From the Guidelines
Tendinopathy in the long head of the biceps tendon with tenosynovitis is often an indication for arthroscopic biceps tenotomy or tenodesis, as these procedures can provide significant relief from pain and improve quality of life. These procedures are typically considered when conservative treatments like physical therapy, anti-inflammatory medications, and activity modification have failed to provide adequate relief 1. Tenotomy involves simply cutting the tendon, while tenodesis involves detaching the tendon and reattaching it to the humerus. The choice between these procedures depends on factors such as patient age, activity level, and cosmetic concerns.
- Tenodesis is generally preferred for younger, active patients who want to maintain normal biceps contour and strength, while tenotomy may be more appropriate for older, less active patients.
- These procedures effectively address the pain caused by the damaged tendon by removing it as a source of symptoms.
- Recovery typically involves a rehabilitation protocol starting with protected motion for 4-6 weeks, followed by progressive strengthening exercises over 3-4 months before returning to full activities. It's worth noting that the current evidence does not provide a clear recommendation for or against biceps tenotomy or tenodesis in certain cases, such as shoulder arthroplasty for glenohumeral osteoarthritis, due to the limited and variable nature of the existing literature 1. However, in the context of tendinopathy with tenosynovitis, arthroscopic biceps tenotomy or tenodesis can be a viable treatment option to improve morbidity, mortality, and quality of life.
From the Research
Tendonopathy in Long Head of Biceps Tendon with Tenosynovitis
- Tendonopathy of the long head of the biceps tendon with tenosynovitis is a common cause of shoulder pain and disability 2, 3, 4.
- The condition is often associated with degenerative processes of the rotator cuff and the joint, but the etiology remains largely unknown 4.
- Histologic findings of the extra-articular portion of the LHB tendon and synovial sheath have shown chronic degenerative changes, such as tenocyte enlargement and proliferation, ground substance expansion, and increased vascularization, rather than acute inflammation 5.
Arthroscopic Biceps Tenotomy/Tenodesis as a Treatment Option
- Arthroscopic biceps tenotomy and tenodesis have gained widespread acceptance as effective procedures to manage both isolated LHB pathology and combined lesions of the rotator cuff and biceps-labral complex 3.
- A study comparing the outcomes of tenotomy and tenodesis of the LHBT under shoulder arthroscopy found similar clinical efficacy between the two procedures, with comprehensive assessment and optimization of therapeutic schedules using the enhanced recovery after surgery (ERAS) concept recommended 6.
- Another study found that tenodesis of the long head of the biceps tendon can be an effective treatment option for patients with chronic inflammation and irreversible findings of tendonopathy, with satisfactory results and minimal complications 2.
Indications for Arthroscopic Biceps Tenotomy/Tenodesis
- The presence of irreversible findings of chronic inflammation, such as atrophy, excessive fraying, or partial rupture, may indicate the need for tenodesis of the long head of the biceps tendon 2.
- Tenosynovitis of the long head of the biceps tendon, which commonly accompanies subacromial impingement syndrome, may also be an indication for arthroscopic biceps tenotomy/tenodesis 2, 3.
- A comprehensive assessment of the patient's condition, including the extent of tendonopathy and the presence of any associated lesions, is necessary to determine the most appropriate treatment option 6.