Abstract
Background: We prospectively tested technical feasibility and clinical outcome of percutaneous ultrasound-guided tenotomy of long head of biceps tendon (LHBT). Methods: We included 11 patients (6 women; age: 73 ± 8.6 years) with symptomatic full-thickness rotator cuff tear and intact LHBT, in whom surgical repair was not possible/refused. After ultrasound-guided injection of local anesthetic, the LHBT was cut with a scalpel under continuous ultrasound monitoring until it became no longer visible. Pain was recorded before and at least six months after procedure. An eight-item questionnaire was administered to patients at follow-up. Results: A median of 4 tendon cuts were needed to ensure complete tenotomy. Mean procedure duration was 65 ± 5.7 s. Mean length of skin incision was 5.8 ± 0.6 mm. Pre-tenotomy VAS score was 8.2 ± 0.7, post-tenotomy VAS was 2.8 ± 0.6 (p < 0.001). At follow-up, 5/11 patients were very satisfied, 5/11 satisfied and 1/11 neutral. One patient experienced cramping and very minimal pain in the biceps. Six patients had still moderate shoulder pain, 1/11 minimal pain, 2/11 very minimal pain, while 2/11 had no pain. No patients had weakness in elbow flexion nor limits of daily activities due to LHBT. One patient showed Popeye deformity. All patients would undergo ultrasound-guided tenotomy again. Conclusion: ultrasound-guided percutaneous LHBT tenotomy is technically feasible and effective.
Highlights
Complete rotator cuff (RC) tears are a common cause of disability and shoulder pain [1]
One patient reported to our Department for increased shoulder pain related to fluid effusion in the subacromial bursa, which was treated with US-guided steroid injection
Our main findings are that US-guided percutaneous tenotomy of the long head of biceps tendon (LHBT) is a procedure with 100% technical success and technique efficacy, high degree of patient’s satisfaction and no immediate complications
Summary
Complete rotator cuff (RC) tears are a common cause of disability and shoulder pain [1]. The biomechanical contribution of LHBT to the shoulder remains to be clarified in some aspects, its spontaneous rupture in patients with RC pathology is commonly associated with pain relief [2] For this reason, arthroscopically guided LHBT tenotomy or tenodesis are commonly practiced in cases where spontaneous rupture does not occur, besides often being part of arthroscopic repair of RC tendons [15,16]. Arthroscopically guided LHBT tenotomy or tenodesis are commonly practiced in cases where spontaneous rupture does not occur, besides often being part of arthroscopic repair of RC tendons [15,16] These two surgical options for LHBT pathology have shown similar clinical outcomes [2,17], tenotomy seems to provide earlier pain relief, despite at higher risk of cosmetic deformity due to prominent bump of the muscle belly (Popeye sign), while tenodesis tends to result in superior functional outcomes [18,19,20]. Conclusion: ultrasound-guided percutaneous LHBT tenotomy is technically feasible and effective
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