2017 ISAKOS Biennial Congress ePoster #2117


Arthroscopic Tenotomy of the Long Head of Biceps: Muscle Changes at Medium Term Follow Up

Allan Wang, FRACS, PhD, FAOrthA, Perth, WA AUSTRALIA
Bertram The, MD PhD, Breda NETHERLANDS
Nicholas Wambeek, MD FRANZCR, Fremantle, WA AUSTRALIA
Peter Terence Campbell, M.B.B.S(Hons.1st Class) FRACS(Orth)FAOrthA, Perth, WA AUSTRALIA

St John of God Hospital, Perth, Western Australia, AUSTRALIA

FDA Status Cleared


In the mid term following arthroscopic LHB tenotomy in active males of working age, fatty infiltration and substantial atrophy of the anterior musculature of the arm is not observed both in subjects with a popeye muscle deformity and those with a clinically normal bicep muscle contour.



Pathology of the long head of biceps tendon is commonly treated by tenotomy. This study investigates the mid term effect of tenotomy on the anterior musculature of the arm by assessment for fatty infiltration and muscle atrophy, as well as clinical outcome in active working age male patients. Our hypothesis is that patients with LHB tenotomy resulting in bicep muscle distal retraction will be associated with more atrophy and fatty infiltration of the anterior arm musculature, and worse clinical outcomes compared to patients with a clinically normal bicep muscle contour.


A sample size calculation for this study was based on the incidence of fatty infiltration of the infraspinatus muscle after chronic rotator cuff tendon tear. Twenty five male subjects (mean age 51 years) were retrospectively evaluated at a minimum of 4.0 years (mean followup of 6.7 years) after LHB tenotomy. MRI scans of the upper arm were performed, and fatty infiltration in the anterior muscle compartment was assessed compared to the ipsilateral triceps muscle, using an adaptation of the Goutellier classification. MRI assessment of the contralateral arm showed seventeen subjects had an intact LHB. Anterior muscle compartment volume was measured by serial cross sectional area measurements of axial scans and compared between the LHB tenotomy arm and contralateral arm with an intact LHB. Quick DASH and the Oxford Elbow Score outcomes were measured, and the occurrence of a popeye biceps muscle deformity was recorded.


Good clinical function was obtained at mid term followup with a Quick DASH score of 7.1 (SE 1.8) and a mean Oxford Elbow Score of 97.9 (SE 1.2). 11 of the 25 subjects (44%) had a clinically apparent popeye biceps muscle deformity.
Four subjects showed signs of biceps fatty infiltration and all were minor (Grade 1). Two of those four subjects had an obvious popeye deformity.
Of the 17 subjects with a contralateral intact LHB, the mean relative decrease in total volume of the anterior musculature was 3.6%. The difference in the total muscle volume between patients with and without a popeye deformity was no different (p=0.8).


In the midterm, LHB tenotomy in active males of working age does not result in fatty infiltration or substantial atrophy of the anterior musculature of the arm. The presence of a clinical popeye muscle deformity does not correlate with worse MRI evaluation or clinical outcomes, compared to subjects with a clinically normal biceps muscle contour.