There were 337 patients who underwent open subpectoral biceps tenodesis, between january 2005 and june 2015, 23 were identified as being over the age of 65 with a minimum follow up of 12 months. Between 2006 and 2012, a total of 36 subpectoral biceps tenodesis procedures were performed in 33 patients for type ii or iv slap lesions. From january 2015 to june 2016, a total of 259 patients underwent lhb tenodesis surgery. The glenoid labrum is a ring of cartilage that turns the. Subpectoral biceps tenodesis using an expanding peek device. Laterally eccentric malpositioned biceps tenodesis caused significant reduction 25% in humeral strength, which might be clinically relevant and contribute to postsurgical humeral shaft fracture. Subpectoral biceps tenodesis re liably relieves pain and improves function. The xpulley technique for subpectoral long head of the. While a litany of surgical techniques exists, the optimal method for ensuring an anatomic lengthtension relationship during tenodesis remains elusive. Subpectoral biceps tenodesis rehabilitation protocol created date. Biceps tenodesis versus tenotomy in the treatment of. Biceps tenodesis protocol the intent of this protocol is to provide the clinician with a guideline of the postoperative rehabilitation course of a patient that has undergone a biceps tenodesis for biceps dysfunction. Tenodesis of the biceps tendon is a common procedure performed during operative management of shoulder pathology.
The purpose of this study was to analyze the effects of simultaneous rcr with biceps tenodesis rcrbt on time to achieve maximum improvement and. The long head of the biceps lhb tendon is a potential source of shoulder pain encountered by orthopaedic surgeons. Various techniques for performing it have been described, but none is without problems. In order to ensure that usersafety is not compromised and you enjoy faster downloads, we have used trusted 3rdparty repository links that are. Thomas hackett, md, vail, co demonstrates his technique for a subpec proximal biceps tenodesis using the bicepsbutton and tension slide technique. Subpectoral biceps tenodesis surgical technique 1a. Proximal humerusfractureafteropen subpectoral biceps tenodesis or keyhole tenodesis has been reported by dein and. Subpectoral biceps tenodesis using a novel anterior cortical button. Biceps tenodesis shoulder surgeon chicago, westchester. Biceps tenotomy and tenodesis have become two of the most commonly performed surgical procedures for lesions of the. A multitude of approaches to addressing lhb tendinopathy have been described. May 23, 20 over 200 subpectoral biceps tenodesis procedures have been performed at our institution using the described technique over the last 4 years, without any known failures to date. Apr 16, 2015 subpectoral biceps tenodesis yogesh joshi, chetan bhalla, mehek asad and asad syed discuss differing techniques for the repair, tenotomy and tenodesis of the long head of the biceps biceps pathology in shoulder problems has been studied extensively in literature. The biceps tendon is a known source of shoulder pain.
Analysis of suprapectoral and subpectoral biceps tenodesis. Sep 15, 2008 bioabsorbable interference screw fixation has superior biomechanical properties compared to suture anchor fixation for biceps tenodesis. Subpectoral biceps tenodesis was developed as an improvement over arthroscopic proximal biceps tenodesis because of the reported occurrence of screw reaction, tenosynovitis, and shoulder pain after arthroscopic tenodesis. Pdf subpectoral biceps tenodesis matthew provencher.
T1 allarthroscopic suprapectoral versus open subpectoral tenodesis of the long head of the biceps brachii. This case report details the formation of an enthesophyte at the site of subpectoral biceps tenodesis as a complication of the aforementioned. Biceps tenodesis is a commonly employed surgical intervention for refractory symptoms related to the biceps labral complex, those intraarticular and those within the extraarticular bicipital tunnel. Arthroscopic biceps tenodesis using interference screw feat. Rotator cuff tear with concomitant long head of biceps.
Subpectoral biceps tenodesis was used in favor of proximal biceps tenodesis because it allows treatment of concomitant bicipital tendon sheath pathology. Biceps tenodesis versus tenotomy in the treatment of lesions of. Concomitant biceps tendon pathology is often present in patients undergoing rotator cuff repair rcr. The humeral bone socket is approximately 5 mm superior to the inferior border of. The authors present their technique of open subpectoral tenodesis, which demonstrates a high success rate with. Most people have a functional range of motion and adequate strength by four to six months.
This study aimed to compare clinical and functional outcomes of open subpectoral versus arthroscopic intraarticular tenodesis in patients with. Biceps surgery outcomes the cleveland shoulder institute. Methodthe techniques currently described for subpectoral tenodesis. May 14, 2018 subpectoral biceps tenodesis surgical technique using the qfix allsuture anchor, by michael t. Sep 17, 2012 biceps tenodesis is indicated for the treatment for partial or fullthickness biceps tendon tears, severe biceps tendonopathy, or biceps instability associated with a rotator cuff tears.
The intent of this protocol is to provide the clinician with a guideline of the postoperative rehabilitation course for a patient that has undergone a subpectoral biceps tenodesis. Minimize shoulder pain and inflammatory response achieve gradual restoration of passive range of motion prom enhanceensure adequate scapular function precautionspatient education. Complications associated with subpectoral biceps tenodesis. Both patients required open reduction and internalfixationfor managementoftheir fractures. Kiran alluri, md2, michael batech, drph3, raffymirzayan, md4 1. However, surgery may be the right option for those with partial tears whose symptoms are not relieved with nonsurgical treatment. Similar to distal biceps repair, the cortical button fixation coupled with an interference screw provides surgeons with a simple, reliable and biomechanically stable repair of the long head of the biceps. Miniopen subpectoral biceps tenodesis using a suture anchor.
Rehabilitation guidelines for biceps tenodesis with soft. They compared suture anchor with tenodesis screw fixation and confirmed that a suture anchor construct showed failure at 45% to. An open subpectoral biceps tenodesis obt using an interference screw technique has been reported advantageous due to its simplicity, the maintenance of muscle tendon and soft tissue units, the preservation of the lengthtension relationship, the distal removal of the tendon from the bicipital groove and from the shoulder, and the biomechnical. Miniopen subpectoral biceps tenodesis using a suture anchor christopher arena, m. Management of biceps pathology has been reported to influence outcomes of rcr. There is debate over which procedure provides better patient outcomes. Surgical treatment for a biceps tendon tear of the shoulder is rarely needed.
This procedure is recommended for patients who have partial or fullthickness biceps tendon tears, biceps instability, slap lesions, or biceps tendinopathy. Acquiring a preferable technique to repair both cuff and long head of biceps tendon lhbt lesions was the aim of several recent studies. In this blog post, we are going to share a free pdf download of atlas of advanced shoulder arthroscopy pdf using direct links. The subpectoral biceps tenodesis incision is placed just below the most inferior border of the pectoralis major. It involves rest, wearing a sling, and physical therapy. We hypothesize that subpectoral interference screw fixation offers relevant clinical advantages over suture anchor fixation for biceps tenodesis. Subpectoral biceps tenodesis for treatment of isolated. Compare patientreported outcomes and satisfaction between biceps tenotomy and tenodesis.
Subpectoral definition of subpectoral by medical dictionary. However, it is unknown whether fixation technique influences clinical results. Subpectoral biceps tenodesis using cortical buttons and the tension slide technique allows the surgeon to tension and repair the long head of the biceps in either a bicortical or unicortical repair. Article information, pdf download for subpectoral biceps tenodesis. Allarthroscopic suprapectoral versus open subpectoral tenodesis of the long head of the biceps brachii without the use of. Subpectoral biceps tenodesis has demonstrated excellent clinical outcomes for patients with primary biceps pathology, as well as failed slap repairs. Nerve injury with subpectoral long head of the biceps tenodesis christopher l. This retrospective cohort study including all patients undergoing arthroscopic biceps tenodesis or tenotomy as.
Pdf open subpectoral tenodesis of the proximal biceps. Residual pain at the site of tenodesis may be an issue when suture anchors are used in the subpectoral location. Subpectoral biceps tenodesis is a minimally invasive surgical technique that efficiently and reproducibly addresses long head of the biceps lhb tendon pathology. Rehabilitation guidelines for biceps tenodesis the shoulder has two primary joints. Twentysix patients with 29 shoulder surgeries were available for followup. Tenodesis of the biceps tendon can prevent cosmetic deformity 1 and may preserve strength. Humeral fracture after subpectoral tenodesis of the lhb is a complication that may be minimized with careful surgical technique. Allarthroscopic suprapectoral versus open subpectoral tenodesis of the long head of the biceps brachii without the use of interference screws. In total, 25 patients with revision biceps tenodesis were identified at a mean followup of 76. One part of the shoulder blade, called the glenoid fossa forms a flat, shallow surface. Biceps tenodesis protocol boston shoulder institute.
Jul 16, 2014 analysis of suprapectoral and subpectoral biceps tenodesis the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Arthroscopic versus open comparison of long head of. Subpectoral biceps tenodesis walton linkedin slideshare. No evidence in literature to support tenodesis essentially cosmetic procedure 3.
The purpose of this study was to evaluate the clinical outcomes of patients undergoing primary subpectoral biceps tenodesis for bicipital tendonitis and a slap tear. University of pittsburgh medical center, sports medicine, pittsburgh, pa 2. Subpectoral long head of the biceps tenodesis is gaining popularity as a technique for treating patients with various pathologies of the tendon or its anchor to the superior labrum. The open subpectoral tenodesis of the long head of the biceps is a safe and reproducible technique with a low. No difference between tenotomy vs tenodesis for the long head. Complications of proximal biceps tenotomy and tenodesis. Pdf long head of the biceps lhb tendon pathology is a common cause of pain in the shoulder. A simple surgical technique for subpectoral biceps tenodesis. There are several different techniques to perform this procedure. Few highlevel studies have attempted to determine whether biceps tenotomy or tenodesis is the optimal approach in the treatment of biceps pathology.
Subpectoral biceps tenodesis using cortical buttons. Use of an interference screw is an accepted method of fixation for biceps tenodesis. Allarthroscopic suprapectoral versus open subpectoral tenodesis of the long. Open subpectoral biceps tenodesis with allsuture anchor fixation.
Using the tendon fork, push the suturetendon complex into the bone tunnel. Arthroscopic suprapectoral tenodesis of the long head. Biceps tenotomy and tenodesis are surgical treatments for pathology of the proximal tendon of the long head of the biceps. Lesions associated with the biceps tendon are commonly detected during arthroscopic repair of rotator cuff tears. Among them, 117 patients 60 females and 57 males who met the inclusion and exclusion criteria were enrolled into the. Mar 19, 2015 subpectoral biceps tenodesis walton 1. This is a retrospective case series of prospectively collected data of all patients 65 or older who underwent open subpectoral biceps tenodesis with an interference screw fixation, between 2005 and june 2015, in a singles surgeons practice n 380.
Subpectoral biceps tenodesis for bicipital tendonitis with. Verma will release the tendon arthroscopically at its attachment site and a small cosmetic incision in the armpit subpectoral approach is used to reattach the. This video is intended for healthcare professionals in the united states and canada only. Tenodesis as a treatment for a symptomatic long head of biceps lhb tendon is becoming more prevalent and new techniques exist which are purported to make the procedure faster and more effective. Surgical indications for long head biceps tenodesis. Subpectoral biceps tenodesis orthopaedic product news. Effect of biceps tenodesis on speed of recovery after. Surgical technique subpectoral biceps tendon handling, tendon fork 7 option 1. Download atlas of advanced shoulder arthroscopy pdf free. He details proper location, tunnel drilling, button loading and insertion as well as commenting on his recent research on the proximity of the radial and axillary nerve to the drill hole.
All arthroscopic suprapectoral versus open subpectoral tenodesis of the long. Subpectoral biceps tenodesis rehabilitation protocol. Subpectoral biceps tenodesis using cortical buttons data on file proximal tenodesis implant system distal biceps repair implant system bicortical. Subpectoral open biceps tenodesis using interference screw. Allarthroscopic suprapectoral versus open subpectoral. Open subpectoral biceps tenodesis in patients over 65 does.
There was no statistically significant difference in the outcomes studied between the two fixation techniques. This is coupled with the humerus shaped like a golf ball to make up the joint. Indications for biceps tenodesis include traumatic and degenerative tearing, biceps instability, rupture, and failed surgery. The bicortical technique utilizes the bicepsbutton to draw the tendon against the distal cortex of the bone socket. Biceps pathology in shoulder problems has been studied extensively in literature. Most available literature is of lesser scientific quality and shows varying results in the comparison of tenotomy and tenodesis. Subpectoral biceps tenodesis on the proximal aspect of the biceps. The bicepsbutton and tension slide technique are ideally suited for subpectoral proximal biceps tenodesis. The open subpectoral tenodesis of the long head of the biceps is a safe and reproducible technique with a low complication rate for patients with pathologies of the proximal biceps. Nerve injury with subpectoral long head of the biceps. Arthrex subpectoral biceps tenodesis using cortical buttons.
Biceps subpectoral miniopen tenodesis springerlink. Subpectoral biceps tenodesis protocol the intent of this protocol is to provide the therapist with a guideline of the postoperative rehabilitation course for the patient that has undergone a subpectoral biceps tenodesis. Arthrex subpectoral biceps tenodesis on the proximal. Subpectoral biceps tenodesis for the treatment of type ii and. Biomechanical analysis of subpectoral biceps tenodesis. Surgical technique the narrated video provides an overview of the described surgical technique video 1. Rehabilitation guidelines for biceps tenodesis with soft tissue fixation the shoulder has two primary joints. Subpectoral biceps tenodesis using cortical buttons arthrex. Listing a study does not mean it has been evaluated by the u. Verma may also recommend a subpectoral biceps tenodesis in the case of a complete long head of the biceps rupture or failed biceps tenodesis procedure.
Differences regarding proximity of subpectoral biceps tenodesis to neurovascular structures. Jan 01, 2015 open subpectoral biceps tenodesis represents a reliable surgical technique for treating all lhb tendon disorders, including biceps tendonitis and tears, subluxation, and type ii slap tears. Neers concerns about resection of the biceps aggravating impingement problems by removing one restraint to superior migration of the humeral head seconded this negative assessment of biceps tenodesis. This procedure has proven to be an efficient, reproducible, and reliable means of treating lhb tendon pathology commonly seen in our active military population. It is no means intended to be a substitute for ones clinical decision. Pdf modified subpectoral biceps tenodesis researchgate. Biceps tenodesis is a minimally invasive surgical procedure used to repair a rupture or partial tear of the biceps tendon. Therefore, although tenotomy is a simpler and quicker procedure, tenodesis is increasingly preferred for treatment of biceps pathology. Article information, pdf download for biceps tenodesis versus tenotomy.
Consolidated proximal biceps tenodesis and subscapularis. All patients older than 45, those who had prior surgery on the index shoulder, and those who had any concomitant reconstructive shoulder. The skin incision for the subpectoral biceps tenodesis dentification of. Tenodesis of this tendon is a common treatment option for patients experiencing biceps tendon related pain. Biceps tenodesis is a common procedure performed for tendinopathy of the long head of the biceps brachii lhb. Proximal intraarticular tenodesis can be performed but leaves the tendon within the intertubercular groove. Moreover, although there is controversy regarding a preferential location for biceps tenodesis, green et al. Within 3 months postoperatively, the vas score significantly improved in the open subpectoral tenodesis group compared with the. The determination of appropriate surgical indications for the procedure will facilitate proper analysis and comparisons of the varied techniques. The animation is presented in a neat format, without audio or text overlays. Patients with at least 2 years of followup who underwent open subpectoral biceps tenodesis or allarthroscopic suprapectoral biceps tenodesis without concomitant rotator cuff repair, labral repair, or mumford procedure were. All patients over the age of 65 were evaluated pre and postoperatively using simple shoulder test sst, american shoulder and elbow surgeons ases. Arthroscopic biceps tenodesis using interference screw.
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