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

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.

Outcomes following long head of biceps tendon tenodesis

“…Sekiya et al presented a description of a percutaneous soft-tissue technique (PITT) and reported predictable pain relief, absence of cosmetic deformity, and good patient satisfaction in their 4-year experience using this technique [78]. Delle Rose et al, in a retrospective study of 56 patients who underwent arthroscopic soft tissue LHB tenodesis, reported a significant improvement in the clinical outcome scores (Constant score (48.9 to 84.9), VAS (8.8 to 1.4) and DASH score (55.8 to 11.4), and a failure rate of 5.3 % (3 cases)) [103].…”

Open subpectoral biceps tenodesis in patients over 65 does not result in an increased rate of complications

“…Due to the concern regarding increased rates of complications in older patients, some surgeons elect to perform only biceps tenotomies in these patients. The limited evidence in the literature, reports comparable outcomes for biceps tenodesis versus tenotomy [18][19][20][21][22][23], though studies show that patients treated with tenotomies have greater incidence of postoperative cramping and cosmetic deformity [18][19][20][21]23].…”

Biomechanical properties of tenotomy versus biceps knot in a cadaver model

“…[1][2][3][4][5]15 The long head of the biceps tendon (LHBT) is an independent pain generator that is a frequent complaint in patients with shoulder pain. 3 There is a ''net-like pattern'' of sensory and sympathetic neural fibers concentrated at the tendon origin on the glenoid that is a major contributor to pain in the shoulder.…”

“…3 There is a ''net-like pattern'' of sensory and sympathetic neural fibers concentrated at the tendon origin on the glenoid that is a major contributor to pain in the shoulder. 2 LHBT pathologies have recently become more commonly recognized in association with other pathologies of the shoulder. Ignoring LHBT pathology has been shown to lead to an inferior outcome.…”

“…3,6,7 There is no clear answer in the literature as to what the function of the LHBT is and if it is needed at all in a fully functional shoulder. 2,7,8 The two most common techniques used to treat LHBT pathology are biceps tenotomy and biceps tenodesis. 1 Tenotomy has been shown to be effective at resolving complaints of pain but can cause a cosmetic deformity commonly referred to as a Popeye deformity from 3 to 70% of the time.…”