Isolated Biceps Reflection Pulley Tears Treated With Subpectoral Biceps Tenodesis: Minimum 2-Year Outcomes

Lesions of the long head of the biceps (LHB) tendon are commonly recognized as generators of anterior shoulder pain. In particular, disruption of the biceps reflection pulley (BRP) has been shown to be part of the differential considered when evaluating the LHB and anterior shoulder pain. The BRP is a capsuloligamentous complex that stabilizes the LHB tendon in the bicipital groove and is composed of 4 major structures: the superior glenohumeral ligament, the coracohumeral ligament, the upper margin of the subscapularis (SSC) tendon, and anterior fibers of the supraspinatus (SSP) tendon. More precisely, the BRP is located within the rotator interval between the anterior edge of the SSP tendon and the superior edge of the SSC tendon. Recent biomechanical work by Braun has shown that BRP lesions may be a direct result of increased shear loads in a forward flexion position with internal or neutral rotation, and in a neutral arm position with internal rotation. Le Huec similarly described a fall on the outstretched arm in combination with full external or internal rotation, as well as a fall backward on the hand or elbow as a trigger for pulley lesions. In contrast, Gerber and Sebesta reported repetitive forceful internal rotation above the horizontal plane as the inciting cause. Although there is no specific consensus on the mechanism of BRP lesions, it is likely a combination of chronic lesions and acute triggers that are responsible for most BRP lesions. Because of the infrequent occurrence, surgical management of this pathology, in particular biceps tenodesis (BT), has not been thoroughly evaluated; however, BRP lesions do have the potential to diminish patient quality of life and prevent patients from engaging in sports and other recreational activities. Indeed, surgeons and patients may have concerns regarding BT in young and active patients under the age of 50 years because this procedure is more common in elderly people.

Therefore, the purpose of the study was to investigate if patients younger than 50 years old had improved functional outcomes after subpectoral BT for the treatment of BRP lesions at minimum 2-year postoperative follow-up. Further goals were to determine whether a correlation exists between patient age and clinical outcome scores and to ascertain the ability of patients to return to activity. It was hypothesized that subpectoral BT would result in reduced pain, improved functional outcomes, and a high return-to-activity rate.

Full Article: Isolated Biceps Reflection Pulley Tears Treated With Subpectoral Biceps Tenodesis: Minimum 2-Year Outcomes

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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