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Open Subpectoral Biceps Tenodesis: Surgical Tips to Safely Restore Function and Cosmesis
The anatomy of the long head of the biceps (LHB) is unique. In its proximal part, the LHB tendon is fixed at its site of origin, and after a brief intra-articular course (approximately 3 cm), it is again relatively anchored in the bicipital groove for approximately 3 to 4 cm. This fixation of the proximal part of the LHB at two sites in the setting of extensive mobility of the glenohumeral joint predisposes the LHB tendon to excessive wear and tear stress. Although its functional importance remains the subject of debate, the LHB tendon is well accepted as an important source of anterior shoulder pain. The LHB tendon can be affected by trauma in association with superior labrum anterior to posterior (SLAP) tears or rupture of the LHB, instability associated with subscapularis and supraspinatus tears, intrinsic degeneration, inflammation, and fibrosis or scarring in the rotator interval, which is often encountered postoperatively or with chronic rotator cuff pathology. Because LHB tendon pathology often occurs concomitantly with other pathology in the shoulder joint, determining the role of the LHB tendon in a patient’s pain can be challenging. Clinical tests for LHB pathology are neither sensitive nor specific. Diagnostic injection into the biceps tendon sheath in the bicipital groove can be helpful, but the best corroborative and diagnostic test is arthroscopic examination of the intra-articular and intertubercular portion of the LHB tendon.