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

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.