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Patient acceptance of long head of biceps brachii tenotomy

Authors: Samuel J. Duff & Peter T. Campbell

References: J Shoulder Elbow Surg (2012) 21, 61-65

Hypothesis:
Long head of biceps brachii tenotomy is well accepted by patients and the procedure has comparable outcomes in younger manually active and older sedentary populations.

Materials and methods:
A total of 117 individuals at least 12 months after tenotomy of the long head of biceps brachii attended for review. Typical of clinical practice, in only one patient was the tenotomy performed in isolation. Interviews, clinical examination, and strength testing were performed to determine the rates of (1) cosmetic deformity, (2) cramping pain in the biceps muscle, (3) weakness, and (4) patient satisfaction.

Results:
There was no significant difference between the younger manually active and the older sedentary groups in measures of cramping, weakness, or deformity, and 95% of patients were satisfied or very satis- fied with the outcome of their surgery. Three percent of patients were concerned with deformity but none requested correction. Objective testing found no statistical difference in elbow flexion or forearm supination strength between the operated-on and nonoperated-on sides. Nineteen percent of patients reported cramping sensations.

Discussion:
This study demonstrated similar rates of adverse effects to previous tenotomy studies in cramping sensations, strength deficits, and cosmetic deformity. It demonstrated that results are similar in older sedentary and younger manually active patients and are comparable to the alternative, tenodesis.

Conclusions: Biceps tenotomy is well accepted by most patients with good overall results. Some adverse effects occur but appear to be mild and of little concern to patients. The procedure is tolerated in manually active populations.
Level of evidence: Level IV, Case Series, Treatment Study.


Data summary from study:

Deformity:

  • 27% reported a noticeable deformity postoperatively
  • Of these 4 (11%) were concerned by this appearance. 
  • Objectively, 72 (57%) of shoulders were observed to have some degree of deformity. 
  • The manually active group had a 60% incidence of Popeye deformities and the sedentary had a 55% incidence. 

Biceps cramping:
  • 24 patients (19%) reported experiencing cramping sensations in the biceps. 
  • The rate was 17% (95% confidence interval [CI] 6%-28%) amongst the manually active group and 20% (95% CI, 11%-29%) amongst the sedentary. 
  • Moderate or severe cramping was experienced by 11% of patients.

Weakness:
  • A degree of weakness in the operated-on arm was reported by 31% of patients
  • 16% rated this as moderate or severe. 
  • The rate was 23% (95% CI, 10%-35%) in the manually active group and 36% (95% CI, 25%-47%) in the sedentary group. 

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