Nanoscopic long head of the biceps tendon tenotomy under suprascapular nerve block: a feasibility study

Pathology of the long head of the biceps tendon (LHBT) is a common source of anterior shoulder pain. Nanoscopic techniques allow minimally invasive tenotomy under local or regional anesthesia. Suprascapular nerve block (SSNB) provides targeted intraarticular analgesia and may facilitate awake shoulder procedures.

To evaluate the feasibility, procedural tolerance, visualization quality, and short-term clinical outcomes of nanoscopic LHBT tenotomy performed under SSNB in elderly patients with isolated LHBT-related pain.

Eight patients (mean age 72.5 ± 2.7 years; range 68-76) with ≥ 12 months of isolated LHBT-related pain were included after screening 30 candidates. All had LHBT tendinopathy or partial tear confirmed by ultrasound or MRI and had failed ≥ 3 physiotherapy cycles and ≥ 2 corticosteroid injections. Procedures were performed with the Arthrex NanoScope under ultrasound-guided SSNB (6 mL). Pain (VAS) and function (Constant Score, CS) were recorded preoperatively and at 1 day, 2 weeks, and 6 weeks postoperatively. Exploratory one-way ANOVA was used to assess temporal improvements.

All procedures were completed without sedation, conversion, or complications. Mean operative time was 12 min. VAS improved from 7.8 preoperatively to 4.2 (day 1), 4.0 (2 weeks), and 3.4 (6 weeks). CS improved from 51.5 to 68.4, 70.2, and 71.8, respectively. ANOVA demonstrated significant temporal change (VAS: F = 158.4, p < 0.0001; CS: F = 355.5, p < 0.0001). Visualization quality averaged 4.5/5. Mean patient satisfaction at 6 weeks was 4.6/5, with return to daily activity at 10 days. No Popeye deformity was observed.

Nanoscopic LHBT tenotomy under SSNB is feasible, safe, and well tolerated in elderly patients selected for isolated LHBT pathology. Early pain and function outcomes improved consistently. Larger comparative studies with longer follow-up are required.

Trial registration RNN/60/25/KE.