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Sympathetic and Sensory Neural Elements in the Tendon of the Long Head of the Biceps
Kalliopi Alpantaki, MD1; David McLaughlin, PhD1; Domna Karagogeos, PhD1; Alexander Hadjipavlou, MD1; George Kontakis, MD2
1 Department of Orthopaedics-Traumatology (K.A. and A.H.) and Neurosciences Laboratory (D.McL. and D.K.), University of Crete, 711 10, Heraklion, Crete, Greece
2 1 Pindarou Street, 713 05 Heraklion, Crete, Greece. E-mail address: kontak@med.uoc.gr
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Investigation performed at the Department of Orthopaedics-Traumatology and Neurosciences Laboratory, University of Crete, Heraklion, Crete, Greece

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2005 Jul 01;87(7):1580-1583. doi: 10.2106/JBJS.D.02840
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Background: Although the tendon of the long head of the biceps is a well-known source of shoulder pain, the pathophysiological basis of this pain has yet to be explained. The aim of this study was to detect and characterize any nervous element of the tendon and to determine a possible explanation for pain originating from this structure.

Methods: The nature of the neuronal innervation of the tendon of the long head of the biceps was studied immunohistochemically, in four tendons from different human cadavers, with use of neurofilament antibody 2H3, neurofilament-like antibody 3A10, calcitonin gene-related peptide, substance P, and tyrosine hydroxylase.

Results: A large neuronal network, asymmetrically distributed along the length of the tendon with a higher degree of innervation at the tendon origin, was identified by the neurofilament and neurofilament-like antibodies 2H3 and 3A10. This innervation was found to be positive for calcitonin gene-related peptide and substance P, suggesting the presence of thinly myelinated or unmyelinated sensory neurons. It was also positive for tyrosine hydroxylase, suggesting a post-ganglionic sympathetic origin.

Conclusions and Clinical Relevance: These findings demonstrate that the tendon of the long head of the biceps is innervated by a network of sensory sympathetic fibers, which may play a role in the pathogenesis of shoulder pain.

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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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