Search Our Scientific Publications & Authors

J ISAKOS 2022 Mar 31. Epub 2022 Mar 31.

Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA.

Long head biceps tendinopathy can be a significant pain generator, often presenting with pain localised to the anterior shoulder. Biceps tenodesis, both open and arthroscopic, is a well-established treatment for long head biceps pathology. In this presentation, we describe a novel arthroscopic onlay technique for long head biceps tenodesis using a lasso configuration with two knotless suture anchors that provide an efficient, low-profile construct to limit scarring and adhesions while providing circumferential fixation. Read More

ANZ J Surg 2022 May 12. Epub 2022 May 12.

Melbourne Orthopaedic Group, Melbourne, Victoria, Australia.

Background: Tendinopathy of the long head of biceps (LHB) tendon is a common cause of anterior shoulder pain and dysfunction. The extra-articular portion within the bicipital groove undergoes frequent load and friction during shoulder movements and pathology within this area is frequently missed during arthroscopic assessment.

Methods: We quantified the arthroscopically assessable length of tendon within the shoulder in 14 consecutive patients undergoing subpectoral biceps tenodesis. Read More

Jt Dis Relat Surg 2022 28;33(1):142-148. Epub 2022 Mar 28.

Muğla Sıtkı Koçman Üniversitesi Eğitim ve Araştırma Hastanesi Ortopedi ve Travmatoloji Kliniği, 48000 Menteşe, Muğla, Türkiye.

Objectives: This study aims to investigate the relationship between proximal biceps tendon disorders and the degree of subacromial impingement in patients who underwent arthroscopic subacromial debridement.

Patients And Methods: Between January 2015 and June 2021, a total of 110 patients (44 males, 66 females; mean age: 52.5±11. Read More

J Hand Surg Am 2022 May 25;47(5):454-459. Epub 2022 Mar 25.

Department of Orthopaedic Surgery and Traumatology, Ziekenhuis Oost-Limburg, Belgium. Electronic address:

Purpose: Magnetic resonance imaging (MRI) is used widely for complete ruptures of the distal biceps tendon. The validity of this investigation for bicipital bursitis and tendinosis is unknown. The purpose of present study was to assess the prevalence of incidental (asymptomatic) signal changes in the distal biceps tendon in patients who underwent MRI including the elbow. Read More

BMC Musculoskelet Disord 2022 Feb 26;23(1):185. Epub 2022 Feb 26.

Department of Orthopaedics, Chan Gunn Pavilion, Allen McGavin Sports Medicine Clinic, University of British Columbia, 2553 Wesbrook Mall, Vancouver, BC, V6T1Z3, Canada.

Background: The aim of this study is to describe and quantitatively analyze the histopathology of proximal long head biceps (LHB) tendinopathy in patients who have undergone LHB tenodesis. The hypothesis is that severe histopathologic changes of the LHB tendon (LHBT) will most likely be reflected with improved postoperative clinical outcomes.

Methods: The study included patients with isolated LHB tendinopathy or LHB tendinopathy associated with concomitant shoulder pathologies. Read More

Semin Musculoskelet Radiol 2021 Dec 22;25(6):769-784. Epub 2021 Dec 22.

Department of Radiology, Division of Musculoskeletal Imaging and Intervention, University of Colorado Anschutz Medical Campus, Aurora, Colorado.

Musculoskeletal injections serve a variety of diagnostic and therapeutic purposes, with ultrasonography (US) guidance having many advantages: no ionizing radiation, real-time guidance, high spatial resolution, excellent soft tissue contrast, and the ability to identify and avoid critical structures. Sonography can be cost effective and afford flexibility in resource-constrained settings. This article describes US-guided musculoskeletal injections relevant to many radiology practices and provides experience-based suggestions. Read More

Curr Med Imaging 2021 Dec 5. Epub 2021 Dec 5.

Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna. Italy.

Shoulder pain is an extremely common condition. The painful shoulder may be the result of a wide spectrum of underlying pathological conditions, including calcific tendinopathy of the rotator cuff, subacromial-subdeltoid bursitis, acromioclavicular or glenohumeral arthritis, tenosynovitis of the long biceps tendon, rotator cuff lesions, and many other less common conditions. Ultrasound imaging is an effective tool for the diagnosis and also for the image guidance of treatment of the majority of these conditions. Read More

J Shoulder Elbow Surg 2022 Mar 10;31(3):532-536. Epub 2021 Nov 10.

Department of Orthopedic Surgery, AZ Monica, Antwerp, Belgium; Department of Orthopedic Surgery, University Hospital Antwerp, Edegem, Belgium; Orthopaedic Specialists, Harley Street Specialist Hospital, London, UK.

Background: The clinical diagnosis of partial distal biceps tendon ruptures or tendinosis can be challenging. Three clinical tests have been described to aid in an accurate and timely diagnosis: biceps provocation test, tilt sign, and resisted hook test. However, not much is known about the sensitivity, specificity, and inter-rater reliability as the available evaluations are based on small groups or are case based. Read More

JBJS Rev 2021 10 25;9(10). Epub 2021 Oct 25.

Rothman Orthopaedic Institute, Philadelphia, Pennsylvania.

»: Pathology of the long head of the biceps tendon is a common source of shoulder pain and often occurs in combination with other shoulder disorders.

»: Nonsurgical management, including rest and activity modification, use of nonsteroidal anti-inflammatory drugs, physical therapy, and corticosteroid injections, is usually the first line of treatment.

»: Patients with symptoms that are refractory to nonsurgical management are indicated for biceps tenotomy or various tenodesis procedures. Read More

Orthop Traumatol Surg Res 2022 Apr 12;108(2):103114. Epub 2021 Oct 12.

Department of Orthopaedic Surgery, Upper Limb Surgical Unit, Lapeyronie Hospital, University Hospital of Montpellier, Montpellier, France.

Introduction: Shoulder pain associated with tendinopathy of the long head of biceps (LHB) is common. Surgical treatment with arthroscopic tenotomy of the LHB has been shown to be effective. However, it's efficacy is inconsistent. Read More

Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2021 Oct;35(10):1293-1297

Department of Sports Medicine, Affiliated Xinhua Hospital of Dalian University, Dalian Liaoning, 116021, P.R.China.

Objective: To compare the effectiveness of arthroscopic intertubercular groove and open subpectoral tenodesis in treatment of long head of biceps tendon (LHBT) tendinopathy.

Methods: A clinical data of 80 patients with LHBT tendinopathy who were admitted between June 2013 and May 2017 and met the selection criteria was retrospectively analyzed. After cutting LHBT under arthroscopy, the arthroscopic intertubercular groove tenodesis was performed in 40 cases (group A) and open subpectoral tenodesis was performed in 40 cases (group B). Read More

Arthroscopy 2021 10;37(10):3022-3024

Vail, Colorado.

Tendinopathy of the long head of the biceps tendon (LHB) encompasses a range of pathology, including inflammatory tendinitis to degenerative tendinosis that can lead to pain, as well as instability of the LHB and its surrounding stabilizers. Accordingly, tenodesis of the LHB during shoulder surgery has been increasingly cited in the literature as a viable surgical option for the treatment of LHB pathology. While current treatment options include the use of multiple devices for tenodesis of the LHB, there remains a paucity of literature that investigates the biomechanical advantages of all-suture anchor devices compared to interference screws. Read More

Arthrosc Sports Med Rehabil 2021 Aug 3;3(4):e1199-e1209. Epub 2021 Jul 3.

Department of Orthopaedic Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands.

Purpose: The purpose of this meta-analysis was to provide an up-to-date comparison of clinical outcomes of tenotomy and tenodesis in the surgical treatment of long head of the biceps brachii (LHB) tendinopathy.

Methods: A literature search was conducted in EMBASE, Pubmed/Medline and the Cochrane database from January 2000 to May 2020. All studies comparing clinical outcomes between LHB tenotomy and tenodesis were included. Read More

J Pain Res 2021 16;14:2481-2490. Epub 2021 Aug 16.

Department of Orthopaedic Surgery, Kochi Medical School, Kochi University, Nankoku-City, Japan.

Purpose: Degenerative long head of biceps tendon (LHBT) has been recognized as a notable pain source in patients with rotator cuff tear (RCT). Tenotomy or tenodesis of LHBT is frequently indicated together with arthroscopic rotator cuff repair (ARCR) aiming for complete pain relief; however, it has not been fully investigated whether resected LHBT is really a source of pain. The purpose of this study was to investigate expression levels of pain-associated mediators in LHBT and its association with preoperative pain profiles. Read More

Eur J Radiol 2021 Oct 9;143:109876. Epub 2021 Aug 9.

Universitair Ziekenhuis Brussel, Department of Radiology, Brussels, Belgium. Electronic address:

Purpose: Tendon pathology around the hip is a common entity. The aim of this study was to detect tendon abnormalities around the hip in a population of asymptomatic volunteers.

Materials And Methods: Fifty volunteers (100 hips) referred for non-musculoskeletal conditions were evaluated with an additional coronal STIR-weighted MRI imaging on a 1. Read More

Orthop J Sports Med 2021 Jul 28;9(7):23259671211019360. Epub 2021 Jul 28.

Department of Orthopaedic Surgery, Konkuk University School of Medicine, Seoul, Republic of Korea.

Background: Previous research investigating rotator cuff (RC) tendinopathy has usually focused on pathoanatomy. The pathologic response to anticipatory postural adjustments (APAs) has not yet been investigated.

Purpose/hypothesis: To explore changes in APAs as detected by pre-emptive activation of shoulder muscles during ball catching. Read More

J Am Acad Orthop Surg 2021 Sep;29(17):732-739

From the Department of Orthopaedics, MedStar Georgetown University Hospital, Washington, DC.

Shoulder injury related to vaccine administration (SIRVA) is a rare yet increasingly recognized complication of immunization. Although a medicolegal term rather than a true diagnosis, SIRVA was introduced in 2010 by the Vaccine Injury Compensation Program after an increase in claims filed for vaccine-related shoulder injury. Patients typically present with severe pain and limited range of motion within 48 hours of vaccination and may experience notable functional limitations. Read More

J Clin Orthop Trauma 2021 Aug 21;19:216-223. Epub 2021 May 21.

Shoulder & Elbow Unit, University Hospitals of Leicester, Leicester, UK.

Tendinopathies are common causes of pain around the elbow resulting in significant functional impairment in athletes or the working-age population. Patients complain of a gradual onset pain with or without any specific trauma. Tissue histology shows chronic fibroblast and vascular proliferation, with a disorganized collagen pattern and absence of inflammatory mediators. Read More

Clin Shoulder Elb 2021 06 27;24(2):93-97. Epub 2021 May 27.

Department of Orthopedic Surgery, OLVG, Amsterdam, The Netherlands.

Background: Injection therapy around the distal biceps tendon insertion is challenging. This therapy may be indicated in patients with a partial distal biceps tendon tear, bicipitoradial bursitis and tendinopathy. The primary goal of this study was to determine the accuracy of manually performed injections without ultrasound guidance around the biceps tendon. Read More

J ISAKOS 2021 11 20;6(6):356-362. Epub 2021 May 20.

Department of Orthopaedics, University of Colorado at Boulder, Boulder, Colorado, USA

Importance: Arthroscopic suprapectoral biceps tenodesis (ABT) and open subpectoral biceps tenodesis (OBT) are two surgical treatment options for relief of long head of the biceps tendon (LHBT) pathology and superior labrum anterior to posterior (SLAP) tears. There is insufficient knowledge regarding the clinical superiority of one technique over the other.

Objective: To systematically review the literature in order to compare the clinical outcomes and safety of ABT and OBT for treatment of LHBT or SLAP pathology. Read More

Ther Adv Chronic Dis 2021 24;12:2040622321990262. Epub 2021 Feb 24.

Orthopedics and Traumatology Department, Hacettepe Universitesi, Ankara, Turkey.

Aim: The purpose of this study was to investigate whether there is an association between smoking, the extent of the degeneration process in the biceps tendinopathy, including cells and extracellular matrix (ECM) alterations, and long-term surgical results.

Methods: This study comprised 40 consecutive patients admitted for shoulder arthroscopy due to symptomatic biceps tendinopathy and classified into three groups based on smoking status: active smokers, former smokers, and non-smokers. According to the classical Bonar score criteria, the histopathologic evaluation of the harvested intra-articular portion of the tendon was done. Read More

Clin Orthop Relat Res 2021 Jul;479(7):1561-1573

Orthopedic Surgery Department, Escola Paulista de Ortopedia, Universidade Federal de São Paulo, São Paulo, SP, Brazil.

Background: Although tenotomy and tenodesis are frequently used for long head of the biceps tendon lesions, controversies remain as to which technique is superior regarding pain, functionality, complications, and cosmetic appearance.

Questions/purposes: (1) For long head of biceps tendon lesions, does tenotomy or tenodesis result in greater improvements in VAS score for pain? (2) Which approach has superior results when evaluating function outcome (Constant) scores? (3) Does tenotomy or tenodesis have fewer complications? (4) Does tenotomy or tenodesis result in better cosmesis (Popeye sign)?

Methods: A systematic review was performed in the Cochrane Library, Embase, PubMed, and Literatura Latino Americana e do Caribe em Ciências da Saúde (LILACS) using the keywords "long head of the biceps tendon," "biceps tenodesis," and "tenotomy." We completed the search in June 2020. Read More

Open Vet J 2021 01 22;10(4):457-464. Epub 2020 Dec 22.

Faculty of Veterinary Medicine, University of Calgary, 11877 85th St NW, Calgary, Alberta, T3R 1J3, Canada.

Background: Bicipital tendinitis and/or tendinopathy is a common cause of forelimb lameness in dogs, particularly in larger and more active patients. Although conservative treatment aimed at resolving discomfort and preserving the tendon remains the primary therapeutic goal, in certain cases it is necessary to surgically transect the tendon to eliminate pain and lameness. Transection of the tendon can be performed by open arthrotomy, arthroscopically, or percutaneously using a scalpel blade. Read More

J Clin Med 2021 Feb 5;10(4). Epub 2021 Feb 5.

Department of Orthopaedics, Orvit Clinic, Citomed Healthcare Center, 87-100 Torun, Poland.

The purpose of this study was to investigate the association of smoking and functional outcomes after arthroscopic treatment of complex shoulder injuries: rotator cuff tears (RCTs) with biceps tendon (LHBT) tears. This retrospective case-control study has been conducted on a cohort of patients who underwent shoulder arthroscopy between 2015 and 2017 due to complex injury treatment. The outcomes were assessed using the American Shoulder and Elbow Surgeons Score (ASES), the University of California at Los Angeles (UCLA) Shoulder Score, need for non-steroid anti-inflammatory drugs (NSAIDs) consumption and the visual analog scale (VAS). Read More

Orthop J Sports Med 2021 Jan 21;9(1):2325967120977538. Epub 2021 Jan 21.

Allegheny General Hospital, Pittsburgh, Pennsylvania, USA.

Background: Lesions of the long head of the biceps can be successfully treated with biceps tenotomy or tenodesis when surgical management is elected. The advantage of a tenodesis is that it prevents the potential development of a cosmetic deformity or cramping muscle pain. Proponents of a subpectoral tenodesis believe that "groove pain" may remain a problem after suprapectoral tenodesis as a result of persistent motion of the tendon within the bicipital groove. Read More

Phys Ther Sport 2021 May 28;49:15-20. Epub 2021 Jan 28.

Postgraduate Program in Rehabilitation and Functional Performance, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Brazil. Electronic address:

Objective: Systematic review investigated efficacy of conservative therapy on pain and function in people with tendinopathy-related shoulder pain.

Methods: Searches were conducted on six databases. All randomized controlled trials investigating efficacy of any conservative therapy on pain and function in people with tendinopathy-related shoulder pain were included. Read More

Arch Orthop Trauma Surg 2021 Jan 23. Epub 2021 Jan 23.

Wrightington Hospital Upper Limb Unit, Wrightington Hospital, Wrightington, Wigan and Leigh NHS Foundation Trust, Hall Ln, Appley Bridge, Wigan, WN6 9EP, UK.

Introduction: The purpose of this study was to evaluate the demographics, complications and prodromal symptoms (any pain or unpleasant sensation in the area distal biceps tendon preceding the injury) of distal biceps tendon tears (DBTTs) of patients treated with primary repair or Achilles allograft reconstruction.

Materials And Methods: 228 consecutive DBTTs in 226 patients from a single centre were evaluated. The demographic data, prodromal symptoms and postoperative adverse events were documented. Read More

J Funct Morphol Kinesiol 2020 Jul 29;5(3). Epub 2020 Jul 29.

Department of Health Human Function and Rehabilitation Sciences, The George Washington University, Washington, DC 20006, USA.

Background And Purpose: Distal biceps brachii tendinopathy is an uncommon diagnosis. Various exercise prescriptions have demonstrated efficacy in the management of tendinopathy, although studies frequently focus on the effects of a specific type of muscular contraction (i.e. Read More

Acta Orthop Belg 2020 Jun;86(2):262-271

Overuse injuries of the knee are a common cause of missed training and competition days in elite cyclists, however the underlying conditions causing this knee pain are not well defined. We conducted a diagnostic study, investigating a consecutive series of 53 high level cyclists with non-traumatic knee pain over a 14 month period. Demographic data on the participants' cycling specialty and training level was noted. Read More