Ps2pdf free online pdf merger allows faster merging of pdf files without a limit or watermark. These include various surgical techniques such as tenodesis versus tenotomy, an arthroscopic versus an open approach, and differing methods of tenodesis fixation. 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. Our study included 31 patients who underwent subpectoral tenodesis of the long head of the biceps tendon utilizing all suture anchors from december, 20 to november, 2015. Subpectoral biceps tenodesis on the proximal aspect of the biceps. 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. We describe a surgical technique for subpectoral biceps tenodesis using a single doubleloaded suture anchor implant. The lhb tendon is an intraarticular yet extrasynovial. Subpectoral biceps tenodesis with interference screw fixation. Its not an ideal first choice, but can be an effective alternative after previous labral repair attempts are unsuccessful. Proximal biceps tenodesis surgical techniques suprapec and subpec approaches biceps tenodesis system procedural efficiency and versatility with the industry leading biocomposite1,2.
Nerve injury with subpectoral long head of the biceps. University of pittsburgh medical center, sports medicine, pittsburgh, pa 2. In an allarthroscopic repair, the surgeon does not need to pull the tendon out. Biceps tenodesis vs tenotomy 111215 1 biceps tenodesis. The determination of appropriate surgical indications for the procedure will facilitate proper analysis and comparisons of the varied techniques. A common cause of pain and tenderness located on the front of the shoulder is biceps tendonitis. Biceps tenodesis protocol boston shoulder institute.
Biceps tenodesis is a common procedure performed for tendinopathy of the long head of the biceps. Henninger, phda,b adepartment of orthopaedics, orthopaedic research laboratory, university of utah, salt lake city, ut, usa bdepartment of bioengineering, university of utah, salt lake city, ut, usa. Orthopedics a simple and effective technique is described for incorporating arthroscopic biceps tenodesis into arthroscopic suture anchor rotator cuff repair. Complications associated with subpectoral biceps tenodesis. Bicep tenodesis protocol weeks 12 full time in sling to minimize biceps activity and avoid shoulder extension at night when supine. Biceps tenodesis surgery is a procedure to repair the biceps tendon, a long cordlike structure that attaches the biceps muscle of your upper arm to the elbow at one end and the shoulder at the other.
Tenodesis of the long head of the biceps tendon is a common procedure used to alleviate pain caused by instability or inflammation of the tendon. 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. Subpectoral biceps tenodesis is a minimally invasive surgical technique that efficiently and reproducibly addresses long head of the biceps lhb tendon pathology. Pdf subpectoral biceps tenodesis with interference screw. Arthroscopic proximal biceps tenodesis with reelx stt. Rehabilitation guidelines for biceps tenodesis the shoulder has two primary joints. A biceps tenodesis procedure involves cutting of the long head of the biceps just prior to its insertion on the superior labrum and then anchoring the tendon along its anatomical course more distally along the humerus. The procedure offers several advantages including a safe dissection zone, a small bony tunnel, and adequate fixation strength. Several authors have described various arthroscopic and open techniques for biceps tenodesis. Only do strengthening 3xweek to avoid rotator cuff tendonitis begin ue ergometer. The intent of this protocol is to provide the clinician with a guideline of the post operative rehabilitation course of a patient that has. Apply ice to the shoulder to reduce pain and swelling.
Pdf subpectoral biceps tenodesis matthew provencher. Thomas hackett, md, vail, co demonstrates his technique for a subpec proximal biceps tenodesis using the bicepsbutton and tension slide technique. The mission of the association is to promote camaraderie of past and. Your biceps tendons attach the biceps muscle of your upper arm to the elbow on one end and to the shoulder on the other. Biceps tenodesis rehabilitation boston sports medicine. Biceps tenodesis shoulder surgeon chicago, westchester. 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. Subpectoral biceps tenodesis rehabilitation protocol. With the tenodesis, the lhbt is reattached to the humerus outside of the joint. Walter reed bethesda orthopaedic alumni association. Subpectoral biceps tenodesis for tenosynovitis of the long. Of the 31 total patients, 28 had additional procedures performed along with the tenodesis including rotator cuff repair 24, subacromial decompression 17, labral. The biceptor tenodesis system does not require whipstitching the tendon, resulting in an efficient allarthroscopic repair.
The 2 surgeons performed a biceps tenodesis on 26% of their patients undergoing soft tissue procedures during this time period. Romeo, md arthroscopic biceps tenodesis with interference screw fixation. Minimize shoulder pain and inflammatory response achieve gradual restoration of arom begin light waist level functional activities wean out of sling by the end of the 23 postop week return to light computer work. Miniopen subpectoral biceps tenodesis using a suture. Biceps tenodesis protocol brigham and womens hospital. Open techniques have been associated with complications such as wound infection and nerve injury.
Pdf the proximal part of the long head of the biceps muscle has become a recognized cause of significant shoulder pain. The mean age of patients with complications was 44. Surgical indications for long head biceps tenodesis. Arthroscopic biceps tenodesis incorporated into rotator. Biceps tenotomy and biceps tenodesis are two procedures that have emerged as quick, simple, and costeffective methods for the treatment of isolated abnormalities of the long head of the biceps. Arthroscopic and subpectoral long head of biceps tenodesis. Seven of 353 patients had complications after open subpectoral biceps tenodesis with an incidence of 2. This year also saw the initiation of the walter reed bethesda orthopaedic alumni association, of which this journal is a product. Subpectoral biceps tenodesis has proven to be an effective procedure to relieve pain and maintain function. It appears i have a rather rare injury to my biceps tendon longitudinal split tear of the extraarticular cartilage.
Biceps tenodesis surgery cooper university health care. Rehabilitation following tenodesis will progress more slowly over the first 6 weeks to protect healing biceps tendon. Miniopen subpectoral biceps tenodesis with an allsuture. Biceps tenodesis is a common procedure performed for tendinopathy of the long head of the biceps brachii lhb. The biceps tendon is located on the arm between the shoulder and elbow and is responsible for elbow flexion and the ability to rotate the forearm. It has the added advantage of addressing bicipital groove pathologies. The xpulley technique for subpectoral long head of the. Pass the biceps tendon through the hifi suture loop at the leading edge of the tenolok implant, and secure it at this 20mm location on the tendon. Its not an ideal first choice, but can be an effective alternative after. Ive seen more and more biceps tenodesis coming our way as postop clients, and my views closely parallel what mike reinold talks about in this article. 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. Multiple different surgical techniques have previously been described to address long head of the biceps tendinopathy. Subpectoral biceps tenodesis is a minimally invasive surgical technique that efficiently and reproducibly addresses lhb tendon pathology without the need for advanced arthroscopic skills.
Arthroscopic and subpectoral long head of biceps tenodesis tenodesis of the proximal biceps leads to pain relief, preservation of function without deformity. The long head of the biceps lhb tendon is a potential source of shoulder pain encountered by orthopaedic surgeons. Subpectoral biceps tenodesis surgical technique 1a. When is a slap better treated by biceps tenotomy or tenodesis. Indications for biceps tenodesis include traumatic and degenerative tearing, biceps instability, rupture, and failed surgery. No active or passive shoulder extension beyond neutral with the elbow extended for 8 weeks. Forked eyelets are also available for an allarthroscopic approach. Soda pdf merge tool allows you to combine two or more documents into a single pdf file for free. Both lhbt tenotomy and tenodesis involve severing the lhbt from the intraarticular attachment. Planning to have a biceps tenodesis at the end of the month. Bach jr, md t endinopathy of the long head of the biceps brachii lhb is a common source of anterior shoulder pain. This is coupled with the humerus shaped like a golf ball to make up the joint.
Sep 17, 2012 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. Biceps tenodesis protocol the intent of this protocol is to provide the clinician with a guideline of the postoperative rehabilitation course of a patient that has undergone a biceps tenodesis for biceps dysfunction. Our pdf merger allows you to quickly combine multiple pdf files into one single pdf document, in just a few clicks. Tenodesis technique shoulder tension slide technique shoulder. 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. Biomechanical analysis of subpectoral biceps tenodesis. A simple surgical technique for subpectoral biceps.
The milagro br biceps tenodesis system enables secure fixation of the biceps tendon when used with the appropriate sockettoscrew sizing. I tried rehab several times, but the shoulder kept getting reinjured. If performing an arthrosopic tenodesis, the forked end of the tendon fork can be used to estimate the tendon size. Humeral fracture after subpectoral tenodesis of the lhb is a complication that may be minimized with careful surgical technique. Educate patient on limited use of operative arm despite potential lack of or minimal pain complaints. Open and arthroscopic proximal biceps tenodesis source. A biceps tenodesis is a type of surgery used to treat a tear in the tendon that connects your biceps muscle to your shoulder. Pdf merge combinejoin pdf files online for free soda pdf. Biceps tenodesis is a common treatment for pathology of the long head of the biceps tendon. It is an option when pain is caused by problems with the biceps.
On the shoulder end, the biceps tendon divides into two strands, known as the long head and the short head. Various techniques for performing it have been described, but none is without problems. Subpectoral tenodesis tenodesis assume tenodesis is the answer. By san diego shoulder institute 2017 featuring anthony romeo. Biceps tenodesis procedure, rehab protocol and physiotherapy. Operative techniques in sports medicine arthroscopic biceps tenodesis in the beach chair position augustus d.
Biceps tenodesis is a commonly employed surgical intervention for refractory symptoms related to the bicepslabral complex, those. The milagro br biceps tenodesis system enables subpectoral and suprapectoral biceps tenodesis in one easytouse system. A simple surgical technique for subpectoral biceps tenodesis. The cosmetic appearance of the biceps muscle after long. The tenodesis may be performed alone or as part of a larger procedure. Arthrex subpectoral biceps tenodesis using cortical buttons. Nerve injury with subpectoral long head of the biceps tenodesis. There are a number of open and arthroscopic approaches to proximal biceps tenodesis, namely soft tissue tenodesis, subpectoral or suprapectoral tenodesis, or tenodesis within the bicipital groove.
Biceps tenodesis page 2 of 5 completion of phase i activities without pain or difficulty phase ii. The glenoid labrum is a ring of cartilage that turns the. The bicepsbutton and tension slide technique are ideally suited for subpectoral proximal biceps tenodesis. 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. Use this as often as you can over a 24hr period for the next 810 days. Tenodesis of the biceps in the subpectoral position offers. Biomechanical evaluation of subpectoral biceps tenodesis. One part of the shoulder blade, called the glenoid fossa forms a flat, shallow surface.
The animation is presented in a neat format, without audio or text overlays. This procedure is more complex than a tenotomy, but avoids the risks of biceps deformity and weakness. Using the tendon fork, push the suturetendon complex into the bone tunnel. Tenodesis of the biceps tendon can prevent cosmetic deformity 1 and may preserve strength. You will go to the recovery room and generally will be discharged after 12 hours.
The family of swivelock tenodesis implants is designed to support a multitude of proximal biceps tenodesis techniques and maximize or efficiency. 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. Biceps tenodesis involves detaching the lhb from the superior labrum in the shoulder joint and reattaching it to the humerus. Subpectoral bicipital tendon tenodesis with all suture anchor. The goal of lhbt tenodesis is to provide the patient with pain relief, restore elbow function and provide a satisfactory cosmetic outcome. It is no means intended to be a substitute for ones clinical decision. In total, 25 patients with revision biceps tenodesis were identified at a mean followup of 76. Indications include partialthickness lhb tear, tendon subluxation with or without subscapularis tear, and failed conservative management of bicipital tenosynovitis. Laterally eccentric malpositioned biceps tenodesis caused significant reduction 25% in humeral strength, which might be clinically relevant and contribute to postsurgical humeral shaft fracture. Biceps tenodesis procedure technique in simple definition, this procedure aims to remove the increasing pressure of the biceps by cutting the attachment of the biceps tendon from the shoulder socket and attaching it to the long bone of the arm humerus.
The cosmetic appearance of the biceps muscle after longhead tenotomy versus tenodesis article in arthroscopy the journal of arthroscopic and related surgery 185. Biceps tenodesis is a commonly employed surgical intervention for refractory symptoms related to the biceps labral complex, those intraarticular and those within the extraarticular bicipital tunnel. Slap type ii repairbiceps tenodesistenotomy protocol. Subpectoral biceps tenodesis surgical technique all suture anchor system surelock allsuture anchor 2. The normal attachment of the long head of the biceps is surgically cut and reattached to the humerus with either a soft tissue or hardware fixation technique. Allsuture anchor fixation for subpectoral biceps tenodesis. This free online tool allows to combine multiple pdf or image files into a single pdf document. If performing the procedure open, the tendon fork or optional. Open and arthroscopic proximal university of washington. Subpectoral biceps tenodesis 247 figure 3 a the long head of the biceps tendon is cut 20 mm proximal to its musculotendinous junction. Rehabilitation guidelines for biceps tenodesis uw health. Kiran alluri, md2, michael batech, drph3, raffymirzayan, md4 1. The purpose of this study was to analyze the biomechanical behavior of the bonetendonscrew complex of polyetheretherketone peek interference screws of different size and length used for biceps tenodesis at both.
A multitude of approaches to addressing lhb tendinopathy have been described. Arthrex subpectoral biceps tenodesis on the proximal. Biceps tenodesis has been shown to be effective in the treatment of intraarticular biceps and slap pathology, with an overall complication rate as low as 2% and complications mainly consisting of. After diagnostic arthroscopy, the lhb tendon is tenotomized at its origin and allowed to retract distally. Vail, co demonstrates his technique for a subpec proximal biceps tenodesis using the bicepsbutton and tension slide technique. He details proper location, tunnel drilling, button loading and insertion as. The johns hopkins hospital patient information compliedcreated surgery 5710 nelson8 biceps tenodesis discharge instructions icing your shoulder if an iceman was provided for you, please refer to the iceman handout for instructions on proper usage of this cooling device. Subpectoral biceps tenodesis for tenosynovitis of the long head of the biceps in active patients younger than 45 years old dimitri s. Biceps tenodesis is a surgical procedure used to reduce pain in the shoulder and surrounding area. Nerve injury with subpectoral long head of the biceps tenodesis christopher l. I never could get to working out as hard as i would have liked. Implants are available with suture eyelets or closed eyelets for surgeons who prefer a whipstitching technique.
We prefer a miniopen, distal subpectoral biceps tenodesis technique due to reduced incidence of residual pain and stiffness. Surgical technique subpectoral biceps tendon handling, tendon fork 7 option 1. 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. Hohmann and chandler retractors are used to main imal humerus to retract the pectoralis muscle proximally and tain the exposure. Arthroscopic proximal biceps tenodesis with reelx stt vumedi. Cervical rom week 1week 3 at 1 week postop, begin codmans exercise in the elbow straight as long as patient can do these exercises without pulling in the biceps. A biceps tenodesis is a surgical procedure performed for the treatment of a damaged proximal long head of biceps tendon. 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. 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. 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.
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