Adhesion of the Long Head of the Biceps Tendon: A Case Series

Abstract

Purpose To present the clinical and imaging findings and results of treatment in patients with intra-articular long head of the biceps tendon (LHBT) adhesion to the undersurface of the rotator cuff found incidentally during shoulder arthroscopy. Methods Patients with intra-articular LHBT adhesion to the undersurface of the rotator cuff found incidentally during arthroscopy were included with a minimal 2-year follow-up. Demographic data, images, and physical examinations were recorded. LHBT release, tenotomy, or tenodesis were performed according to the patient’s age and surgeon’s preference. Results Twelve patients were included in the study. All of them presented with chronic anterior shoulder pain and positive Speed and O’Brien tests. The average age was 46.8 ± 17 years (range 20-79 years) and the pain sustained from 6 to 96 (average 25.5 ± 28.6) months. Before the operation, 6 patients had a positive Jobe’s test, 1 had a positive lift-off test, and all had positive O’Brien and Speed tests and tenderness over the LHBT. Three release, 4 tenotomy, and 5 LHBT tenodesis were done in addition to other procedures if needed. All range of motion except external rotation, pain visual analog score, and functional outcome scores showed significant improvement at 6 months after surgery. There were no significant differences in range of motion and functional scores between 6 months and 12 months postoperatively. No difference was found in LHBT scores at 6 and 12 months after the operation. Magnetic resonance imaging revealed thickened coracohumeral ligament overlying the LHBT. Conclusions Patients who had intra-articular LHBT adhesion to the undersurface of the rotator cuff and underwent release of the adhesion around LHBT, tenotomy, or tenodesis all had good clinical outcomes. The lesion was observed in 2.2% of all shoulder arthroscopies. Although difficult to diagnose before surgery, surgeons should be aware of this unusual condition in patients with chronic and insidious anterior shoulder pain. Level of Evidence Level IV, Therapeutic case series.

Complications of Long Head of the Biceps Tenotomy in Association with Arthroscopic Rotator Cuff Repair: Risk Factors and Influence on Outcomes

“…LHB tenotomy is a relatively simple and inexpensive procedure to manage biceps disorders associated with rotator cuff disorders, providing good results [ 3 , 4 , 6 , 7 , 8 , 17 ]. However, biceps-related complications may occur [ 6 , 12 , 13 , 14 ].…”

“…The inclusion criterion was RCR associated with LHB tenotomy based on injury to the pulley and LHB tendinopathy. The exclusion criteria were (1) intra-articular absence of LHB at surgery due to pre-existing tendon tear or congenital variants, (2) LHB adhesions [ 17 ], (3) preserved biceps in case of an intact pulley, (4) tenotomy associated with tenodesis, (5) isolated tenotomy in the absence of RCR (because of isolated LHB disease without rotator cuff tear or irreparable massive cuff tear). The study was performed according to the Declaration of Helsinki principles, was approved by the Comité d’Ethique de Recherche Clinique Vivalto Santé (CERC—IRB) (IRB number CERC-VS−2020−09−1), and all patients gave informed written consent.…”