Technical Note
Ultrasound-Guided Percutaneous Tenotomy of Biceps Tendon: Technical Feasibility on Cadavers

https://doi.org/10.1016/j.ultrasmedbio.2016.06.008Get rights and content

Abstract

We tested the technical feasibility of ultrasound-guided percutaneous tenotomy of the long head of the biceps tendon (LHBT) in cadavers. Both shoulders of two fresh cadavers were scanned anteriorly to evaluate the extra-articular portion of the LHBT. Under ultrasound monitoring, a scalpel was advanced obliquely up to touch the superficial medial side of the LHBT, cutting it until the tendon was not visible anymore. Ultrasound evaluation was repeated after the procedure, and anatomic dissection was performed. The procedure was 100% feasible: four cuts were made to completely sever the tendon; the duration was less than 1 min. Skin incision measured 5 mm in two cases and 6 mm in two cases. Anatomic dissection confirmed complete tendon cut in all cases with proximal and distal tendon stumps very close to each other. Ultrasound-guided percutaneous LHBT tenotomy was 100% technically feasible in cadavers with a quick procedure and minimal cutaneous incision.

Introduction

Rotator cuff (RC) full-thickness tears are a common cause of painful shoulder dysfunction. Treatment options depend on several parameters, and conservative treatment is associated with success rates ranging from 40% to 82%. When patients are still symptomatic, surgery may represent the treatment of choice, but the re-tear rate may reach 70%, particularly in patients aged ≥65 y (Saccomanno et al., 2015, Spennacchio et al., 2015, Szabó et al., 2008). In these patients, the long head of the biceps tendon (LHBT) may be still attached to the glenoid, and LHB tendinopathy has been seriously implicated as a pain source (Delle Rose et al., 2012, Kelly et al., 2005, Szabó et al., 2008). Spontaneous rupture of the LHBT is also a common event, does not require any treatment and results in substantial pain relief after the acute episode subsides (Szabó et al. 2008). Thus, arthroscopic LHB tenotomy is performed to accelerate the natural history of spontaneous tear (Szabó et al. 2008). There remain controversial data on whether LHB tenotomy favors the progression of glenohumeral osteoarthritis (Elser et al., 2011, Szabó et al., 2008, Walch et al., 2005).

Ultrasonography is a well-established imaging modality that can be effectively used to diagnose RC and LHB abnormalities (Corazza et al., 2015, Klauser et al., 2012, Yablon et al., 2013) and has been reported to be useful for guidance of interventional procedures around the shoulder, such as intra- and peri-articular injections and treatment of intratendinous pathology (Corazza et al., 2015, Fabbro et al., 2012, Klauser et al., 2012, Yablon et al., 2013) with a very low complication rate (Fabbro et al., 2012, Lanza et al., 2015, Messina et al., 2016a, Messina et al., 2016b, Sconfienza et al., 2014). To our knowledge, ultrasound-guided tenotomy of the LHBT on cadavers has been reported in two articles (Aly et al., 2015, Lévy et al., 2012) and in a case report on a single patient (Greditzer et al. 2014) with conflicting results.

Thus, the aim of our work was to test the technical feasibility of ultrasound-guided percutaneous tenotomy of the LHBT in cadavers.

Section snippets

Study population

Institutional review board approval was not needed for the present cadaver study. Local regulations for cadaver use were strictly respected.

This study is concerned with the technical feasibility of ultrasound-guided percutaneous tenotomy of the LHBT. We tested feasibility on both shoulders of two fresh cadavers (four shoulders in total): one 84-y-old man who died from a cerebral stroke and one 88-y-woman who died from cardiac failure. No clinical information other than reason for death was

Results

The LHBT was present in all four shoulders. At ultrasound evaluation, all tendons presented with oval cross-sectional area and preserved fibrillar echotexture. No fluid distension of the sheath was seen. The LHBT was normally located in the bicipital groove; however, its stability was not assessed because of the low mobility of the upper limb.

The procedure was feasible in all four shoulders (100% technical feasibility). In all cases, the scalpel was passed four times over the biceps to ensure

Discussion

Our main finding is that in cadavers, ultrasound-guided percutaneous tenotomy of the LHBT is 100% feasible and quick, with a minimal skin incision.

Tenotomy of the LHBT is indicated in painful shoulders with rotator cuff tears in patients who do not wish or cannot undergo surgery and in whom conservative treatments (rest, rehabilitation, oral anti-inflammatory drugs, steroid injections) have failed (Szabó et al. 2008). There are no clear data indicating that isolated LHBT tenotomy without RC

Conclusions

In a series of four cadavers, ultrasound-guided percutaneous LHBT tenotomy was 100% feasible with a quick procedure and a minimal cutaneous incision. If confirmed in patients, this procedure may represent an alternative to arthroscopic tenotomy in patients who cannot or do not wish to undergo surgery. However, further studies to test the clinical applicability of this technique are warranted.

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