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Duke Orthopaedics
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Wheeless' Textbook of Orthopaedics

Biceps Tendonitis - Tendonopathy


- See: Proximal Biceps Tendon Rupture: and SLAP tear and arthroscopic rotator cuff repair

- Discussion:
    - inflammation of long head of biceps tendon usually occurs w/ rotator cuff inflammation (esp subscapular tears);
    - clinically, it may be difficult to differentiate the pain patterns of rotator cuff and biceps tendon inflammation;
           - symptoms indicating of biceps inflammation include pain radiating to biceps, pain w/ internal rotation, & pain w/ forward flexion of
    - isolated biceps tenodesis is usually not indicated, unless shoulder reconstructive surgery is required for other reasons;
    - references:
            - Entrapment of the long head of the biceps tendon: the hourglass biceps--a cause of pain and locking of the shoulder.
    - role of biceps tendon with rotator cuff tear and massive rotator cuff tear:
            - Isolated arthroscopic biceps tenotomy or tenodesis improves symptoms in patients with massive irreparable rotator cuff tears.
            - The role of the biceps tendon in massive rotator cuff tears.
            - The long biceps tendon as the main cause of shoulder pain in rotator cuff tears

- Shoulder Exam:
    - pain over the bicipital groove is suggestive of biceps compromise;
    - Yergason test: biceps tendon stability;
            - patient fully flexes elbow and supinates, orthopaedist externally rotates and presses downward on flexed elbow;
            - positive exam elicits pain;
 
- Tenotomy:
    - in the report by Osbahr DC, et al, the authors question whether biceps tenodesis is necessary;
            - 5 consecutive years of patients receiving biceps tenotomy (80 patients; 40 males, 40 females; average age, 58 years) or tenodesis procedures
 were retrospectively
                    followed-up by grading anterior shoulder pain, muscle spasms in the biceps, and cosmetic deformity of the biceps muscle;
            - no statistical significance was found between the biceps tenotomy and biceps tenodesis groups;
            - there was also no statistical significance when comparing the biceps tenotomy and biceps tenodesis groups;
     - technical points:
            - ensure that there is no locking of the biceps stump into the bicipital sheath (which can be a source of pain)
     - references:
             - Arthroscopic tenotomy of the long head of the biceps in the treatment of rotator cuff tears: clinical and radiographic results of 307 cases
             - Clinical results of arthroscopic tenotomy of the long head of the biceps brachii in full thickness tears of the rotator cuff without repair: 40 cases
             - Patient acceptance of long head of biceps brachii tenotomy. 
             - Patient-related factors and complications after arthroscopic tenotomy of the long head of the biceps tendon.
             - Arthroscopic release of the long head of the biceps tendon: functional outcome and clinical results.
             - Anatomic and biomechanical study of the biceps vinculum, a structure within the biceps sheath.  

- Soft Tissue Tenodesis: (incorporation of biceps tendon into RTC repair)
       - references: 
               - Biceps tenodesis associated with arthroscopic repair of rotator cuff tears.
               - Arthroscopic Biceps Tenodesis Incorporated Into Rotator Cuff Repair Using Suture Anchors
               - Soft tissue tenodesis of the long head of the biceps tendon associated to the Roman Bridge repair
               - Arthroscopic Biceps Tenodesis to Supraspinatus Tendon: Technical Note
               - Arthroscopic repair of large and massive rotator cuff tears using the biceps-incorporating technique: mid-term clinical and anatomical results.
               - Arthroscopic biceps augmentation for avoiding undue tension in repair of massive rotator cuff tears.
               - Bridging the gap in immobile massive rotator cuff tears: augmentation using the tenotomized biceps.

- Operative Treatment (Tenodesis):
    - may be indicated for cosmesis or if shoulder reconstruction is required for other reasons;
          - patients can expect only a small increase in flexion strength (10%);
    - surgical treatment involves then excision of the intraarticular part of tendon, & fixation of remaining tendon to bicipital groove or into coracoid process;
    - fixation to the bicipital groove is performed using "key hole technique":
          - a narrow slit is cut into the bone, just underneath a larger drill hole;
          - the biceps tendon is passed into the drill hole and is then allowed to to wedge down into the slit;
          - the main difficulty with this procedure is obtaining proper tension on the muscle tendon unit;
          - references:
                 - Complications associated with subpectoral biceps tenodesis: low rates of incidence following surgery.
                 - Tenodesis of the long head of the biceps brachi for chronic bicipital Tendinitis. Long-term results.
                 - Arthroscopic treatment of isolated type II SLAP lesions: biceps tenodesis as an alternative to reinsertion.
                 - To detach the long head of the biceps tendon after tenodesis or not: outcome analysis at the 4-year follow-up of two different techniques
                 - Management of failed biceps tenodesis or tenotomy: causation and treatment.
                 - Clinical success of biceps tenodesis with and without release of the transverse humeral ligament




The cosmetic appearance of the biceps muscle after long-head tenotomy versus tenodesis

Disorders of the long head of the biceps tendon

Treatment of biceps tendon lesions in the setting of rotator cuff tears: prospective cohort study of tenotomy versus tenodesis

A Comparison of Forearm Supination and Elbow Flexion Strength in Patients With Long Head of the Biceps Tenotomy or Tenodesis 

Biceps Tenotomy Versus Tenodesis: Clinical Outcomes.

Clinical and isokinetic comparison between tenotomy and tenodesis in biceps pathologies.

Isokinetic strength, endurance, and subjective outcomes after biceps tenotomy versus tenodesis: a postoperative study.

A comparison of forearm supination and elbow flexion strength in patients with long head of the biceps tenotomy or tenodesis.

Anterior and posterior instability of the long head of the biceps tendon in rotator cuff tears: a new classification based on arthroscopic observations.

Biceps Tenotomy Versus Tenodesis: Clinical Outcomes 




Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Monday, October 28, 2013 11:21 am