Clinical and radiological efficacy of biceps tendon pathologies in patients undergoing arthroscopic shoulder surgery

Objective: The aim of this study is to investigate the effects of tenotomy performed on biceps tendon pathologies in patients undergoing arthroscopic surgical procedures on pain and functional outcomes. Additionally, the reliability of magnetic resonance imaging (MRI) will be determined. Materials and Methods: In this study, postoperative shoulder functions of 41 patients who underwent arthroscopic shoulder surgery at Harran University Faculty of Medicine Hospital Orthopedics and Traumatology Clinic between 2022 and 2023 were examined during follow-up examinations. Patients were divided into two groups based on the presence or absence of isolated tendinitis; these groups were further subdivided into two groups each based on whether tenotomy was performed or not. In total, biceps tenotomy was performed on 23 patients, while 18 patients did not undergo tenotomy. The patients' MRI information, socio-demographic data (socio-demographic form), shoulder joint range of motion, pain status using the Visual Analog Scale (VAS) score, functional status using the American Shoulder and Elbow Surgeons score (ASES), Constant score, Shoulder Pain and Disability Index (SPADI), Arm-Shoulder-Hand Problems questionnaire (DASH), Oxford Shoulder Score, and health status using the Health Criteria Questionnaire (SF-36) were recorded through preoperative and postoperative 2-month follow-up examinations. The development of the Popeye sign in patients undergoing biceps tenotomy was evaluated postoperatively. The reliability of MRI was assessed by comparing preoperative MRI with arthroscopic images taken during the surgery. Results: Of the 41 patients included in the study, 15 were male and 26 were female. The average age was 53.29 years and 26 patients were operated on the right arm and 15 patients were operated on the left arm. No statistically significant difference was observed in terms of gender and surgical side across all groups (p>0.05). MRI was not compatible in 15 patients, and Popeye deformity developed postoperatively in 15 patients. In the group with isolated tendinitis, statistically significant improvement was observed in VAS and SPADI indices in patients who underwent tenotomy compared to those who did not undergo tenotomy (p<0.05). When all groups were examined individually, a statistically significant improvement was detected after surgery in terms of shoulder pain and functions (p<0.05). Conclusion: It was observed that patients with isolated tendinitis who underwent biceps tenotomy demonstrated superior improvements in terms of pain and functional recovery compared to those who did not undergo tenotomy. Additionally, it was noted that MRI missed biceps tendinitis in 36.58% of the patients, indicating its low reliability. Keywords: Biceps Tendon, Biceps Tendinitis, Biceps Tenotomy, MRI, Shoulder Arthroscopy