The role of the long head of the biceps in subacromial impingement syndrome and arthroscopic assisted tenodesis

Abstract

Tenosynovitis of the long head of the biceps tendon, which commonly accompanies subacromial impingement syndrome, is one of the most important underlying cause of shoulder pain. We evaluated our experience with arthroscopic subacromial decompression and tenodesis of the long head of the biceps using mini-open approach. Among patients who underwent arthroscopic subacromial decompression (112 patients) alone or in combination with mini-open rotator cuff repair (55 patients), 19 patients (11%; 12 females, 7 males; mean age 47 years, range 42 to 62 years) had tenodesis of the long head of the biceps. During arthroscopy of the glenohumeral joint, the decision for tenodesis was based on the presence of irreversible findings of chronic inflammation such as atrophy, excessive fraying, or partial rupture. The patients were divided into two groups depending on the surgery, namely, mini-open rotator cuff repair (group 1, 9 patients) and arthroscopic subacromial decompression alone (group 2, 10 patients). The mean follow-up was 17.6 months in group 1 (range 12 to 28 months), and 19.6 months in group 2 (range 12 to 40 months). Seven patients in group 1 (78%) did not complain about pain, while two patients had pain after vigorous physical activity. In group 2, nine patients (90%) were pain-free, whereas one patient had moderate pain. None of the patients had any cosmetic deformity. Two patients in group 1, and one patient in group 2 had mild biceps spasms. Despite the small sample size and a relatively short follow-up period, our results for tenodesis may be regarded as satisfactory. Special attention should be paid to the arthroscopic evaluation of the biceps tendon and tenodesis may be inevitable in the presence of chronic changes.