This retrospective study evaluated isolated arthroscopic biceps tenotomy or tenodesis in 68 patients (72 shoulders) with massive irreparable rotator cuff tears. The central question: can addressing biceps pathology alone provide meaningful pain relief and functional improvement without repairing the cuff?
You have a 70-year-old with a massive irreparable cuff tear, severe shoulder pain, and a pathological biceps on CT arthrography. The key decision before offering biceps tenotomy or tenodesis is whether the shoulder is functional or pseudoparalytic.
If the patient can hold the arm above horizontal when you passively place it there (landing test negative), they have a functional shoulder limited by pain — this procedure will help. If they cannot maintain that position, they have true pseudoparalysis, and biceps tenotomy will relieve pain but will not restore elevation. Those patients need reverse shoulder arthroplasty.
Also check the teres minor on preoperative imaging. An atrophic or absent teres minor predicts only 18° of postoperative external rotation vs 40° with an intact teres minor — counsel the patient accordingly, or consider adding a latissimus dorsi transfer if external rotation is a priority.
Acromioplasty should be omitted in this setting. The coracoacromial arch is a functional restraint in massive cuff tears, and removing it risks converting a painful but functional shoulder into a painful, unstable one.
This retrospective study evaluated isolated arthroscopic biceps tenotomy or tenodesis in 68 patients (72 shoulders) with massive irreparable rotator cuff tears. The central question: can addressing biceps pathology alone provide meaningful pain relief and functional improvement without repairing the cuff?
You have a 70-year-old with a massive irreparable cuff tear, severe shoulder pain, and a pathological biceps on CT arthrography. The key decision before offering biceps tenotomy or tenodesis is whether the shoulder is functional or pseudoparalytic.
If the patient can hold the arm above horizontal when you passively place it there (landing test negative), they have a functional shoulder limited by pain — this procedure will help. If they cannot maintain that position, they have true pseudoparalysis, and biceps tenotomy will relieve pain but will not restore elevation. Those patients need reverse shoulder arthroplasty.
Also check the teres minor on preoperative imaging. An atrophic or absent teres minor predicts only 18° of postoperative external rotation vs 40° with an intact teres minor — counsel the patient accordingly, or consider adding a latissimus dorsi transfer if external rotation is a priority.
Acromioplasty should be omitted in this setting. The coracoacromial arch is a functional restraint in massive cuff tears, and removing it risks converting a painful but functional shoulder into a painful, unstable one.