- See:
Proximal Biceps Tendon Rupture: and
SLAP tear
- 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 usually not indicated, unless shoulder
reconstructive surgery is required for
other reasons;
- Tenotomy:
- 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;
- 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
- 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.