Ultrasound-Guided Percutaneous Tenotomy of the Long Head of Biceps Tendon in Patients with Symptomatic Complete Rotator Cuff Tear: In Vivo Non-contRolled Prospective Study

Abstract

<jats:p>Background: We prospectively tested technical feasibility and clinical outcome of percutaneous ultrasound-guided tenotomy of long head of biceps tendon (LHBT). Methods: We included 11 patients (6 women; age: 73 ± 8.6 years) with symptomatic full-thickness rotator cuff tear and intact LHBT, in whom surgical repair was not possible/refused. After ultrasound-guided injection of local anesthetic, the LHBT was cut with a scalpel under continuous ultrasound monitoring until it became no longer visible. Pain was recorded before and at least six months after procedure. An eight-item questionnaire was administered to patients at follow-up. Results: A median of 4 tendon cuts were needed to ensure complete tenotomy. Mean procedure duration was 65 ± 5.7 s. Mean length of skin incision was 5.8 ± 0.6 mm. Pre-tenotomy VAS score was 8.2 ± 0.7, post-tenotomy VAS was 2.8 ± 0.6 (p &lt; 0.001). At follow-up, 5/11 patients were very satisfied, 5/11 satisfied and 1/11 neutral. One patient experienced cramping and very minimal pain in the biceps. Six patients had still moderate shoulder pain, 1/11 minimal pain, 2/11 very minimal pain, while 2/11 had no pain. No patients had weakness in elbow flexion nor limits of daily activities due to LHBT. One patient showed Popeye deformity. All patients would undergo ultrasound-guided tenotomy again. Conclusion: ultrasound-guided percutaneous LHBT tenotomy is technically feasible and effective.</jats:p>

Clinical indications for image-guided interventional procedures in the musculoskeletal system: a Delphi-based consensus paper from the European Society of Musculoskeletal Radiology (ESSR)—part IV, hip

“…Acknowledgements All authors are members of the Ultrasound and/or Interventional Subcommittees of the European Society of Musculoskeletal Radiology (ESSR). 1,56…”

“…Joint, tendon, and bursal injections are routinely performed by different physicians, including radiologists, orthopedists, and physiotherapists. However, radiologists have an arrow in the quiver, namely the possibility to use imaging to guide interventional procedures [1][2][3][4][5]. In the hip, the most common interventional procedures focus on the treatment of joint osteoarthritis, mostly using corticosteroids and hyaluronic acid, and greater trochanteric pain syndrome (GTPS), by injecting medications or performing needling, while other bursal and tendon procedures are less frequently adopted [6][7][8][9].…”

Shoulder ultrasound: current concepts and future perspectives

“…A complete rupture is generally associated with pain and palpable retracted muscle belly (known as the “Popeye sign”), possibly followed by pain relief ( Fig. 2 ) ( 8 ) . Partial tears are more challenging to detect ( 7 ) .…”

Ultrasound-guided musculoskeletal interventional procedures around the shoulder

“…6 ). Interestingly, after some feasibility studies on cadavers ( 29 ) , a novel approach to obtain pain relief in patients with full-thickness rotator cuff tear and intact LHBBT, namely ultrasound-guided tenotomy of the LHBTT, has been recently tested with promising results in a prospective non-controlled trial ( 29 ) . The procedure is feasible, but its clinical value still needs to be supported by randomized-controlled studies ( 1 ) .…”