

The forelock sign: A new arthroscopic finding in partial subscapularis tears

Öz:

Objectives: This study aims to identify the forelock sign ofpartial tears of the subscapularis and to compare the incidences ofthis sign and air bag sign.Patients and methods: One hundred and twenty patients(39 males, 81 females; mean age 51.3 years; range, 25 to 79)diagnosed as isolated subscapularis tear or isolated supraspinatustear from among patients who underwent shoulder arthroscopybetween January 2013 and January 2016 were divided into fourgroups of 30 patients each as the subscapularis tear (group 1), fullthicknesssupraspinatus tear (group 2), bursal-side supraspinatustear (group 3), and articular-side supraspinatus tear (group 4)groups. All patients had video records of their operation. Theintegrity of the long head of biceps tendon (LHBT), Lafosseclassification of the subscapularis tear, and the incidence of theforelock and air bag signs were evaluated.Results: The incidence of the air bag sign in group 1 was 10%and that of the forelock sign was 60%. The forelock sign wassignificantly more frequent in group 1 than in the other groups(odds ratio 10.46: 3.9-27.8 with 95% confidence interval) andthe air bag sign (p<0.001). The LHBT was mostly pathologic inthis group, which was also statistically significant (p<0.01). Theincidence of the forelock sign in group 1 was similar in each LHBTpathology and Lafosse subgroups.Conclusion: The forelock sign identified in this study wassignificantly frequent (60%) in partial subscapularis tendon tearswith strong inter- and intra-observer consistency while the airbag sign was rare (10%). The LHBT disorders were stronglyassociated with subscapularis tears; however, the forelock sign wasnot an indicator of the condition of the LHBT and type of partialsubscapularis tendon tear according to the Lafosse classification.

Anahtar Kelime:

Kakül işareti: Parsiyel subskapularis yırtıklarında yeni bir artroskopik bulgu

Öz:

Amaç: Bu çalışmada, subskapularis parsiyel yırtıklarının kakül işareti tanımlandı ve bu işaret ile hava yastığı işaretinin insidansları karşılaştırıldı. Hastalar ve yöntemler: Ocak 2013-Ocak 2016 tarihleri arasında omuz artroskopisi uygulanan hastalar arasından izole subskapularis yırtığı veya izole supraspinatus yırtığı tanısı konulan 120 hasta (39 erkek, 81 kadın; ort. yaş 51.3 yıl; dağılım, 25-79 yıl) subskapularis yırtığı (grup 1), tam kat supraspinatus yırtığı (grup 2), bursal yüz supraspinatus yırtığı (grup 3) ve eklem yüzü supraspinatus yırtığı (grup 4) grubu olmak üzere 30’ar hastalık dört gruba ayrıldı. Tüm hastaların ameliyatının video kaydı vardı. Biseps tendonunun uzun başı (BTUB)’nın bütünlüğü, subskapularis yırtığının Lafosse sınıflandırması ve kakül ve hava yastığı işaretlerinin insidansı değerlendirildi. Bulgular: Grup 1’de hava yastığı işaretinin insidansı %10, kakül işaretininki %60 idi. Kakül işareti grup 1’de diğer gruplardan (olasılık oranı %95 güven aralığında 10.46: 3.9-27.8) ve hava yastığı işaretinden anlamlı olarak daha sıktı (p<0.001). Biseps tendonunun uzun başı bu grupta çoğunlukla patolojikti ve bu da istatistiksel olarak anlamlıydı (p<0.01). Grup 1’de kakül işareti insidansı her BTUB patolojisinde ve Lafosse alt gruplarında benzerdi. Sonuç: Bu çalışmada tanımlanan kakül işareti parsiyel subskapularis tendonu yırtıklarında güçlü gözlemciler arası ve gözlemciler içi tutarlılıkla anlamlı olarak sık (%60) iken hava yastığı işareti nadirdi (%10). BTUB’nin bozuklukları subskapularis yırtıklarıyla güçlü bir şekilde ilişkiliydi fakat kakül işareti BTUB’nin durumunun veya Lafosse sınıflandırmasına göre parsiyel subskapularis tendon yırtığı tipinin bir göstergesi değildi.

Anahtar Kelime:

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık

1. Gerber C, Krushell RJ. Isolated rupture of the tendon of the subscapularis muscle. Clinical features in 16 cases. J Bone Joint Surg [Br] 1991;73:389-94.
2. Lo IAN, Burkhart S. Subscapularis Tears: Arthroscopic Repair of the Forgotten Rotator Cuff Tendon. Tech Shoulder Elbow Surg 2002;3:282-91.
3. Lanz U, Fullick R, Bongiorno V, Saintmard B, Campens C, Lafosse L. Arthroscopic repair of large subscapularis tendon tears: 2- to 4-year clinical and radiographic outcomes. Arthroscopy 2013;29:1471-8.
4. Grueninger P, Nikolic N, Schneider J, Lattmann T, Platz A, Chmiel C, et al. Arthroscopic Repair of Massive Cuff Tears With Large Subscapularis Tendon Ruptures (Lafosse III/ IV): A Prospective Magnetic Resonance Imaging-Controlled Case Series of 26 Cases With a Minimum Follow-up of 1 Year. Arthroscopy 2015;31:2173-82.
5. Seppel G, Plath JE, Völk C, Seiberl W, Buchmann S, Waldt S, et al. Long-term results after arthroscopic repair of isolated subscapularis tears. Am J Sports Med 2017;45:759-66.
6. Saltzman BM, Collins MJ, Leroux T, Arns TA, Griffin JW, Romeo AA, et al. Arthroscopic repair of isolated subscapularis tears: a systematic review of techniquespecific outcomes. Arthroscopy 2017;33:849-60.
7. Neyton L, Daggett M, Kruse K, Walch G. The Hidden lesion of the subscapularis: arthroscopically revisited. Arthrosc Tech 2016;5:877-81.
8. Sahu D, Fullick R, Giannakos A, Lafosse L. Sentinel sign: a sign of biceps tendon which indicates the presence of subscapularis tendon rupture. Knee Surg Sports Traumatol Arthrosc 2016;24:3745-9.
9. Wani Z, Mangattil R, Butterfield T, Hildebrand K, Kamineni S. Subscapularis partial tear nodule causing shoulder rotational triggering. Knee Surg Sports Traumatol Arthrosc 2015;23:573-6.
10. Saremi H. Interstitial tear of the subscapularis tendon, arthroscopic findings and technique of repair. Arch Bone Jt Surg 2016;4:177-80.
11. Bey MJ, Elders GJ, Huston LJ, Kuhn JE, Blasier RB, Soslowsky LJ. The mechanism of creation of superior labrum, anterior, and posterior lesions in a dynamic biomechanical model of the shoulder: the role of inferior subluxation. J Shoulder Elbow Surg 1998;7:397-401.
12. Chen CH, Chen CH, Chang CH, Su CI, Wang KC, Wang IC, et al. Classification and analysis of pathology of the long head of the biceps tendon in complete rotator cuff tears. Chang Gung Med J 2012;35:263-70.
13. Cetinkaya M, Pozisyonlar. In: Kanatli U, editor. Yeni başlayanlar için omuz artroskopisi. Ankara: Azim Matbaacılık; 2015. s. 113-6.
14. Lafosse L, Jost B, Reiland Y, Audebert S, Toussaint B, Gobezie R. Structural integrity and clinical outcomes after arthroscopic repair of isolated subscapularis tears. J Bone Joint Surg [Am] 2007;89:1184-93.
15. Ataoglu MB, Cetinkaya M, Ozer M, Ayanoglu T, Kanatli U. The high frequency of superior labrum, biceps tendon, and superior rotator cuff pathologies in patients with subscapularis tears: A cohort study. J Orthop Sci 2018;23:304-9.
16. Burkhart SS, Tehrany AM. Arthroscopic subscapularis tendon repair: Technique and preliminary results. Arthroscopy 2002;18:454-63.
17. Atik OŞ. Which articles do we prefer to publish? Eklem Hastalik Cerrahisi 2018;29:1.
18. Özer M, Ataoğlu MB, Çetinkaya M, Ayanoğlu T, Kaptan AY, Kanatlı U. Do intra-articular pathologies accompanying symptomatic acromioclavicular joint degeneration vary across age groups? Eklem Hastalik Cerrahisi 2019;30:2-9.
19. Kanatli U, Ayanoğlu T, Aktaş E, Ataoğlu MB, Özer M, Çetinkaya M. Grade of coracoacromial ligament degeneration as a predictive factor for impingement syndrome and type of partial rotator cuff tear. J Shoulder Elbow Surg 2016;25:1824-8.
20. Edwards TB, Walch G, Nové-Josserand L, Boulahia A, Neyton L, O’Connor DP, et al. Arthroscopic debridement in the treatment of patients with isolated tears of the subscapularis. Arthroscopy 2006;22:941-6.
21. Clark JM, Harryman DT 2nd. Tendons, ligaments, and capsule of the rotator cuff. Gross and microscopic anatomy. J Bone Joint Surg [Am] 1992;74:713-25.
22. Walch G, Nove-Josserand L, Levigne C, Renaud E. Tears of the supraspinatus tendon associated with “hidden” lesions of the rotator interval. J Shoulder Elbow Surg 1994;3:353-60.
23. Arai R, Mochizuki T, Yamaguchi K, Sugaya H, Kobayashi M, Nakamura T, et al. Functional anatomy of the superior glenohumeral and coracohumeral ligaments and the subscapularis tendon in view of stabilization of the long head of the biceps tendon. J Shoulder Elbow Surg 2010;19:58-64.
24. Arai R, Sugaya H, Mochizuki T, Nimura A, Moriishi J, Akita K. Subscapularis tendon tear: an anatomic and clinical investigation. Arthroscopy 2008;24:997-1004.
25. DePalma AF. Surgery of the shoulder. 3rd ed. Philadelphia: J.B. Lippincott; 1973.
26. Neer CS 2nd, Satterlee CC, Dalsey RM, Flatow EL. The anatomy and potential effects of contracture of the coracohumeral ligament. Clin Orthop Relat Res 1992;280:182-5.
27. Wu YT, Su WR, Wu PT, Shen PC, Jou IM. Degradation of elastic fiber and elevated elastase expression in long head of biceps tendinopathy. J Orthop Res 2017;35:1919-26.

APA	Cetinkaya M, Kanatlı U, Ataoğlu B, özer m, Ayanoğlu T, BOLUKBASI S (2019). The forelock sign: A new arthroscopic finding in partial subscapularis tears. , 185 - 192. 10.5606/ehc.2019.66814
Chicago	Cetinkaya Mehmet,Kanatlı Ulunay,Ataoğlu Baybars,özer mustafa,Ayanoğlu Tacettin,BOLUKBASI SELCUK The forelock sign: A new arthroscopic finding in partial subscapularis tears. (2019): 185 - 192. 10.5606/ehc.2019.66814
MLA	Cetinkaya Mehmet,Kanatlı Ulunay,Ataoğlu Baybars,özer mustafa,Ayanoğlu Tacettin,BOLUKBASI SELCUK The forelock sign: A new arthroscopic finding in partial subscapularis tears. , 2019, ss.185 - 192. 10.5606/ehc.2019.66814
AMA	Cetinkaya M,Kanatlı U,Ataoğlu B,özer m,Ayanoğlu T,BOLUKBASI S The forelock sign: A new arthroscopic finding in partial subscapularis tears. . 2019; 185 - 192. 10.5606/ehc.2019.66814
Vancouver	Cetinkaya M,Kanatlı U,Ataoğlu B,özer m,Ayanoğlu T,BOLUKBASI S The forelock sign: A new arthroscopic finding in partial subscapularis tears. . 2019; 185 - 192. 10.5606/ehc.2019.66814
IEEE	Cetinkaya M,Kanatlı U,Ataoğlu B,özer m,Ayanoğlu T,BOLUKBASI S "The forelock sign: A new arthroscopic finding in partial subscapularis tears." , ss.185 - 192, 2019. 10.5606/ehc.2019.66814
ISNAD	Cetinkaya, Mehmet vd. "The forelock sign: A new arthroscopic finding in partial subscapularis tears". (2019), 185-192. https://doi.org/10.5606/ehc.2019.66814

APA	Cetinkaya M, Kanatlı U, Ataoğlu B, özer m, Ayanoğlu T, BOLUKBASI S (2019). The forelock sign: A new arthroscopic finding in partial subscapularis tears. Eklem Hastalıkları ve Cerrahisi Dergisi (Eski Adı: Artroplasti Artroskopik Cerrahi Derg.), 30(3), 185 - 192. 10.5606/ehc.2019.66814
Chicago	Cetinkaya Mehmet,Kanatlı Ulunay,Ataoğlu Baybars,özer mustafa,Ayanoğlu Tacettin,BOLUKBASI SELCUK The forelock sign: A new arthroscopic finding in partial subscapularis tears. Eklem Hastalıkları ve Cerrahisi Dergisi (Eski Adı: Artroplasti Artroskopik Cerrahi Derg.) 30, no.3 (2019): 185 - 192. 10.5606/ehc.2019.66814
MLA	Cetinkaya Mehmet,Kanatlı Ulunay,Ataoğlu Baybars,özer mustafa,Ayanoğlu Tacettin,BOLUKBASI SELCUK The forelock sign: A new arthroscopic finding in partial subscapularis tears. Eklem Hastalıkları ve Cerrahisi Dergisi (Eski Adı: Artroplasti Artroskopik Cerrahi Derg.), vol.30, no.3, 2019, ss.185 - 192. 10.5606/ehc.2019.66814
AMA	Cetinkaya M,Kanatlı U,Ataoğlu B,özer m,Ayanoğlu T,BOLUKBASI S The forelock sign: A new arthroscopic finding in partial subscapularis tears. Eklem Hastalıkları ve Cerrahisi Dergisi (Eski Adı: Artroplasti Artroskopik Cerrahi Derg.). 2019; 30(3): 185 - 192. 10.5606/ehc.2019.66814
Vancouver	Cetinkaya M,Kanatlı U,Ataoğlu B,özer m,Ayanoğlu T,BOLUKBASI S The forelock sign: A new arthroscopic finding in partial subscapularis tears. Eklem Hastalıkları ve Cerrahisi Dergisi (Eski Adı: Artroplasti Artroskopik Cerrahi Derg.). 2019; 30(3): 185 - 192. 10.5606/ehc.2019.66814
IEEE	Cetinkaya M,Kanatlı U,Ataoğlu B,özer m,Ayanoğlu T,BOLUKBASI S "The forelock sign: A new arthroscopic finding in partial subscapularis tears." Eklem Hastalıkları ve Cerrahisi Dergisi (Eski Adı: Artroplasti Artroskopik Cerrahi Derg.), 30, ss.185 - 192, 2019. 10.5606/ehc.2019.66814
ISNAD	Cetinkaya, Mehmet vd. "The forelock sign: A new arthroscopic finding in partial subscapularis tears". Eklem Hastalıkları ve Cerrahisi Dergisi (Eski Adı: Artroplasti Artroskopik Cerrahi Derg.) 30/3 (2019), 185-192. https://doi.org/10.5606/ehc.2019.66814