Surgical treatment of lesions of the long head of the biceps

Abstract

A follow-up study was carried out on 20 patients with a Hitchcock type of biceps tenodesis performed during the past seven years at the Hospital for Special Surgery. Thirteen cases were diagnosed as biceps tendinitis and seven as biceps instability. At follow-up, there was a 30% failure rate; the failures were related to misdiagnosing biceps instability, not identifying an impingement syndrome, or glenohumeral instability. Those patients who were relieved of symptoms had in addition to biceps tenodesis, an excision of a portion of the coracoacromial ligament. In four of the six failures, the coracoacromial ligament was not released. Two patients had a fixed dislocation of the biceps tendon noted preoperatively by arthrography and confirmed at surgery, and were successfully treated by biceps tenodesis. Two other patients who had unsuccessful biceps tenodesis and coracoacromial ligament excision were subsequently shown to have humeral head impingement with the coracoid process. Coracoid osteotomy relieved their pain. The role of the biceps tendon in the production of shoulder pain is difficult to assess and is easily overestimated, The biceps tendon inflammation may be a secondary manifestation of an impingement syndrome and unless treated as such, surgery will not be successful. Conversely, biceps lesions secondary to disorders of the bicipital groove can be treated by tenodesis. Instability of the biceps tendon can be difficult to evaluate preoperatively. Arthrography was noted to be diagnostic in dislocation of the biceps tendon.