Nanoscopic Long Head of the Biceps Tendon Tenotomy with Suprascapular Nerve Block: A Feasibility Study

Abstract Background: Pathology of the long head of the biceps tendon (LHBT) is a common indication for tenotomy. Needle arthroscopy (NA) has emerged as a minimally invasive alternative to conventional shoulder arthroscopy. The suprascapular nerve block (SSNB) is a promising yet underutilized method of analgesia in orthopedic shoulder procedures. This prospective feasibility study aimed to evaluate the safety, efficiency, and functional outcomes of nanoscopic LHBT tenotomy performed under SSNB in elderly patients. Materials and Methods: Five patients (mean age >70) with isolated anterior shoulder pain and confirmed LHBT pathology were enrolled. All procedures were performed by a single experienced shoulder surgeon using the Arthrex NanoScope system. SSNB was administered preoperatively to minimize discomfort and facilitate muscle relaxation. Visual Analogue Scale (VAS) and Constant Score (CS) assessments were conducted 1 day preoperatively, and at 1 day, 2 weeks, and 6 weeks postoperatively. Results: All procedures were completed without complications. Mean surgical time was 12 minutes. Preoperative VAS averaged 7.8 and CS 51.5. At 1 day postoperatively, mean VAS improved to 4.2 and CS to 68.4. Continued improvements were observed at 2 weeks (VAS 4.0; CS 70.2) and 6 weeks (VAS 3.4; CS 71.8). Conclusion: Nanoscopic LHBT tenotomy under SSNB appears to be a feasible and well-tolerated outpatient procedure in a select group of elderly patients. The addition of SSNB may reduce procedural discomfort and facilitate better visualization by promoting muscle relaxation. Further studies on larger populations are needed to validate these findings. Level of evidence: IV Trial registration: RNN/60/25/KE