The Role of Ultrasound in Postoperative Assessment of Biceps Tenodesis: A Case Report

Superior labral anterior-posterior (SLAP) tears frequently occur following overhead activities or traumatic shoulder injuries. While magnetic resonance arthrography (MRA) remains the gold standard for diagnosis, ultrasound shows promise for postoperative monitoring of long head biceps tendon (LHBT) tenodesis. We present the case of a 55-year-old man with a type III SLAP tear who developed a screw cut-out after subpectoral tenodesis. Initial conservative management was unsuccessful, necessitating surgical intervention. At one-year follow-up, ultrasound evaluation demonstrated an empty bicipital groove, preserved tendon architecture, and stable subpectoral fixation, findings later confirmed by magnetic resonance imaging (MRI).  The ultrasound findings were largely concordant with the MRI findings while offering the advantages of real-time dynamic assessment, cost-effectiveness, and immediate bedside availability. This case demonstrates the reliability of ultrasound for postoperative monitoring of biceps tenodesis. The modality enables early detection of complications without radiation exposure, though operator experience remains important for optimal results. While MRI retains superiority for preoperative diagnosis, ultrasound serves as an effective screening and follow-up tool with the unique capability to assess tendon motion dynamically. However, its accuracy is operator-dependent, and variability in interpretation between clinicians can affect diagnostic consistency, factors that are particularly important to consider in this context.  The findings of this case support the growing role of ultrasound in sports medicine practice, bridging the gap between clinical examination and advanced imaging. Further standardization of ultrasound protocols could significantly improve postoperative shoulder assessment. The case highlights how ultrasound can optimize patient care pathways while maintaining diagnostic accuracy for biceps tenodesis monitoring.