Arthroscopic Transfer of the Long Head of the Biceps Tendon: Functional Outcome and Clinical Results
Inflammation of the long head of the biceps (LHB) brachii tendon is a well-recognized source of shoulder pain. A recent study by Alpantaki used immunohistochemical stains to identify sympathetic and sensory neural elements in the tendon of the LHB. Their findings demonstrated that the tendon of the LHB is innervated by a network of nerve fibers which may play a role in the etiology of shoulder pain.However,the diagnosis and management of biceps tendonitis remains controversial. Biceps tendon pathology can occur in isolation or in conjunction with other shoulder injuries, further complicating both diagnosis and treatment. Initial management should consist of nonoperative treatments, such as activity modification, physical therapy, oral anti-inflammatories, and local steroid injections.
When nonoperative management fails, surgical options include tenotomy or tenodesis. Tenotomy has been reported to provide reliable pain relief (95% to 100%), but complications including cosmetic deformity and fatigue discomfort are common in younger, more active patients. Tenodesis techniques have traditionally involved bony fixation of the tendon to the proximal humerus. Multiple techniques of fixation have been described, including bone tunnels, suture anchors, staples, interference screws, and soft tissue tenodesis to the transverse ligament. While most studies report satisfactory pain relief, some reports have indicated a high failure rate (6% to 40%) of the tenodesis.
Recently, an arthroscopic technique of transferring the LHB tendon to the conjoint tendon has been described. This is an attractive option because it allows for soft tissue healing which may result in less pain than soft tissue to bone healing. Also, the transfer allows the surgeon to directly visualize the tension being applied to the tendon during suturing to prevent overtightening. While reports comparing tenotomy to tenodesis have shown little clinical difference between techniques, there have been no reports comparing tenodesis with transfer of the biceps tendon.
In specific cases where the physical exam is consistent with biceps pain and a diagnosis of biceps tendonitis has been attained, it is our belief that transfer of the LHB may yield relief of pain and symptoms. In addition, this procedure offers advantages over biceps tenodesis and tenotomy. Biceps pain can be an isolated pathology or part of a larger disease process such as impingement syndrome. However, biceps symptoms can be isolated from other causes of shoulder pain, and treatments may be examined.
This study sought to evaluate the clinical function of the biceps in a cohort of patients who underwent transfer of the LHB with a minimum of 2 years of follow-up. We hypothesize that transfer of the LHB is an appropriate procedure which will give patients predictable pain relief. Furthermore, those undergoing transfer will experience equivalent or improved pain relief with less morbidity when compared against the historical controls of tenodesis or tenotomy.