Is arthroscopic biceps tenotomy/tenodesis (arthroscopic surgical procedure to repair or remove the biceps tendon) indicated for patients with a moderate amount of glenohumeral joint effusion (fluid accumulation in the shoulder joint) and subcoracoid and subdeltoid/subacromial bursitis (inflammation of the fluid-filled sacs in the shoulder)?

Arthroscopic Biceps Tenotomy/Tenodesis for Glenohumeral Joint Effusion with Bursitis

Based on current evidence, arthroscopic biceps tenotomy or tenodesis is not specifically indicated for patients with only glenohumeral joint effusion and subacromial/subcoracoid bursitis without evidence of biceps tendon pathology. 1

Evaluation of Biceps Pathology

When considering biceps intervention, the following assessment is critical:

• Imaging findings to look for:

  • Evidence of biceps tendon pathology such as atrophy, excessive fraying, or partial rupture 2
  • Tendinopathy of the long head of the biceps 3
  • Associated rotator cuff tears 4

• MRI is the preferred imaging modality:

  • MRI without contrast is rated 9/9 for evaluating biceps tenosynovitis 1
  • MR arthrography (9/9 rating) if labral pathology is also suspected 1
  • Ultrasound (9/9 rating) is equally effective if local expertise is available 1

Indications for Biceps Tenotomy/Tenodesis

Biceps tenotomy or tenodesis is indicated when:

1. Biceps tendon shows:

   • Irreversible findings of chronic inflammation
   • Atrophy
   • Excessive fraying
   • Partial rupture 2

2. Associated conditions:

   • Often performed in conjunction with other procedures such as rotator cuff repair, subacromial decompression, or distal clavicle resection 5
   • Can be a valuable option for pain reduction in patients with irreparable rotator cuff tears 4

Current Guidelines

The American Academy of Orthopaedic Surgeons states:

• "We are unable to recommend for or against biceps tenotomy or tenodesis when performing shoulder arthroplasty in patients who have glenohumeral osteoarthritis." (Recommendation grade: I, Level of evidence: V) 1

• Current practice regarding biceps management during shoulder procedures is based primarily on surgeon experience rather than high-quality evidence 1

Surgical Considerations

If biceps pathology is confirmed and intervention is warranted:

• Tenodesis is generally preferred for:

  • Younger patients
  • Those concerned about cosmetic deformity ("Popeye" deformity)
  • Patients who want to maintain biceps strength 3

• Tenotomy may be sufficient for:

  • Older, less active patients
  • Those with lower cosmetic concerns 4

• Technique options:

  • All-arthroscopic suprapectoral tenodesis (places fixation site distal to bicipital groove, potentially reducing persistent pain) 6
  • Bridge tenodesis (combination of soft tissue and bony fixation) during rotator cuff repair 3

Caution and Pitfalls

• Mere presence of glenohumeral effusion and bursitis without biceps pathology is not sufficient indication for biceps intervention
• Biceps tenotomy can result in muscle power reduction, cramping, and "Popeye's deformity" 3
• Tenodesis site placement is important - placement within the bicipital groove may lead to persistent pain 6
• While tenotomy/tenodesis can reduce pain and improve functional range of motion, it does not improve shoulder strength or alter progressive radiographic changes in rotator cuff tears 4

In summary, arthroscopic biceps tenotomy/tenodesis should be reserved for cases with confirmed biceps pathology rather than performed solely based on the presence of glenohumeral joint effusion and bursitis.