Subpectoral open biceps tenodesis using interference screw. He describes the pallium pectoralis as a new anatomic. Surgical technique biceps tenodesis diagnostic arthroscopy a diagnostic shoulder arthroscopy is performed in either the beach chair or lateral decubitus position as per surgeon preference. One part of the shoulder blade, called the glenoid fossa forms a flat, shallow surface. Tenodesis as a treatment for a symptomatic long head of biceps lhb tendon is becoming more prevalent and new techniques exist which are purported to make the procedure faster and more effective. Gupta and colleagues35 retrospectively analyzed 28 cases of concomitant slap tear and biceps tendonitis treated with primary open subpectoral biceps tenodesis. He details proper location, tunnel drilling, button loading and insertion as. Pdf subpectoral biceps tenodesis matthew provencher. Given individual variability, however, we believe such efforts may still fall short in setting patientspecific lengthtension relationship.
A modification of the standard lateral portal can be placed in a more anterior position. Open subpectoral biceps tenodesis and allarthroscopic supra pectoral biceps. Reliable treatment for all biceps tendon pathology. Subpectoral biceps tenodesis using interference screw fixation appears to be a promising, reproducible, reliable technique for addressing anterior shoulder pain related to pathology of the long. The 2 surgeons performed a biceps tenodesis on 26% of their patients undergoing soft tissue procedures during this time period. In situ subpectoral biceps tenodesis with a cortical button. Biceps tenodesis rehabilitation protocol this protocol is intended to be independent of a rotator cuff repair rcr protocol. By kevin freedman 12 videos featuring patrick kane. A simple surgical technique for subpectoral biceps. Miniopen subpectoral biceps tenodesis using a suture. The authors present their technique of open subpectoral tenodesis, which demonstrates a high success rate with consistent. One should note that the biceps tendon bt that was present proximal to the tenodesis site has been excised from its labral insertion.
The determination of appropriate surgical indications for the procedure will facilitate proper analysis and comparisons of the varied techniques. There was significant improvement in patients functional. Shoulder arthroscopic technique for biceps tenodesis using. If desired, push forward on the blue knob lock to allow free rotation of the gun body. Miniopen subpectoral biceps tenodesis using a suture anchor. Listing a study does not mean it has been evaluated by the u. Arthroscopic and subpectoral long head of biceps tenodesis.
Slap repair and primary biceps tenodesis are required in order to make a strong recommendation for one technique over another. Rehabilitation guidelines for biceps tenodesis uw health. Biceps tenodesis is a minimally invasive surgical procedure used to repair a rupture or partial tear of the biceps 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. Biceps tenodesis protocol boston shoulder institute.
The subpectoral biceps tenodesis incision is placed just below the most inferior border of the pectoralis major. Thomas hackett, md, vail, co demonstrates his technique for a subpec proximal biceps tenodesis using the bicepsbutton and tension slide technique. 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. Open and arthroscopic proximal biceps tenodesis source. For active patients with refractory biceps tendinosis, tenodesis of the tendon to either soft tissue or the humerus is the preferred surgical treatment. The milagro br biceps tenodesis system enables subpectoral and suprapectoral biceps tenodesis in one easytouse system.
Open and arthroscopic proximal university of washington. Biceps tenodesis surgery technique colorado shoulder. It is no means intended to be a substitute for ones clinical decision. The bicepsbutton and tension slide technique are ideally suited for subpectoral proximal biceps tenodesis. Analysis of suprapectoral and subpectoral biceps tenodesis the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. This is coupled with the humerus shaped like a golf ball to make up the joint.
Subpectoral definition of subpectoral by medical dictionary. Arthrex was inserted, fixing the corresponding biceps tendon. Surgical arthroscopy of shoulder and open biceps tenodesis. Article information, pdf download for subpectoral biceps tenodesis. Arthroscopic and subpectoral long head of biceps tenodesis tenodesis of the proximal biceps leads to pain relief, preservation of function without deformity. Biomechanical evaluation of subpectoral biceps 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. Full rotator cuff and bicep strength on manual muscle testing. Arthrex subpectoral biceps tenodesis using cortical buttons. Subpectoral biceps tenodesis, operative techniques in sports. Biceps tenodesis rehabilitation boston sports medicine.
Jul 16, 2014 analysis of suprapectoral and subpectoral biceps tenodesis the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. By use of a free curved suture needle, 1 blue strand is sutured to the. Subpectoral biceps tenodesis using a novel anterior cortical button. Henninger, phda,b adepartment of orthopaedics, orthopaedic research laboratory, university of utah, salt lake city, ut, usa. Consolidated proximal biceps tenodesis and subscapularis. The purpose of this report is to describe a simple and efficient means by which a patients anatomic lengthtension relationship can be set during open subpectoral biceps tenodesis. Multiple different surgical techniques have previously been described to address long head of the biceps tendinopathy. Allarthroscopic suprapectoral versus open subpectoral tenodesis. Postoperative protocols in this procedure, the superior labrum and biceps anchor is reattached to the superior glenoid or upper humerus. The birmingham biceps technique for open subpectoral.
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. Biceps tenodesis clinical practice guideline background indications for tenodesis include partial tears 25%, tendon subluxation, recalcitrant tendinopathy, chronic tendon atrophy, and impingement, slap, or rotator cuff treatment. The free suture ends are then toggled to flip the button against the undersurface of the anterior cortex. Complications associated with subpectoral biceps tenodesis. Rehabilitation guidelines for biceps tenodesis with soft. 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. The free suture ends are then toggled to flip the button against the.
A finger sweep through the incised fascia is performed to free the pectoralis major muscle, and the lhb tendon is palpated in the bicipital. Biceps tenodesis has several advantages over tenotomy, including. Pain free, gentle passive range of motion for shoulder flexion, abduction, internal. Biceps tenodesis protocol orthopaedic medical group of. Subpectoral biceps tenodesis on the proximal aspect of the biceps.
Biceps tenotomyprocedure the long head of biceps tendon is released from its attachment in the shoulder joint, allowing it to fall down into the upper arm and out. Surgical indications for long head biceps tenodesis. Subpectoral biceps tenodesis with interference screw fixation. Subpectoral biceps tenodesis offers a unique advantage by. 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. Biceps tenodesis is a common strategy to address the lhbt.
The animation is presented in a neat format, without audio or text overlays. Biomechanical analysis of subpectoral biceps tenodesis. A biceps tenodesis is a type of surgery used to treat a tear in the tendon that connects your biceps muscle to your shoulder. A simple surgical technique for subpectoral biceps tenodesis. Nikhil verma, shoulder surgeon treating the chicago, westchester, oak brook and hinsdale, illinois communities. The skin incision for the subpectoral biceps tenodesis. We describe a surgical technique for subpectoral biceps tenodesis using a single doubleloaded suture anchor implant. Subpectoral biceps tenodesis is a minimally invasive surgical technique that efficiently and reproducibly addresses long head of the biceps lhb tendon pathology. Open subpectoral biceps tenodesis and allarthroscopic supra. To learn more about biceps tenodesis and subpectoral biceps tenodesis, please contact the orthopedic office of dr. The glenoid labrum is a ring of cartilage that turns the. Subpectoral long head of the biceps tenodesis is gaining popularity as a technique for treating patients with various pathologies of the tendon or its anchor to the superior labrum. The tenodesis may be performed alone or as part of a larger procedure.
Subpectoralis biceps tenodesis orthopedic coding ask. It has the added advantage of addressing bicipital groove pathologies. In total, 25 patients with revision biceps tenodesis were identified at a mean followup of 76. 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. We present here a novel technique in which the biceps tendon is tenodesed in a subpectoral manner. 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. Subpectoral biceps tenodesis rehabilitation protocol.
Pdf modified subpectoral biceps tenodesis researchgate. Although subpectoral biceps tenodesis has been described before, the method described here allows for in situ fixation of the long head of the biceps tendon using a cortical button. Pdf subpectoral biceps tenodesis with interference screw. Biceps tenodesis shoulder surgeon chicago, westchester. Postop guidelines surgical arthroscopy of shoulder and. Failure to reestablish a patients normal lengthtension relationship can lead to cramping, fatigue, and. Methodthe techniques currently described for subpectoral tenodesis. Subpectoral biceps tenodesis has proven to be an effective procedure to. Residual free ends of the suture were tied over the screw. Early passive range of motion is highly beneficial to enhance circulation within the joint to promote healing. The cinch loop technique is an allarthroscopic procedure for biceps tenodesis using the qfix allsuture anchor in a cinching lasso loop technique to treat long head biceps tendon lhbt pathology. Analysis of suprapectoral and subpectoral biceps tenodesis. The xpulley technique for subpectoral long head of the. 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.
Subpectoral biceps tenodesis protocol the intent of this protocol is to provide the therapist with a guideline of the postoperative rehabilitation course for the patient that has undergone a subpectoral biceps tenodesis. Subpectoral biceps tenodesis using cortical buttons arthrex pdf. Sep 01, 2012 subpectoral biceps tenodesis is a minimally invasive surgical technique that efficiently and reproducibly addresses long head of the biceps lhb tendon pathology. Subpectoral biceps tenodesis has proven to be an effective procedure to relieve pain and maintain function. Pdf long head of the biceps lhb tendon pathology is a common cause of pain in the shoulder. However, surgery may be the right option for those with partial tears whose symptoms are not relieved with nonsurgical treatment. Educate patient on limited use of operative arm despite potential lack of or minimal pain complaints. Lesions of the long head of the biceps tendon concomitant. The patient is symptomatic for 6 weeks following rerupture and opted for revision long head biceps repair with open subpectoral biceps tenodesis.
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. Arthroscopic view of the left shoulder, with the patient in the beachchair position and the 30 arthroscope in the. Bicep tenodesis protocol weeks 12 full time in sling to minimize biceps activity and avoid shoulder extension at night when supine. Subpectoral biceps tenodesis surgical technique all suture anchor system surelock allsuture anchor 2. May 23, 20 multiple different surgical techniques have previously been described to address long head of the biceps tendinopathy. If a biceps tenodesis is performed with a rcr, follow the rcr protocol for the shoulder and refer to the biceps protocol for distal extremity. 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 birmingham biceps implant system contains the fiberlink plus, 5. Pdf the proximal part of the long head of the biceps muscle has become a recognized. The eclipse soft tissue anchor is compatible with arthroscopic suprapectoral, miniopen suprapectoral, and subpectoral biceps tenodesis. Pull on the free suture limbs to seat the button against once the tendon is fully seated, use a free needle and the humerus. The overall goals of the surgical procedure and rehabilitation are to. Tenodesis technique shoulder tension slide technique shoulder.
Subpectoral biceps tenodesis orthopaedic product news. 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. The normal attachment of the long head of the biceps. The mean age of patients with complications was 44. Subpectoral tenodesis may be a preferred technique in the setting of complete lhb rupture, failed tenotomy. Rehabilitation guidelines for biceps tenodesis with soft tissue fixation the shoulder has two primary joints. Although subpectoral biceps tenodesis with interference screw fixation has gained a great deal of popularity, morbidities are associated with this technique. Pdf open subpectoral tenodesis of the proximal biceps. To ensure consistency and reproducibility and allow for sufficiently powered comparisons between groups, 8mm tenodesis screws were used for all specimens. Failed biceps tenotomy generally results from a lack of thorough preoperative discussion of potential outcomes rather than from technical problems.
It has the added advantage of addressing bicipital. 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. Vail, co demonstrates his technique for a subpec proximal biceps tenodesis using the bicepsbutton and tension slide technique. To our knowledge, our case of osteomyelitis is the first one reported, and no formal investigations have been published in the literature. 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. Slap type ii repairbiceps tenodesistenotomy protocol. A free needle is used to pass 3 running krackow stitches of suture a through the lateral aspect of the lhb tendon from the anatomic anteriortoposterior direction, progressing from proximally to distally. Seven of 353 patients had complications after open subpectoral biceps tenodesis with an incidence of 2. Proximal biceps tenodesis surgical techniques suprapec and subpec approaches biceps tenodesis system procedural efficiency and versatility with the industry leading biocomposite1,2. The long head of the biceps tendon lhbt is a common source of shoulder pain. A biceps tenodesis is a surgical procedure performed for the treatment of a damaged proximal long head of biceps tendon. Arthrex subpectoral biceps tenodesis on the proximal. Rehabilitation guidelines for biceps tenodesis the shoulder has two primary joints.
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