Dynamic Movement of the Long Head of the Biceps Tendon in Frozen Shoulders

Abstract

To assess the importance of the dynamic movement of the long head of the biceps (LHB) tendon for treatment of frozen shoulder. 87 consecutive patients (with 88 frozen shoulders) aged 36 to 77 (mean, 54) years underwent arthroscopic capsular release by a single surgeon. Preoperative treatments included rehabilitation, steroid and/or hyaluronic acid injections. The inclusion criteria were severe night pain, no improvement of flexion and external rotation, and poor response to rehabilitation for at least 6 months. Shoulders were divided into 3 types; types A/B/C indicate slight/moderate/severe degree of synovitis and adhesion of the LHB tendon to the rotator interval. 23 shoulders were type A, 26 type B, and 39 type C. 18 of the 39 type-C shoulders were controls with release of the capsule alone but not the LHB tendon. Patients were followed up for a mean of 21 (range, 12-35) months. Changes in the American Shoulder and Elbow Surgeons (ASES) score, range of movement, and muscle strength (flexion and external rotation) among types A, B, C, and controls were compared. The severity of the adhesion of the LHB tendon to the rotator interval was associated with the ASES score. In all adhesion types, muscle strength and the range of movement in flexion, external rotation, and internal rotation improved postoperatively. Arthroscopic capsular release for adhesion of the LHB tendon to the rotator interval improves the sliding movement and thereby shoulder function.