Outcomes of biceps suspension procedure for painful inferior glenohumeral subluxation in hemiplegic patients and arthroscopic technique

Abstract

Introduction Painful gleno-humeral subluxation (GHS) may develop in hemiplegic patients. The objectives of this study were, to report our outcomes with the use of biceps suspension procedure for the treatment of shoulder pain associated with GHS in hemiplegic patient and to present our arthroscopic technique. Methods This study is a retrospective case series of six consecutive patients with hemiplegia with painful gleno-humeral subluxation. Two patients had open surgery procedure and four procedures were realized under arthroscopy. The surgical procedure consisted of practicing a distal tenotomy of the long head of the biceps tendon, and passing it through an intra-osseous tunnel created in the humerus. The tendon was pulled through the tunnel proximally to distally and then fix on the humeral diaphysis by a Blount staple under maximal traction while a manual reduction of the subluxation was maintained. An evaluation was conducted before and after surgery for pain, physical examination, radiographs findings and patient satisfaction with the outcome of the surgery. Results Average patient age was 59 (range 36 to 78 years). The mean duration of the patient follow-up was 18,6 months (range 6 to 37 months). Four patients were wearing a sling permanently preoperatively, one intermittently and one was wearing an orthosis. All patients had permanently quit their sling at the time of evaluation, except for the one with preoperative orthosis who was using a simple sling. There was a statistically significant decrease of the pain (p = 0.002) with a mean preoperative score on the numeric pain rating scale of 6,6 (range, 5 to 9) and 2,6 (range 1 to 5) postoperatively. The mean Ashworth postoperative score was lower compared with preoperative score (2 from 2,6) but the difference was not statistically significant (p = 0.06). Three patients considered that the result of the surgery was very good, two good, one fair. Three patients had complete reduction of the glenohumeral joint at the last radiographic control, two had a partial reduction and one had a recurrent of inferior subluxation. The results were similar for the pain reduction between the two open procedures and the arthroscopic procedure. There was one complication recorded which was an anchor migration that did not require additional surgery. Conclusion This study confirm the good results in pain relief and patient satisfaction with a biceps suspension procedure for painful inferior glenohumeral subluxation in hemiplegic patients and report for the first time the possibility to perform the procedure under arthroscopy.