When the long head of the biceps tendon is diseased, tenodesis is an appropriate treatment strategy. The specific technique used is dependent on visualization, fixation method and hardware, and tenodesis location. For suprapectoral tenodesis techniques, those that fix the tendon within or below the bicipital groove can be challenging owing to the transverse humeral ligament covering the groove. To accurately identify the biceps tendon in this area, the ligament often requires resection. Ultrasound provides surgeons with a safe and noninvasive tool to visualize the biceps tendon as it exits the bicipital groove, negating the need for unroofing and other pitfalls associated with traditional techniques. This technical note describes an ultrasound-guided suprapectoral biceps tenodesis procedure.

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Massive rotator cuff tears, involving the posterosuperior rotator cuff, remain difficult to treat particularly in the younger population. Fatty infiltration of the muscle, excessive chronic tendon retraction, and degeneration are the main irreversible factors predisposing to high failure rates of direct repair. There are many techniques for Superior Capsular Reconstruction (SCR) mainly using allograft. However low accessibility to the dermal grafts in many countries led the authors to use and suggest autograft of the fascia lata as other option for the reconstruction of the superior capsule of the shoulder. The SCR have presented good functional and biomechanical results. These techniques are reliable options for irreparable lesions of the rotator cuff.