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Biceps Tenotomy Versus Tenodesis in Active Patients Younger Than 55 Years: Is There a Difference in Strength and Outcomes?

Friedman JL, FitzPatrick JL, Rylander LS, Bennett C, Vidal AF, McCarty EC - Orthop J Sports Med (2015)

Bottom Line: Strength was not significantly different between groups for isometric strength and endurance measures.Subjective functional outcome measured by the DASH, ASES, and VAS scores were similar between groups.Despite increased demands and activity placed on biceps function in a younger population, this study showed no differences in functional and subjective outcome measurements.

View Article: PubMed Central - PubMed

Affiliation: University of Connecticut Health Center, University of Connecticut School of Medicine, Farmington, Connecticut, USA.

ABSTRACT

Background: Proximal biceps pathology is a significant factor in shoulder pain. Surgical treatment options include biceps tenotomy and subpectoral biceps tenodesis. Tenotomy is a simple procedure, but it may produce visible deformity, subjective cramping, or loss of supination strength. Tenodesis is a comparatively technical procedure involving a longer recovery, but it has been hypothesized to achieve better outcomes in younger active patients (<55 years).

Hypothesis: This study investigated the outcomes of younger patients who underwent either a biceps tenotomy or tenodesis as part of treatment for shoulder pain. The hypothesis was that, apart from cosmetic deformity, there will be no difference in outcome between the 2 treatment options.

Study design: Cohort study; Level of evidence, 3.

Methods: Isometric strength and endurance testing of operative and nonoperative shoulders for forearm supination (FS) and elbow flexion (EF) were tested utilizing an isometric dynamometer. Objective physical assessment was also performed. Subjective outcomes using the modified American Shoulder and Elbow Surgeons score (ASES); Disability of the Arm, Shoulder, and Hand (DASH); visual analog scale (VAS); and perceived biceps symptoms were collected.

Results: A total of 42 patients (22 tenotomy, 20 tenodesis) with an average follow-up of 3.3 years were studied. The average age at follow-up was 49.9 years. Thirty-five percent (7/20) of tenotomy patients exhibited a "Popeye" deformity, compared with 18.2% (4/22) of tenodesis patients. Strength prior to fatiguing exercise was similar between tenodesis and tenotomy for FS (6.9 vs 7.3 lbs; P < .05), EF in neutral (35.4 vs 35.4 lbs), and EF in supination (33.8 vs 34.2 lbs). Strength was not significantly different between groups for isometric strength and endurance measures. Subjective functional outcome measured by the DASH, ASES, and VAS scores were similar between groups. Frequency of complaints of cramping was higher in the tenotomy group (4/20 vs 1/22), and complaints of pain were higher in the tenodesis group (11/22 vs 5/20).

Conclusion: Despite increased demands and activity placed on biceps function in a younger population, this study showed no differences in functional and subjective outcome measurements. The choice between biceps tenotomy and tenodesis for pathology of the proximal biceps tendon can continue to be based on surgeon and patient preference.

No MeSH data available.


Related in: MedlinePlus

Maximum isometric strength of elbow supination in the supine position for tenodesis and tenotomy before and after fatiguing exercise. aSignificant difference between operative and nonoperative arm, P < .05. FE, fatiguing exercise; non-OA, nonoperative able arm; OA, operative arm.
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fig2-2325967115570848: Maximum isometric strength of elbow supination in the supine position for tenodesis and tenotomy before and after fatiguing exercise. aSignificant difference between operative and nonoperative arm, P < .05. FE, fatiguing exercise; non-OA, nonoperative able arm; OA, operative arm.

Mentions: Maximum isometric elbow flexion strength in the supinated position was significantly different from operative to nonoperative arm in both surgical groups (P < .05) (Figure 2). In the tenodesis group, elbow flexion strength in the supinated position between the operative and nonoperative arm (32.7 ± 15.3 lbs vs 34.4 ± 15.2 lbs, respectively) was not significantly different from the tenotomy group (36.1 ± 15.7 lbs vs 34.7 ± 14.4 lbs, respectively). There was no difference in fatigue rates between the operative and nonoperative arm between surgery types (P > .05) (Figure 2). Forearm supination maximal strength was not significantly different between groups before or after fatiguing exercise (P > .05) (Figure 3). Hand dominance did not influence the differences between the operative and nonoperative arms.


Biceps Tenotomy Versus Tenodesis in Active Patients Younger Than 55 Years: Is There a Difference in Strength and Outcomes?

Friedman JL, FitzPatrick JL, Rylander LS, Bennett C, Vidal AF, McCarty EC - Orthop J Sports Med (2015)

Maximum isometric strength of elbow supination in the supine position for tenodesis and tenotomy before and after fatiguing exercise. aSignificant difference between operative and nonoperative arm, P < .05. FE, fatiguing exercise; non-OA, nonoperative able arm; OA, operative arm.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License 1 - License 2 - License 3
Show All Figures
getmorefigures.php?uid=PMC4555607&req=5

fig2-2325967115570848: Maximum isometric strength of elbow supination in the supine position for tenodesis and tenotomy before and after fatiguing exercise. aSignificant difference between operative and nonoperative arm, P < .05. FE, fatiguing exercise; non-OA, nonoperative able arm; OA, operative arm.
Mentions: Maximum isometric elbow flexion strength in the supinated position was significantly different from operative to nonoperative arm in both surgical groups (P < .05) (Figure 2). In the tenodesis group, elbow flexion strength in the supinated position between the operative and nonoperative arm (32.7 ± 15.3 lbs vs 34.4 ± 15.2 lbs, respectively) was not significantly different from the tenotomy group (36.1 ± 15.7 lbs vs 34.7 ± 14.4 lbs, respectively). There was no difference in fatigue rates between the operative and nonoperative arm between surgery types (P > .05) (Figure 2). Forearm supination maximal strength was not significantly different between groups before or after fatiguing exercise (P > .05) (Figure 3). Hand dominance did not influence the differences between the operative and nonoperative arms.

Bottom Line: Strength was not significantly different between groups for isometric strength and endurance measures.Subjective functional outcome measured by the DASH, ASES, and VAS scores were similar between groups.Despite increased demands and activity placed on biceps function in a younger population, this study showed no differences in functional and subjective outcome measurements.

View Article: PubMed Central - PubMed

Affiliation: University of Connecticut Health Center, University of Connecticut School of Medicine, Farmington, Connecticut, USA.

ABSTRACT

Background: Proximal biceps pathology is a significant factor in shoulder pain. Surgical treatment options include biceps tenotomy and subpectoral biceps tenodesis. Tenotomy is a simple procedure, but it may produce visible deformity, subjective cramping, or loss of supination strength. Tenodesis is a comparatively technical procedure involving a longer recovery, but it has been hypothesized to achieve better outcomes in younger active patients (<55 years).

Hypothesis: This study investigated the outcomes of younger patients who underwent either a biceps tenotomy or tenodesis as part of treatment for shoulder pain. The hypothesis was that, apart from cosmetic deformity, there will be no difference in outcome between the 2 treatment options.

Study design: Cohort study; Level of evidence, 3.

Methods: Isometric strength and endurance testing of operative and nonoperative shoulders for forearm supination (FS) and elbow flexion (EF) were tested utilizing an isometric dynamometer. Objective physical assessment was also performed. Subjective outcomes using the modified American Shoulder and Elbow Surgeons score (ASES); Disability of the Arm, Shoulder, and Hand (DASH); visual analog scale (VAS); and perceived biceps symptoms were collected.

Results: A total of 42 patients (22 tenotomy, 20 tenodesis) with an average follow-up of 3.3 years were studied. The average age at follow-up was 49.9 years. Thirty-five percent (7/20) of tenotomy patients exhibited a "Popeye" deformity, compared with 18.2% (4/22) of tenodesis patients. Strength prior to fatiguing exercise was similar between tenodesis and tenotomy for FS (6.9 vs 7.3 lbs; P < .05), EF in neutral (35.4 vs 35.4 lbs), and EF in supination (33.8 vs 34.2 lbs). Strength was not significantly different between groups for isometric strength and endurance measures. Subjective functional outcome measured by the DASH, ASES, and VAS scores were similar between groups. Frequency of complaints of cramping was higher in the tenotomy group (4/20 vs 1/22), and complaints of pain were higher in the tenodesis group (11/22 vs 5/20).

Conclusion: Despite increased demands and activity placed on biceps function in a younger population, this study showed no differences in functional and subjective outcome measurements. The choice between biceps tenotomy and tenodesis for pathology of the proximal biceps tendon can continue to be based on surgeon and patient preference.

No MeSH data available.


Related in: MedlinePlus