Review Question - QID 219768

Biceps Tendonitis Treatment Operative QID: 219768 (SBQ24SM.9)

QID 219768 (Type "219768" in App Search)

A 38-year-old male laborer presents to the clinic for continued management of left anterior shoulder pain unresponsive to physical therapy and over-the-counter analgesic medications. On examination, Speed, and Yergason's tests are positive, with pain associated with resisted elbow flexion. He is subsequently sent for an MRI, as shown in Figure A. The decision is made for subpectoral biceps tenodesis. Which of the following is true when comparing suprapectoral versus subpectoral biceps tenodesis?

Type & Select Correct Answer

Type in at least one full word to see suggestions list

Range of motion is increased with subpectoral tenodesis

12/750

Suprapectoral tenodesis confers similar rates of residual anterior shoulder pain

61%

455/750

Subpectoral tenodesis provides better cosmesis and reduces popeye deformity rates

16%

121/750

Subpectoral tenodesis exhibits lower rates of nerve injury

15%

115/750

Suprapectoral tenodesis has inferior patient-reported outcomes

37/750

Select Answer to see Preferred Response

This 38-year-old male exhibits findings of left biceps tendinitis unresponsive to nonoperative treatment. Suprapectoral tenodesis exhibits similar complication rates compared to subpectoral tenodesis (Answer 2).

The long head of the biceps is a common cause of anterior shoulder pain and is often associated with subacromial impingement and subscapularis tendon tears. In addition to anterior shoulder pain, an examination would reveal positive Speed and Yergason's testing, while an MRI may demonstrate thickening with tenosynovitis. When the condition fails to respond to nonoperative treatment (e.g., physical therapy, NSAIDs), surgical management in the form of tenotomy versus tenodesis is indicated. Regarding the latter treatment, suprapectoral and subpectoral techniques exist. The two techniques perform similarly, with residual pain, bicipital groove pain, Popeye deformity, range of motion, and patient-reported outcomes all being similar.

Deng et al. performed a systematic review and meta-analysis of 18 studies (n= 471 patients) comprising ten level 4, seven level 3, and one level 1 study examining the outcomes of arthroscopic suprapectoral tenodesis versus open subpectoral tenodesis. Patient-reported outcomes, residual pain, popeye deformity, and all-cause postoperative complications were found to be similar between the two techniques. Despite this, the authors do note a slightly higher risk of wound and nerve injury rates. The authors postulate that while the techniques perform similarly, large randomized controlled trials are required to fully delineate their differences.

Van Deurzen et al. similarly performed a systematic review and meta-analysis of seven studies totaling 409 patients comparing suprapectoral versus subpectoral tenodesis for biceps tendinopathy. The authors noted a significant difference in American Shoulder Elbow Scores (p=0.01), but believed the difference (2.15) was not of clinical significance. The authors otherwise noted no differences between recurrent bicipital groove pain as well as popeye deformity.

Figure A is a T2-weighted axial MRI of the left shoulder demonstrating increased fluid within the biceps tendon sheath.

Incorrect Answers:
Answers 1, 3, 4, and 5: subpectoral and suprapectoral results in similar postoperative range of motion, overall complication rates, popeye deformity rates, and patient-reported outcomes.