Ultrasound-Guided Percutaneous Long Head of Biceps Tenotomy: A Safe and Effective Treatment in Elderly

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Introduction. Patients with painful shoulder and long head of the biceps (LHB) tendinopathy are candidates for shoulder arthroscopy or other major procedures. However, for patients with comorbidities or to old, a minimal­ly invasive LHB tenotomy may be indicated. We describe the outcomes of ultrasound-assisted LHB tenotomy performed under local anesthesia. Materials and methods. Between 2015 and 2020, 33 patients underwent echo-guided tenotomy surgery. Inclusion criteria were painful shoulder without pseudo paralysis, intact LHB, and inability or refusal to major surgery. Under ultrasound guidance, the LHB is located and fixed with a 18G needle at the proximal biceps groove. After local anesthe­sia, a mini-open tenotomy is performed. Both a Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score and pain on the visual analog scale (VAS) were record­ed at baseline and at follow-up. Satisfaction (1 to 5) and adverse events were recorded. Results. Among the 33 eligible patients, 7 were lost at follow-up. The 26 (of which 17 women) patients enrolled had a median age of 76.5 years (IQR = 7). Mean follow-up was 39.5 months (range 8-63). Median QuickDASH changed from 67.1 to 21.6. Medi­an VAS score before and after tenotomy was 8.5 and 3.5 respectively. Mean satisfac­tion score was 4.1. We recorded 7 Popeye deformities and 6 hematomas. Four patients presented with cramps and 6 reported a reduction of strength. Only 4/26 would not undergo the procedure again. Conclusions. The ultrasound-assisted LHB tenotomy was confirmed as a reliable and safe.

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