The tendon of the long head of the biceps (LHB) is a common source of pain in the shoulder, and the surgical treatments proposed are tenotomy or tenodesis performed in different ways. The purpose of this study is to compare the clinical results (objective and subjective) of tenotomy versus soft tissue tenodesis. One-hundred and four patients with an isolated LHB pathology, arthroscop- ically treated between 2004 and 2007, were observed ret- rospectively. Forty-eight of these patients were treated with tenotomy and 56 with a soft tissue tenodesis technique. All the patients were evaluated by an independent observer with a minimum follow-up of 2 years which included VAS, DASH questionnaire, Constant score and ROM evaluation with a goniometer. All these evaluations were performed pre- and post-operatively. An independent expert radiologist then performed an ultrasound examina- tion only in the post-operative evaluation of the tenodesis group looking to confirm the effectiveness of the proce- dure. In both groups, the scores were significantly improved. In the tenotomy group, 16.6 % of the patients had bicipital cramps for a mean post-operative time of 1 month. Constant score improved in both groups: 46.6 to 86.1 in tenotomy group and 48.9–84.9 in tenodesis group; VAS improved from 8.4 to 1.5 in tenotomy group and from 8.8 to 1.4 in tenodesis group; DASH scores changed from 42.5 to 13.6 in tenotomy group and from 55.8 to 11.4 in tenodesis group. Popeye sign was present in 37.5 % in the tenotomy group and in 5.3 % in tenodesis group. In 3 G. Delle Rose M. Borroni (&) A. Silvestro R. Garofalo M. Conti P. De Nittis A. Castagna Istituto Clinico Humanitas, Via Manzoni, 56 Rozzano, Milan, Italy e-mail: mario.borroni@gmail.com patients of the tenodesis group, ultrasound revealed com- plete failure of the tenodesis. In conclusion, both proce- dures are effective in terms of treatment of LHB pathologies. Tenotomy does not require specific post- operative treatment and is easy to perform, but cramp and Popeye sign may occur after surgery. The soft tissue tenodesis technique is an easy and cost-effective way to perform tenodesis with good results, especially in pre- venting the Popeye sign, but requires a longer rehabilitation time.

The long head of biceps as a source of pain in active population: tenotomy or tenodesis? A comparison of 2 case series with isolated lesions

Castagna A
2012

Abstract

The tendon of the long head of the biceps (LHB) is a common source of pain in the shoulder, and the surgical treatments proposed are tenotomy or tenodesis performed in different ways. The purpose of this study is to compare the clinical results (objective and subjective) of tenotomy versus soft tissue tenodesis. One-hundred and four patients with an isolated LHB pathology, arthroscop- ically treated between 2004 and 2007, were observed ret- rospectively. Forty-eight of these patients were treated with tenotomy and 56 with a soft tissue tenodesis technique. All the patients were evaluated by an independent observer with a minimum follow-up of 2 years which included VAS, DASH questionnaire, Constant score and ROM evaluation with a goniometer. All these evaluations were performed pre- and post-operatively. An independent expert radiologist then performed an ultrasound examina- tion only in the post-operative evaluation of the tenodesis group looking to confirm the effectiveness of the proce- dure. In both groups, the scores were significantly improved. In the tenotomy group, 16.6 % of the patients had bicipital cramps for a mean post-operative time of 1 month. Constant score improved in both groups: 46.6 to 86.1 in tenotomy group and 48.9–84.9 in tenodesis group; VAS improved from 8.4 to 1.5 in tenotomy group and from 8.8 to 1.4 in tenodesis group; DASH scores changed from 42.5 to 13.6 in tenotomy group and from 55.8 to 11.4 in tenodesis group. Popeye sign was present in 37.5 % in the tenotomy group and in 5.3 % in tenodesis group. In 3 G. Delle Rose M. Borroni (&) A. Silvestro R. Garofalo M. Conti P. De Nittis A. Castagna Istituto Clinico Humanitas, Via Manzoni, 56 Rozzano, Milan, Italy e-mail: mario.borroni@gmail.com patients of the tenodesis group, ultrasound revealed com- plete failure of the tenodesis. In conclusion, both proce- dures are effective in terms of treatment of LHB pathologies. Tenotomy does not require specific post- operative treatment and is easy to perform, but cramp and Popeye sign may occur after surgery. The soft tissue tenodesis technique is an easy and cost-effective way to perform tenodesis with good results, especially in pre- venting the Popeye sign, but requires a longer rehabilitation time.
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/11699/578
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