Wednesday, April 23, 2014

How we do a biceps tenodesis with shoulder arthroplasty?

We stive to maintain the long head of the biceps tendon in performing shoulder arthroplasty unless it is frayed or unstable. While contrary to the opinion of some, we do not find that the biceps becomes a 'pain generator' after arthroplasty.
However, if the biceps is unstable or frayed, a tenodesis can easily be performed using what we call the 'in and out' technique.
In this technique, we transect the biceps at its insertion to the supraglenoid tubercle,  make a 8 mm hole in the strong bone of the biceps groove 10 cm below the humeral neck cut. The proximal end of the long head tendon is threaded through this hole and then brought out the neck cut. When the humeral component is driven into position, it robustly fixes the long head tendon so that no modification of the post operative rehabilitation is necessary.

Here's a photo from yesterday's OR. The patient had inflammatory arthritis with biceps tendon involvement. The lower blue arrow points to the hole in the bicipital groove with the tendon entering it. The upper blue arrow points to the tendon (with a single traction suture in it) exiting the medullary space where it will be fixed when the prosthesis is seated. The other six sutures have been placed for repair of the subscapularis.

And a diagram from Steve Lippitt

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