Shoulder injuries

Background: Effectiveness of any individualized therapeutic modality in reducing pain in frozen shoulder is questionable and the combination of therapies has contradictory results. Objectives: The purpose of this study was to check the effectiveness between the treatment modalities of Ultrasound therapy and End range mobilization over Cryotherapy and Stretching as a treatment program in alleviating pain of patients with frozen shoulder. Methods: Forty subjects diagnosed to have frozen shoulder were randomly assigned to two groups. Subjects in Group I received Ultrasound therapy and End range mobilization of shoulder while subjects in Group II got Cryotherapy and Stretching of shoulder. Both the groups were treated for 6 days a week for 4 weeks. Response to pain was considered as the outcome measure. Results: Statistical analysis was done considering p<0.05 as statistically significant and the"t" value were estimated. It was found that ultrasound therapy when combined with end range mobilization had"t" value of 1.8342 in comparison to that of cryotherapy combined with stretching group. Conclusion: Ultrasound therapy with end range mobilization produced a better result than cryotherapy with stretching in reducing pain and therefore can be recommended in the treatment of frozen shoulder.

Background: Effectiveness of any individualized therapeutic modality in reducing pain in frozen shoulder is questionable and the combination of therapies has contradictory results. Objectives: The purpose of this study was to check the effectiveness between the treatment modalities of Ultrasound therapy and End range mobilization over Cryotherapy and Stretching as a treatment program in alleviating pain of patients with frozen shoulder. Methods: Forty subjects diagnosed to have frozen shoulder were randomly assigned to two groups. Subjects in Group I received Ultrasound therapy and End range mobilization of shoulder while subjects in Group II got Cryotherapy and Stretching of shoulder. Both the groups were treated for 6 days a week for 4 weeks. Response to pain was considered as the outcome measure. Results: Statistical analysis was done considering p&lt;0.05 as statistically significant and the„t‟ value were estimated. It was found that ultrasound therapy when combined with end ran...

""Background: Effectiveness of any individualized therapeutic modality in reducing pain in frozen
shoulder is questionable and the combination of therapies has contradictory results. Objectives: The
purpose of this study was to check the effectiveness between the treatment modalities of Ultrasound
therapy and End range mobilization over Cryotherapy and Stretching as a treatment program in
alleviating pain of patients with frozen shoulder. Methods: Forty subjects diagnosed to have frozen
shoulder were randomly assigned to two groups. Subjects in Group I received Ultrasound therapy and
End range mobilization of shoulder while subjects in Group II got Cryotherapy and Stretching of
shoulder. Both the groups were treated for 6 days a week for 4 weeks. Response to pain was considered
as the outcome measure. Results: Statistical analysis was done considering p<0.05 as statistically
significant and the„t‟ value were estimated. It was found that ultrasound therapy when combined with
end range mobilization had„t‟ value of 1.8342 in comparison to that of cryotherapy combined with
stretching group. Conclusion: Ultrasound therapy with end range mobilization produced a better result
than cryotherapy with stretching in reducing pain and therefore can be recommended in the treatment
of frozen shoulder.
Keywords: Frozen shoulder, ultrasound therapy, end range mobilization, cryotherapy, stretching""

Background: Effectiveness of any individualized therapeutic modality in improving the range of motion of shoulder in adhesive capsulitis is questionable and the combination of therapies has contradictory results. Objectives: The purpose of this study was to check the effectiveness between the treatment modalities of Ultrasound and End range mobilization over Cryotherapy and Stretching as a treatment program in improvement of active range of motion in patients with adhesive capsulitis of shoulder. Methods: Forty subjects diagnosed to have adhesive capsulitis were randomly assigned to two groups. Subjects in Group I received Ultrasound and End range mobilization of shoulder while subjects in Group II got Cryotherapy and Stretching of shoulder. Both the groups were treated for 6 days a week for 4 weeks. ROM‘s of shoulder in abduction and external rotation were the outcome measures considered. Results: Statistical analysis was done considering p<0.05 as statistically significant and the‗t‘ values were estimated. It was found that ultrasound when combined with end range mobilization had a value of 3.4498 in comparison to 1.7773 of cryotherapy combined with stretching group. Conclusion: Ultrasound with end range mobilization produced a better result than cryotherapy with stretching and therefore can be recommended in the treatment of second stage adhesive capsulitis of shoulder.

Introduction: Rotator cuff tendinopathy (RCTe) is the most frequent cause of shoulder pain, resulting in considerable losses to society and public resources. Muscle imbalance and inadequate sensorimotor control are deficits often associated with RCTe. Kinesiotaping (KT) is widely used by clinicians for rehabilitation of RCTe. While previous studies have examined the immediate effects of KT on shoulder injuries or the effects of KT as an isolated method of treatment, no published study has addressed its mid- and long-term effects when combined to a rehabilitation program for patients with RCTe. The primary objective of this randomised controlled trial (RCT) will be to assess the efficacy of therapeutic KT, added to a rehabilitation program, in reducing pain and disabilities in individuals with RCTe. Secondary objectives will look at the effects of KT on the underlying factors involved in shoulder control, such as muscular activity, acromiohumeral distance (AHD), and range of motion (ROM).

Methods and analysis: A single-blind RCT will be conducted. Fifty-two participants, randomly allocated to one of two groups (KT or no-KT), will take part in a 6-week rehabilitation program. The KT-group will receive KT added to the rehabilitation program, whereas the no-KT group will receive only the rehabilitation program. Measurements will be taken at baseline, week-3, week-6, week-12 and 6-months. Primary outcomes will be symptoms and functional limitations assessed by the DASH questionnaire. Secondary outcomes will include shoulder ROM, AHD at rest and at 60º of abduction, and muscle activation during arm elevation. The added effects of KT will be assessed through a 2-way ANOVA for repeated measures.

Ethics and Dissemination: Ethics approval was obtained from the Ethics Committee of Quebec Rehabilitation Institute (IRDPQ) of the Center Integrated University Health and Social Services (CIUSSS-CN). Results will be disseminated through international publications in peer-reviewed journals, in addition to international conference presentations.

Trial registration number: Protocol registered at ClinicalTrials.gov (NCT02881021) on August 25, 2016. The World Health Organization Trial Registration Data Set can also be found as a supplementary file.

Keywords: elastic tape, kinesiology taping, physiotherapy, rotator cuff, shoulder pain, tendon injuries.

The coracoid process is a hook-shaped bone structure projecting anterolaterally from the superior aspect of the scapular neck. Surgeons often refer to the coracoid process as the "lighthouse of the shoulder" given its proximity to major neurovascular structures such as the brachial plexus and the axillary artery and vein, its role in guiding surgical approaches, and its utility as a landmark for other important structures in the shoulder. The coracoid also serves as a critical anchor for many tendinous and ligamentous attachments. These include the tendons of the pectoralis minor, coracobrachialis, and short head of the biceps brachii muscles, and the coracoclavicular, coracohumeral, coracoacromial, and transverse scapular ligaments. Consequently, the coracoid and its associated structures are linked to numerous shoulder pathologic conditions. This article will detail the anatomy of the coracoid and its associated structures and review the clinical and radiologic findings of corresponding pathologic conditions in this region with original illustrations and multimodality imaging examples. Highlighted in this article are the coracoclavicular joint, the classification and management of coracoid fractures, subcoracoid impingement, the coracoacromial arch and subacromial impingement, the coracohumeral ligament and the biceps pulley, the coracoclavicular ligament and its surgical reconstruction, adhesive capsulitis, the suprascapular notch and suprascapular notch impingement, subcoracoid bursitis, coracoid transfer procedures, and coracoid tumors. A brief summary of the pathophysiology, potential causes, and management options for each of the pathologic entities will also be discussed. ©

Background: Effectiveness of any individualized therapeutic modality in improving the range of motion of shoulder in adhesive capsulitis is questionable and the combination of therapies has contradictory results. Objectives: The purpose of this study was to check the effectiveness between the treatment modalities of Ultrasound and End range mobilization over Cryotherapy and Stretching as a treatment program in improvement of active range of motion in patients with adhesive capsulitis of shoulder. Methods: Forty subjects diagnosed to have adhesive capsulitis were randomly assigned to two groups. Subjects in Group I received Ultrasound and End range mobilization of shoulder while subjects in Group II got Cryotherapy and Stretching of shoulder. Both the groups were treated for 6 days a week for 4 weeks. ROM‘s of shoulder in abduction and external rotation were the outcome measures considered. Results: Statistical analysis was done considering p&lt;0.05 as statistically significant and ...

n progetto internazionale e multidisciplinare concentrato sui resti scheletrici di un uomo vissuto seicento anni fa a Castiglione, villaggio rurale oggi scomparso presso Conversano, e progressivamente allargato all’intero nucleo insediativo e alla storia della sua comunità nel delicato momento di passaggio tra l’età angioina e l’età aragonese.
La ricerca ha investito l’ambiente naturale, le testimonianze materiali e i dati rinvenuti con scavi archeologici, le componenti architettoniche dei resti dell’abitato, le fonti documentarie; un secondo e più specifico campo di indagine ha riguardato in modo dettagliato gli aspetti prettamente antropologici relativi all’individuo e agli altri antichi abitanti di Castiglione; l’insieme dei dati, infine, è confluito nelle riflessioni di carattere più spiccatamente storico e nelle proposte di valorizzazione dei contenuti scientifici maturati.
Oggi possediamo su quest’uomo molte informazioni: per esempio che mangiava molta carne, che andava costantemente a cavallo da cui è caduto procurandosi una lussazione-frattura della spalla mai guarita, che è morto probabilmente per un infarto intorno ai 50 anni. Eppure, ci sfuggono diversi aspetti: non sappiamo il suo nome, né possiamo avanzare ipotesi sicure sul suo ruolo all’interno della comunità in cui viveva.
Tuttavia, gli elementi a nostra disposizione, le riflessioni e gli studi sono confluiti in una vera e propria ricostruzione materiale del nostro uomo, che ha quasi il sapore di una “fotografia”, con il volto segnato dal dolore e dagli acciacchi di una vita certo non facile anche se più agiata rispetto agli standard dell’epoca. Un’istantanea preziosa che ci consente di aprire una finestra sulla storia della Puglia intorno alla prima metà del XV secolo.
Il progetto, conclusosi con la pubblicazione di un volume, ha investito anche il territorio, gli enti, le amministrazioni, gli organismi di tutela, in un percorso comune di sviluppo e valorizzazione di uno dei numerosissimi beni culturali della nostra regione, costituendo una vera e propria filiera territoriale in cui anche un virtuoso comparto privato ha fornito competenza professionale e sostegno progettuale al lavoro pubblico.

Background: Effectiveness of any individualized therapeutic modality in reducing pain in frozen shoulder is questionable and the combination of therapies has contradictory results. Objectives: The purpose of this study was to check the effectiveness between the treatment modalities of Ultrasound therapy and End range mobilization over Cryotherapy and Stretching as a treatment program in alleviating pain of patients with frozen shoulder. Methods: Forty subjects diagnosed to have frozen shoulder were randomly assigned to two groups. Subjects in Group I received Ultrasound therapy and End range mobilization of shoulder while subjects in Group II got Cryotherapy and Stretching of shoulder. Both the groups were treated for 6 days a week for 4 weeks. Response to pain was considered as the outcome measure. Results: Statistical analysis was done considering p<0.05 as statistically significant and the"t" value were estimated. It was found that ultrasound therapy when combined with end range mobilization had"t" value of 1.8342 in comparison to that of cryotherapy combined with stretching group. Conclusion: Ultrasound therapy with end range mobilization produced a better result than cryotherapy with stretching in reducing pain and therefore can be recommended in the treatment of frozen shoulder.

The inferior glenohumeral ligament (IGHL) complex is comprised of three components supporting the inferior aspect of the shoulder. It consists of an anterior band, a posterior band, and an interposed axillary pouch. Injuries to the IGHL complex have a unifying clinical history of traumatic shoulder injury, which are often sports or fall-related, with the biomechanical mechanism, positioning of the arm, and individual patient factors determining the specific component of the ligamentous complex that is injured, the location of the injury of those components, and the degree of bone involvement. Several acronyms are employed to characterize these features, specifying whether there is involvement of a portion of the anterior band, posterior band, or midsubstance, and if there is avulsion from the humeral attachment, glenoid attachment, or both. Imaging recommendations for the evaluation of the IGHL complex include magnetic resonance imaging (MRI), and injuries to this complex are best v...

Jimenez-Olmedo, J.M., & Penichet-Tomas, A. (2015). Injuries and pathologies in beach volleyball players: A systematic review. J. Hum. Sport Exerc., 10(4), pp.936-948. The aim of this paper is to review the available literature published on injuries and pathology in beach volleyball. The databases consulted were the Web of Sciende and Pubmed. After establishing the criteria for selection and filtering, a total of 32 articles were selected. All items found can be classified into four research lines. First are the studies focused on specific injuries such as shoulder, shoveling, knee and foot. The second line of research focuses on the study of the incidence, prevalence and frequency of injuries of beach volleyball players, whereas the third line deals on infections reported in the literature produced by nematodes or fungi. Finally, the last line of research includes articles addressing different objectives related to health such as the effects of training programs related to injuries, influence of weather conditions on the players, as well as publications for validation of assessment instruments or develop of guidelines and protocols for the evaluation and diagnosis of injuries.

To produce a best evidence synthesis of exercise prescription used when treating shoulder pathology in the overhead athlete. A systematic review of exercises used in overhead athletes including case studies and clinical commentaries. MEDLINE, PubMed, SPORTDiscus and CINAHL from database inception through July 8, 2016. We examined data from randomised controlled trials and prospective cohort (level I-IV evidence) studies that addressed exercise intervention in the rehabilitation of the overhead athlete with shoulder pathology. Case studies and clinical commentaries (level V evidence) were examined to account for expert opinion-based research. Data were combined using best evidence synthesis and graded (A-F) recommendations (Centre for Evidence-Based Medicine). There were 33 unique exercises in six level I-IV studies that met our inclusion criteria. Most exercises were single-plane, upper extremity exercises performed below 90o of elevation. There were 102 unique exercises in 33 level...

Background: Frozen shoulder is an insidious condition that begins with pain and gradual restriction of movement in the shoulder region. There are various methods of treating frozen shoulder (both surgical and non-surgical).Among the non-surgical methods there is no specific method accepted universally. Purpose of this study is to determine the combined effectiveness of Glenohumeral End-Range Mobilization and Contract-Relax technique for glenohumeral internal rotators in patients with adhesive capsulitis.
Methods: 60 frozen shoulder patients randomized 30 subjects into each experimental and control group. Group A (experimental group) received Glenohumeral End-Range Mobilization, Contract-Relax Technique for glenohumeral internal rotators and Shoulder Pendular Exercises 2 times a week for a period of 4 weeks (8 sessions).Group B (control group) received Shoulder Pendular exercises 2 times a week for a period of 4 weeks (8 sessions). Outcome measures included are VAS, SPADI and goniometry for assessing pain, functional ability and ROM for the shoulder joint.
Results: The average improvement of VAS for Group A and Group B were 4.5 and 3 respectively using median. The U-value was 176, which is statistically highly significant (p value = 0.000).The average improvement of Shoulder Pain and Disability Index for Group A and group B were 56.9333 and 10.3667 respectively using mean and Standard Deviation. The t-value was 35.91181, which is statistically highly significant (p value = 0.000).
Conclusion: The results indicated that both Group A and Group B had significant improvement in the scores of VAS, SPADI and GONIOMETRY scores at the 4th week when compared to base line values, but when comparing the end results of group A and group B it has been found out that group A intervention is more effective then Group B in treating the internal rotators of patients with adhesive capsulitis

In this paper, the most common injuries in university beach volleyball players are studied through a 33 participant sample at the University Spanish Championship. Injuries were assessed by means of personal interviews and a validated questionnaire. Results show that the body region with the highest incidence was the ankle (33%), followed by the fingers (18.5%), knees (13.0%), shoulders (11.1%) and back (5.6%). Data was also retrieved about the moment of injury (competition or training), origin (impact or overuse) and characteristic of the injury (new or recurrent injury). Statistical processing of data for establishing significant differences was performed using the Chi-square test. Results established a

The glenohumeral joint has the most mobility of any in the body, and contact between the humeral head and glenoid labrum contributes to its stability. Patients with recurrent dislocations may have bone defects in one or both of these surfaces, due to the presence of a Bankart lesion or an engaging Hill-Sachs lesion. We present a case of an adult whose left shoulder required intervention following a 10-year history of chronic, recurrent glenohumeral dislocation. Our assessment revealed a large Bankart lesion combined with a large Hill-Sachs lesion. We performed an open surgery with bone augmentation of the glenoid osseous defect using a tricortical autogenous bone graft harvested from the iliac crest. Intra-operative assessment showed adequate stability without intervention for the humeral head defect. The technical aspect of the surgery is described together with the clinical outcomes of the patient. We briefly review therapeutic options for glenohumeral osseous defects described in the literature.

Work-related injuries of the shoulder complex represent a challenge for clinicians because of the large variety of clinical entities involved and the broad anatomic structures that can be affected. Furthermore, commonly performed orthopedic tests have demonstrated limited accuracy for diagnosing the injury despite considerable research efforts. The aim of this study protocol is therefore to describe a comprehensive approach integrating both a clinical- and functional status-based pathology and an adapted rehabilitation prescription. A longitudinal cohort study will be performed at the Department of Rehabilitation and Medical Assistance of a mutual insurance society for work-related injury management in Spain (Mutua Navarra, Pamplona, Navarra Spain). Patients will be attended by an occupational physician who specializes in work-related injuries and is part of the project team that will systematically visit all the participants. After the medical diagnosis and any requested supplement...

Over the last decade, the concept of internal impingement has continued to evolve, and the frequency with which this condition is recognised continues to increase. This syndrome should be clearly differentiated from the classical (external) impingement that is thought to be caused by compression of the subacromial bursa, long head of the biceps tendon and rotator cuff (RC) by the coraco-acromial arch. Internal (posterosuperior) impingement syndrome is typified by a painful shoulder due to impingement of the soft tissue, including the RC, joint capsule and the posterosuperior part of the glenoid. The aetiology of this syndrome is unclear, but hypotheses include anterior shoulder instability or micro-instability, contracture of the posterior capsule, reduced humeral retroversion and scapular dyskinesis. Non-operative therapy represents the first line of treatment for this syndrome and includes the management of pain, stretching of the posterior capsule and a muscle strengthening programme. Surgical treatment should only be considered when conservative management fails. A number of different surgical procedures have been proposed, but the results are variable. The success rate is generally improved when the subtle instability, associated with internal impingement, is also addressed.

BACKGROUND Arthroscopy is the established &#39;gold standard&#39; diagnostic investigation for detection of shoulder disorders. We aimed to compare the diagnostic accuracy of arthroscopy with magnetic resonance arthrography (MRA) for detection of shoulder disorders. METHODS Patients who underwent arthroscopy by a single surgeon and preoperative MRA between February 2011 and March 2012 for shoulder instability were identified. MRAs were reported by experienced musculoskeletal radiologists. Labral tears, anterior labral tears, superior labral anterior posterior (SLAP) lesions, posterior labral tears, rotator-cuff tears (RCTs), osteoarthritis, loose bodies and Hill-Sachs lesions were identified. Sensitivity, specificity, positive predictive value and negative predictive value, positive likelihood ratio and negative likelihood ratio were calculated. RESULTS A total of 194 patients were identified. The sensitivity and specificity for anterior labral tears was 0.60 and 0.92, SLAP lesions ...

Background: Effectiveness of any individualized therapeutic modality in reducing pain in frozen shoulder is questionable and the combination of therapies has contradictory results. Objectives: The purpose of this study was to check the effectiveness between the treatment modalities of Ultrasound therapy and End range mobilization over Cryotherapy and Stretching as a treatment program in alleviating pain of patients with frozen shoulder. Methods: Forty subjects diagnosed to have frozen shoulder were randomly assigned to two groups. Subjects in Group I received Ultrasound therapy and End range mobilization of shoulder while subjects in Group II got Cryotherapy and Stretching of shoulder. Both the groups were treated for 6 days a week for 4 weeks. Response to pain was considered as the outcome measure. Results: Statistical analysis was done considering p&lt;0.05 as statistically significant and the„t‟ value were estimated. It was found that ultrasound therapy when combined with end ran...

Context: Scapular dyskinesis has been identified as a possible risk factor for injury in overhead athletes. There is a need to develop a simple, inexpensive, time-efficient field-based test that can establish the presence and severity of both scapular dyskinesis and its individual components in a musculoskeletal preparticipation screening. To ensure confidence in the test results, high reliability must be displayed. Objective: To establish the intertester and intratester reliability of a simple field-based screening tool for scapular dyskinesis. Design: Reliability study. Setting: Athletic therapy facilities. Participants: 15 physically active men (19.46 ± 0.63 y) free from any orthopedic or neurological disorders, recruited from a convenience sample of college students. Intervention: Testers underwent 3 training sessions where the instructions and scoring system of the test were explained, demonstrations of the tests were given, and opportunities to practice the test were provided....

Objective: to evaluate the effect of physical therapy on the range of motion of the shoulders and perimetry of the upper limbs in women treated with radiotherapy for breast cancer. Methods: a total of 35 participants were randomized into two groups, with 18 in the control group (CG) and 17 in the study group (SG). Both of the groups underwent three evaluations to assess the range of motion of the shoulders and perimetry of the upper limbs, and the study group underwent supervised physical therapy for the upper limbs. Results: the CG had deficits in external rotation in evaluations 1, 2, and 3, whereas the SG had deficits in flexion, abduction, and external rotation in evaluation 1. The deficit in abduction was recovered in evaluation 2, whereas the deficits in all movements were recovered in evaluation 3. No significant differences in perimetry were observed between the groups. Conclusion: the applied supervised physical therapy was effective in recovering the deficit in abduction a...

The coracoid process is a hook-shaped bone structure projecting anterolaterally from the superior aspect of the scapular neck. Surgeons often refer to the coracoid process as the "lighthouse of the shoulder" given its proximity to major neurovascular structures such as the brachial plexus and the axillary artery and vein, its role in guiding surgical approaches, and its utility as a landmark for other important structures in the shoulder. The coracoid also serves as a critical anchor for many tendinous and ligamentous attachments. These include the tendons of the pectoralis minor, coracobrachialis, and short head of the biceps brachii muscles, and the coracoclavicular, coracohumeral, coracoacromial, and transverse scapular ligaments. Consequently, the coracoid and its associated structures are linked to numerous shoulder pathologic conditions. This article will detail the anatomy of the coracoid and its associated structures and review the clinical and radiologic findings of corresponding pathologic conditions in this region with original illustrations and multimodality imaging examples. Highlighted in this article are the coracoclavicular joint, the classification and management of coracoid fractures, subcoracoid impingement, the coracoacromial arch and subacromial impingement, the coracohumeral ligament and the biceps pulley, the coracoclavicular ligament and its surgical reconstruction, adhesive capsulitis, the suprascapular notch and suprascapular notch impingement, subcoracoid bursitis, coracoid transfer procedures, and coracoid tumors. A brief summary of the pathophysiology, potential causes, and management options for each of the pathologic entities will also be discussed. ©

The acromion is one of the two processes of the scapula. It plays a role in the field of orthopedics by having a correlation with some diseases. The morphology of this process has a significant role in upper limb pathology. The aim of the present study was to describe the different types of acromion process based on its morphology and to discuss its relation to some orthopedics diseases. We carried out a research which included 30 scapulae of unknown sex and age, provided by the Medical University of Sofia. Digital Vernier caliper and goniometer were used to calibrate the parameters (length, width etc.) of the process. We established three types of acromion process: type 1-flat, type 2-curved and type 3-hooked. Our study showed that type 2 (curved) was the most commonly observed-around 80 % of the fixed materials; type 1 (flat) was seen in 11% and type 3 (hooked)-in 9%. People with type 3 (hooked) acromion process tend to suffer more often from the subacromial impingement syndrome. Knowledge of the morphology of the acromion process may help with the diagnosis and treatment of various diseases discussed in the present study and may supplement the work of shoulder surgeons and people occupied with this field of work.

Over the last decade, the concept of internal impingement has continued to evolve, and the frequency with which this condition is recognised continues to increase. This syndrome should be clearly differentiated from the classical (external) impingement that is thought to be caused by compression of the subacromial bursa, long head of the biceps tendon and rotator cuff (RC) by the coraco-acromial arch. Internal (posterosuperior) impingement syndrome is typifi ed by a painful shoulder due to impingement of the soft tissue, including the RC, joint capsule and the posterosuperior part of the glenoid. The aetiology of this syndrome is unclear, but hypotheses include anterior shoulder instability or micro-instability, contracture of the posterior capsule, reduced humeral retroversion and scapular dyskinesis. Non-operative therapy represents the fi rst line of treatment for this syndrome and includes the management of pain, stretching of the posterior capsule and a muscle strengthening programme. Surgical treatment should only be considered when conservative management fails. A number of different surgical procedures have been proposed, but the results are variable. The success rate is generally improved when the subtle instability, associated with internal impingement, is also addressed.

Long head biceps (LHB) tendon pathologies are becoming increasingly recognized causes of shoulder pain in the published literature. Instability of LHB presenting as dislocation or subluxation has been recently recognized as a possible cause of disabling pain or discomfort of the shoulder. A clinical diagnosis of LHB instability is very difficult and often confounding because of association with other shoulder pathologies. However, an early diagnosis of LHB instability is important in order to prevent the evolution of lesions of the biceps pulley until an internal anterosuperior impingement of the shoulder (ASI) and subscapular tear occur. The advent of arthroscopy contributed to enhance understandings. The goal of this article is to describe an arthroscopic sign, the chondral print on the humeral head, associated with a LHB instability, that when present can be very useful to help the surgeon to make the diagnosis of unstable LHB tendon.