A challenging complication of arthroscopic biceps surgery is the persistent painful cramping of the biceps. There is a paucity of data upon nonsurgical treatment of this debilitating complication. We pro- pose an intramuscular injection of botulinum toxin A (BTX-A) for painful bicipital cramping after tenotomy of the long head of the biceps brachii tendon (LHBT). Ten patients with a painful Popeye sign after tenotomy of LHBT, were treated with intramuscular injection of 100 IU of BTX-A. Mean patient age was 56 years and mean time from surgery to infiltration was 317 days. The Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score was obtained. Pain was objectified by a visual analogue scale (VAS). Patient satisfaction was described as excellent, good, satisfactory, or poor, three and six months after injection. Mean VAS prior to infiltration was 6.8 and decreased significantly to 2.6 at follow-up. Mean QuickDash was 54.04 prior to infiltration and decreased to 19.84 at follow-up. Patient satisfaction was excellent in 9 and good in 1 patient. We report a significant pain reduction and functional improvement following BTX-A infiltration as treatment of painful bicipital cramping after tenotomy of LHBT.

The purpose of this study was to evaluate the clinical results of surgical repair for proximal long head of the biceps (LHB) tendon ruptures comparing chronic primary and postsurgical revision LHB tendon ruptures.

Patients who underwent subpectoral LHB tenodesis for chronic ruptures with a minimum of 2 years from surgery were identified. ASES and SF-12 PCS scores and surgical and demographic data were collected prospectively. At final follow-up, patients were interviewed regarding symptoms related to their biceps. Symptoms were converted into a Subjective Proximal Biceps Score (SPBS).

Twenty-seven patients (22 males, 5 females) with a mean age of 61 years (range 40-76 years) underwent LHB tenodeses. Twenty patients (74.1 %) were primary repairs for chronic ruptures and seven patients (25.9 %) were revision repairs after failed prior LHB tenodesis. Twenty-five patients (92.6 %; n = 18 primary; n = 7 revision) were available for follow-up a mean of 3.8 years (range 2-6.1). The overall median postoperative SPBS showed significant improvement over the preoperative baseline (p < 0.001). Individual components of the SPBS showed substantial improvements. The SPBS significantly correlated with the postoperative ASES score (r = -0.478; p = 0.038). There were no differences in postoperative SPBSs between the primary and revision tenodesis groups. The mean postoperative ASES score was 90.3 and SF-12 PCS was 52.6.

Open subpectoral LHB tenodesis was a safe and effective method for the treatment of chronic LHB tendon ruptures and for the revision of failed post-surgical LHB ruptures. Patients had less pain, cramping, and deformity after LHB tenodesis. The SPBS, ASES, and SF-12 PCS scores significantly improved among this group of patients.

Level III; Retrospective comparative study.

"Popeye biceps" deformity represents the appearance of a distally retracted biceps muscle resulting from either a traumatic long biceps tendon (LBT) rupture or an iatrogenic LBT tenotomy. Cosmetic and functional problems associated with the deformity may necessitate surgical correction, and surgical exposure using multiple incisions is recommended. The technique presented here describes a novel mini-open approach using a single 1-in incision that provides access to 3 peripectoral anatomical zones. Preoperative sonographic localization of the ruptured and retracted LBT is used to guide incision placement, and facilitates intraoperative tendon retrieval via a limited incision and minimal dissection. Inferolateral retraction of the mini-incision window permits infrapectoral and subpectoral LBT mobilization and dissection. Deltopectoral access via superomedial retraction of the same skin window is used to expose the suprapectoral zone and is employed for LBT retrieval and proximal tenodesis. Technical tips for safe dissection via a mini-incision, and methods for biological LBT augmentation are discussed.