Ultrasound-guided percutaneous tenotomy of the long head of the biceps tendon: a non-reliable technique

Abstract

This study shows that ultrasound-guided percutaneous tenotomy of the long head of the biceps tendon is not reliable.

Feasibility of ultrasound-guided percutaneous tenotomy of the long head of the biceps tendon-A pilot cadaveric study

“…Last, the fourth drawback of the US‐guided approach was the presence of a proximal tendon stump attached to the antero‐superior glenoid rim, which was also evident in our specimens after the dissection. Although this proximal tendon stump was reported to be a potential limitation, the authors did note that there was no clear evidence that a residual proximal LGBT stump would be a cause for any functional limitations . It should be noted however that a spontaneous complete tear of the LHBT at a similar site in patients aged over 50 years with rotator cuff pathology is known to occur and often results in pain resolution without any functional limitations …”

“…The embalming process is known to decrease the quality of the sonographic scans and increases the rigidity of the soft tissue structures compared with fresh frozen cadavers . (2) The tenotomies were performed using a disposable scalpel (size 11 blade), which could account for additional difficulties with manipulating the blade under sonographic guidance . Second, the surgeon did not feel certain that a successful transection of the LHBT was performed during the US‐guided tenotomies.…”

“…This was due to the rotator cuff tendons being intact in four of the six specimens, and postmortem rigor mortis impeding optimal shoulder positioning (modified Crass position). Second, each blade was used once on two cadaveric shoulders, as we wanted to trial three different blades to address some of the reported limitations to this procedure . Thus, further investigations are needed with larger numbers to assess the accuracy of the US‐guided tenotomy using the hook blade (deep to superficial approach).…”

“…[19][20][21][22][23][24] However, Levy et al evaluated the feasibility of US-guided percutaneous tenotomy of the LHBT and reported several drawbacks to the US-guided procedure. 6 First, the presence of incomplete transections in 75% of the procedures. However, two limitations are important to consider in relation to their findings: (1) the tenotomies were performed on formaldehyde-embalmed cadavers (preserved for an average of 6 months prior to the procedure).…”

“…A prior study evaluated the feasibility of ultrasound‐guided (US‐guided) percutaneous tenotomy of LHBT and reported that it was a unreliable technique . However, several limitations were noted in that study, which could have impacted the feasibility of performing a complete transection of the LHBT without iatrogenic injuries to the surrounding structures . The main purpose of this study was to evaluate the applicability and safety of two different approaches for US‐guided proximal percutaneous tenotomy of LHBT, utilizing three different arthroscopic blades.…”