Risk Factors for Biceps Related Complications Following Arthroscopic Tenotomy of the Long Head of the Biceps Tendon

Objectives: Our objective was to evaluate complications after arthroscopic tenotomy of the long head of the biceps tendon (LHBT) and identify patient-related factors associated with postoperative cosmetic (Popeye) deformity, subjective weakness, and residual anterior shoulder pain. Methods: After obtaining IRB approval, the records of patients who underwent an arthroscopic LHBT tenotomy, between 2008 and 2015, at an integrated multi-center (14) and multi-surgeon (55) were retrospectively reviewed. Exclusion criteria included LHBT tenodesis, arthroplasty, neoplastic, or fracture surgery, age below 18, or indata. Demographic data, concomitant procedures, the appearance of the biceps tendon (presence or absence of hypertrophy) at time of arthroscopy, and postoperative complications were recorded. The development of each postoperative complication was compared by age, gender, hand dominance, workers’ compensation status, and intra-operative LHBT morphology. Results: 192 patients met our inclusion criteria. The average age was 60.6 ± 9.5 years and 55% were male. Average follow-up was 10.6 ± 13.6 months. The most common concomitant procedures were subacromial decompression (82%), rotator cuff repair (72%), distal clavicle resection (26%), and glenohumeral debridement (18%). LHBT morphology based on arthroscopic images was as follows: normal (56%), mildly hypertrophic (24%), severely hypertrophic (20%). Postoperative complications cosmetic deformity (14%), subjective weakness (10.4%), persistent (residual) anterior shoulder pain (7.8%), conversion to tenodesis (3.6%), venous thromboembolism (1%). Seven (3.6%) patients underwent a revision surgery to convert the LHBT tenotomy to a tenodesis, most commonly for postoperative cosmetic deformity (6 patients, 86%). Male gender was significantly associated with the development of postoperative cosmetic deformity (Odds Ratio of 3.21, P<0.05). Biceps tenotomy on the dominant shoulder was significantly associated with postoperative subjective weakness (Odds Ratio 3.17, P<0.05). Patients with workers’ compensation injuries were more likely to have continued postoperative anterior shoulder pain (6.57, P<0.05). A full list of individual patient-related factors association with postoperative complications is presented in Table 1. Conclusion: In our series, in patients undergoing LHBT tenotomy, 14% developed a cosmetic deformity, 10% subjective reported weakness and 8% had persistent (residual) anterior shoulder pain. Male gender was associated with developing a cosmetic deformity, the dominant shoulder was associated with postoperative subjective weakness, and workers’ compensation status was associated with residual anterior shoulder pain. Older age and a hypertrophic biceps tendon demonstrated decreased odds of developing a postoperative cosmetic deformity but did not reach statistical significance. Surgeons who perform LHBT tenotomy should take these risk factors under consideration to minimize complications. [Table: see text]

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Risk Factors and Complications Following Arthroscopic Tenotomy of the Long Head of the Biceps Tendon

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120904361 ◽

2020 ◽

Vol 8 (2) ◽

pp. 232596712090436 ◽

Cited By ~ 1

Author(s):

Raffy Mirzayan ◽

Christopher McCrum ◽

Rebecca K. Butler ◽

Ram Kiran Alluri

Keyword(s):

Risk Factors ◽

Postoperative Complications ◽

Smoking Status ◽

Biceps Tendon ◽

Workers Compensation ◽

Level Of Evidence ◽

Related Factors ◽

Compensation Claims ◽

Long Head ◽

Popeye Deformity

Background: Controversy exits regarding performing a tenotomy versus a tenodesis of the long head of the biceps tendon (LHBT). Purpose: To evaluate the complications after arthroscopic tenotomy of the LHBT and characterize the incidence of cosmetic deformity, cramping, subjective weakness, and continued anterior shoulder pain (ASP). Additionally, to identify patient-related factors that may predispose a patient to these complications. Study Design: Case-control study; Level of evidence, 3. Methods: Records of patients who underwent an arthroscopic LHBT tenotomy at an integrated health care system under the care of 55 surgeons were retrospectively reviewed. Exclusion criteria included LHBT tenodesis, arthroplasty, neoplastic, or fracture surgery; age younger than 18 years; incomplete documentation of physical examination; or incomplete operative reports. Characteristic data, concomitant procedures, LHBT morphology, and postoperative complications were recorded. Patients with and without postoperative complications—including cosmetic deformity, subjective weakness, continued ASP, and cramping—were analyzed by age, sex, dominant arm, body mass index (BMI), smoking status, workers’ compensation status, and intraoperative LHBT morphology to identify risk factors for developing these postoperative complications. Results: A total of 192 patients who underwent LHBT tenotomy were included in the final analysis. Tenotomy was performed with concomitant shoulder procedures in all but 1 individual. The mean ± SD patient age was 60.6 ± 9.5 years, and 55% were male. The overall complication rate was 37%. The most common postoperative complications include cosmetic (Popeye) deformity (14.1%), subjective weakness (10.4%), cramping (10.4%), and continued postoperative ASP over the bicipital groove (7.8%). Every 10-year increase in age was associated with 0.52 (95% CI, 0.28-0.94) times the odds of continued ASP and 0.59 (95% CI, 0.36-0.98) times the odds of cramping pain. Male patients had 3.9 (95% CI, 1.4-10.8) times the odds of cosmetic (Popeye) deformity. Patients who had active workers’ compensation claims had 12.5 (95% CI, 2.4-63.4) times the odds of having continued postoperative ASP. Tenotomy on the dominant arm, BMI, and active smoking status demonstrated no statistically significant association with postoperative complications. Conclusion: Patients experiencing complications after tenotomy were significantly younger and more likely to be male and to have a workers’ compensation injury. LHBT tenotomy may best be indicated for elderly patients, female patients, and those without active workers’ compensation claims.

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Anterior shoulder pain due to persistence of a septum between long head biceps tendon and intra-articular supraspinatus

Journal of Shoulder and Elbow Surgery ◽

10.1016/j.jse.2011.10.019 ◽

2012 ◽

Vol 21 (6) ◽

pp. e15-e17

Author(s):

Albert Broch ◽

Antoni Salvador ◽

Felipe G. Delgado ◽

Francesc García Retamero ◽

Luís Ximeno ◽

...

Keyword(s):

Shoulder Pain ◽

Biceps Tendon ◽

Long Head Biceps Tendon ◽

Long Head ◽

Long Head Biceps ◽

Anterior Shoulder Pain

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Associations between wheelchair user’s shoulder pain index and tendinitis in the long head of the biceps tendon among female wheelchair basketball players from the Japanese national team

Asia-Pacific Journal of Sports Medicine Arthroscopy Rehabilitation and Technology ◽

10.1016/j.asmart.2021.01.003 ◽

2021 ◽

Vol 24 ◽

pp. 29-34

Author(s):

Kenji Tsunoda ◽

Hirotaka Mutsuzaki ◽

Kyoko Kanae ◽

Kaori Tachibana ◽

Yukiyo Shimizu ◽

...

Keyword(s):

Shoulder Pain ◽

Biceps Tendon ◽

Wheelchair Basketball ◽

Basketball Players ◽

National Team ◽

Long Head

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Patient-Related Factors and Complications After Arthroscopic Tenotomy of the Long Head of the Biceps Tendon

The American Journal of Sports Medicine ◽

10.1177/0363546510388158 ◽

2011 ◽

Vol 39 (4) ◽

pp. 783-789 ◽

Cited By ~ 42

Author(s):

Tae Kang Lim ◽

Eun Sun Moon ◽

Kyoung Hwan Koh ◽

Jae Chul Yoo

Keyword(s):

Biceps Tendon ◽

Related Factors ◽

Long Head

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Prevalence and Grading of Rotator Cuff and Labral Injuries in Shoulder Pain and Instability using MRI: ACross-sectional Study

JOURNAL FOR CLINICAL AND DIAGNOSTIC RESEARCH ◽

10.7860/jcdr/2021/48773.14845 ◽

2021 ◽

Author(s):

Ashok Srikar Chowdhary ◽

Naresh Babu Lakshmipathi Nikhil ◽

Nidhi Hemendra Chandrakar ◽

Nidhi Raj Buddaraju

Keyword(s):

Rotator Cuff ◽

Shoulder Pain ◽

Biceps Tendon ◽

Supraspinatus Tendon ◽

Sectional Study ◽

Rotator Cuff Injuries ◽

Rotator Cuff Injury ◽

Biceps Pulley ◽

Study Population ◽

Long Head

Introduction: Shoulder joint is a highly mobile joint but is prone for rotator cuff injuries and dislocations. It is necessary to accurately diagnose rotator cuff and labral injuries so that appropriate plan of action for treatment can be taken. Magnetic Resonance Imaging (MRI) can be used to diagnose and describe the extent of rotator cuff tendon and labral injuries and any secondary rotator cuff muscle abnormalities. Aim: To study the demographic profile of patients presenting with shoulder pain and instability, identify the various rotator cuff injuries causing shoulder pain, identify the rotator cuff interval lesions causing microinstability, identify the various labral and bony pathologies in instability, describe the MRI features of the rotator cuff, rotator cuff interval, labral and bony injuries. Materials and Methods: This study was a cross-sectional study of patients with symptoms of either shoulder pain or instability who underwent MRI evaluation of the shoulder in the Department of Radiodiagnosis, Rajarajeswari Medical College and Hospital, Bengaluru, Karnataka, India, from July 2018 to December 2020. The study population consisted of 54 patients with either shoulder pain or instability who underwent MRI of shoulder. All the MRI scans of the shoulder in this study were performed using 1.5 Tesla Siemens Magnetom Avanto (Tim 76x18) MR machine using a flex coil. Results: The study population consisted of 54 patients comprising of 38 males and 16 females. The age of the patients ranged from 20-77 years. Majority of the patients were older than 50 years constituting about 33.33% of the total study population. Rotator cuff injury was the commonest cause of pain. Tendinosis was the commonest type of rotator cuff injury followed by partial-thickness and full-thickness tendon tears. The commonest grade of tendinosis was mild or grade 1. Supraspinatus tendon was the most commonly affected tendon followed by subscapularis and infraspinatus tendons. Teres minor tendon was normal in all the cases. Anterior instability was the commonest type of instability with equal prevalence of soft tissue Bankart, bony Bankart and Perthes lesions. Biceps pulley lesions resulted in long head of biceps tendon instability, microinstability and internal impingement. Conclusion: Rotator cuff injuries are the commonest cause of shoulder pain and are seen more frequently after the fifth decade. Shoulder instability is most commonly seen in young male adults. Tendinosis is the commonest type of rotator cuff injury. Supraspinatus tendon is the most commonly injured tendon. Anterior instability is the commonest type of shoulder instability. Biceps pulley lesions result in long head of biceps tendon instability, microinstability and internal impingement. MRI can diagnose interstitial or intrasubstance tendon tears which are not visualised on arthroscopy. MRI description of tendon and labral tears, tendon retraction and muscle atrophy can guide the orthopaedician during arthroscopy and in treatmentplanning.

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Long head of the biceps pathology as a cause of anterior shoulder pain after shoulder arthroplasty

Journal of Shoulder and Elbow Surgery ◽

10.1016/j.jse.2005.09.004 ◽

2006 ◽

Vol 15 (4) ◽

pp. 415-418 ◽

Cited By ~ 22

Author(s):

David V. Tuckman ◽

David M. Dines

Keyword(s):

Shoulder Pain ◽

Shoulder Arthroplasty ◽

Long Head ◽

Anterior Shoulder Pain

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Coracoid syndrome: a neglected cause of anterior shoulder pain

Joints ◽

10.11138/jts/2016.4.1.031 ◽

2016 ◽

Vol 04 (01) ◽

pp. 031-038

Author(s):

Antonio Gigante ◽

Carlo Bottegoni ◽

Pamela Barbadoro

Keyword(s):

Shoulder Pain ◽

Repeated Measures ◽

Trigger Point ◽

Biceps Tendon ◽

Case Series ◽

Coracoid Process ◽

Level Of Evidence ◽

Simple Shoulder Test ◽

Anterior Shoulder Pain ◽

Eq Vas

Purpose: the present prospective open-label study was designed to gain further insights into a condition thought to constitute a neglected but not uncommon syndrome characterized by anterior shoulder pain and tenderness to palpation over the apex of the coracoid process, not related to rotator cuff or pectoralis minor tendinopathy, long head of the biceps tendon disorders, or instability. The aim was to clarify its prevalence, clinical characteristics, differential diagnosis and response to corticosteroid injections. Methods: patients with primary anterior shoulder pain precisely reproduced by deep pressure on the apex of the coracoid process were recruited. Patients with clinical or instrumental signs of other shoulder disorders were excluded. Patients were given an injection of triamcinolone acetonide 40 mg/ml 1 ml at the coracoid trigger point. They were evaluated after 15, 30 and 60 days and at 2 years using Equal Visual Analog Scale (EQ-VAS) and the italian version of the Simple Shoulder Test (SST). Results: between January 1 and December 31 2010, we treated 15 patients aged 26-66 years. The majority were women (86.67%). At 15 days, 6 (40%) patients reported complete resolution of their symptoms, while 9 (60%) complained of residual symptoms and received another injection. At 30 days, 14 (93.33%) patients were pain-free and very satisfied. At 2 years, the 14 patients who had been asymptomatic at 30 days reported that they had experienced no further pain or impaired shoulder function. The analysis of variance for repeated measures showed a significant effect of time on EQ-VAS and SST scores. Conclusions: the present study documents the existence, and characteristics, of a “coracoid syndrome” characterized by anterior shoulder pain and tenderness to palpation over the apex of the coracoid process and showed that the pain is usually amenable to steroid treatment. This syndrome should be clearly distinguished from anterior shoulder pain due to other causes, in order to avoid inappropriate conservative or surgical treatment. Level of evidence: Level IV, therapeutic case series.

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Prevalence and related factors of lesions of the long head of the biceps tendon in elderly patientss

Journal of Shoulder and Elbow Surgery ◽

10.1016/j.jse.2021.01.013 ◽

2021 ◽

Vol 30 (4) ◽

pp. e184

Author(s):

Minoru Takeshima ◽

Toru Morihara ◽

Yoshihiro Kai ◽

Hitoshi Koda ◽

Tomoyuki Matsui ◽

...

Keyword(s):

Biceps Tendon ◽

Related Factors ◽

Long Head

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Biceps tendon instability with or without pulley tears: an arthroscopic diagnostic study

10.21203/rs.2.24703/v1 ◽

2020 ◽

Author(s):

Jo-Ting Kao ◽

Chih-Hao Chiu ◽

Kuo-Yau Hsu ◽

Shih-Sheng Chang ◽

Yi-Sheng Chan ◽

...

Keyword(s):

Shoulder Pain ◽

Biceps Tendon ◽

Diagnostic Study ◽

Significant Group ◽

Subscapularis Tear ◽

Ramp Test ◽

Significant Difference ◽

Group A ◽

Group B ◽

Anterior Shoulder Pain

Abstract Background To investigate long head of the biceps tendon (LHBT) instability and biceps reflection pulley (BRP) lesions with dynamic arthroscopy in patients with refractory anterior shoulder pain and determine associated intraarticular pathologies. Methods Patients with refractory anterior shoulder pain and arthroscopically-diagnosed LHBT instability were enrolled. LHBT instability was confirmed by either static dislodge from the groove or subluxation induced by the hook probe (ramp test), and the integrity of BRP and concomitant intra-articular lesions were investigated. Demographics and arthroscopic findings were compared between patients with and without BRP tear. Results A total of 40 patients with refractory anterior shoulder pain and arthroscopically-diagnosed LHBT instability identified through review of medical records at a single surgeon’s practice from 2014 to 2017 were enrolled. BRP tear was noted in 25 patients (group A) and superior glenohumeral ligament (SGHL) insufficiency through ramp test, in 15 patients (group B). No significant difference of patient characteristics was observed between the two groups. Concomitant intraarticular pathologies were noted in 27 patients, including 19 in group A (76%) and eight in group B (53%), without significant group-wise difference (P = 0.083). The incidence of articular-side subscapularis tear was significantly higher in group A (P = 0.021), and those of the other intraarticular pathologies were similar between groups A and B. Fraying at the articular side of the subscapularis and supraspinatus tendons was frequent in group B, without difference of incidence as compared to group A (P = 0.5 and P = 0.084, respectively). Conclusions LHBT instability was a common disorder in patients with refractory shoulder pain. In patients with refractory anterior shoulder pain, dynamic assessment of BRP lesions and SGHL insufficiency and meticulous survey of associated intra-articular pathologies, including subscapularis tear are necessary for making accurate diagnosis.

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