B. Wziętek1, B. Sienkiewicz2, K. Kusek1
1Artroskop Centrum Medyczne Bogdan Wziętek, Trzebinia, Poland,
2Jagelonian University, Krakow, Poland
Objectives:
Shoulder pain caused by pathology of the long head of the biceps brachii (LHBT) tendon that does not subside after conservative treatment is an indication for surgical treatment. However, in elderly people with anesthetic contraindications, LHBT needle tenotomy under ultrasound guidance may be a solution.
The aim of the study is to assess the results – the degree of relief of anterior shoulder pain after LHBT needle tenotomy under ultrasound guidance.
Methods:
The study was conducted retrospectively on a group of 11 patients treated between 2022 and 2025. 2 patients underwent surgery on both shoulders. Data from the patient’s records were used. The group included 10 women and 1 man, aged 50 to 92. The majority (11 out of 13 cases) also had massive damage to the rotator cuff tendons. The indication for the procedure was shoulder pain caused by LHBT pathology (VAS 5-10, average 6.85 +/- 2.15) that did not subside after conservative treatment. Procedure: surgical skin washing, anesthesia with 10 ml of 1% lignocaine, 14 MHz linear ultrasound probe in a sterile casing. The probe is applied transversely above the biceps sulcus. The incision is made with a 15 G needle, 1.6 mm x 40 mm under in-plane ultrasound control in the upper part of the intertubercular sulcus, or on the smaller tubercle in the case of tendon dislocation. Tip: Cutting the tendon is easier if the patient tenses the muscle during the procedure. In the final phase, the patient tenses the muscle with full force against the operator’s elbow, with the elbow bent at 60 degrees, until a snapping sound is heard. The procedure took up to 10 minutes.
Results:
All patients except one were satisfied with the result of the procedure (4.69 +/- 0.85 on a scale of 1-5) and this was already at the first follow-up visit. The pain decreased to VAS 1.15 +/- 1.14; p<0.01. Their range of motion also improved (limitation decreased from 4.15 +/- 2.3 to 1 +/- 0.91 on a scale of 0-10); p<0.01. As for complications, apart from minor hemorrhages on the shoulder, only Popeye’s sign occurred, which was observed in 7 cases, however, the patients did not complain about this defect in particular because in women the deformity was poorly visible. Weakening of elbow flexion strength was not reported. 2 patients decided to have the other shoulder operated. No complications were noted with the proximal stump.
Conclusions:
1. Ultrasound-guided LHBT tenotomy is effective for minimally invasive tendon transection
2. No significant complications except for Popeye’s sign
3. No complications were noted with the proximal stump
4. Unnoticeable weakening of elbow flexion strength
5. Significant pain reduction, confirmed by patient satisfaction, statistically significant pain relief and improved range of motion (p<0.01), and two patients deciding to undergo surgery on the other shoulder
6. The effectiveness of tenotomy in eliminating shoulder pain despite massive rotator cuff damage indicates that the tendon itself is the main source of pain.
