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.

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