Biceps tendon and superior labrum injuries: decision making

Although the anatomy of the biceps tendon and the restraining structures within the rotator interval are well defined, biceps function is not clearly understood. Biceps pathology is often associated with rotator cuff disease. Although careful clinical examinations along with diagnostic testing can accurately identify patients with biceps pathology, arthroscopy is extremely valuable in the diagnosis and treatment of biceps pathology. Surgical treatment options for biceps pathology include decompression, débridement, tenotomy, and tenodesis. Several factors must be considered in this decision. The most important factors when deciding between tenodesis or tenotomy are the activity expectations of the patient, cosmesis, patient compliance, associated pathology, and patient age. Those older than 60 years tolerate a tenotomy with the fewest adverse effects. Various arthroscopic tenodesis techniques exist, including an interference screw in bone, suture anchor fixation, and suture to adjacent tissue fixation. An open subpectoral tenodesis is another option and appropriate for a retracted biceps rupture or when the biceps disease extends distal to the bicipital groove. A superior labrum anterior and posterior (SLAP) lesion at the attachment site of the biceps tendon to the superior glenoid labrum is uncommon. Clinically significant SLAP lesions are found in about 5% of all shoulder arthroscopies and may be mistaken for normal superior labral variations. Clinical examinations and diagnostic imaging tests for SLAP lesions are often unreliable, and the ultimate diagnostic confirmation is made by arthroscopy. Surgical treatment is focused on the reattachment of the unstable biceps-labral complex.