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Musculoskeletal Imaging

E2306. Biceps Tenodesis for the Radiologists: Understand the Surgery, Find the Complications

Cecava N1,  Mansfield L1,2,  Chen D1,  Burns T1,  Alderete J.1 1. Brooke Army Medical Center, Fort Sam Houston, San Antonio, TX; 2. Uniformed Services University of the Health Sciences, Bethesda, MD

Address correspondence to L. Mansfield (liem_mansfield@hotmail.com)

Background Information: The purpose of this exhibit is to review indications and surgical techniques for biceps tenodesis and to report various types of complications radiologists may encounter during postoperative imaging.

Educational Goals/Teaching Points: Participants will understand the long head of biceps tendon presurgical and postsurgical tenodesis anatomy, understand surgical indications and techniques for biceps tenodesis, understand the role of different imaging techniques to optimally evaluate the tenodesis, associated surgical devices and surrounding structures, recognize various complications of biceps tenodesis and understand the clinical implications.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques: The anatomy of the long head of biceps tendon predisposes it to frequent injury and the tendon is a common source of shoulder pain. Injury at the tendon origin can be associated with labral injuries. The intraarticular segment at the rotator interval is highly mobile and therefore susceptible to acute or chronic trauma in conjunction with biceps pulley injuries. The tendon is subject to injury at the bicipital groove with subscapularis tendon or transverse ligament injuries. The tendon can also be injured distal to the bicipital groove. Indications for biceps tenodesis include long head biceps tendon pain, inflammation, tear or instability. There are various surgical techniques for biceps tenodesis. Common techniques include open, arthroscopic, and combined techniques with the surgeon choosing between suprapectoral and subpectoral tenodesis sites. Tenodesis methods include bone tunnel, keyhole, sutural anchor, cortical button, interference screw, and soft tissue tenodesis. Operative positioning with external shoulder rotation is used to move the musculocutaneous nerve away from the subpectoral tenodesis site. Imaging evaluation of a tenodesis site often begins with radiography to assess the osseous tenodesis site and radiodense anchor devices if present. MRI is often employed for advanced imaging of suspected tenodesis failure or for radiographic findings of pseudotumor at the tenodesis site. Sonography and CT have a limited role, mainly for problem solving. Potential complications of biceps tenodesis include humeral fracture, failure of the tenodesis anchoring device, partial or complete tear of the biceps tendon, or inadequate biceps tendon tension. Iatrogenic nerve damage can involve the brachial plexus, suprascapular, musculocutaneous, radial, or median nerves. Other complications include infection, hematoma, seroma formations, pseudotumors, and persistent pain. Poor clinical outcomes include decreased biceps function and strength; a biceps “Popeye” cosmetic deformity; and pain from mechanical, inflammatory or neuropathic pain, including complex regional pain syndrome.

Conclusion: Biceps tenodesis is a frequently performed procedure. Radiologists must understand the pre-surgical and post-surgical anatomy of the long head of biceps tendon and be ready to recognize the complications of this procedure.