d Original Contribution ULTRASOUND-GUIDED INJECTION FOR THE BICEPS BRACHII TENDINITIS: RESULTS AND EXPERIENCE JINGWEI ZHANG,* NABIL EBRAHEIM, y and GREGORY E. LAUSE y *Department of Orthopaedic Surgery, Sixth Hospital of Ningbo, China; and y Department of Orthopaedic Surgery, University of Toledo Medical Center, Toledo, OH (Received 2 December 2010; revised 16 February 2011; in final form 21 February 2011) Abstract—The purpose of this study was to identify the results of ultrasound-guided injection of corticosteroid for biceps brachii tendinitis. In this randomized and prospective study, we evaluated 45 patients who were treated by free-hand injection without ultrasound guidance (group A) and 53 patients who were treated by ultrasound-guided injection (group B). The mean age was 47 y (range, 28 to 72). The average follow-up was 33 weeks (range, 24 to 56). The visual analog scale score decreased from 7.1 ± 2.3 before injection to 4.2 ± 3.1 at follow-up in group A and from 6.9 ± 2.6 to 2.1 ± 1.9 in group B (p , 0.05). The Constant-Murley score improved from 31.4 ± 11.6 before injection to 73.5 ± 19.2 at follow-up in group A and from 32.5 ± 14.7 to 85.5 ± 10.3 (p , 0.01). The ultrasound-guided injection therefore demonstrated a statistically significantly greater degree of pain relief. However, the outcome of injection was not satisfactory for the patients who demonstrated severely frayed tendons at arthroscopy. There were no complications related to the injection in both groups. Corticosteroid injection under ultrasound guidance is a safe and well-tolerated procedure with a satisfactory rate of symptom relief in patients with biceps brachii tendinitis. (E-mail: awei3@sohu.com) Ó 2011 World Federation for Ultrasound in Medicine & Biology. Key Words: Injection, Biceps brachii, Tendinitis, Ultrasound. INTRODUCTION The tendon of the long head of the biceps brachii is commonly involved in pathological processes and has been a recognized cause of shoulder pain and dysfunc- tion. However, the treatment of biceps brachii tendinitis remains controversial. Some authors believe that treat- ment of the primary disease may entail biceps tenodesis; others suggest biceps tendinopathy is the result of an ongoing subacromial impingement syndrome. Some authors have reported favorable results from surgeries with tenodesis or tenotomy (Checchia et al. 2005; Gill et al. 2001; Edwards and Walch 2002). There are also reports showing 84% failure rates for tenodesis (Becker and Cofield 1989) and 35% for tenotomy (Kelly et al. 2005). Moreover, tenodesis or tenotomy may produce proximal migration of the humeral head from the loss of the depressing function provided by the intra- articular portion of the biceps brachii tendon (Kumar et al. 1989; Rodosky et al. 1994). Many nonoperative treatments including local anes- thetic and steroid injections have been advocated for the treatment of biceps brachii tendinitis (Morrison and Frogameni 1997; Petri et al. 1987). To achieve maximum benefit, steroid should be injected into the tendon sheath only and intratendinous injection should be avoided. This injection is technically difficult to achieve. Many articles have described that the ultrasound-guided interventions are safe, effective and accurate because of the lack of ionizing radiation and dynamic visualization in multiple planes (Holm 1998). However, a study comparing ultrasound-guided injection and free-hand injection for the long head of biceps brachii tendonitis has not been performed. In this article, we report our experience in ultrasound- guided injection for patients with biceps brachii tendinitis. MATERIALS AND METHODS Patients From February 2008 to March 2010, there were 1532 patients who came to our clinic center with shoulder pain. There were only 98 patients with isolated biceps Address correspondence to: Jingwei Zhang, M.D., Department of Orthopaedic Surgery, Sixth Hospital of Ningbo, No. 1059 East Zhong- shan Road, Ningbo, Zhejiang, 315040 China. E-mail: awei3@sohu.com 729 Ultrasound in Med. & Biol., Vol. 37, No. 5, pp. 729–733, 2011 Copyright Ó 2011 World Federation for Ultrasound in Medicine & Biology Printed in the USA. All rights reserved 0301-5629/$ - see front matter doi:10.1016/j.ultrasmedbio.2011.02.014