SLAP at Patolohiya ng Biceps Impormasyon

Ano ang nararamdaman mo

Maaaring mapansin mo ang malalim na pananakit sa harap ng iyong balikat. Karaniwang nasa eksaktong lugar kung saan ang long head ng biceps tendon ay nakadikit sa itaas ng shoulder socket ang sakit na ito. Dahil maaaring magmukhang katulad ng ibang problema ang mga sintomas na ito, tulad ng impingement o mga problema sa rotator cuff, maaaring hindi malinaw ang eksaktong pinagmulan sa simula. Maaari ring maramdaman mo ang pakiramdam ng kawalan ng katatagan, parang ang iyong balikat ay nakakadikit o nalilipat.

Karaniwang lumala ang sakit sa mga gawain na nangangailangan ng pagtaas ng braso. Ang pag-abot pataas upang kunin ang bagay mula sa mataas na shelf o ang pag-angat ng mga bagay sa itaas ng iyong ulo ay maaaring mag-trigger ng matulis na kahirapan. Maaaring mahirapan kang gawin ang mga pang-araw-araw na gawain na nangangailangan na ang iyong braso ay nasa likod ng iyong likod, tulad ng pagkakabit ng bra o pagtutukoy ng damit. Ang mga simpleng galaw tulad ng pag-ikot ng doorknob o pag-angat ng mabigat na grocery bag ay maaari ring magpalala sa lugar na ito.

Maraming pasyente ang nag-uulat na lumalala ang sakit sa gabi. Ang pagtulog sa apektadong gilid ay madalas na nagiging imposible, na nakakaapekto sa iyong pagtulog. Maaaring gumising ka sa may matigas at masakit na balikat sa umaga. Habang ang pahinga ay maaaring magbigay ng ilang ginhawa, ang kahirapan ay madalas na bumabalik habang ikaw ay muling nagsisimula sa iyong karaniwang mga gawain.

Mahalagang tandaan na ang mga sintomas na ito ay maaaring mag-iba. Sa ilang kaso, maaaring mayroon kang SLAP lesion kasama ang pulley lesion, bagaman ang kombinasyong ito ay bihira, nangyayari lamang sa humigit-kumulang 10% ng mga pasyente na may parehong kondisyon. Minsan, ang sakit ay maaaring konektado sa calcific tendinitis, kung saan ang mga deposito ng calcium ay bumubuo sa pinagmulan ng tendon. Kung ikaw ay nag-iisip na ito, ang iyong surgeon ay mag-aalala kung mayroong concurrent SLAP lesion.

Dahil ang diagnosis ay maaaring mag-iba, ang iyong surgeon ay mabuti-buting susuriin ang iyong partikular na mga sintomas. Paano man ikaw ay nasa ilalim ng 30 o higit sa 50, ang layunin ay tukuyin ang tamang paggamot para sa iyo. Maaaring kasama ng mga opsyon ang repair o biceps tenodesis, isang proseso kung saan ang tendon ay muling idinidikit sa mas mababang bahagi. Ang iyong surgeon ay talakayin kung alang-alang ang pinakamainam na functional results para sa iyong edad at antas ng aktibidad.

Ano ang nangyayari

Ang iyong balikat ay may isang bilog na cartilage na tinatawag na labrum. Isipin ang bilog na ito bilang gasket o shock absorber na nagpapalalim sa socket. Pinapanatili nito ang iyong buto ng braso sa lugar at nagbibigay ng matibay na anchor para sa long head ng iyong biceps tendon. Ang tendon na ito ay dumadaloy sa loob ng joint tulad ng lubid, tumutulong sa pag-angat at pag-ikot ng iyong braso.

Ang SLAP tear ay nangyayari kapag nasira ang anchor point na ito. Ang tear ay maaaring magbago ng paraan ng paggalaw ng iyong balikat, na maaaring magdulot ng instability o karagdagang stress sa joint. Madalas itong nararamdaman bilang matulis na sakit kapag umabot ka sa itaas. Minsan, ang pinsalang ito ay nagmimimito ng ibang mga problema sa balikat, na nagiging mahirap tukuyin ang eksaktong pinagmulan ng iyong hindi komportable nang walang maingat na pagsusuri.

Habang tumatanda ka, ang mga pagbabago sa cartilage na ito ay karaniwan at hindi laging nauugnay sa isang partikular na pinsala. Sa katunayan, ang mga taong nasa edad na higit sa 50 ay madalas na nagpapakita ng mga pagbabagong ito kahit walang malaking sakit. Gayunpaman, kung ikaw ay nasa ilalim ng 30 at aktibo, mas malamang na ang isang tear ay makakaapekto sa iyong kakayahang bumalik sa sports o mabigat na trabaho.

Nauunawaan namin na ang pagharap sa sakit sa balikat ay nakakairita. Ang iyong surgeon ay titingnan ang iyong mga partikular na sintomas at edad upang desisyunin ang pinakamainam na landas. Para sa maraming pasyente, lalo na ang mga matatanda, ang non-surgical na paggamot tulad ng pahinga at therapy ay isang ligtas at epektibong unang hakbang. Ang pamamaraang ito ay tumutulong bawasan ang sakit at mapabuti ang function nang walang surgery.

Para sa mga mas batang, aktibong pasyente, maaari naming talakayin ang mga surgical na opsyon. Kasama rito ang pag-aayos ng nasirang tissue o pag-attach muli ng biceps tendon sa ibang lugar (tenodesis). Parehong mga pamamaraan ay layuning bawasan ang sakit at ibalik ang stability. Pinipili namin ang opsyon na pinaka-angkop sa iyong lifestyle at mga layunin sa recovery, tinitiyak na makabalik ka sa mga gawain na iyong minamahal nang ligtas.

Ano ang maaari naming gawin dito

Ang gabay na ito ay sumasalamin sa paraan ni Dr. Kieran Hirpara, isang upper-limb surgeon sa Mater Private Hospital Rockhampton, kung paano niya ito pinamamahalaan sa aming klinika. Dumadating ang mga pasyente sa aming klinika sa pamamagitan ng referral mula sa GP o physiotherapist. Isang pagsusuri sa klinika, kasama ang history, examination, at imaging kung kinakailangan, ang nagtataguyod ng diagnosis. Para sa mga degenerative o matagal nang problema, karaniwan naming sinusubukan muna ang non-operative care. Kasama rito ang pagbabago ng aktibidad, physiotherapy o hand therapy, paggamit ng splint, at mga injection. Pinag-aaralan namin ang surgery kapag hindi ito nagbigay ng sapat na pagpapabuti. Para sa mga structural o acute na problema, maaaring irekomenda agad ang surgery, nang walang naunang non-operative trial.

Ang non-operative treatment na may angkop na regimen ay nagbigay ng sapat na clinical outcomes sa mga middle-aged na pasyente na may symptomatic SLAP lesions at dapat itong isaalang-alang bago irekomenda ang operative treatment. Ang mga desisyon sa paggamot para sa mga SLAP lesions ay pinamumunuan pangunahin ng pagkakaroon ng sakit, antas ng overhead activity, at naunang non-operative management. Isang clinical prediction model na binubuo ng mga variables na naglalarawan ng mga katangian ng pasyente, partikular na mga sintomas, at ang uri ng mga non-operative treatment modalities na ginamit ay natuklasan na may moderate accuracy sa pag-predict ng pagkabigo ng non-operative management ng mga SLAP tear. Layunin naming bawasan ang sakit at ibalik ang function sa pamamagitan ng mga targeted na ehersisyo. Dapat mong bigyan ng patas na trial ang approach na ito bago isaalang-alang ang ibang mga opsyon.

Ang medical management ay nakatuon sa pagkontrol ng sakit at pamamaga. Maaaring irekomenda ng iyong surgeon ang pain medication o anti-inflammatories upang tulungan kang pamahalaan ang iyong mga pang-araw-araw na gawain. Maaaring mag-alok ng mga injection, tulad ng cortisone, hyaluronic acid, o PRP, upang bawasan ang pamamaga at sakit sa kasukasuan. Nagbibigay ang mga treatment na ito ng pansamantalang ginhawa upang makilahok ka sa physiotherapy. Karaniwang tumatagal ang epekto ng mga injection na ito ng ilang linggo hanggang buwan, depende sa iyong indibidwal na tugon at sa kabiguan ng tear. Hindi nila pinapagaling ang tear ngunit maaari nitong gawing mas epektibo ang conservative management.

Isinasalang-alang ang surgery kapag naabot na ng conservative care ang hangganan nito at nananatili ang sakit o instability. Sa aming klinika, pinag-uusapan namin ang pinakamainam na surgical option base sa iyong edad, antas ng aktibidad, at sa partikular na uri ng tear. Para sa mga aktibong pasyente na nasa ilalim ng 30 taong gulang, ang primary biceps tenodesis ay nagbibigay ng mas mahusay na functional results sa mga aktibong pasyente na nasa ilalim ng 30 taong gulang kumpara sa SLAP repair sa minimum na 2 year follow-up. Sa isang batang aktibong populasyon, ang biceps tenodesis ay maaaring maging isang viable na surgical alternative para sa mga type II SLAP lesions at maaari nitong facilitahan ang mas maagang pagbabalik sa aktibidad kumpara sa repair. Ang open subpectoral biceps tenodesis ay maaaring maging isang maaasahang alternative sa arthroscopic repair para sa mga SLAP tear sa mga pasyente na nasa ilalim ng 30 taong gulang. Ang primary biceps tenodesis ay nag-aalok ng tumaas na epektibidad kumpara sa parehong primary SLAP repair at nonoperative treatment at mas mababang gastos kaysa sa primary SLAP repair. Parehong ang arthroscopic repair at ang mga intervention ng biceps tenotomy at tenodesis ay may mga benepisyo sa mga type II SLAP lesions. Ang arthroscopic biceps tenodesis ay maaaring isaalang-alang na isang epektibong alternative sa reinsertion sa paggamot ng mga isolated na type II SLAP lesions. Ang biceps tenodesis ay isang ligtas, epektibo, at teknikal na straightforward na alternative sa primary SLAP repair sa mga pasyente na may type II at IV SLAP tears. Ang subpectoral biceps tenodesis ay nagbibigay ng sapat na outcomes para sa paggamot ng mga Type II at Type IV SLAP lesions sa mga middle-aged na pasyente. Parehong ang SLAP repair at biceps tenodesis ay nag-aalok ng mga viable na treatment options ngunit mayroong partikular na mga advantage at disadvantage, at ang desisyon ay huling ginagawa nang indibidwal kasama ang pasyente. Ang biceps tenodesis ay patuloy na ginagamit para sa management ng mga SLAP lesions, na may mga kamakailang pag-aaral na nag-uulat ng mataas na rates ng pagbabalik sa sports, mataas na satisfaction, at magagandang hanggang excellent na patient-reported outcomes sa maingat na piniling mga atleta.

Ano ang inaasahan

Ang iyong prognosis ay nakadepende sa uri ng tear at sa iyong edad. Para sa mga aktibong pasyenteng nasa ilalim ng 30 taong gulang, ang biceps tenodesis (paglipat ng attachment ng biceps tendon) ay madalas na nagbibigay ng mas magandang function kaysa sa SLAP repair (pag-attach muli ng torn labrum). Ang approach na ito ay tumutulong sa iyo na muling makabalik sa aktibidad nang mas maaga. Para sa mga pasyenteng nasa middle age, ang prosedurang ito ay nagbabawas din ng pain at nagpapabuti ng shoulder function nang malaki.

Kung ikaw ay babae, ang iyong mga resulta sa parehong treatment ay katulad-tulad sa tingnan ang pain at sports ability. Gayunpaman, ang ilang mga factor ay nagpapataas ng risk ng pagkakaroon ng revision surgery pagkatapos ng SLAP repair. Kasama rito ang pagiging higit sa 40 taong gulang, pagiging babae, obesity, pag-iinom ng sigarilyo, o pagkakaroon ng biceps tendinitis o tear ng long head ng biceps.

Para sa mga failed repairs, ang biceps tenodesis ay isang ligtas at epektibong salvage option. Ito ay maaasahan na nagpapabuti ng outcomes kahit na hindi na gumana ang nakaraang surgery. Sa mga competitive overhead athletes, 81% ay bumabalik sa kanilang nakaraang antas ng paglalaro sa average na 4.1 buwan pagkatapos ng operasyon (postoperatively) pagkatapos ng subpectoral biceps tenodesis para sa symptomatic SLAP tear.

Ang mga outcomes ay nag-iiba-iba base sa iyong partikular na pathology at mga katangian. Habang maraming pasyente ay nag-uulat ng mataas na satisfaction at magagandang outcomes, ang desisyon sa pagitan ng repair at tenodesis ay individualized. Ang iyong surgeon ay magwawasto ng mga benepisyo at disadvantages ng bawat paraan upang pumili ng pinakamainam na landas para sa iyo.

Kailan pumunta sa doktor

Kumonsulta sa iyong doktor kung mayroon kang patuloy na sakit sa balikat na hindi gumagaling kahit magpahinga. Humingi ng pagsusuri ng espesyalista kung mayroon kang kahinaan, kawalan ng katatagan, o pakiramdam ng pagkakasara o pagbagsak ng balikat. Maaaring makagambala ang mga sintomas na ito sa iyong pagtulog o trabaho. Ang biglaang paglala ng sakit ay dahilan din upang humingi ng tulong medikal. Tandaan na ang mga sugat sa SLAP ay maaaring magpakatawan ng ibang kondisyon tulad ng impingement o mga isyu sa rotator cuff. Dahil maaaring mag-iba-iba ang diagnosis, mahalaga ang propesyonal na pagsusuri. Tutulungan ka ng iyong surgeon na matukoy kung ang sakit ay nanggagaling sa isang SLAP tear o sa ibang sanhi. Ang maagang pagsusuri ay tumutulong na linawin ang iyong mga sintomas at gabayan ang tamang landas para sa iyong paggaling.

Evidence & references

This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Overview

Both arthroscopic repair and biceps tenotomy and tenodesis interventions had benefits in type II SLAP lesions [1].
Biceps tenodesis is a safe, effective, and technically straightforward alternative to primary SLAP repair in patients with type II and IV SLAP tears [4].
SLAP repairs are generally favored in younger, active patients [6].
Treating the biceps is preferred in lower-demand patients aged >30 years [6].
Biceps tenodesis has been increasingly used for the management of SLAP lesions [7].
Recent studies report high rates of return to sport, high satisfaction, and good to excellent patient-reported outcomes with biceps tenodesis in carefully selected athletes [7].
SLAP repair and biceps tenodesis both present viable treatment options but come with specific advantages and disadvantages [8].
The decision between SLAP repair and biceps tenodesis is ultimately made individually with the patient [8].
Primary subpectoral open biceps tenodesis for SLAP tears or pathology of the long head of the biceps tendon provides significant improvement in shoulder outcomes [9].
Primary subpectoral open biceps tenodesis for SLAP tears or pathology of the long head of the biceps tendon provides a reliable return to activity level with low risk for complications [9].
Biceps tenodesis is a predictable, safe, and effective treatment for failed arthroscopic SLAP tears at a minimum 2-year follow-up [10].
Treatment of proximal biceps pathology is largely based on expert opinion and patient preferences rather than robust randomized evidence [20].
Primary biceps tenodesis offers increased effectiveness when compared with both primary SLAP repair and nonoperative treatment [24].
Primary biceps tenodesis has lower costs than primary SLAP repair [24].
The indications and technique of biceps tenodesis in the elite pitcher still need to be defined [26].
High-demand patients with biceps tendonitis in the setting of a SLAP lesion with labral instability who undergo combined tenodesis and labral repair have significantly worse outcomes than patients who undergo either isolated labral repair for type II SLAP tears or isolated biceps tenodesis for a SLAP tear and biceps tendonitis [44].

Anatomy & Pathophysiology

Understanding the function and pathology surrounding the teres minor is paramount in comprehensive management of patients with shoulder pathology [12].
In the context of rotator cuff disease, the etiology of anterior shoulder pain with macroscopic changes in the biceps tendon is related to the complex interaction of the tendon and surrounding soft tissues, rather than a single entity [17].
Biomechanical studies indicate that the long head of the biceps contributes to stability of the glenohumeral joint in all directions [28].
In vivo studies have not yet established the stabilizing effect of the long head of the biceps on the glenohumeral joint [28].
The physiologic load required for the long head of the biceps to stabilize the glenohumeral joint remains unknown [28].
The long head of the biceps has a pertinent biomechanical role in glenohumeral stability regardless of the condition of the superior labrum [32].
Validity for strength testing of the serratus anterior muscle is optimal with subjects in a seated position and the shoulder flexed at 90° in the scapular plane [33].
Treatment of scapular dyskinesis is directed at managing underlying causes and restoring normal scapular muscle activation patterns by kinetic chain–based rehabilitation protocols [35].
Both proposed superior labral reconstruction techniques increased the force needed for humeral head superior migration in the setting of a labral tear [36].
The long head of the biceps tendon serves as a source of local autograft with biological and biomechanical properties that aid outcomes of complex primary and revision shoulder surgery procedures [40].
Potential prognostic variables associated with final subscapularis strength remain elusive [42].
The ultimate load to failure and stiffness for unicortical button fixation and the compared method in proximal subpectoral biceps tenodesis were not different [43].

Classification

Arthroscopic repair and biceps tenotomy/tenodesis both provide benefits for type II SLAP lesions [1].
Calcific tendinitis of the long head of the biceps brachii at its origin may be associated with a concurrent SLAP lesion [2].
A positive subpectoral biceps test is associated with gross pathologic changes of the biceps in 93% of patients [3].
Biceps tenodesis is a safe, effective, and technically straightforward alternative to primary SLAP repair for type II and IV SLAP tears [4].
Biceps tenodesis yields consistent and reliable results for operative treatment in overhead athletes, whereas return to play after SLAP repair can be unpredictable [5].
SLAP repair and biceps tenodesis are both viable treatment options with specific advantages and disadvantages, with the decision made individually with the patient [8].
Appropriate treatment for biceps pathology, whether conservative or surgical, should be based on established pathology [11].
There is no single pattern of pain that distinguishes biceps conditions from other shoulder abnormalities [16].
Biceps tenodesis may be considered a valid primary or revision surgery for symptomatic type II SLAP tears due to no detrimental effect on glenohumeral stability [21].
Biceps tenodesis remains a reliable treatment for pathologic abnormality of the long head of the biceps [50].

Clinical Presentation

A positive subpectoral biceps test was associated with gross pathologic changes of the biceps in 93% of patients [3].
Diagnosis of long head biceps tendon and subscapularis pathology in association with shoulder rotator cuff pathology can be challenging due to limitations in MRI and arthroscopic visualization [22].
Surgeons should maintain a high level of suspicion and utilize specific techniques to prevent missing pathology when diagnosing long head biceps tendon and subscapularis pathology in association with shoulder rotator cuff pathology [22].
The concomitant presence of SLAP and pulley lesions is significantly rare, occurring in only about 10% of all patients with SLAP and pulley lesions [25].
If calcific tendinitis of the long head of the biceps brachii at its origin is suspected, it may be helpful to consider the presence of a concurrent SLAP lesion and its management [2].
A 10.1% incidence of subsequent surgery after isolated SLAP repair was identified, often related to an additional diagnosis [14].
Clinicians should consider other potential causes of shoulder pain when considering surgery for patients with SLAP lesions [14].

Investigations

Biceps tendon pain in the absence of tears is associated with microscopic changes consistent with tendinopathy, which are often missed by MRI [46].
MRI and intraoperative assessment did not show significant structural abnormalities within the tendon despite significant histopathologic changes in patients with chronic long head biceps tendinopathy undergoing open subpectoral tenodesis [19].
Most abnormal MRI findings were not different in frequency between symptomatic and asymptomatic shoulders [47].
Bicipital groove morphology measured by MRI has no correlation to intra-articular biceps tendon pathology [48].
Preoperative MRI scans of the shoulder interpreted by orthopaedic surgeons with a systematic approach resulted in improved accuracy in diagnosing subscapularis tendon tears compared with previous studies [51].
In approximately 80% of intra-articular biceps tears evaluated, a 'hidden lesion' was observed going beyond the bicipital groove and extending to the distal extra-articular portion [55].
The myotendinous junction (MTJ) of the biceps begins further proximal than may be appreciated intraoperatively [56].
If calcific tendinitis of the long head of the biceps brachii at its origin is suspected, it may be helpful to consider the presence of a concurrent SLAP lesion [2].
Clinicians should consider other potential causes of shoulder pain when considering surgery for patients with SLAP lesions, as there is a 10.1% incidence of subsequent surgery after isolated SLAP repair often related to an additional diagnosis [14].

Treatment

Operative Management: SLAP Repair vs. Biceps Tenodesis/Tenotomy

For operative treatment, biceps tenodesis has consistent and reliable results, whereas return to play after SLAP repair can be unpredictable [5].
SLAP repairs are generally favored in younger, active patients, whereas treating the biceps is preferred in lower-demand patients aged >30 years [6].
Biceps tenodesis has been increasingly used for the management of SLAP lesions, with recent studies reporting high rates of return to sport, high satisfaction, and good to excellent patient-reported outcomes in carefully selected athletes [7].
SLAP repair and biceps tenodesis both present viable treatment options but come with specific advantages and disadvantages, with the decision ultimately made individually with the patient [8].
Increased patient age correlates with the likelihood of treatment with biceps tenodesis or tenotomy versus SLAP repair [13].
Primary biceps tenodesis offers increased effectiveness when compared with both primary SLAP repair and nonoperative treatment and lower costs than primary SLAP repair [24].
The treatment option of biceps tenodesis is an appealing alternative to SLAP repair, but the indications and technique of biceps tenodesis in the elite pitcher still need to be defined [26].

Biceps Tenodesis vs. Tenotomy

Patients undergoing treatment for LHBT or SLAP pathology with either biceps tenodesis or tenotomy can be expected to experience similar improvements in patient-reported and functional outcomes [23].
Patient age should not be used as the sole criterion when deciding between biceps tenotomy and tenodesis [49].

Subpectoral Biceps Tenodesis Outcomes

Primary subpectoral open biceps tenodesis for SLAP tears or pathology of the LHBT provides significant improvement in shoulder outcomes with a reliable return to activity level with low risk for complications [9].
Short-term follow-up of 20 procedures has not shown any failure of fixation or residual biceps discomfort [15].
Subpectoral biceps tenodesis utilizing a dual suture anchor technique is a treatment option for SLAP lesions, partial thickness tears, subluxation, and tenosynovitis of the long head of the biceps with high rates of postoperative patient satisfaction, a low failure rate, and improved outcome scores [31].
Although revision to subpectoral biceps tenodesis may be an effective strategy to address failed prior biceps surgery, the potential complication of persistent pain must be emphasized [54].

Nonoperative Management

Diagnosis and nonoperative management of long head of biceps tendon disorders are categorized as inflammation, instability, and rupture, requiring specific protocols [41].

Associated Pathology

Complications

The incidence of subsequent surgery after isolated arthroscopic SLAP repair is 10.1% [14].
Subsequent surgery after isolated SLAP repair is often related to an additional diagnosis [14].
Risk factors for revision surgery after SLAP repair include age >40 years [18].
Risk factors for revision surgery after SLAP repair include female sex [18].
Risk factors for revision surgery after SLAP repair include obesity [18].
Risk factors for revision surgery after SLAP repair include smoking [18].
Risk factors for revision surgery after SLAP repair include diagnosis of biceps tendinitis or long head of the biceps tearing [18].
Short-term follow-up of 20 procedures using an all-suture anchor fixation for subpectoral biceps tenodesis has not shown any failure of fixation [15].
Short-term follow-up of 20 procedures using an all-suture anchor fixation for subpectoral biceps tenodesis has not shown any residual biceps discomfort [15].
In patients with chronic long head biceps tendinopathy undergoing open subpectoral tenodesis, MRI and intraoperative assessment did not show significant structural abnormalities within the tendon despite significant histopathologic changes [19].

Recovery

Biceps tenodesis is increasingly used for SLAP lesions, with recent studies reporting high rates of return to sport, high satisfaction, and good to excellent patient-reported outcomes in carefully selected athletes [7].
Primary subpectoral open biceps tenodesis for SLAP tears or long head of the biceps pathology provides significant improvement in shoulder outcomes, reliable return to activity level, and low risk for complications [9].
There is a 10.1% incidence of subsequent surgery after isolated SLAP repair, often related to an additional diagnosis [14].
Short-term follow-up of 20 procedures using an all-suture anchor fixation for subpectoral biceps tenodesis showed no failure of fixation or residual biceps discomfort [15].
Risk factors for revision surgery after SLAP repair include age >40 years, female sex, obesity, smoking, and diagnosis of biceps tendinitis or long head of the biceps tearing [18].
Superior clinical outcomes are seen in nonsmokers, those with only 1 tendon affected, and those who undergo tenotomy instead of tenodesis for a damaged long head of biceps tendon [58].

Key Evidence

[L1] Both arthroscopic repair and biceps tenotomy and tenodesis interventions had benefits in type II SLAP lesions. [1] (10.1186/s13018-019-1096-y)
[L4] The authors conclude that if calcific tendinitis of the long head of the biceps brachii at its origin is suspected, it may be helpful to consider the presence of a concurrent SLAP lesion and its management. [2] (10.1007/s00167-007-0323-y)
[L3] A positive subpectoral biceps test was associated with gross pathologic changes of the biceps in 93% of patients. [3] (10.1016/j.arthro.2019.02.017)
[L4] Based on these results, biceps tenodesis is a safe, effective, and technically straightforward alternative to primary SLAP repair in patients with type II and IV SLAP tears. [4] (10.1177/0363546514540273)
[L5] For operative treatment, biceps tenodesis has consistent and reliable results, whereas return to play after SLAP repair can be unpredictable. [5] (10.1016/j.csm.2015.08.009)
[L5] SLAP repairs are generally favored in younger, active patients, whereas treating the biceps is preferred in lower-demand patients aged >30 years. [6] (10.1016/j.jse.2024.09.040)
[L5] Biceps tenodesis has been increasingly used for the management of SLAP lesions, with recent studies reporting high rates of return to sport, high satisfaction, and good to excellent patient-reported outcomes in carefully selected athletes. [7] (10.5435/jaaos-d-21-01199)
[L5] SLAP repair and biceps tenodesis both present viable treatment options but come with specific advantages and disadvantages, with the decision ultimately made individually with the patient. [8] (10.1016/j.arthro.2019.02.026)
[L4] Primary subpectoral open biceps tenodesis for SLAP tears or pathology of the LHBT provides significant improvement in shoulder outcomes with a reliable return to activity level with low risk for complications. [9] (10.1016/j.arthro.2019.06.035)
[L4] Biceps tenodesis is a predictable, safe, and effective treatment for failed arthroscopic SLAP tears at a minimum 2-year follow-up. [10] (10.1177/0363546513520122)
[Paper] The article outlines that appropriate treatment for biceps pathology, whether conservative or surgical, should be based on established pathology. [11] (10.1016/j.csm.2009.12.003)
[L5] Understanding the function and pathology surrounding the teres minor is paramount in comprehensive management of the patient with shoulder pathology. [12] (10.5435/jaaos-d-15-00258)
[L3] Increased patient age correlates with the likelihood of treatment with biceps tenodesis or tenotomy versus SLAP repair. [13] (10.1177/0363546514534939)
[L3] We identified a 10.1% incidence of subsequent surgery after isolated SLAP repair, often related to an additional diagnosis, suggesting that clinicians should consider other potential causes of shoulder pain when considering surgery for patients with SLAP lesions. [14] (10.1016/j.arthro.2016.01.053)
[L5] Short-term follow-up of 20 procedures has not shown any failure of fixation or residual biceps discomfort. [15] (10.1007/s00167-014-3348-z)
[L5] There is no single pattern of pain that distinguishes biceps conditions from other shoulder abnormalities. [16] (10.1016/j.csm.2015.08.004)
[L4] In the context of rotator cuff disease, the etiology of anterior shoulder pain with macroscopic changes in the biceps tendon is related to the complex interaction of the tendon and surrounding soft tissues, rather than a single entity. [17] (10.1016/j.jse.2008.05.044)
[L3] Risk factors for revision surgery after SLAP repair include age >40 years, female sex, obesity, smoking, and diagnosis of biceps tendinitis or long head of the biceps tearing. [18] (10.1177/0363546517691950)
[L4] In patients with chronic long head biceps tendinopathy who underwent open subpectoral tenodesis, MRI and intraoperative assessment did not show significant structural abnormalities within the tendon despite significant histopathologic changes. [19] (10.1016/j.arthro.2018.01.021)
[L5] Treatment of proximal biceps pathology is largely based on expert opinion and patient preferences rather than robust randomized evidence. [20] (10.1097/corr.0000000000002448)
[L5] Biceps tenodesis may be considered a valid primary or revision surgery for patients suffering from symptomatic type II SLAP tears due to no detrimental effect on glenohumeral stability. [21] (10.1016/j.jse.2013.07.036)
[L5] Diagnosis of long head biceps tendon and subscapularis pathology in association with shoulder rotator cuff pathology can be challenging due to limitations in MRI and arthroscopic visualization; surgeons should maintain a high level of suspicion and utilize specific techniques to prevent missing pathology. [22] (10.1016/j.arthro.2017.09.005)
[L1] Patients undergoing treatment for LHBT or SLAP pathology with either biceps tenodesis or tenotomy can be expected to experience similar improvements in patient-reported and functional outcomes. [23] (10.1016/j.jse.2020.11.012)
[L3] Primary biceps tenodesis offers increased effectiveness when compared with both primary SLAP repair and nonoperative treatment and lower costs than primary SLAP repair. [24] (10.1016/j.arthro.2018.01.029)
[L4] The concomitant presence of SLAP and pulley lesions is significantly rare, occurring in only about 10% of all patients with SLAP and pulley lesions. [25] (10.1016/j.arthro.2011.01.005)
[L5] The treatment option of biceps tenodesis is an appealing alternative to SLAP repair, but the indications and technique of biceps tenodesis in the elite pitcher still need to be defined. [26] (10.1016/j.arthro.2018.01.001)
[L5] Biomechanical studies indicate that the long head of the biceps contributes to stability of the glenohumeral joint in all directions, though in vivo studies have yet to establish this stabilizing effect and the physiologic load required remains unknown. [28] (10.1016/j.arthro.2010.10.014)
[L4] Subpectoral biceps tenodesis utilizing a dual suture anchor technique is a treatment option for SLAP lesions, partial thickness tears, subluxation, and tenosynovitis of the long head of the biceps with high rates of postoperative patient satisfaction, a low failure rate, and improved outcome scores. [31] (10.1007/s00402-017-2810-z)
[L5] The long head of the biceps has a pertinent biomechanical role in glenohumeral stability regardless of the condition of the superior labrum. [32] (10.1016/j.arthro.2025.05.022)
[L4] Validity for strength testing of the serratus anterior muscle is optimal with subjects in a seated position and the shoulder flexed at 90° in the scapular plane. [33] (10.1186/s12891-019-2741-7)
[L5] Treatment is directed at managing underlying causes and restoring normal scapular muscle activation patterns by kinetic chain–based rehabilitation protocols. [35] (10.5435/00124635-200303000-00008)
[L5] Both proposed superior labral reconstruction techniques increased the force needed for humeral head superior migration in the setting of a labral tear. [36] (10.1016/j.arthro.2018.08.049)
[L5] This review examines the role of the LHBT as a source of local autograft, with biological and biomechanical properties, in aiding outcomes of complex primary and revision shoulder surgery procedures. [40] (10.1016/j.jse.2023.04.009)
[L5] Diagnosis and nonoperative management of long head of biceps tendon disorders are categorized as inflammation, instability, and rupture, requiring specific protocols. [41] (10.1016/j.csm.2015.08.006)
[L4] Potential prognostic variables associated with final subscapularis strength remain elusive. [42] (10.1016/j.jse.2014.06.042)
[L5] The ultimate load to failure and stiffness for the two methods were not different. [43] (10.1007/s00167-013-2775-6)
[L3] High-demand patients with biceps tendonitis in the setting of a SLAP lesion with labral instability who undergo combined tenodesis and labral repair have significantly worse outcomes than patients who undergo either isolated labral repair for type II SLAP tears or isolated biceps tenodesis for a SLAP tear and biceps tendonitis. [44] (10.1007/s00167-015-3774-6)
[L5] Biceps tendon pain in the absence of tears is associated with microscopic changes consistent with tendinopathy, which are often missed by MRI. [46] (10.1016/j.csm.2015.08.002)
[L3] Most abnormal MRI findings were not different in frequency between symptomatic and asymptomatic shoulders. [47] (10.1016/j.jse.2019.04.001)
[L1] We do not find any value in bicipital groove morphology measured by MRI as a predictor of biceps tendon or rotator cuff pathology at the time of surgery. [48] (10.1016/j.jse.2010.04.044)
[L4] Patient age should not be used as the sole criterion when deciding between biceps tenotomy and tenodesis. [49] (10.1016/j.arthro.2016.04.022)
[L3] Biceps tenodesis remains a reliable treatment for pathologic abnormality of the long head of the biceps. [50] (10.1177/0363546515570024)
[L3] Preoperative MRI scans of the shoulder interpreted by orthopaedic surgeons with the described systematic approach resulted in improved accuracy in diagnosing subscapularis tendon tears compared with previous studies. [51] (10.1016/j.arthro.2012.04.142)
[L4] Although this may be an effective strategy to address failed prior biceps surgery, the potential complication of persistent pain must be emphasized. [54] (10.1177/0363546519892922)
[L4] In approximately 80% of the intra-articular biceps tears evaluated in this study, a 'hidden lesion' was observed going beyond the bicipital groove and extending to the distal extra-articular portion. [55] (10.1177/0363546514554193)
[L5] The MTJ of the biceps begins further proximal than may be appreciated intraoperatively. [56] (10.1177/0363546513482297)
[L4] Superior clinical outcomes are seen in nonsmokers, those with only 1 tendon affected, and those who undergo tenotomy instead of tenodesis for a damaged long head of biceps tendon. [58] (10.1016/j.jse.2019.12.011)

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