American Shoulder and Elbow Surgeons
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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?
Elbow flexion weakness
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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.
Osbahr DC, Diamond AB, Speer KP.
Arthroscopy. 2002 May-Jun;18(5):483-7. PMID: 11987057 (Link to Abstract)
Frost A, Zafar MS, Maffulli N
Am J Sports Med. 2009 Apr;37(4):828-33. PMID: 18762669 (Link to Abstract)
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Session III - Biceps Tenodesis Author: Scott Trenhaile, MD Duration: 7:23
Video portrays Speed's test of shoulder for proximal biceps tendonitis.
Video portrays Yergason's test of the shoulder for proximal bicep pathology.
Video shows arthroscopic proximal biceps tenodesis technique.
Short video describing pathology of proximal biceps tendonitis and its treatment...