This 2005 technical note by Mazzocca et al. describes the subpectoral biceps tenodesis using bioabsorbable interference screw fixation. The technique arthroscopically tenotomizes the long head of the biceps, then fixes it through a small axillary incision just distal to the bicipital groove beneath the pectoralis major tendon. It was designed to eliminate the groove's synovial lining as a persistent pain source while maintaining native biceps length-tension.
Prior groove-based tenodesis techniques left the biceps tendon within the intertubercular groove, a synovium-lined structure that can perpetuate tenosynovitis and cause recalcitrant pain even after technically successful fixation.
When a patient presents with persistent anterior shoulder pain after groove-based tenodesis, the groove environment itself may be the culprit — this is the pathoanatomic rationale for moving fixation to the subpectoral position.
When you encounter biceps instability intraoperatively, proceed directly to tenodesis rather than attempting coracohumeral ligament reconstruction: stabilization attempts fail with secondary rupture in at least 25% of cases.
On physical exam, elicit the lateral shift sign: bicipital groove tenderness that moves laterally with arm external rotation is specific for biceps tendinosis and distinguishes it from rotator cuff or subacromial pathology. The groove is found 7 cm below the acromion with the arm in 10 degrees of internal rotation.
During subpectoral dissection, keep medial retraction gentle — the musculocutaneous nerve is at risk, and vigorous traction is the most avoidable serious complication of this approach.
This 2005 technical note by Mazzocca et al. describes the subpectoral biceps tenodesis using bioabsorbable interference screw fixation. The technique arthroscopically tenotomizes the long head of the biceps, then fixes it through a small axillary incision just distal to the bicipital groove beneath the pectoralis major tendon. It was designed to eliminate the groove's synovial lining as a persistent pain source while maintaining native biceps length-tension.
Prior groove-based tenodesis techniques left the biceps tendon within the intertubercular groove, a synovium-lined structure that can perpetuate tenosynovitis and cause recalcitrant pain even after technically successful fixation.
When a patient presents with persistent anterior shoulder pain after groove-based tenodesis, the groove environment itself may be the culprit — this is the pathoanatomic rationale for moving fixation to the subpectoral position.
When you encounter biceps instability intraoperatively, proceed directly to tenodesis rather than attempting coracohumeral ligament reconstruction: stabilization attempts fail with secondary rupture in at least 25% of cases.
On physical exam, elicit the lateral shift sign: bicipital groove tenderness that moves laterally with arm external rotation is specific for biceps tendinosis and distinguishes it from rotator cuff or subacromial pathology. The groove is found 7 cm below the acromion with the arm in 10 degrees of internal rotation.
During subpectoral dissection, keep medial retraction gentle — the musculocutaneous nerve is at risk, and vigorous traction is the most avoidable serious complication of this approach.