AANA Lab Course 906- Técnicas Avanzadas de Cirugía de Hombro-Tenodesis o tenotomía de la porción larga del bíceps_ Cuando, dónde y cómo

Tenodesis o tenotomía de la porción larga del bíceps_ Cuando, dónde y cómo_-Mauricio Largacha, MD

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This document outlines the pathophysiology, diagnosis, and surgical treatment options for proximal biceps tendon issues. Key pathologies include inflammation, impingement ("biceps hourglass"), instability (medial-lateral and subtle), degeneration, and rupture. Signs of rupture include the "Popeye deformity" and absence of the tendon in the bicipital groove.<br /><br />Clinically, symptoms are often nonspecific but may involve anterior shoulder pain and tenderness at the bicipital groove. Diagnostic tests such as the resisted supination test have moderate positive predictive value (~50-60%).<br /><br />Surgical options discussed include:<br />- Debridement (for up to 25% tendon involvement, stable cases with some atrophy)<br />- Tenotomy (commonly for patients over 50 years, with severely compromised or irreparable tendons, aimed at pain management though cramps can occur)<br />- Tenodesis (preferred for younger, dominant arm use, partial ruptures (~25%), instability, sport participation, or cosmetic concerns)<br /><br />Tenodesis techniques vary:<br />- Soft tissue fixation (anchors or screws)<br />- Intra-articular (e.g., Snyder technique) requiring removal of proximal stump<br />- Open subpectoral approach, however, this may be associated with complications like pain (7% subpectoral region), cyst formation, neurological lesions, fractures, and a reported 60% reduction in torsional strength with screws smaller than 8mm.<br /><br />Results with suprapectoral screw fixation show approximately 98% good or excellent outcomes but include 5% poor outcomes (pain or Popeye deformity) and 9.4% stiffness, which resolves over time. Use of PEEK material may prevent bone lysis, and no axillary nerve injuries have been reported.<br /><br />Conclusions emphasize that proximal biceps pathology typically occurs with associated shoulder disorders, presents diagnostic challenges, and multiple surgical techniques exist. Subpectoral tenodesis remains debated. Reported revision rates are about 12% proximally and 3% distally. Overall, management should be individualized based on patient factors and tendon involvement.

Keywords

proximal biceps tendon

biceps tendon pathology

biceps hourglass impingement

Popeye deformity

anterior shoulder pain

resisted supination test

biceps tenotomy

biceps tenodesis

subpectoral tenodesis complications

PEEK screw fixation