BACKGROUND Shoulder pain-mostly related to rotator cuff tendinopathy-is the most common reason adults seek upper limb specialty care. Tendinopathy of the long head of the biceps may be part of rotator cuff tendinopathy, which most of us develop as we age. Evidence that these processes are related and that both are part of human shoulder senescence could contribute to a reconceptualization of shoulder tendinopathy as a single set of age-related changes, which are often well-accommodated, sometimes misinterpreted as an injury, and associated with notable nonspecific treatment effects, thus meriting caution regarding the potential for overtreatment. QUESTIONS/PURPOSES This study reviewed a consecutive series of MRI scans ordered for the evaluation of shoulder pain and asked: (1) Is long head of the biceps tendinopathy associated with advancing age? (2) Is long head of the biceps tendinopathy associated with concomitant degeneration of the rotator cuff tendons? METHODS Five hundred consecutive radiologist interpretations of MRIs of the shoulder obtained between May 2016 and June 2017 for assessment of shoulder pain in adults at a radiology group that provides approximately 80% of the imaging in all practices in our region were reviewed. Patients with bilateral MRIs had one MRI included at random. Patients with fractures, dislocations, previous surgery, and soft tissue masses seen on MRI were excluded, leaving 406 shoulder MRI interpretations for review. The radiology reports were used to identify the presence and severity of rotator cuff and long head of the biceps tendinopathy. Forty-nine percent (197 of 406) were men with a mean ± SD age of 55 ± 14 years, and 54% (220 of 406) were right shoulders. Multivariable analyses accounting for age and gender evaluated the association of long head of the biceps tendinopathy with age and tendinopathy of the rotator cuff tendons. RESULTS After controlling for tendinopathy of the other rotator cuff tendons, long head of the biceps tendinopathy was more common with advancing age (OR 1.04 [95% CI 1.02 to 1.06] per year; p < 0.001), meaning the prevalence increases by approximately 4% per year. Among people who were imaged for shoulder pain, everyone 85 years or older had both long head of the biceps and rotator cuff tendinopathy. Any rotator cuff pathophysiology was also notably associated with any long head of the biceps pathophysiology (OR 6.9 [95% CI 2.4 to 20]; p < 0.001). About half (49% [162 of 328]) of long head of the biceps tendons were normal in the presence of any supraspinatus tendinopathy, and 5% (9 of 175) of supraspinatus tendons were normal in the presence of any long head of the biceps tendinopathy. CONCLUSION The finding that among people seeking care for shoulder pain, long head of the biceps tendinopathy and rotator cuff tendinopathy occur together and are more common with increasing age (and ubiquitous by the latter half of the ninth decade) suggests that most shoulder pain in adults is associated with expected aging of the shoulder tendons inclusive. In this light, clinicians can guide patients to an understanding of shoulder pain as age-appropriate, safe and sound, and accommodated by a large percentage of people as they age, all of which may be unexpected and counterintuitive. Effective assimilation of this knowledge-which may take time and merits patience-has the potential to both put people at ease and open up possibilities for fewer visits, tests, and treatments addressing tendinopathy, allowing patients to manage on their own (agency) with a set of simple exercises and perhaps occasional use of over-the-counter analgesics. LEVEL OF EVIDENCE Level III, prognostic study.

中文翻译：

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长头二头肌腱病与年龄和袖带肌腱病相关，MRI 用于评估肩痛。


背景 肩痛 - 主要与肩袖肌腱病有关 - 是成年人寻求上肢专业护理的最常见原因。二头肌长头肌腱病可能是肩袖肌腱病的一部分，我们大多数人会随着年龄的增长而发展。有证据表明这些过程是相关的，并且两者都是人类肩部衰老的一部分，这可能导致肩部肌腱病被重新概念化为一组与年龄相关的变化，这些变化通常被很好地适应，有时被误解为一种损伤，并与显着的非特异性治疗效果相关，因此值得警惕过度治疗的可能性。问题/目的 本研究回顾了为评估肩痛而订购的连续系列 MRI 扫描，并询问： （1） 二头肌长头肌腱病是否与年龄增长有关？（2） 肱二头肌长头肌腱病是否与伴随的肩袖肌腱退化有关？方法 回顾了 2016 年 5 月至 2017 年 6 月期间获得的 500 次放射科医生对肩部 MRI 的连续解释，用于评估我们地区所有实践中约 80% 的影像学组的成人肩痛。双侧 MRI 患者随机纳入 1 例 MRI。排除了 MRI 上看到的骨折、脱位、既往手术和软组织肿块的患者，留下 406 例肩部 MRI 解释供审查。放射学报告用于确定肩袖和二头肌肌腱病长头的存在和严重程度。49%（406 人中的 197 人）是平均 ± SD 年龄为 55 ± 14 岁的男性，54%（406 人中的 220 人）是右肩。 考虑年龄和性别的多变量分析评估了肱二头肌长头肌腱病与年龄和肩袖肌腱病的相关性。结果 在控制了其他肩袖肌腱的肌腱病后，随着年龄的增长，二头肌肌腱病的长头更常见 （OR 1.04 [95% CI 1.02 - 1.06];p < 0.001），这意味着患病率每年增加约 4%。在接受肩痛影像学检查的人群中，85 岁或以上的每个人都患有二头肌长头和肩袖肌腱病。任何肩袖病理生理学也与肱二头肌的任何长头病理生理学显著相关 （OR 6.9 [95% CI 2.4 - 20];p < 0.001）。在存在任何冈上肌腱病的情况下，大约一半（49% [328/162]）的肱二头肌腱长头是正常的，而 5%（175 个中的 9 个）的冈上肌腱在存在任何长头腱的情况下是正常的。结论 在寻求肩痛护理的人群中，肱二头肌长头肌腱病和肩袖肌腱病同时发生，并且随着年龄的增长而更常见（并且在 90 岁后半期普遍存在）表明，大多数成人肩痛与肩肌腱的预期衰老有关，包括肩肌腱。有鉴于此，临床医生可以指导患者理解肩痛是适合年龄的、安全和合理的，并且随着年龄的增长，很大一部分人可以适应肩痛，所有这些都可能是意想不到的和违反直觉的。 有效吸收这些知识 - 可能需要时间和耐心 - 有可能既使人们放松，又有可能为减少针对肌腱病的就诊、测试和治疗开辟可能性，让患者通过一组简单的练习和可能偶尔使用非处方镇痛药来自己管理（代理）。证据级别 III 级，预后研究。