Biceps tenodesis protocol orthopaedic medical group of. Biceps tenodesis versus tenotomy in the treatment of lesions of. Ive seen more and more biceps tenodesis coming our way as postop clients, and my views closely parallel what mike reinold talks about in this article. Arthroscopic biceps tenodesis is indicated for the treatment of severe biceps tendonopathy, partial or fullthickness tendon tears, or biceps instability typically associated with rotator cuff tear, although there has been considerable debate on tenotomy versus tenodesis. Maintain your operative dressing, loosen bandage if swelling of the elbow, wrist, or hand occurs. A multitude of approaches to addressing lhb tendinopathy have been described. Verma will release the tendon arthroscopically at its attachment site and a small cosmetic incision in the armpit subpectoral approach is used to reattach the. A simple surgical technique for subpectoral biceps. After the biceps tenodesis surgery, physical therapy will be required.
It involves rest, wearing a sling, and physical therapy. Biceps tenodesis protocol brigham and womens hospital. Biceps tenodesis fixation may include interference fixation, suspensory fixation, allsuture anchors, and soft tissue fixation. This tendon rarely is a source of pain and provides a significant portion of the flexion strength of the arm.
Biceps tenodesis procedure, rehab protocol and physiotherapy. Biceps tenodesis is indicated for the treatment for partial or fullthickness biceps tendon tears, severe biceps tendonopathy, or biceps instability associated with a. Historically, biceps tenotomy was indicated in older, less active patients with biceps pathology, whereas in thinner patients or patients younger than age 55 years, a biceps tenodesis was the recommended treatment. The long head of biceps has origin from the superior glenoid where it is anchored to the. Long head biceps tenodesis or tenotomy in arthroscopic. A recent meta analysis revealed no difference in strength or functional outcome between treatments. This portal is typically inferior and lateral to the. Surgical treatment for a biceps tendon tear of the shoulder is rarely needed. This procedure has proven to be an efficient, reproducible, and reliable means of treating lhb tendon pathology commonly seen in our active military population. The amount of time for the procedure can be an as short as an hour or more. Arthroscopic biceps tenodesis is a procedure indicated for the treatment of severe biceps tendonopathy, partial or fullthickness tendon tears, or biceps instability typically associated with rotator cuff tear. Biceps tenodesis is a minimally invasive surgical procedure used to repair a rupture or partial tear of the biceps tendon. Pain free, gentle passive range of motion for shoulder flexion, abduction, internal.
Open and arthroscopic proximal university of washington. Jan 01, 2015 open subpectoral biceps tenodesis represents a reliable surgical technique for treating all lhb tendon disorders, including biceps tendonitis and tears, subluxation, and type ii slap tears. Video of arthroscopic biceps tenodesis performed for a partial tear of the biceps tendon. Biceps tendonitis at the shoulder is a slow onset repetitive strain injury of the shoulder injury caused by activities like pitching or swimming. Shoulder arthroscopic technique for biceps tenodesis. Most biceps tendon ruptures occur when lifting heavy objects or when the arm is stressed during elbow flexion. Open access journals are freely available online throughout the world, for you to read, download, copy, distribute, and use. The included studies varied in methodological quality, and only two were randomized controlled trials rcts. Over 200 subpectoral biceps tenodesis procedures have been performed at our institution using the described technique over the last 4 years, without any known failures to date. Progress to your normal diet if you are not nauseated. Only do strengthening 3xweek to avoid rotator cuff tendonitis begin ue ergometer.
Rehabilitation guidelines for biceps tenodesis the shoulder has two primary joints. Sling use your sling most of the time for the first 3. Pdf nerve injury with long head of the biceps tenodesis. Apr 01, 2015 historically, biceps tenotomy was indicated in older, less active patients with biceps pathology, whereas in thinner patients or patients younger than age 55 years, a biceps tenodesis was the recommended treatment. During biceps tenodesis surgery, the normal attachment of the biceps tendon in. Jun 12, 2016 biceps tenodesis is indicated for the treatment for partial or fullthickness biceps tendon tears, severe biceps tendonopathy, or biceps instability associated with a rotator cuff tears.
One part of the shoulder blade, called the glenoid fossa forms a flat, shallow surface. Arthroscopic proximal biceps tenodesis with reelx stt. Surgical technique for arthroscopic onlay suprapectoral biceps. Increased reoperation rates among patients undergoing shoulder arthroscopy with concomitant biceps tenodesis.
Modified open suprapectoral endobutton tension slide tenodesis. The cinch loop technique is an allarthroscopic procedure for biceps tenodesis using the qfix allsuture anchor in a cinching lasso loop technique to treat long head biceps tendon lhbt pathology. Biceps tenodesis in march of 2018 i had a bicep tenodesis, a subacromial decompression, removal of bone spurs, and repair of a small rotator cuff tear. The biceps tendon is a known source of shoulder pain. A common cause of pain and tenderness located on the front of the shoulder is biceps tendonitis. Its not an ideal first choice, but can be an effective alternative after previous labral repair attempts are unsuccessful. Open subpectoral biceps tenodesis represents a reliable surgical technique for treating all lhb tendon disorders, including biceps tendonitis and tears, subluxation, and type ii. Proximal biceps tenodesis surgical options and techniques feat. There are several options for long head of biceps tenodesis with advantages and.
An open biceps tendon repair or tenodesis is the surgical treatment for a ruptured biceps tendon. Most people have a functional range of motion and adequate strength by four to six months. May 23, 20 over 200 subpectoral biceps tenodesis procedures have been performed at our institution using the described technique over the last 4 years, without any known failures to date. Minimize shoulder pain and inflammatory response achieve gradual restoration of passive range of motion prom enhanceensure adequate scapular function precautionspatient education. Open and arthroscopic proximal biceps tenodesis source. The free suture limb is then pulled through the tendon with the grasper. The biceps muscle in the shoulder divides into two tendons. Subpectoral biceps tenodesis offers a unique advantage by. The long head of the biceps tendon lhbt is a common source of shoulder pain. The incisions are closed with sutures or surgical staples, the shoulder is bandaged, the patient will be given pain relievers and patients should be able to leave the hospital within a day. A biceps tenodesis procedure involves cutting of the long head of the biceps just prior to. My tenodesis repair was a type where they place the relocated bicep tendon into a sleeve and pull it into a hole in the humerus with stitches. Cervical rom week 1week 3 at 1 week postop, begin codmans exercise in the elbow straight as long as patient. Arthrex subpectoral biceps tenodesis using cortical buttons.
Create a biceps tenodesis portal by introducing a needle into the skin until the humerus is engaged. Debride any biceps stump that remains on the labrum. Pdf open subpectoral tenodesis of the proximal biceps. The johns hopkins hospital patient information compliedcreated surgery 5710 nelson8 biceps tenodesis discharge instructions icing your shoulder if an iceman was provided for you, please refer to the iceman handout for instructions on proper usage of this cooling device. Yogesh joshi, chetan bhalla, mehek asad and asad syed discuss differing techniques for the repair, tenotomy and tenodesis of the long head of the biceps. Forked eyelets are also available for an allarthroscopic approach. A biceps tenodesis is a surgical procedure performed for the treatment of a damaged proximal long head of biceps tendon. This is coupled with the humerus shaped like a golf ball to make up the joint. Subpectoral biceps tenodesis using cortical buttons. Miniopen subpectoral biceps tenodesis using a suture. The long head of the biceps lhb tendon is a potential source of shoulder pain encountered by orthopaedic surgeons.
However, surgery may be the right option for those with partial tears whose symptoms are not relieved with nonsurgical treatment. Shoulder arthroscopic technique for biceps tenodesis using. Use this as often as you can over a 24hr period for the next 810 days. The biceps tendon is located on the arm between the shoulder and elbow and is responsible for elbow flexion and the ability to rotate the forearm. These include various surgical techniques such as tenodesis versus tenotomy, an arthroscopic versus an open approach, and differing methods of tenodesis fixation. Begin with clear liquids and light foods jellos, soups, etc. Finally, we advocate using a free needle to pass one suture through the tendon and tie. Simple tenotomy and anchor tenodesis are commonly used in treatment of long biceps tendon lhb pathologies. The normal attachment of the long head of the biceps is surgically cut and reattached to the humerus with either a soft tissue or hardware fixation technique. A simple surgical technique for subpectoral biceps tenodesis. Biceps tenodesis has several advantages over tenotomy, including.
The open subpectoral tenodesis of the long head of the biceps is a safe and reproducible technique with a low complication rate for patients with pathologies of. Subpectoral biceps tenodesis orthopaedic product news. Biceps tenodesis protocol the intent of this protocol is to provide the clinician with a guideline of the postoperative rehabilitation course of a patient that has undergone a biceps tenodesis for biceps dysfunction. Cervical rom week 1week 3 at 1 week postop, begin codmans exercise in the elbow straight as long as patient can do these exercises without pulling in the biceps. Rehabilitation following tenodesis will progress more slowly over the first 6 weeks to protect healing biceps tendon.
Similar to distal biceps repair, the cortical button fixation coupled with an interference screw provides surgeons with a simple, reliable and biomechanically stable repair of the long head of the biceps. Biceps tenodesis shoulder surgeon chicago, westchester. Biceps tenodesis rehabilitation boston sports medicine. The glenoid labrum is a ring of cartilage that turns the. A biceps tenodesis may be performed as an isolated procedure but more often is part of a larger shoulder surgery, such as a rotator cuff repair. The goal of biceps tenodesis surgery is to cut the tendon free from the top of the shoulder and reattach it to the upper arm. Arthroscopic tenodesis is recommended at this point. The family of swivelock tenodesis implants is designed to support a multitude of proximal biceps tenodesis techniques and maximize or efficiency. Sep 17, 2012 biceps tenodesis is indicated for the treatment for partial or fullthickness biceps tendon tears, severe biceps tendonopathy, or biceps instability associated with a rotator cuff tears. Verma may also recommend a subpectoral biceps tenodesis in the case of a complete long head of the biceps rupture or failed biceps tenodesis procedure. Article information, pdf download for biceps tenodesis versus. Concomitant subpectoral biceps tenodesis and superior labral repair.
An increasing body of evidence suggests that biceps tenodesis may be an effective treatment for slap tears because many have associated bicipital tendonitis. The intent of this protocol is to provide the clinician with a guideline of the postoperative rehabilitation course for a patient that has undergone a subpectoral biceps tenodesis. No active or passive shoulder extension beyond neutral with the elbow extended for 8 weeks. Sling use your sling most of the time for the first 3 weeks. Implants are available with suture eyelets or closed eyelets for surgeons who prefer a whipstitching technique. Subpectoral biceps tenodesis using cortical buttons data on file proximal tenodesis implant system distal biceps repair implant system bicortical. Subpectoral biceps tenodesis using cortical buttons and the tension slide technique allows the surgeon to tension and repair the long head of the biceps in either a bicortical or unicortical repair. Arthroscopic proximal biceps tenodesis with reelx stt vumedi. The short head of the biceps inserts on the coracoid, a bony prominence of the scapula the shoulder blade. Biceps tenodesis can be an outpatient surgery or may need hospital admission, depending on the presented case. The open subpectoral tenodesis of the long head of the biceps is a safe and reproducible technique with a low complication rate for patients with pathologies of the proximal biceps. Biceps tendon pathology is often overlooked as a cause of shoulder pain. It is no means intended to be a substitute for ones clinical decision.
Subpectoral biceps tenodesis for bicipital tendonitis with. A modification of the standard lateral portal can be. Subpectoral biceps tenodesis was developed as an improvement over arthroscopic proximal biceps tenodesis because of the reported occurrence of screw reaction, tenosynovitis, and shoulder pain after arthroscopic tenodesis. Once the benefits and risks of the procedure have been discussed, patient must agree to everything before the actual procedure takes place. Optimal treatment of the diseased long head of the biceps lhb tendon during rotator cuff repair remains a topic of debate. Biceps pathology in shoulder problems has been studied extensively in literature. This can be done for biceps tendon ruptures that occur at the shoulder or elbow attachment. Subpectoral biceps tenodesis rehabilitation protocol. Biceps tenodesis is a common strategy to address the lhbt. Create a standard lateral portal to clear bursal tissue from the subacromial space. The bicepsbutton and tension slide technique are ideally suited for subpectoral proximal biceps tenodesis.
1435 965 58 582 483 29 434 19 767 1173 183 424 1356 1238 255 307 741 1264 697 1330 522 870 732 1229 205 404 1253 1160 911 1245 38 1034 991 983 1074 247 858 274 1371 1345 925 1198 644 929 446