Biceps tenotomy has earlier pain relief compared to biceps tenodesis: a randomized prospective study

Abstract

Purpose Surgical management for long head of the biceps (LHB) tendinopathy with either biceps tenotomy or tenodesis is a reliable, but debated treatment option. The aim of this prospective, randomized, single-blinded study is to evaluate diferences in pain relief and subjective outcomes between biceps tenotomy versus tenodesis for LHB tendinopathy. Methods Subjects were randomized and blinded to biceps tenotomy versus arthroscopic tenodesis intra-operatively. Outcomes evaluated included subjective patient outcome scores, pain, and cosmetic deformity. Subjective outcomes scores and pain were analyzed using a two-way ANOVA, controlling for concomitant rotator cuf repair. Binary outcomes were compared using Chi-square tests. Results Thirty-four subjects (31 male, 3 female) with a median age of 56 (range 30-77) were enrolled. Twenty subjects were randomized to tenotomy and 14 to tenodesis. Fifty-six percent had concomitant rotator cuf repairs. The mean VAS pain score at 3 months was lower with tenotomy versus tenodesis. 2-year follow-up demonstrated no statistically signiicant diferences for VAS, ASES, or SANE. 15/20 (75%) subjects with biceps tenotomy reported no pain medication use at the 2-week postoperative visit versus 5/14 (33%) for biceps tenodesis. Popeye deformity was found in 5/20 (25%) of tenotomy subjects versus 1/14 (7%) in tenodesis subjects. Conclusion Outcomes appear similar between biceps tenotomy versus tenodesis; however, the tenotomy group demonstrated greater incidence of cosmetic deformity but an earlier improvement in postoperative pain. Level of evidence Treatment Studies, Level II.

Arthroscopic isolated long head of biceps tenotomy in patients with degenerative rotator cuff tears: mid-term clinical results and prognostic factors

“…French orthopedic surgeons popularized arthroscopic tenotomy of the long head of biceps tendon (LHB) as a treatment option for patients with degenerative rotator cuff tears [6]. A tenotomy of the long head of biceps is found to produce an earlier pain relief compared to tenodesis [7] and minimal residual symptoms [8]. Also biceps surgery in combination with a rotator cuff repair, superior outcome is seen [9].…”

Ultrasound-Guided Percutaneous Tenotomy of the Long Head of Biceps Tendon in Patients with Symptomatic Complete Rotator Cuff Tear: In Vivo Non-contRolled Prospective Study

“…For this reason, arthroscopically guided LHBT tenotomy or tenodesis are commonly practiced in cases where spontaneous rupture does not occur, besides often being part of arthroscopic repair of RC tendons [ 15 , 16 ]. These two surgical options for LHBT pathology have shown similar clinical outcomes [ 2 , 17 ], although tenotomy seems to provide earlier pain relief, despite at higher risk of cosmetic deformity due to prominent bump of the muscle belly (Popeye sign), while tenodesis tends to result in superior functional outcomes [ 18 , 19 , 20 ]. The tenotomy is indicated in painful shoulders with ruptured RC tendons in which conservative treatments (rest, rehabilitation, oral anti-inflammatory drugs, steroid injections) have failed, in patients with irreparable injuries and in those not willing to undergo surgery, since a non-negligible number of patients do not wish to undergo shoulder arthroscopic surgery due to their concern for negative outcomes [ 1 , 21 ].…”

Effectiveness and safety of tenosynovitis of the long head of the biceps brachii with acupuncture: a protocol for a systematic review and meta-analysis

“…Currently, there are two main methods to treat tenosynovitis of LHB brachii including conventional treatments and surgical interventions. Conservative management of symptomatic LHB brachii tendinopathy is usually considered the first-line treatment, such as rest, non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroid injection, and physical therapy [2,6,7]. NSAIDs are the most commonly prescribed drugs for treatment of tenosynovitis [8], which can significantly reduce the intensity of pain and improve the range of motion.…”

“…Surgical treatments include long head biceps tenotomy and tenodesis, which are the most common surgical procedures on the treatment of tenosynovitis in clinic [7]. However, studies have reported that surgery also has many limitations, including pain recurrence after operation and varying degrees of joint deformities [6,12,13]. In addition, due to patient's fear of surgery, many patients with tenosynovitis of LHB brachii will not select surgery as their first treatment choice.…”