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The long head of biceps as a source of pain in active population: tenotomy or tenodesis? A comparison of 2 case series with isolated lesions

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Abstract

The tendon of the long head of the biceps (LHB) is a common source of pain in the shoulder, and the surgical treatments proposed are tenotomy or tenodesis performed in different ways. The purpose of this study is to compare the clinical results (objective and subjective) of tenotomy versus soft tissue tenodesis. One-hundred and four patients with an isolated LHB pathology, arthroscopically treated between 2004 and 2007, were observed retrospectively. Forty-eight of these patients were treated with tenotomy and 56 with a soft tissue tenodesis technique. All the patients were evaluated by an independent observer with a minimum follow-up of 2 years which included VAS, DASH questionnaire, Constant score and ROM evaluation with a goniometer. All these evaluations were performed pre- and post-operatively. An independent expert radiologist then performed an ultrasound examination only in the post-operative evaluation of the tenodesis group looking to confirm the effectiveness of the procedure. In both groups, the scores were significantly improved. In the tenotomy group, 16.6 % of the patients had bicipital cramps for a mean post-operative time of 1 month. Constant score improved in both groups: 46.6 to 86.1 in tenotomy group and 48.9–84.9 in tenodesis group; VAS improved from 8.4 to 1.5 in tenotomy group and from 8.8 to 1.4 in tenodesis group; DASH scores changed from 42.5 to 13.6 in tenotomy group and from 55.8 to 11.4 in tenodesis group. Popeye sign was present in 37.5 % in the tenotomy group and in 5.3 % in tenodesis group. In 3 patients of the tenodesis group, ultrasound revealed complete failure of the tenodesis. In conclusion, both procedures are effective in terms of treatment of LHB pathologies. Tenotomy does not require specific post-operative treatment and is easy to perform, but cramp and Popeye sign may occur after surgery. The soft tissue tenodesis technique is an easy and cost-effective way to perform tenodesis with good results, especially in preventing the Popeye sign, but requires a longer rehabilitation time.

Level of evidence IV.

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References

  1. Rockwood CA, Matsen FA, Lippit SB, Wirth MA (2009) The shoulder. Elsevier Health Sciences, USA

    Google Scholar 

  2. Rodosky MW, Harner CD (1994) Fu FH The role of the long head of the biceps muscle and superior glenoid labrum in anterior stability of the shoulder. Am J Sports Med 22:121–130

    Article  PubMed  CAS  Google Scholar 

  3. Warner JJ, McMahon PJ (1995) The role of the long head of the biceps brachii in superior stability of the glenohumeral joint. J Bone Jt Surg Am 77(3):366–372

    CAS  Google Scholar 

  4. Yamaguchi K, Riew KD, Galatz LM, Syme JA, Neviaser RJ (1997) Biceps activity during shoulder motion: an electromyographic analysis. Clin Orthop Relat Res 336:122–129

    Article  PubMed  Google Scholar 

  5. Pagnani MJ, Deng XH, Warren RF, Torzilli PA, O’Brien SJ (1996) Role of the long head of the biceps brachii in glenohumeral stability: a biomechanical study in cadavera. J Should Elbow Surg 5(4):255–262

    Article  CAS  Google Scholar 

  6. Kim SH, Ha KI, Kim HS, Kim SW (2001) Electromyographic activity of the biceps brachii muscle in shoulders with anterior instability. Arthroscopy 17(8):864–868

    PubMed  CAS  Google Scholar 

  7. Itoi E, Kuechle DK, Newman SR, Morrey BF, An KN (1993) Stabilising function of the biceps in stable and unstable shoulders. J Bone Jt Surg Br 75(4):546–550

    CAS  Google Scholar 

  8. Mariani PP, Bellelli A, Botticella C (1997) Arthroscopic absence of the long head of the biceps tendon. Arthroscopy 13(4):499–501

    Article  PubMed  CAS  Google Scholar 

  9. Dierickx C, Ceccarelli E, Conti M, Vanlommel J, Castagna A (2009) Variations of the intra-articular portion of the long head of the biceps tendon: a classification of embryologically explained variations. J Should Elbow Surg 18(4):556–565

    Article  Google Scholar 

  10. Yamaguchi K, Bindra R (1999) Disorders of the biceps tendon. In: Iannotti J, Williams GR (eds) Disorders of the shoulder: diagnosis and management. Lippincott Williams and Wilkins, Philadelphia, pp 159–190

    Google Scholar 

  11. Monteggia GB (1803) Istituzioni Chirurgiche, vol 170. G. Truffi, Milan, pp 1829–1830

    Google Scholar 

  12. Soden J (1841) Two cases of dislocation of the long head of the biceps. Med Chir 24:212

    CAS  Google Scholar 

  13. Habermayer P, Magosh P, Pritsch M et al (2004) Anterosuperior impingement of the shoulder as a result of pulley lesions: a prospective arthroscopic study. J Should Elbow Surg 13:5–12

    Article  Google Scholar 

  14. Lafosse L, Reiland Y, Baier GP et al (2007) Anterior and posterior instability of the long head of the biceps tendon in rotator cuff tears: a new classification based on arthroscopic observations. Arthroscopy 23:73–80

    Article  PubMed  Google Scholar 

  15. Duplay S (1872) La periarthrite scapulo humeral. Arch Gen Med 69:571–573

    Google Scholar 

  16. Patton WC, McCluskey GM III (2001) Biceps tendinitis and subluxation. Clin Sports Med 20(3):505–529

    Article  PubMed  CAS  Google Scholar 

  17. Habermeyer P, Magosh P, Lichtenberg S (2006) Classifications and scores of the shoulders. Springer, Berlin

    Google Scholar 

  18. Snyder SJ, Karzel RP, Del Pizzo W et al (1990) SLAP lesion of the shoulder. Arthroscopy 6:274–279

    Article  PubMed  CAS  Google Scholar 

  19. Ahrens PM, Boileau P (2007) The long head of biceps and associated tendinopathy. J Bone Jt Surg 89(8):1001

    Article  CAS  Google Scholar 

  20. Walch G, Edwards BE, Boulahia A et al (2005) Arthroscopic tenotomy of the long head of the biceps in the treatment of rotator cuff tears: clinical and radiographic results of 307 cases. J Should Elbow Surg 14:238–246

    Article  Google Scholar 

  21. Lo IK, Burkhart SS (2004) Arthroscopic biceps tenodesis using a bioabsorbable interference screw. Arthroscopy 20:85–95

    Article  PubMed  Google Scholar 

  22. Klepps S, Hazrati Y, Flatow E (2002) Arthroscopic biceps tenodesis. Arthroscopy 18:1040–1045

    Article  PubMed  Google Scholar 

  23. Gartsman GM, Hammerman SM (2000) Arthroscopic biceps tenodesis: operative technique. Arthroscopy 16:550–552

    Article  PubMed  CAS  Google Scholar 

  24. Romeo AA, Mazzocca AD, Tauro JC (2004) Arthroscopic biceps tenodesis. Arthroscopy 20:206–213

    Article  PubMed  Google Scholar 

  25. Kim SH, Yoo JC (2005) Arthroscopic biceps tenodesis using interference screw: end tunnel technique. Arthroscopy 21:1405e1–1405e2

    Google Scholar 

  26. Nord KD, Smith GB, Mauck BM (2005) Arthroscopic biceps tenodesis using suture anchors through the subclavian portal. Arthroscopy 21:248–252

    Article  PubMed  Google Scholar 

  27. Elser F, Braun S, Dewing CB, Giphart E, Millett P (2011) Anatomy, function, injuries, and treatment of the long head of the biceps brachii tendon. Arthrosc J Arthrosc Relat Surg 27(4):581–592

    Article  Google Scholar 

  28. Castagna A, Conti M, Mouhsine E, Bungaro P (2006) Garofalo arthroscopic biceps tendon tenodesis: the anchorage technical note. Knee Surg Sports Traumatol Arthrosc 14:581–585

    Article  PubMed  CAS  Google Scholar 

  29. Hudak PL, Amadio PC, Bombardier C (1996) Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand). The Upper Extremity Collaborative Group (UECG). Am J Ind Med 29(6):602–608

    Article  PubMed  CAS  Google Scholar 

  30. Constant CR, Murley AH (1987) A clinical method of functional assessment of the shoulder. Clin Orthop 214:160–164

    PubMed  Google Scholar 

  31. Bianchi S, Martinoli C (2007) Ultrasound of the musculoskeletal system. Springer, Berlin

    Google Scholar 

  32. Szabó I, Boileau P, Walch G (2008) The proximal biceps as a pain generator and results of tenotomy. Sports Med Arthrosc 16(3):180–186

    Article  PubMed  Google Scholar 

  33. Elkousy HA, Fluhme DJ, O’Connor DP et al (2005) Arthroscopic biceps tenodesis using the percutaneous, intra-articular trans-tendon technique: preliminary results. Orthopedics 28:1316–1319

    PubMed  Google Scholar 

  34. Mazzocca AD, Rios CG, Romeo AA et al (2005) Subpectoral biceps tenodesis with interference screw fixation. Arthroscopy 21:e1–e7

    Google Scholar 

  35. Boileau P, Parratte S, Chuinard C, Roussanne Y, Shia D, Bicknell R (2009) Arthroscopic treatment of isolated type II SLAP lesions: biceps tenodesis as an alternative to reinsertion. Am J Sports Med 37(5):929–936 (Epub 19 Feb 2009)

    Google Scholar 

  36. Scheibel M, Schröder RJ, Chen J, Bartsch M (2011) Arthroscopic soft tissue tenodesis versus bony fixation anchor tenodesis of the long head of the biceps tendon. Am J Sports Med 39:1046–1052

    Article  Google Scholar 

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Authors and Affiliations

  1. Istituto Clinico Humanitas, Via Manzoni, 56 Rozzano, Milan, Italy

    Giacomo Delle Rose, Mario Borroni, Alessandro Silvestro, Raffaele Garofalo, Marco Conti, Pasquale De Nittis & Alessandro Castagna

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  1. Giacomo Delle Rose
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  2. Mario Borroni
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  3. Alessandro Silvestro
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  4. Raffaele Garofalo
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  5. Marco Conti
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  6. Pasquale De Nittis
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  7. Alessandro Castagna
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Correspondence to Mario Borroni.

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Delle Rose, G., Borroni, M., Silvestro, A. et al. The long head of biceps as a source of pain in active population: tenotomy or tenodesis? A comparison of 2 case series with isolated lesions. Musculoskelet Surg 96 (Suppl 1), 47–52 (2012). https://doi.org/10.1007/s12306-012-0189-0

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  • DOI: https://doi.org/10.1007/s12306-012-0189-0

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