Keyhole Tenodesis of Biceps Origin at the Shoulder

Currently there is heightened interest in management of problems related to the biceps tendon at the shoulder.12 Tenosynovitis or subluxation of the tendon of the long head of the biceps brachii is being seen more frequently in tennis players and ballplayers as the result of frequent throwing movements of the arm. Rupture of the involved biceps tendon is not uncommon. To make surgical management of bicipital tenosynovitis, subluxation and tendon rupture more acceptable, we have devised a simplified method of reattaching the biceps tendon to the upper humerus. The procedure is simple to perform and the postoperative management requires no elbow or shoulder immobilization or prolonged limitation of use of the operated extremity. We feel that except in the aged or infirm, the ruptured biceps tendon should be reattached in the management of the acute case, not only to restore the normal contour of the upper arm muscle mass, but also to completely return the power of elbow flexion and forearm supination. If pain in the shoulder and tenderness over the bicipital groove persist, and stillness remains the same or increases after conservative treatment for the bicipital tenosynovitis, surgical treatment is justified. In the case of subluxing biceps tendon, the affected individual can be restored to his favorite sports, relieved of pain, in a relatively short period of time after surgery. A comprehensive discussion of shoulder pain is not the purpose of this paper, which will be confined to describing our technique of biceps tenodesis at the shoulder.