Subpectoral Biceps Tenodesis for Tenosynovitis of the Long Head of the Biceps in Active Patients Younger Than 45 Years Old

Authors:

Dimitri S Tahal, J Christoph Katthagen, Alexander R Vap, Marilee P Horan, Peter J Millett

Abstract:

Isolated tenosynovitis of the long head of the biceps (LHB) tendon is an uncommon finding that can be the cause of chronic anterior shoulder pain resulting in limited function. LHB tenosynovitis in active patients is most commonly found in conjunction with impingement syndrome, but the exact cause is not known. LHB tenosynovitis has previously been associated with repetitive movement and overuse, such as from sports activities, acute trauma, variations in bicipital groove morphology, and inflammation of nearby glenohumeral structures.

It has been proposed that older patients develop LHB tenosynovitis due to the degeneration of the LHB tendon, which commonly occurs concurrently with rotator cuff tears. Conversely, LHB tenosynovitis in isolation is rare and occurs most frequently in active patients with resultant shoulder pain and dysfunction.

Initial management of LHB tenosynovitis consists of nonoperative treatment that includes nonsteroidal anti-inflammatory drugs, physiotherapy, and corticosteroid injections. Surgery can be considered in cases that have nearby glenohumeral structures. Failed a trial of conservative treatment with persistent shoulder pain and dysfunction. Intraoperatively, tenosynovitis of the LHB presents with vascular injection and reddening of the tendon and sheath, thickening of the tendon, and edema between the LHB tendon and sheath. The 2 recommended surgical treatment options are biceps tenotomy and tenodesis. While there is no consensus on which LHB surgical technique is superior, several studies have shown that LHB tenodesis, in contrast to tenotomy, has a lower complication rate, better shoulder function, and less postoperative cramp- ing pain and deformity, with better cosmesis. Subsequently, tenodesis seems to be the more appropriate intervention for an active population with biceps pathology. Biceps tenodesis (BT) can be performed in either a suprapectoral or subpectoral technique based mainly on surgeon preference.

Recently, there have been multiple outcomes studies for BT treatment of LHB tenosynovitis in conjunction with other LHB pathology and rotator cuff tears. However, in the last 2 decades there has been a lack of outcome studies for BT treatment of LHB tenosynovitis without any other concomitant reparative or reconstructive procedures. The objective of this study was to assess the outcomes after subpectoral BT for LHB tenosynovitis in active patients <45 years old. It was hypothesized that subpectoral BT for LHB tenosynovitis in active patients would result in reduced pain and improved functional outcomes.

For the complete study: Subpectoral Biceps Tenodesis for Tenosynovitis of the Long Head of the Biceps in Active Patients Younger Than 45 Years Old

Peter Millett, MD

Average rating:

39 reviews

Alexandra Thompson

Mar 23, 2024

by Alexandra Thompson on Peter Millett, MD

110%

Dr. Millett and his team did a SLAP tear repair and bicep tenodesis on my left shoulder. I use my arms as an artist, and love to swim in the ocean, surf, paddle, and telemark ski. So regaining full use of my shoulder and keeping my bicep attached was very important to me. Now, over two years later, my shoulder has the equivalent range of motion as my other arm and as before the injury, and no pain. After the first three months it felt so good and was so strong that - to my horror - I completely forgot my six-month follow-up.

Not only did Dr. Millett and his team make my arm as good as new, but having had the experience of such kindness and expertise throughout the process of surgery and recovery is like an added shoulder superpower.

Thank you Rita, Brooke, Jason, Sarah, Camille, Olivia, Dr. Millett and everyone! And see you soon when my husband comes in for his knee...

Jeff Chandler

Jan 31, 2022

by Jeff Chandler on Peter Millett, MD

Flawless procedure, Easy recovery

Dr. Millet's repaired my knee and tibia, following a botched operation by a different surgeon. That procedure was virtually pain free and I was weight bearing within a few days. That was 18 years ago and the knee is still strong. A few years after the knee incident, Dr Millet repaired my shoulder. My insurance company approved me for 3 months of disability following that surgery. I was off pain medication in 2 days and had 90% range of motion within a week. I withdrew my disability claim and returned to work within two weeks of surgery. I’m not a famous athlete—just a regular guy. Nonetheless, I was treated like an NFL at the Steadman clinic. Most notable was the time for recovery. Other surgeons perform their hour-long task in the OR and don’t involve themselves in the other functions. Peter and his team manages the entire process from diagnosis, anesthesia, nursing care, and therapy. He takes a holistic approach to patient care and doesn’t skip any steps.

Jenn West

Jul 2, 2021

by Jenn West on Peter Millett, MD

Saved My Life

I went to Dr. Millett after 7 knee surgeries (6 on my right and 1 on my left) and had seen 11 different surgeons who all refused to remove femur metal from my right leg. I am highly allergic to metal and the chronic pain was leaving me bedridden for 3.5wks out of a month. He personally wrote me back on my inquiry, listened to my concerns, scheduled my surgery within a week (due to insurance issues) and personally followed up with my recovery. The level of patient care from Dr. Millett and his ENTIRE team is above any care I have ever received in my 20 years of dealing with orthopedic surgeons. There are not enough words to describe the level of care, dedication and professionalism you receive from Dr. Millett and his staff.
My only disappointment is that I did not find him sooner!!!

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Subpectoral Biceps Tenodesis for Tenosynovitis of the Long Head of the Biceps in Active Patients Younger Than 45 Years Old

Authors:

Abstract:

About the Author: Peter Millett, MD