A Comparison of Supination and Elbow Flexion Strength in Patients with either Proximal Biceps Release or Biceps Tenodesis (SS-40)

Abstract

Arthroscopic proximal biceps tenotomy and tenodesis are two techniques used to treat symptomatic patients with biceps pathology. We have found little functional difference between patients who have had biceps release versus tenodesis, and have observed that patients with biceps release recover quicker. No studies have evaluated strength in patients who have had an elective proximal biceps release. The purpose of this study was to establish normal data for flexion and supination and compare this to groups of patients who have had either a biceps tenodesis or release. Patients and control subjects volunteering for this study were between the ages of 20 and 70 and had either: 1) no previous shoulder surgery or other shoulder pathology (Control group) or 2) be fully recovered from shoulder surgery and at least 6 months post-operation from either biceps release or tenodesis. Subjects were classified into three groups, those with normal shoulders, those having proximal biceps release, and those having proximal biceps tenodesis. Supination and elbow flexion isokinetic strength was measured at 60 and 120 degrees per second with a Cybex dynamometer. The difference in torque between the dominant and non-dominant extremities in supination and pronation and elbow flexion and extension for the normal shoulders were used as a control. The difference in torque between the surgical shoulder (biceps release or biceps tenodesis) and the non-surgical shoulder, taking into account arm dominance, were calculated and used as the criterion measure. Torque differences between the three groups of patients were compared statistically using an analysis of variance. Seventeen biceps release, 20 biceps tenodesis and 30 age, gender and BMI matched controls subjects were tested for supination and elbow flexion strength of both arms. Comparison between groups utilizing an ANOVA showed no significant strength difference in either elbow flexion or forearm supination in control, release, and tenodesis groups. Results of this study suggest that both biceps tenotomy and tenodesis are useful in painful proximal biceps pathology. While there is no statistically significant difference in postoperative strength measurements, there was a trend towards weaker forearm supination strength in patients undergoing biceps tenotomy. We postulate tenodesis of the long head of the biceps tendon in the athlete or those requiring maximal forearm supination strength.