Pathologic Changes in the Long Head of the Biceps Tendon

Introduction: The extent to which the long head of the biceps brachii (LHB) tendon contributes to anterior shoulder pain in the setting of rotator cuff syndrome is controversial. In the United States biceps tenodesis is an increasingly favored treatment option for those patients with rotator cuff syndrome and anterior shoulder pain with the presumption that inflammatory or degenerative disease of the LHB is contributing to the pain. However, there is little evidence on intraoperative examination of the LHB that facilitates the decision to pursue tenodesis. Previous research has suggested LHB inflammation, degenerative change, and vascular insufficiency may contribute to anterior shoulder pain in patient’s with rotator cuff syndrome. Further understanding of the pathology as well as location of the pathology may better inform the therapeutic etiology of pain relief from a tenodesis as well as the indications for tenodesis. The goal of this study was to further characterize the pathology and location of the pathology in the LHB tendon in the setting of patients undergoing arthroscopic rotator cuff repair and tenodesis. Methods: All patients who provided informed consent and underwent arthroscopic rotator cuff surgery which included suprapectoral biceps tenodesis between 7/2014-12/2016 from one orthopedic surgeon’s patient population were included. The biceps tendon specimen was harvested with an average length of 3.59cm. Tendon samples were cross sectioned into three zones (1-3) and examined for degree of inflammation, degenerative change and papillary tenosynovitis. A four-graded scale was used to describe the pathology: 0-3 or none, slight, moderate, and severe. Results: 53 patients were included. 21 with rotator cuff tears (RCTs). 32 without tears. 42/53 patients had higher than grade 1 papillary tenosynovitis. Grade 2 or higher degenerative change was seen in 34/53 patients. Of these 30 had proximal degeneration, and 14 had distal degeneration. A higher degree of degenerative change was found in tendons from patients with a RCT. Of patient’s with concurrent RCTs 79% had greater or equal to grade 2 degeneration. Only 33% of tendons without RCTs had greater or equal to grade 2 degeneration. Conclusion: Regardless of whether there is a concurrent RCT significant inflammation is not found in the LHB in patient’s undergoing arthroscopic surgery for rotator cuff syndrome. However, degenerative change of the LHB is more likely to be found in patient’s with full thickness RCTs. Degenerative change is more likely to be found in the proximal tendon versus the distal tendon