- 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/ IR, & pain w/ forward flexion
- 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
- Arthroscopic tenodesis versus tenotomy of the long head of biceps tendon in simultaneous rotator cuff repair.
- 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;
- Soft Tissue Tenodesis: (incorporation of biceps tendon into RTC repair)
- soft tissue biceps tenodesis can be performed by incorporating the biceps tendon against the supraspinatus (w/ several passes of
the shuttle), and following this the biceps is released;
- 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.
- Arthroscopic proximal biceps tenodesis at the articular margin: evaluation of outcomes, complications, and revision rate.
- Combined arthroscopic tenodesis of the long head of biceps and rotator cuff repair in antero-superior cuff tears
- Osseous 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 long head of biceps tendon after tenodesis or not: outcome analysis at 4-year follow-up of 2 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 Efficacy of Biceps Tenodesis in the Treatment of Failed Superior Labral Anterior Posterior Repairs
- Upper-Extremity Thrombosis in a Patient After Biceps Tenodesis
- Chronic rupture of the long head of the biceps tendon: comparison of 2-year results following primary versus revision open subpectoral biceps tenodesis.
- Biceps 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 long head of biceps in 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.
- The cosmetic appearance of the biceps muscle after long-head tenotomy versus tenodesis.
- Biceps Fatty Infiltration and Atrophy. A Midterm Review After Arthroscopic Tenotomy of the Long Head of the Biceps
The cosmetic appearance of the biceps muscle after long-head tenotomy versus tenodesis
Disorders of the long head of the biceps tendon
Biceps Tenotomy Versus Tenodesis: Clinical Outcomes.
Clinical and isokinetic comparison between tenotomy and tenodesis in biceps pathologies.
Biceps Tenotomy Versus Tenodesis: Clinical Outcomes
Diagnostic Glenohumeral Arthroscopy Fails to Fully Evaluate the Biceps-Labral Complex