This case series evaluated arthroscopic release of the long head of the biceps tendon in 40 patients with chronic, refractory biceps tendinitis at minimum 2-year follow-up. Most patients had concomitant shoulder pathology; only 9 underwent isolated tenotomy. The study quantifies the primary trade-offs of tenotomy: reliable pain relief versus predictable cosmetic deformity and functional fatigue.
The core decision in managing refractory biceps tendinitis is tenotomy versus tenodesis, and patient selection drives everything.
This series provides the numbers you need for that conversation. Popeye sign will develop in 7 of 10 patients — and in 8 of 10 men. Fatigue discomfort is common in younger patients but absent in those over 60. Prior tenodesis literature reports 6%-40% unacceptable results, so tenotomy is not clearly inferior on pain relief. It just trades one complication profile for another.
The practical framework: tenotomy is a reasonable choice for older, lower-demand patients with isolated biceps pain or significant concomitant pathology where simplicity matters. Avoid it in young patients, heavy laborers, and athletes who need full elbow flexion strength. The 38% fatigue discomfort rate and Popeye sign risk are unacceptable in that population.
Critical appraisal matters here. This is a Level 4 case series with only 9 isolated tenotomies, mixed concomitant pathology, and no tenodesis comparison group. The functional scores reflect a heterogeneous population. The isolated tenotomy subgroup (ASES 87.8) looks better than the overall cohort. But n=9 is too small to drive practice. Use this paper to set expectations with patients, not to settle the tenotomy-vs-tenodesis debate.
This case series evaluated arthroscopic release of the long head of the biceps tendon in 40 patients with chronic, refractory biceps tendinitis at minimum 2-year follow-up. Most patients had concomitant shoulder pathology; only 9 underwent isolated tenotomy. The study quantifies the primary trade-offs of tenotomy: reliable pain relief versus predictable cosmetic deformity and functional fatigue.
The core decision in managing refractory biceps tendinitis is tenotomy versus tenodesis, and patient selection drives everything.
This series provides the numbers you need for that conversation. Popeye sign will develop in 7 of 10 patients — and in 8 of 10 men. Fatigue discomfort is common in younger patients but absent in those over 60. Prior tenodesis literature reports 6%-40% unacceptable results, so tenotomy is not clearly inferior on pain relief. It just trades one complication profile for another.
The practical framework: tenotomy is a reasonable choice for older, lower-demand patients with isolated biceps pain or significant concomitant pathology where simplicity matters. Avoid it in young patients, heavy laborers, and athletes who need full elbow flexion strength. The 38% fatigue discomfort rate and Popeye sign risk are unacceptable in that population.
Critical appraisal matters here. This is a Level 4 case series with only 9 isolated tenotomies, mixed concomitant pathology, and no tenodesis comparison group. The functional scores reflect a heterogeneous population. The isolated tenotomy subgroup (ASES 87.8) looks better than the overall cohort. But n=9 is too small to drive practice. Use this paper to set expectations with patients, not to settle the tenotomy-vs-tenodesis debate.