It is an option when pain is caused by problems with the biceps. Various fixation techniques and implants are available when performing a subpectoral biceps tenodesis 484950515253. Although previous studies have suggested benefits from a more distal tenodesis location, the literature comparing these locations is sparse. Miniopen cw biceps tenodesis using a subpectoral approach. Complications after subpectoral biceps tenodesis using a. He describes the pallium pectoralis as a new anatomic marker to help place his 5. Operative techniques in sports medicine arthroscopic biceps tenodesis in the beach chair position augustus d. He explains that this tenodesis location helps mitigate concerns about a subpectoral tenodesis potentially creating humeral stress risers.
Allarthroscopic suprapectoral versus open subpectoral tenodesis of the long head of the biceps brachii without the use of interference screws jamison m. Long head of the biceps tenodesis with cortical button. Subpectoral biceps tenodesis rehabilitation protocol. The bio tenodesis screws are composed of plla and are available in numerous sizes to fit all applications. The video shows miniopen subpectoral tenodesis of the long head of the biceps using an expanding peek anchor tenolok anchor, conmed medical, largo, fl on a right shoulder in the lateral decubitus position. The normal attachment of the long head of the biceps is surgically cut and reattached to the humerus with either a soft tissue or hardware fixation technique. The proximal part of the long head of the biceps muscle has become a recognized cause of significant shoulder pain. Subpectoral biceps tenodesis using an expanding peek. Apr 16, 2015 subpectoral biceps tenodesis yogesh joshi, chetan bhalla, mehek asad and asad syed discuss differing techniques for the repair, tenotomy and tenodesis of the long head of the biceps biceps pathology in shoulder problems has been studied extensively in literature. We evaluated the effect of labral repair, biceps tenodesis and sham surgery on slap lesions. A biceps tenodesis procedure involves cutting of the long head of the biceps just prior to its insertion on the superior labrum and then anchoring the tendon along its anatomical course more distally along the humerus. Subpectoral biceps tenodesis has proven to be an effective procedure to relieve pain and maintain function. The 2 surgeons performed a biceps tenodesis on 26% of their patients undergoing soft tissue procedures during this time period. Methods a doubleblind, shamcontrolled trial was conducted with 118 surgical candidates mean age 40 years, with.
We advocate a technique of subpectoral biceps tenodesis. The arthroscopic tenodesis of the long head of the biceps offers a viable option to maintain elbow flexion and supination power, avoid cosmetic deformities, and prevent biceps pain and cramping. Rehabilitation guidelines for biceps tenodesis with soft. Biceps tenodesis protocol boston shoulder institute. Hohmann and chandler retractors are used to main imal humerus to retract the pectoralis muscle proximally and tain the exposure. Subpectoralis biceps tenodesis using the tenolok tenodesis anchor a new addition to conmeds shoulder restoration system, the versatile new tenolok dual expanding tenodesis anchor is used for subpectoral biceps tenodesis repair.
The indications for long head of the biceps lhb tenodesis include severe tendinitistendinosis, frayingtearing of the proximal biceps tendon, or biceps instability usually associated with a rotator cuff tear. Biceps tenodesis shoulder surgeon chicago, westchester. The technique was designed to minimize the potential for postoperative humeral fractures by placing a small 5. Open subpectoral biceps tenodesis represents a reliable surgical technique for treating all lhb tendon disorders, including biceps tendonitis and tears, subluxation, and type ii slap tears. Postop guidelines surgical arthroscopy of shoulder and open. Postop guidelines surgical arthroscopy of shoulder and. A biceps tenodesis is a surgical procedure performed for the treatment of a damaged proximal long head of biceps tendon.
Biceps tenodesis protocol brigham and womens hospital. Nikhil verma, shoulder surgeon treating the chicago, westchester, oak brook and hinsdale, illinois communities. Background labral repair and biceps tenodesis are routine operations for superior labrum anterior posterior slap lesion of the shoulder, but evidence of their efficacy is lacking. Biceps tenodesis may also be performed for superior labrum anterior to posterior tears. It is no means intended to be a substitute for ones clinical decision.
Biceps tenodesis procedure technique in simple definition, this procedure aims to remove the increasing pressure of the biceps by cutting the attachment of the biceps tendon from the shoulder socket and attaching it to the long bone of the arm humerus. Open subpectoral biceps tenodesis in patients over 65 does. Romeo, md arthroscopic biceps tenodesis with interference screw fixation. Distal biceps tendon repair using the bicepsbutton and tensionslide technique allows the surgeon to tension and repair the biceps tendon through a single anterior incision. He details proper location, tunnel drilling, button loading and insertion as well as commenting on his recent research on the proximity of the radial and axillary nerve to the drill hole. Rehabilitation guidelines for biceps tenodesis the shoulder has two primary joints. Allarthroscopic suprapectoral versus open subpectoral. Biceps tenodesis rehabilitation boston sports medicine. Disclosure neither i, nor any family members, have any relevant financial relationships to be discussed, directly or indirectly, referred to, or illustrated with or. The system is ideal for the reattachment of soft tissue to bone in proximaldistal biceps tenodesis. This is a retrospective case series of prospectively collected data of all patients 65 or older who underwent open subpectoral biceps tenodesis with an interference screw fixation, between 2005 and june 2015, in a singles surgeons practice n 380.
Biceps tenodesis procedure, rehab protocol and physiotherapy. During the biceps tenodesis, the normal attachment of the biceps tendon on the shoulder socket glenoid fossa is cut and reattachment of the tendon is made on the humerus upper arm bone. To compare the clinical outcomes of open subpectoral biceps tenodesis ospbt and arthroscopic suprapectoral biceps tenodesis aspbt. Biceps tenodesis is a common procedure performed for tendinopathy of the long head of the biceps. Anterior interosseous nerve neuropraxia secondary to shoulder. A simple surgical technique for subpectoral biceps. Bach jr, md t endinopathy of the long head of the biceps brachii lhb is a common source of anterior shoulder pain. Biceps tenodesis is a surgical procedure used to reduce pain in the shoulder and surrounding area. Subpectoral biceps tenodesis 247 figure 3 a the long head of the biceps tendon. The long head of the biceps lhb tendon is a potential source of shoulder pain encountered by orthopaedic surgeons.
Feb 19, 2015 the bicepsbutton and tension slide technique are ideally suited for subpectoral proximal biceps tenodesis. Subpectoral biceps tenodesis using the tenolok anchor. Open subpectoral biceps tenodesis represents a reliable surgical technique for treating all lhb tendon disorders, including biceps tendonitis and tears, subluxation, and. Nov 24, 2010 the technical challenges of arthroscopic biceps tenodesis distal to the bicipital groove have led to the development of the open subpectoral tenodesis technique. Surgical arthroscopy of shoulder and open biceps tenodesis. Open and arthroscopic proximal university of washington. Subpectoral biceps tenodesis for tenosynovitis of the long head of the biceps in active patients younger than 45 years old.
A biceps tenodesis procedure involves cutting of the long head of the biceps just prior to its insertion on the superior labrum and then anchoring the tendon along. The lhb tendon is an intraarticular yet extrasynovial. A biceps tenodesis may be performed as an isolated procedure but more often is part of a larger shoulder surgery, such as a rotator cuff repair. Subpectoral biceps tenodesis on the proximal aspect of the biceps. To learn more about biceps tenodesis and subpectoral biceps tenodesis, please contact the orthopedic office of dr. Arthroscopic rotator cuff tendon repair is a common elective procedure performed by trained orthopaedic surgeons with a relatively low complication rate. While a litany of surgical techniques exists, the optimal method for ensuring an anatomic lengthtension relationship during tenodesis remains elusive. Tenodesis of the long head of the biceps has been advocated as a treatment for pain resulting from biceps tendonopathy, biceps instability, and biceps tendon tears. A multitude of approaches to addressing lhb tendinopathy have been described. Subpectoral biceps tenodesis for tenosynovitis of the long. It is an option when pain is caused by problems with the biceps tendon in the arm.
Supercoder answered fri 18th of september, 2015 04. Subpectoral biceps tenodesis with interference screw fixation. Seven of 353 patients had complications after open subpectoral biceps tenodesis with an incidence of 2. In this technical note, we describe a method of miniopen long head biceps subpectoral tenodesis. An open subpectoral biceps tenodesis is a procedure which involves removing the long head of the biceps from the glenohumeral joint and fixing it the humerus deep to the pectoralis major tendon. The open subpectoral tenodesis of the long head of the biceps is a safe and reproducible technique with a low complication rate for patients with pathologies of the proximal biceps. Proximal biceps tenodesis surgical techniques suprapec and subpec approaches biceps tenodesis system procedural efficiency and versatility with the industry leading biocomposite1,2. Subpectoral biceps tenodesis orthopaedic product news. Subpectoral biceps tenodesis is a minimally invasive surgical technique that efficiently and reproducibly addresses long head of the biceps lhb tendon pathology. Clinically, outcomes of subpectoral proximal biceps tenodeses using interference screw fixation have been reported with excellent outcomes and rupture rates between 0. Subpectoral biceps tenodesis using an expanding peek device. Surgeons experienced in these techniques can expect, on average, to localize their tenodesis just proximal to the pectoralis major tendon using an arthroscopic technique and just distal to the tendon using an open.
Evaluation of biceps stability is important in the treatment of lhb pathology. A biceps tenodesis is a type of surgery used to treat a tear in the tendon that connects your biceps muscle to your shoulder. Complications associated with subpectoral biceps tenodesis. We describe a surgical technique for subpectoral biceps tenodesis using a single doubleloaded suture anchor implant. Pdf open subpectoral tenodesis of the proximal biceps.
The tenodesis may be performed alone or as part of a larger procedure. The birmingham biceps technique for open subpectoral. One part of the shoulder blade, called the glenoid fossa forms a flat, shallow surface. The intent of this protocol is to provide the clinician with a guideline of the postoperative rehabilitation course for a patient that has undergone a subpectoral biceps tenodesis. Subpectoralis biceps tenodesis orthopedic coding ask. Rehabilitation guidelines for biceps tenodesis with soft tissue fixation the shoulder has two primary joints.
Arthrex subpectoral biceps tenodesis using cortical buttons. Pdf arthroscopic tenodesis of the long head of the biceps. The purpose of this study was to compare outcomes between biceps tenodesis and labral repair for type ii slap lesions in a young active population. Once the tendon is in position, a trocartipped guidewire is placed, the fork is removed, and the screw is inserted. Biceps tenodesis protocol the intent of this protocol is to provide the clinician with a guideline of the postoperative rehabilitation course of a patient that has undergone a biceps tenodesis for biceps dysfunction. Subpectoral biceps tenodesis using cortical buttons youtube. The glenoid labrum is a ring of cartilage that turns the. Pdf subpectoral biceps tenodesis with interference screw. Arthrex subpectoral biceps tenodesis on the proximal.
Indications for biceps tenodesis include traumatic and degenerative tearing, biceps instability, rupture, and failed surgery. Educate patient on limited use of operative arm despite potential lack of or minimal pain complaints. Pdf subpectoral biceps tenodesis matthew provencher. The tendon fork simplifies the procedure and offers controlled delivery of the tendon to the bone socket. A simple surgical technique for subpectoral biceps tenodesis. Miniopen subpectoral biceps tenodesis using a suture. The bicepsbutton and tension slide technique are ideally suited for subpectoral proximal biceps tenodesis. Technique beach chair, arm positioner locate in subdeltoid space biceps accessory portal tunnel 20mm 7mm or 8mm screw tension under visualization back up with suture. Jun 12, 2016 biceps tenodesis is indicated for the treatment for partial or fullthickness biceps tendon tears, severe biceps tendonopathy, or biceps instability associated with a rotator cuff tears. Arthroscopic and subpectoral long head of biceps tenodesis tenodesis of the proximal biceps leads to pain relief, preservation of function without deformity.
Virk et al appreciate and truly comprehend the results of these experiments. There are inconsistencies in the size of simulated type ii slap lesions in different studies, which can affect the degree of glenohumeral translation and. Arthroscopic suprapectoral and open subpectoral techniques result in significantly different locations of biceps tenodesis. There are also titanium and peek tenodesis screws available for use with the system, if desired. Open and arthroscopic proximal biceps tenodesis source. Multiple different surgical techniques have previously been described to address long head of the biceps tendinopathy. Subpectoral open biceps tenodesis using interference screw.
Subpectoral biceps tenodesis 247 figure 3 a the long head of the biceps tendon is cut 20 mm proximal to its musculotendinous junction. Anterior shoulder pain and biceps symptoms were resolved with. The mean age of patients with complications was 44. Bicep tenodesis protocol weeks 12 full time in sling to minimize biceps activity and avoid shoulder extension at night when supine. The animation is presented in a neat format, without audio or text overlays.
Similar to distal biceps repair, the cortical button fixation coupled with an interference screw provides surgeons with a simple, reliable and biomechanically stable repair of the long head of the biceps. Rehabilitation following tenodesis will progress more slowly over the first 6 weeks to protect healing biceps tendon. Thomas hackett, md, vail, co demonstrates his technique for a subpec proximal biceps tenodesis using the bicepsbutton and tension slide technique. Similar to distal biceps repair, the cortical button fixation coupled with an. The combination of the cortical button fixation coupled with an interference screw creates a strong, anatomic repair. Miniopen subpectoral biceps tenodesis using a suture anchor. Interference screw fixation has demonstrated biomechanical superiority in laboratory models. The implant used is a threadless expanding peek polyether ether ketone interference device that fixes the biceps tendon in a drill hole in the humerus under the inferior border of the pectoralis major tendon.
Biceps tenodesis rehabilitation preoperative instructions within one month before surgery as indicated preoperative office visit for history and physical examination and instructions complete blood count cbc electrocardiogram ekg if over the age of 50 within several days before surgery wash the shoulder and axilla well. This takes the pressure off the biceps attachment and places the attachment below the actual shoulder joint. These include various surgical techniques such as tenodesis versus tenotomy, an arthroscopic versus an open approach, and differing methods of tenodesis fixation. Specifically, isolated neuropraxia of the anterior interosseous nerve ain is a very rare complication of shoulder arthroscopy. This is coupled with the humerus shaped like a golf ball to make up the joint.
May 31, 2018 biceps tenodesis is a surgical procedure used to reduce pain in the shoulder and surrounding area. Biceps tenodesis is a commonly employed surgical intervention for refractory symptoms related to the biceps labral complex, those intraarticular and those within the extraarticular bicipital tunnel. May 23, 20 multiple different surgical techniques have previously been described to address long head of the biceps tendinopathy. Bankart slap and biceps tenodesis rehabilitation protocol. Subpectoral biceps tenodesis with an interference screw is a viable treatment option for patients with symptomatic biceps tendinosis. Here the physician is only doing tenodesis, so cpt 23430 is appropriate code for this condition and if the operative report says that the physician is first resected the tendon and then placed or transplanted it, then use cpt 23440. The pallium pectoralis is a fascial sleeve that connects from the top of the pec to the medial border of the humerus approximately 2 cm distal to the. Sham surgery versus labral repair or biceps tenodesis for. The milagro br biceps tenodesis system enables subpectoral and suprapectoral biceps tenodesis in one easytouse system.
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