AANA Lab Course 904 - Shoulder Superstars: Everything You Can Do in a Shoulder Through the Scope! (APEx)-Biceps Tenodesis

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This document discusses the management of painful biceps conditions, particularly focusing on biceps tenodesis—whether performed at a high (articular) or low (subpectoral) location. Pain from biceps pathology arises in various contexts including painful biceps tears, massive rotator cuff tears, SLAP lesions, biceps instability, and revisions. Differentiating the pain source with physical exams (tenderness, Speed’s test) and imaging (fluid in sheath, subluxation, subscapularis tears) is critical.<br /><br />Massive cuff tears present treatment challenges, where pain may originate from both biceps and cuff. Options include tenotomy (biceps release without fixation) and tenodesis (fixation with or without augmentation). Tenodesis aims to improve function and reduce deformity, providing strength and stability, especially when associated with cuff tears or adhesive capsulitis.<br /><br />The technique selection depends on pathology and anatomical considerations. Locations include articular (in the groove or suprapectoralis region), bursal, subpectoral, and open approaches, each offering different advantages in terms of fixation strength, healing potential, and addressing groove pathology or recurrent symptoms. The document highlights the use of implants and discusses “hidden lesions” found during arthrotomy that influence management decisions.<br /><br />In complex cases such as massive cuff tears, augmentation with biceps tissue, capsular grafts, or anterior strut grafts (SCGR) may be employed to support repair and restore anterior cable function. Revision surgery scenarios often favor subpectoral or open tenodesis for robust fixation in poor quality bone or ruptured biceps.<br /><br />In summary, effective biceps tenodesis requires understanding the pain generator, anatomic pathology, and biomechanical demands. This informs the choice of tenodesis location, fixation method, and potential need for augmentation to optimize outcomes in cuff and biceps pathology.

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Dr. Jeffery S. Abrams, M.D.

Keywords

biceps tenodesis

painful biceps tears

massive rotator cuff tears

SLAP lesions

biceps instability

tenotomy

tenodesis fixation

subpectoral tenodesis

arthrotomy hidden lesions

biceps augmentation