The long head of biceps at the shoulder: a scoping review
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ABSTRACT:
SUBMITTER: Diplock B
PROVIDER: S-EPMC10044783 | biostudies-literature | 2023 Jan
REPOSITORIES: biostudies-literature
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Project description:Arthroscopic long head of biceps tenotomy is an established technique for addressing shoulder pain associated with long head of biceps pathology. Arthroscopic techniques, compared with open surgery, have demonstrated improvements in outcomes for patients including rapid recovery, but either regional or general anesthesia is required, which is associated with complications. We describe a novel technique using a Nanoscope needle arthroscopy system that allows for long head of biceps tenotomy to be performed under local anesthetic in the outpatient or office setting.
| S-EPMC7953351 | biostudies-literature
Project description:Surgical procedures to treat anterior shoulder instability are basically split into 2 groups: those for patients with important bone loss and those for patients with no bone loss. However, there is a gray zone between these procedures in which a bone graft would not be needed but bone grafting would result in a desirable improvement in stabilizing mechanisms. We describe a technique based on the triple soft-tissue block, Bankart reconstruction, and long head of the biceps tenodesis at the anterior glenoid rim. The long head of the biceps would add an anterior restrictor by itself, as well as by tensioning the inferior part of the subscapularis.
| S-EPMC6948139 | biostudies-literature
Project description:Subscapularis repair failure following anatomic total shoulder arthroplasty (TSA) can compromise postoperative range of motion and joint stability, often leading to persistent pain and worse outcomes. Augmenting the subscapularis repair, particularly in at-risk patients, may provide a more robust construct and prevent subscapularis failure. The long head of the biceps tendon (LHBT) is an accessible autograft with applications previously described in several shoulder procedures. In this technical note and accompanying video, we describe LHBT augmentation of subscapularis repair following TSA. The LHBT is released from the supraglenoid tubercle and is passed through the subscapularis tendon vertically in a pulvertaft weave fashion. Transosseous sutures are used to complete the peel repair, with the LHBT acting as a rip-stop to help protect the repair from suture pullout. In addition, the incorporated LHBT remains in continuity with the remainder of the biceps distally and may act as a dynamic stabilizer. This technique, termed the "Biceps-Subscap Sling" technique, provides additional structural integrity to subscapularis repair and is a cost-effective, biologically active option.
| S-EPMC10714269 | biostudies-literature
Project description:PurposeTo evaluate the association between rotator cuff tear (RCT) size and long head biceps tendon (LHBT) pathology.MethodsWe retrospectively enrolled 202 consecutive patients (114 women and 88 men with mean age at surgery of 62.14 years [SD, 7.73]) who underwent arthroscopic rotator cuff repair for different sized full-thickness RCTs. LHBT pathology was evaluated considering the presence of inflammation, section alteration, loss of integrity, dislocation, dynamic instability, and absence. The site of LHBT pathology was evaluated considering 3 portions: (1) the insertional element; (2) the free intra-articular portion; (3) the part that enters the intertubercular groove. Statistics were evluated.ResultsThe LHBT was absent in 22 cases (10.9%): 2, 4, 15, and 1 patients with small, large, massive, and subscapularis RCTs, respectively. A significant correlation was found between the prevalence of LHBT absence and massive RCTs (P < .001). In 53 patients (26%), there was a healthy LHBT; a healthy LHBT was present in 47%, 20% and 8% of small, large and massive RCTs, respectively. A significant correlation between LHBT inflammation, section alteration, loss of integrity, and RCT severity was found (P < .001, P < .001, and ). The insertional portion was the most involved (57% of cases); RCT severity was significantly associated with the number of involved portions (P < .001).ConclusionsShoulder LHBT pathology is associated with increasing rotator cuff tear size.Clinical relevanceSurgeons should be aware that biceps pathology is particularly prevalent in patients with larger RTCs.
| S-EPMC8527326 | biostudies-literature
Project description:In the treatment of anterior shoulder instability, there are various conditions in which a sling effect is needed to enhance anterior stability. The traditional Latarjet procedure provides a sling effect but destroys the coracoacromial arch, which may result in superior instability. To preserve the coracoacromial arch and create a sling to enhance the anterior-inferior side of the shoulder, we introduce an arthroscopic technique to transfer the long head of the biceps (LHB) brachii. Indications of LHB transfer are patients younger than 45 years of age who participate in competitive sports, require forceful external rotation and abduction movement of the shoulder, and/or have capsule-ligament insufficiency, as well as patients 45 years o or older who have combined SLAP lesions (type II or IV). The main steps of this procedure include detaching the LHB, retrieving and braiding the LHB, creating a glenoid tunnel, placing a guide suture through the subscapularis and glenoid tunnel, passing the LHB through the subscapularis and into the glenoid tunnel, and suspension fixation of the LHB.
| S-EPMC5797298 | biostudies-literature
Project description:The limitations of transferring the coracoid process along with the conjoined tendon are coracoacromial arch damage, technical difficulty, and nerve injury. The long head of the biceps tendon (LHBT) proximal transposition technique has a weaker sling effect and a risk of nerve injury. The arthroscopic subscapularis augmentation technique may have risks of shoulder external rotation restriction and subscapularis transection. Herein, we introduce an arthroscopic technique for the transfer of the LHBT for subscapularis augmentation to address these risks. Indications of this technique were patients younger than 45 years of age who engage in competitive sports, require forceful external rotation and abduction, have a related capsule-ligament insufficiency, and have a glenoid bone loss <25%. The steps include detaching the LHBT at the upper edge of the pectoralis major, transecting and braiding the LHBT, establishing a scapular tunnel, placing a guide suture through the upper third of the subscapular and scapular tunnel, passing the LHBT through the established tunnels, and fixating the LHBT. This technique achieves stability of the anterior shoulder by transecting and transferring the distal end of the LHBT to press on the upper third of the subscapularis muscle. Technique Video Video 1 The surgical procedure of the arthroscopic technique for the transfer of the long head of the biceps tendon for subscapularis augmentation.
| S-EPMC9134250 | biostudies-literature
Project description:BackgroundManagement of symptomatic long head of biceps tendon (LHBT) pathology remains a source of debate.Questions/purposesThe purpose of this study was to identify consensus trends for the treatment of LHBT pathology among specialists.MethodsA survey was distributed to members of the American Shoulder and Elbow Society (ASES), consisting of three sections-demographics, case scenarios, and general LHBT pathology management. Cases presented common clinical scenarios, and surgeons reported their management preferences. Consensus responses were defined as > 50% of participants giving a single response.ResultsOne hundred and forty-two of 417 (34%) surgeons completed surveys. Forty-seven percent of questions reached a consensus answer. Biceps tenodesis was the overwhelmingly preferred technique in cases demonstrating LHBT pathology, as compared to tenotomy. No consensus, however, was reached regarding a specific surgical technique for biceps tenodesis. The two most popular techniques were arthroscopic tenodesis to bone and open subpectoral biceps tenodesis. Fellowship-trained arthroscopic surgeons and surgeons with a largely arthroscopic practice were more likely to perform tenodesis arthroscopically.ConclusionASES members favored biceps tenodesis over tenotomy for surgical management of LHBT pathology, without consensus regarding a specific surgical technique.
| S-EPMC5786587 | biostudies-literature
Project description:PurposeSurgical options for long head of the biceps tendon (LHBT) lesions include tenotomy and tenodesis. This study aims to determine the optimal surgical strategy for LHBT lesions with updated evidence from randomised controlled trials (RCTs).MethodsLiterature was retrieved from PubMed, Cochrane Library, Embase and Web of Science on 12 January 2022. Randomised controlled trials (RCTs) comparing the clinical outcomes of tenotomy and tenodesis were pooled in the meta-analyses.ResultsTen RCTs with 787 cases met the inclusion criteria, and were included in the meta-analysis. Constant scores (MD, -1.24; p = 0.001), improvement of Constant scores (MD, -1.54; p = 0.04), Simple Shoulder Test (SST) scores (MD, -0.73; p = 0.03) and improvement of SST (p < 0.05) were significantly better in patients with tenodesis. Tenotomy was associated with higher rates of Popeye deformity (OR, 3.34; p < 0.001) and cramping pain (OR, 3.36; p = 0.008]. No significant differences were noticed between tenotomy and tenodesis regarding pain (p = 0.59), American Shoulder and Elbow Surgeons (ASES) score (p = 0.42) and its improvement (p = 0.91), elbow flexion strength (p = 0.38), forearm supination strength (p = 0.68) and range of motion of shoulder external rotation (p = 0.62). Subgroup analyses showed higher Constant scores in all tenodesis types and significantly larger improvement of Constant scores regarding intracuff tenodesis (MD, -5.87; p = 0.001).ConclusionsAccording to the analyses of RCTs, tenodesis better improves shoulder function in terms of Constant scores and SST scores, and reduces the risk of Popeye deformity and cramping bicipital pain. Intracuff tenodesis might offer the best shoulder function as measured with Constant scores. However, tenotomy and tenodesis provide similar satisfactory results for pain relief, ASES score, biceps strength and shoulder range of motion.
| S-EPMC10003204 | biostudies-literature
Project description:The long head of the biceps tendon is frequently involved in shoulder pathologies, often in relation to inflammatory or degenerative damage to the rotator cuff. Biceps tenodesis in the bicipital groove and tenotomy are the main treatment options. Tenotomy of the long head of the biceps tendon is a simpler and quicker procedure than tenodesis, and it does not require the use of implants. However, retraction of the biceps tendon, leading to Popeye deformity, and biceps muscle cramps are common complications after tenotomy. Therefore we propose an arthroscopic technique for tenotomy that limits the risk of Popeye deformity. This procedure consists of creating a loop at the severed end of the biceps tendon, which prevents the tendon from retracting into the bicipital groove.
| S-EPMC4175155 | biostudies-literature
Project description:The long head of the biceps brachii tendon arises mainly from the superior glenoid labrum and supraglenoid tubercle. Biceps brachii display anatomic variations, but these are rarely encountered. We report, for the first time, a technique called arthroscopic intra-articular biceps tenoplasty describing restoration of the long head of the biceps tendon using the superior capsule in a case of anomalous congenital split biceps tendon encountered incidentally during diagnostic glenohumeral arthroscopy in a patient who was treated for shoulder instability and SLAP tear.
| S-EPMC4044499 | biostudies-literature