Management of proximal biceps tendon pathology

Simple Soft Tissue Biceps Tenodesis

“…The LHB is a known pain generator, and performing a tenotomy or tenodesis has been shown to improve symptoms. 1 Debate exists in which technique is optimal for patient outcomes, with tenotomy being reserved for older and lower-demand patients and tenodesis in younger, more active patients. Biceps tenotomy is less technically demanding, reduces intraoperative time, avoids possible complications associated with the tenodesis procedure, and is associated with less postoperative restrictions for the patient.…”

“…Various techniques for fixation are described and include and are not limited to all soft tissue fixation, anchor-based devices, bone tunnels, cortical buttons, and interference screws. 1 Regardless of the techniques used, good clinical outcomes can be expected. 5 …”

“…Techniques for tenodesing the LHB to soft tissue have been described in the literature. 1 , 9 , 10 Apivatgaroon and Chernchujit 9 described an all-arthroscopic technique for LHB tenodesis to the conjoint tendon with good clinical outcomes and low rate of Popeye deformity. The percutaneous intra-articular trans tendon technique has been described using spinal needles percutaneously to pass horizontal mattresses to tie the LHB to the transverse humeral ligament and rotator interval tissue.…”

“…Tendinopathy of the long head of the biceps (LHB) can be a cause of shoulder pain. 1 Many patients can be treated successfully with conservative management such as anti-inflammatories and cortisone injections, but in some cases, surgical treatment is necessary based on the degree of pathology and/or failed conservative management. Surgical management generally consists of either performing an LHB tenotomy or tenodesis.…”

“…Tenotomy, ideally for older and obese patients, avoids having to provide additional fixation of the tendon, but this technique is associated with increased risk for muscle cramping and decreased cosmesis. 1 For the younger and more active patient, a tenodesis of the LHB reduces the risk of muscle cramping and improves cosmesis but necessitates additional steps to provide fixation of the LHB. The ideal technique for tenodesis is thoroughly debated, and the proceeding technique describes a simple and effective method for LHB tenodesis.…”