- See:
Proximal Biceps Tendon Rupture:
- 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
- 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;
- Treatment:
- isolated
biceps tenodesis is not indicated, unless shoulder reconstructive surgery is required for other reasons;
- in the report by
Daryl C. Osbahr 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;
- 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 the 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;
Tenodesis of the long head of the biceps brachi for chronic bicipital Tendinitis. Long-term results.
The cosmetic appearance of the biceps muscle after long-head tenotomy versus tenodesis
