Arthroscopic tenotomy of the long head of the biceps in the treatment of rotator cuff tears: Clinical and radiographic results of 307 cases

Walch, Gilles; Edwards, T. Bradley; Boulahia, Aziz; Nové-Josserand, Laurent; Neyton, Lionel; Szabó, István

doi:10.1016/j.jse.2004.07.008

Cited by 604 publications

(491 citation statements)

References 40 publications

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“…Hemiarthroplasty with an extended humeral head (''CTA head'') has been described for patients with large rotator cuff tears and arthritis who have good active shoulder motion, but improvements in active motion and functional scores may be somewhat limited [18,61]. We prefer nonoperative treatment including therapeutic exercise and joint injections, followed by arthroscopic joint débridement with or without biceps tenotomy or tenodesis if necessary to obtain symptomatic relief [56]. When no arthritis is present, an alternative etiology for pain should be sought.…”

Section: Discussionmentioning

confidence: 99%

“…If these fail, imaging studies should be used to confirm the presence or absence of the biceps tendon. If the long head of the biceps tendon is intact, an arthroscopic joint débri-dement and biceps tenotomy can result in improved functional (Constant) scores and good patient satisfaction, although tenotomy does not appear to affect the development and progression of glenohumeral arthritis [56]. In the rare scenario that a patient with an irreparable rotator cuff tear has disabling pain in the absence of a biceps tendon, an arthroscopic débridement may be performed, although we have observed highly variable functional and clinical outcomes in this situation.…”

Section: Selected Contraindicationsmentioning

confidence: 99%

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Indications for Reverse Total Shoulder Arthroplasty in Rotator Cuff Disease

Drake¹,

O’Connor

Edwards

2010

Clinical Orthopaedics &Amp; Related Research

220

129

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Background Reverse total shoulder arthroplasty (RTSA) was introduced to treat rotator cuff tear arthropathy but is now used to treat a variety of problems. Although its use has expanded substantially since the FDA's approval in 2004, the appropriateness in patients with rotator cuff disease is unclear. Questions/purposes We review the use of RTSA in patients with rotator cuff disease to (1) describe classification of rotator cuff tear reparability and the concept of a balanced shoulder; (2) explore the theory behind RTSA design relative to rotator cuff arthropathy; (3) discuss the indications and contraindications for RTSA; and (4) review published outcomes of RTSA for rotator cuff arthropathy.Methods We performed a selective review of the literature on the use of RTSA in the treatment of rotator cuff disease.Results Modern RTSA designs restore deltoid tension and a functional fulcrum to the rotator cuff deficient shoulder, which allows recovery of active shoulder elevation and effectively restores function in short-and mediumterm followup studies. Conclusions In short-term followup the RTSA relieves symptoms and restores function for patients with cuff tear arthropathy and irreparable rotator cuff tears with pseudoparalysis (preserved deltoid contraction but loss of active elevation). Severely impaired deltoid function, an isolated supraspinatus tear, and the presence of full active shoulder elevation with a massive rotator cuff tear and arthritis are contraindications to RTSA. Clinical Relevance For properly selected patients who have symptomatic and disabling rotator cuff deficiency, RTSA can result in life-changing improvements in pain, motion, function, and patient satisfaction. Level of Evidence Level V therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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Section: Discussionmentioning

confidence: 99%

Section: Selected Contraindicationsmentioning

confidence: 99%

Indications for Reverse Total Shoulder Arthroplasty in Rotator Cuff Disease

Drake¹,

O’Connor

Edwards

2010

Clinical Orthopaedics &Amp; Related Research

220

129

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“…All patients had stage 3 or 4 fatty infiltration of the infraspinatus according to the Goutallier classification [21]. In all patients, the teres minor was either atrophic or fatty infiltrated [46]. Shoulder arthrosis was present in all shoulders and classified as Stage 3 (five cases), 4 (five cases), or 5 (one case) according to the radiographic system of Hamada and Fukuda [24].…”

Section: Methodsmentioning

confidence: 99%

Reverse Shoulder Arthroplasty Combined with a Modified Latissimus Dorsi and Teres Major Tendon Transfer for Shoulder Pseudoparalysis Associated with Dropping Arm

Boileau

Chuinard

Roussanne

et al. 2008

Clinical Orthopaedics &Amp; Related Research

197

146

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Although a reverse shoulder arthroplasty (RSA) can restore active elevation in the cuff deficient shoulder, it cannot restore active external rotation when both the infraspinatus and teres minor muscles are absent or atrophied. We hypothesized that a latissimus dorsi and teres major (LD/TM) transfer with a concomitant RSA would restore shoulder function and activities of daily living (ADLs). We prospectively followed 11 consecutive patients (mean age, 70 years) with a combined loss of active elevation and external rotation (shoulder pseudoparalysis and dropping arm) who underwent this procedure. All had severe cuff tear arthropathy (Hamada Stage 3, 4, or 5) and severe atrophy or fatty infiltration of infraspinatus and teres minor on preoperative MRI or CT-scan.

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“…Tenotomy of the biceps tendon provides pain relief and patient satisfaction has been shown with this procedure [24]. Although outcomes of tenotomy are reportedly similar to those for tenodesis [11], muscle belly retraction (the Popeye sign) is more common with tenotomy [4,25], making it less preferable in patients concerned about the cosmetic appearance of the arm. Tenodesis of the biceps tendon is advocated in physiologically young and active patients, especially those with thin, muscular arms who may be concerned about cosmetic issues; it can be performed via either open [1,3,8,23] or arthroscopic [5,12,13,22] techniques (Table 1).…”

Section: Introductionmentioning

confidence: 99%