BACKGROUND Lesions of the long head of the biceps tendon are often associated with massive rotator cuff tears and may be responsible for shoulder pain and dysfunction. The purpose of this study was to evaluate the clinical and radiographic outcomes of isolated arthroscopic biceps tenotomy or tenodesis as treatment for persistent shoulder pain and dysfunction due to an irreparable rotator cuff tear associated with a biceps lesion. METHODS We conducted a retrospective study of sixty-eight consecutive patients (mean age [and standard deviation], 68 +/- 6 years) in whom a total of seventy-two irreparable rotator cuff tears had been treated arthroscopically with biceps tenotomy or tenodesis. A simple tenotomy was performed in thirty-nine cases, and a tenodesis was performed in thirty-three. No associated acromioplasty was performed. All patients were evaluated clinically and radiographically by an independent observer at a mean of thirty-five months postoperatively. RESULTS Fifty-three patients (78%) were satisfied with the result. The mean Constant score improved from 46.3 +/- 11.9 points preoperatively to 66.5 +/- 16.3 points postoperatively (p < 0.001). A healthy-appearing teres minor on preoperative imaging was associated with significantly increased postoperative external rotation (40.4 degrees +/- 19.8 degrees compared with 18.1 degrees +/- 18.4 degrees ) and a significantly higher Constant score (p < 0.05 for both) compared with the values for the patients with an absent or atrophic teres minor preoperatively. Three patients with pseudoparalysis of the shoulder did not benefit from the procedure and did not regain active elevation above the horizontal level. In contrast, the fifteen patients with painful loss of active elevation recovered active elevation. The acromiohumeral distance decreased 1.1 +/- 1.9 mm on the average, and glenohumeral osteoarthritis developed in only one patient. The results did not differ between the tenotomy and tenodesis groups (mean Constant score, 61.2 +/- 18 points and 72.8 +/- 12 points, respectively). The "Popeye" sign was clinically apparent in twenty-four (62%) of the shoulders that had been treated with a tenotomy; of the sixteen patients who noticed it, none were bothered by it. CONCLUSIONS Both arthroscopic biceps tenotomy and arthroscopic biceps tenodesis can effectively treat severe pain or dysfunction caused by an irreparable rotator cuff tear associated with a biceps lesion. Shoulder function is significantly inferior if the teres minor is atrophic or absent. Pseudoparalysis of the shoulder and severe rotator cuff arthropathy are contraindications to this procedure. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions to Authors for a complete description of levels of evidence.

Isolated arthroscopic biceps tenotomy or tenodesis improves symptoms in patients with massive irreparable rotator cuff tears.

Purpose: The purpose of this study was to document the incidence of lesions of the rotator interval, illustrate the arthroscopic appearance of subtle differences in these lesions, and discuss how various lesions may affect biceps tendon stability in the bicipital groove Type of Study: A Data Registry has been used in my office since 1995 (Microsoft Office Access) This study reports on the results of a retrospective database "query" of the prospectively entered data from 1995 to 1998 Thus, by default, the format of this study is a consecutive sample Only patients with a disruption of rotator cuff tendons, labrum and/or gleno-coracohumeral ligaments are included by study design Methods: This study has identified and reports on 46 arthroscopically identified subscapularis tears, 25 "hidden" rotator interval lesions (SGHL/MCHL complex) and 6 SGHL/CHL complex plastic deformation lesions in 165 patients undergoing shoulder arthroscopy for conditions ranging from anterior instability to rotator cuff tears Arthroscopically identified lesions include partial or complete disruptions of the subscapularis tendon, disruptions of the superior glenohumeral/medial head coracohumeral ligament complex (SGHL/MCHL), disruptions of the lateral head coracohumeral ligament (LCHL), and various combinations of the above Results: The incidence rate of subscapularis tendon involvement in 165 arthroscopically treated shoulder patients was 27% The incidence rate of subscapularis tendon disruptions with rotator cuff pathology was 35% The incidence rate of SGHL/MCHL lesions (tear or stretch) in 165 arthroscopically treated shoulder patients was 18% The incidence rate of SGHL/MCHL tears in 165 arthroscopically treated shoulder patients was 15% Forty-seven percent of all subscapularis tears involved the SGHL/CHL complex Ten percent of all rotator cuff tears involving the supraspinatus tendon involved the LCHL Conclusions: This study has recorded the incidence of lesions of the subscapularis, SGHL/MCHL complex and/or the LCHL, and combinations thereof in degenerative cuff and instability patients Primary lesions of the rotator interval can occur and regardless of the associated pathology, and if these lesions are not repaired, biceps tendon subluxation may exist Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 17, No 2 (February), 2001: pp 173–180

Subscapularis, medial, and lateral head coracohumeral ligament insertion anatomy. Arthroscopic appearance and incidence of "hidden" rotator interval lesions.

The study population consisted of 14 shoulders in 13 consecutive patients with surgically confirmed isolated subscapularis tendon tears. In all but three patients, the mechanism of injury was traumatic hyperextension or external rotation of the abducted arm. All patients reported pain and weakness in the affected shoulder. Physical findings revealed limited passive range of motion at maximal internal and external rotation due to pain, weakness of internal rotation of the shoulder, and tenderness in the region of the intertubercular groove. However, these findings did not conclusively point to the subscapularis tendon as the site of injury. Preoperative interpretation of magnetic resonance imaging studies was used to diagnose tears of the subscapularis tendon in 14 shoulders and biceps tendon subluxation or dislocation in 6 shoulders. On arthroscopic examination, one patient was found to have a partial-thickness tear that was treated with arthroscopic debridement. Six shoulders had full-thickness tears of the subscapularis tendon, and seven shoulders had full-thickness tears associated with concomitant biceps tendon pathologic conditions, including subluxation, dislocation, or rupture. The full-thickness subscapularis tendon tears were repaired via an open anterior approach to the shoulder through the deltopectoral groove. Associated biceps tendon injuries were treated with tenodesis of the tendon to the intertubercular groove. Our early followup results have shown that, with proper diagnoses and surgical treatments, patients have greatly decreased pain and marked improvement in shoulder function.

Traumatic Tears of the Subscapularis Tendon Clinical Diagnosis, Magnetic Resonance Imaging Findings, and Operative Treatment

Entrapment of the long head of the biceps tendon: the hourglass biceps—a cause of pain and locking of the shoulder

Impingement of the deep surface of the subscapularis tendon and the reflection pulley on the anterosuperior glenoid rim: a preliminary report.

In bringing these two conditions together in the title, I am not assuming that they necessarily are always associated and that every case of destruction of this tendon necessarily was first one of dislocation. In most cases, however, dislocation of the tendon probably leads to greater wear, but, as reported previously,1tendons still lying in a normal position and in otherwise normal shoulder joints may show considerable wear. Since the biceps as well as other muscles may be congenitally absent, it follows that the tendon of either head may also be absent congenitally, but it is improbable that all the statements in the literature on this matter can be taken at their face value. I never have seen a clear case of congenital absence of the long head since I have understood the condition better, and few of those reported in the literature, including my own,2are absolutely

Spontaneous dislocation and destruction of tendon of long head of biceps brachii: fifty-nine instances

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Spontaneous dislocation and destruction of tendon of long head of biceps brachii: fifty-nine instances