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  • Well recognized as a pain generator in the shoulder
  • Often associated with other primary shoulder pathology
    • subacromial impingement
    • stenosis of bicipital groove
    • rotator cuff tears
      • especially subscapularis pathology
  • Pathoanatomy
    • more consistent with "tendinosis" than true inflammation
  • Glenohumeral anatomy 
  • Bicep long head tendon 
    • originates off supraglenoid tubercle and superior labrum
    • stabilized within bicipital groove by transverse humeral ligament 
  • Symptoms
    • pain
      • anterior shoulder pain
      • may have pain radiating down the in the region of the biceps
      • symptoms may be simillar in nature and location to rotator cuff or subacromial impingement pain
  • Physical exam 
    • tenderness with palpation over biceps groove 
      • worse with arm internally rotated 10 degrees
    • Speed test 
      • pain elicited in bicipital groove when patient attempts to forward elevate shoulder against examiner resistance while elbow extended and forearm supinated. 
      • may also be positive in patients with SLAP lesions.
    • Yergason's test 
      • pain elicited in biceps groove when patient attempts to actively supinate against examiner resistance with elbow flexed to 90-degrees and forearm pronated 
    • "popeye" deformity
      • indicates rupture
  • Ultrasound
    • can show thickened tendon within bicipital groove
  • MRI 
    • can show thickening and tenosynovitis of proximal biceps tendon
      • increased T2 signal around biceps tendon 
  • Nonoperative
    • NSAIDS, PT strengthening, and steroid injections
      • indications
        • first line of treatment
      • technique
        •  direct steroid injection in proximity, but not into tendon
  • Operative
    • arthroscopic tenodesis vs. tenotomy
      • indications 
        • surgical release reserved for refractory cases for bicep pathology seen during arthroscopy 
      • technique 
        • repair vs. release/tenodesis 
      • outcomes
        • tenotomy may be associated with arm cramping and cosmetic deformity ("Popeye deformity")
        • tenodesis may be associated with "groove pain" q
        • no difference in strength between two techniques

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Questions (1)

(OBQ05.249) While recent studies have failed to demonstrate a significant clinical difference, proximal biceps tenodesis compared to tenotomy is felt to possibly result in a lower incidence of which of the following? Review Topic


Arm cramping




Elbow flexion weakness




Elbow stiffness




Shoulder weakness




Shoulder stiffness



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Concern for cosmetic deformity (“popeye” deformity) and muscle spasm or cramping has been an argument against performing tenotomy in the past. The long head of the biceps tendon has been implicated as a common source of anterior shoulder pain. Surgical options to treat it include biceps tenodesis by various methods and intraarticular biceps tendon release- tenotomy. It is felt by some surgeons that a tenodesis may decrease subjective arm cramping and improve cosmesis. Of note, recent studies have failed to show a significant difference between the two groups.

Osbahr et al retrospectively looked at their patients who had undergone either tenotomy or tenodesis and found non statistically significant differences. The patient were non randomized to treatment groups and therefore selection bias prohibits definitive conclusions.

Frost et al performed a comprehensive review of the literature comparing the outcomes of tenotony and tenodesis, and noted that the studies were predominantly low quality. They concluded that there is a lack of quality evidence to advocate one technique over the other.

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