Tenodesis of the LHBT provides a new, distal level of fixation for the tenotomized tendonand results in lower risk of cosmetic deformity or cramping in the biceps muscle When a tendon in your biceps muscle tears, the muscle can bunch up and form a large, painful ball on your upper arm. This bulge is called a Popeye deformity or Popeye sign. It's named after the.. . Only in the case of complications after tenotomy a Popeye muscle isn't a sign of strength. Instead, there is muscle weakness. Why do these complications occur after a simple biceps tenotomy for shoulder pain The current study showed a 45% prevalence of Popeye deformity and 8% cramplike arm pain on exertion after tenotomy of the LHBT. Among patient factors such as sex, age, dominant arm relation, and body mass index, the male sex was the only factor correlated with occurrence of a Popeye deformity Patients who undergo biceps tenotomy are 3 times more likely than patients who undergo biceps tenodesis to develop a Popeye deformity while having similar patient-reported outcomes, range of motion, and strength
significant concern after shoulder surgery is to regain full flexibility, and about 1-2% of patients have difficulty tolerating the physical therapy and require a second operation to break up the scar tissue. After tenodesis a small percentage of patients can have persistent pain in the muscle belly of the biceps Tenotomy is a simple surgical solution, with the advantage of being quick to perform, with uncomplicated postoperative course , , , , but may cause deformity by retraction of the biceps brachii muscle body, known as the Popeye sign, with loss of strength, bicipital pain and cramps , , . Tenodesis, on the other hand, restores normal anatomy 6 621 Science Drive • MaDiSon, Wi 53711 • uWSportSMeDicine.org rehabilitation guidelines for Biceps tenodesis pHaSe v (begin after meeting phase iv criteria, usually 20 weeks after surgery) Appointments • Rehabilitation appointments are once every 2 to 3 weeks Rehabilitation Goals • Patient to demonstrate stability with higher velocity movements and change o
The Popeye deformity is a recognized complication of release of the long head of the biceps tendon. 3, 4, 6 This is cosmetically undesirable and may result in weakness in supination and flexion One of the common complaints after long head of the biceps brachii tendon (LHBT) surgery is a Popeye deformity, which can occur with both the tenodesis and tenotomy. Tenotomy using the traditional technique has a higher incidence of Popeye deformity as the residual stump is not fixated in place
Tenodesis was proposed by several authors as an alternative to avoid the cosmetic alteration caused by residual deformity (Popeye) and possible muscle discomfort after tenotomy(4). Some techniques use the fixation of the tendon in the intertubercular groove, while others use fixation in soft parts, partially or totally by arthroscopic route The most common postoperative complications were cosmetic (Popeye) deformity (14.1%), subjective weakness (10.4%), cramping (10.4%), and continued postoperative ASP (7.8%). Seven (3.6%) patients underwent revision surgery to convert the LHBT tenotomy to a tenodesis, 6 of 7 (86%) being for postoperative cosmetic deformity The Popeye deformity has been reported to be present in 62% to 70% of patients following tenotomy. 10, 38 However, the resultant negative consequences of a Popeye deformity are relatively benign. 10, 38 Conversely, rehabilitation following tenodesis will progress more slowly over the first 6 weeks to protect the healing biceps tendon. The. Friedman et al. found a popeye deformity in 18.2% of patients that had an open subpectoral LHB tenodesis with suture anchor fixation, compared to 35% of tenotomy patients. All patients in this study were active patients, younger than 55 years old, which may explain the high rates of failures in this particular population FIG. 51.2 Lateral view of a 47-year-old right-hand-dominant patient demonstrating Popeye deformity after previous LHBT tenodesis of his right arm. From Anthony SG, McCormick FJ. Shoulder and Elbow Surgery. 2015;24(2): e36-e40. Feb 1, 2015
Proximal and distal ruptures both involve the biceps brachii but have potential for very different outcomes. Biceps tendon ruptures tend to occur in middle-age men, although they can also occur in younger patients. Approximately 96% involve the long head, 3% the distal, and 1% the short head of the biceps.[1,2 Other evaluations include cosmetic appearance evaluated by the ''Popeye'' deformity, arm cramping pain, elbow flexion strength, MRI evaluation, quality of life, and cost of surgery. To detect non-inferiority with a one-sided, two-sample t-test with a 80% power and a significance level (alpha) of 0.025, the required sample size is 98 patients LHBT tenodesis is possible more than 3 mo after rupture, and outcomes were similar to that after acute tenodesis. In the chronic group, we found a 90% excellent to good clinical outcomes and a 20% rate of popeye deformity. Only 1 of the 2 patients with popeye deformity reported a poor outcome Popeye deformity in the tenodesis group was typically consistent with the patient feeling a pop within 2 months following surgery though failure was not confirmed via physician exam. Confirmatory MRI was also not performed in most cases since none of the patients desired revision tenodesis, and thus, this would not have altered the.
While a Popeye deformity is more common after tenotomy, it is to date unknown to what extent this bothers patients older than 50 years. A limitation of this study is that our comparison of costs is limited to the duration of surgery, without taking into account any other financial aspects incidence of Popeye sign was 70% with 38% complaining of persistent biceps fatigue discomfort after resisted elbow ﬂexion.17 It is interesting to note that there was a marked difference in the incidence of Popeye deformity between men and women, 83% and 37%, respectively. The great majority of biceps pathology is encountere Popeye deformity and cramping pain in the bicipital groove is observed more after LHB tenotomy. In our opinion, tenotomy is a relatively easy procedure, which saves operation time and costs. Tenodesis on the other hand is surgically more challenging but with a lower risk of Popeye deformity and cramping pain in the biceps muscle were more variable, and tended to favour tenodesis (p= 0.07). Only the study with lowest methodological quality reported a mean difference in Constant score that tended to favor tenotomy. The meta analysis further confirmed that a Popeye phenomenon occurred more frequently with biceps tenotomy. Arm cramping pain was also more common after tenotomy
Tenotomy, suprapectoral tenodesis, and subpectoral tenodesis are safe and effective procedures, decreasing pain and improving function. Patient satisfaction rates are as high as 95%.5 Despite their effectiveness, all these procedures have known complications. Biceps tenotomy complications include cosmetic deformity (Popeye deformity) in 27 However, there is a greater chance of a Popeye deformity and occasional muscle cramping with a tenotomy. Recovery from tenodesis varies. Patients may need to wear their arm in a sling for a few weeks, and strenuous activities can be resumed in three months 3 mo after rupture. A case report of LHBT tenodesis 18 mo after rupture found return to full activity and no popeye deformity 6 mo later. In a prior series of 11 symptomatic patients who were treated at least 3 mo after rupture while the LHBT was too short for the authors' preferred method of tenodesis in 6, 3 reporte Tenodesis was proposed by several authors as an alternative to avoid the cosmetic alteration caused by residual deformity (Popeye) and possible muscle discomfort after tenotomy. Some techniques use the fixation of the tendon in the intertubercular groove, while others use fixation in soft parts, partially or totally by arthroscopic route
The odds of developing a perceived Popeye deformity was 4.3 higher after tenotomy compared to tenodesis based on clinician observation. Male gender was trending towards being predictive of having a deformity. Pain and cramping were increased in those with a self-reported Popeye Popeye deformity or have biceps cramping following complete ruptures of the LHBT. Absence of a Popeye deformity after complete biceps rupture is thought to be caused by scarring of the tendon in the bicipital groove, rotator interval, or by the subscapularis tendon. In older patients, this deformity may be less noticeable because of muscle. Tenotomy vs. Tenodesis. So how does Dr. Cole decide between a tenotomy and a tenodesis for these patients? Studies have shown that both procedures provide excellent pain relief. Historically the decision came down to cosmesis: Was the patient willing to accept a Popeye deformity following a tenotomy? If not, a tenodesis was done
(under 65) universally prefer biceps tenodesis to avoid the potential for a biceps deformity (i.e. popeye) after a tenotomy. In the past, we have employed various methods for biceps tenodesis, most commonly performing an arthroscopic tenodesis at the top of the bicipital groove. We have found this procedure to be technicall The advantages of tenodesis include maintaining the length‐tension relationships of LHBT, maintaining postoperative elbow flexion and supination strength, and preventing Popeye deformity. Subpectoral mini‐open tenodesis is a minimally invasive surgical procedure for the treatment of biceps tendon lesions without the need for arthroscopic. The tenodesis may be performed alone or as part of a larger procedure on the shoulder. On the shoulder end, the biceps tendon divides into two strands, known as the long head and the short head. A Popeye deformity is defined as any abnormal shortening or defect of the biceps muscle. The biceps tendon attaches between the elbow and the shoulder Positive clinical tests for biceps pathology were noticed more often in patients after LHB tenodesis (p = 0.0541). The Popeye deformity occurred more often in the tenotomy group; however, no patient complained of the visual appearance of the arm contour (p = 0.0128) Tenotomy of the long head of the biceps tendon is a simpler and quicker procedure than tenodesis, and it does not require the use of implants. However, retraction of the biceps tendon, leading to Popeye deformity, and biceps muscle cramps are common complications after tenotomy
The risks, however, include up to a 70% chance of the biceps tendon slipping down the arm resulting in a cosmetic deformity (i.e. the so-called Popeye deformity), a 40% risk of having fatigue and soreness when flexing the elbow, and 10-25% losses in strength with elbow flexion and supination. 9 The risks associated with tenodesis include. Biceps Tenodesis •369% increase since 2008 •97% with concomitant procedures •61% open •9.7% complication rate. Popeye Deformity Nerve Injury Humeral Shaft Fracture Infection (Deep) n=6 n=2 n=0 n=0 n=0 n=182 patients. Discussion Photos courtesy LTC Christopher Tucker Tenotomy and tenodesis of the long head of biceps (LHB) are very common procedures in shoulder surgery. While tenotomy is an easy and very effective procedure, popeye deformity and biceps muscle-belly cramping are potential drawbacks. To reduce the risk of these side-effects, many surgeons perform a biceps tenodesis, with many technical.
A visible Popeye deformity was not encountered in either group at the final follow-up. Eight patients in the tenotomy group and 7 patients in the subpectoral tenodesis group complained of mild anterior shoulder pain (p = 0.731), and 4 patients in each group complained of groove tenderness (p = 0.969) A visible Popeye deformity was not encountered in either group at the final follow-up. Eight patients in the tenotomy group and 7 patients in the subpectoral tenodesis group complained of mild anterior shoulder pain (p = 0.731), and 4 patients in each group complained of groove tender-ness (p = 0.969)
Biceps Tendonitis. Biceps tendonitis is a well recognized source of anterior shoulder pain that may be associated with subscapularis tears and subacromial impingement. Diagnosis can be suspected clinically with anterior shoulder pain made worse with provocative tests and confirmed with MRI studies to evaluate for concurrent pathology between tenotomy and tenodesis. Tenotomy is a low-demand procedure indicated for low-demand patients. A Popeye deformity may occur in up to 62% of patients, but Boileau and colleagues9 reported that none of their patients were bothered by it. Another concern after tenotomy is fatigue-cramping of the biceps muscle belly Popeye deformity or loosening of the fixation device was considered failures. Additionally, subjects were evaluated both preoperatively and postoperatively for ten-derness in the proximal intertubercular groove and at the site of tenodesis, as well as for the presence of a popeye deformity. Deformity was either evaluated clinically at fol Four tenotomy patients had a popeye deformity, 2 of whom reported painful cramping. Two patients had pain at the tenodesis site. CONCLUSION: Subjective outcomes are similar for patients treated with tenotomy and tenodesis. Tenotomy decreases supination peak torque relative to the nonoperative side and tenodesis
How You Can Avoid the Painful Popeye Deformity A tear in your biceps tendon can leave you looking like Popeye after eating his spinach. Here are three ways to prevent this painful injury Return to unrestricted activities is allowed after 2 to 3 months. Operative. Operative treatment of rupture of the long head is often coupled to treatment of concomitant pathology of the rotator cuff. In the setting of open or arthroscopic rotator cuff repair, the rupture of the biceps tendon can be stabilized with open or arthroscopic tenodesis
tenotomy and tenodesis, the literature suggest that tenodesis provides beneficial closer restoration of normal anatomy, prevents loss of strength and cramping, and has less risk for cosmetic, popeye, deformity. The subpectoral tenodesis location has proven to be a reasonable method a with tenotomy or arthroscopy-assisted tenodesis, and no Popeye deformity was seen in both groups14. Shank et al. found no statistically signiﬁcant forearm supination or elbow ﬂexion strength differences between biceps tenotomy and arthroscopic LHBT tenodesis groups15. While Koh et al.3 and Cho et al.16 argued that the incidence of Popeye defor In the younger, relatively active patient who would potentially be concerned about a biceps Popeye deformity post-tenotomy, the LHB tenodesis remains a predictable option with minimal. Tenotomy vs Tenodesis. Tenotomy of LHB, as the quickest and well tolerated surgical option, has been reported to have complications, such as cosmetic deformity (Popeye deformity), cramp-like arm pain, decrease in elbow flexion strength, and fatigue discomfort
Popeye's Torn Biceps Tendon. When children want to show how strong they are, they flex the upper arm and point to the bulge. This is the biceps muscle. It attaches to the shoulder and to the elbow in two parts. One part helps lift the arm, and the other bends the elbow. When the biceps muscle is torn, it sometimes bunches up and makes a bulge This straightforward surgical approach helps minimize the potential for cramping or cosmetic Popeye deformity, which is often associated with tenotomy. 1. Loop 'N' Tack Tenodesis Implant Systems provide everything required to perform Loop 'N' Tack biceps tenodesis in a simple, convenient kit
the so-called Popeye deformity, biceps cramping, and bi- After anterior and posterior portal placement, a careful and thorough glenohumeral joint assessment is completed. When a signiﬁcant partial- biceps tenodesis (Figs 6 and 7). After the repair is completed, the arm is taken through a range of motio Popeye deformity and cramping pain were more prevalent following LHB tenotomy. Our randomized trial demonstrated that patients older than 50 year who were surgically treated for small to medium sized degenerative rotator cuff tears substantially improved in CMS after both LHB tenotomy and LHB tenodesis They also observed that the Popeye deformity was present in 62% of cases, but it was not always perceived by the patient. Osbahr et al., 30 30 Osbahr DC, Diamond AB, Speer KP. The cosmetic appearance of the biceps muscle after long-head tenotomy versus tenodesis Tenodesis of the proximal biceps leads to. pain relief, preservation of function. potentially be concerned about a biceps Popeye deformity post-tenotomy, the Dec 1, 2012 Headache commonly occurs after the procedure but is only temporary shoulders and arms, which leads to a top-heavy Popeye effect
Average follow-up was 3.1 years, and the average age at follow-up was 49.5 years. In the study, 20% of tenotomy patients had popeye deformity, compared with 8% of tenodesis patients. Strength. In contrast to a tenotomy, a biceps tenodesis can prevent the popeye deformity and most cases of cramping. However, this comes at the expense of a bigger, more invasive surgery that often requires an open incision near the arm pit (1-2 inch incision). Secondly, rehabilitation is prolonged after a tenodesis in comparison to a tenotomy Positive clinical tests for biceps pathology were noticed more often in patients after LHB tenodesis ( p = 0.0541). The Popeye deformity occurred more often in the tenotomy group; however, no patient complained of the visual appearance of the arm contour ( p = 0.0128) The patient may exhibit a reverse Popeye deformity, with a bulge in the proximal arm secondary to retraction of the biceps muscle belly proximally. 1 Diagnosis There are two tests that can be performed to assist in making the diagnosis—the biceps squeeze test and the hook test
It should be higlighted that tenodesis does not eliminate the risk of Popeye deformity, which may still occur if the tenodesis ruptures or if it is performed with inadequate-tension. Therefore, to assume that tenotomy risks cosmetic deformity while tenodesis does not is overly simplistic Subpectoral biceps tenodesis. Yogesh Joshi, Chetan Bhalla, Mehek Asad and Asad Syed discuss differing techniques for the repair, tenotomy and tenodesis of the long head of the biceps. Biceps pathology in shoulder problems has been studied extensively in literature; controversies still exists for the optimum treatment for the condition A complete biceps tendon rupture at the shoulder also may result in a bulge in the upper arm between the elbow and shoulder—what is commonly referred to as a Popeye muscle or Popeye deformity. This happens because after the ruptured tendon retracts the muscle shortens and it bunches up in the arm In our material, the postoperative Popeye deformity was more common in the tenotomy group. However, the Popeye deformity did not occur in % of the patients in the tenotomygroup.Itisalsonoteworthythat% ofthepatients in the tenodesis group developed the Popeye deformity. It hasbeensuggested thatin ammationintherotatorinterval Complete recovery from biceps tenodesis takes approximately 20 weeks or more. Immediately after surgery, a pain block is used to keep the shoulder numb for the next 12-18 hours. Patients are advised to wear a sling for the next 4-6 weeks as the tissue heals. With physical therapy, patients will work on recovery through a series of stages
Moreover, tenotomy has a higher incidence of cosmetic deformity (Popeye sign) than that of tenodesis (43 vs. 8%) . Therefore, tenodesis is currently the preferred technique for treating LHB lesions as it provides a better recovery of physical activity, fewer cosmetic deformities and more closely aligns with normal anatomy, despite a longer. The Popeye deformity occurred in 25% of patients undergoing biceps tenotomy, which is in keeping with the findings of Frost et al study showing incidence of Popeye deformity after biceps tenotomy varied from 3% to 70%; The occurrence of the Popeye deformity in the tenodesis group was 7.8%, which are probably due to failure of the tenodesis o 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 Occasionally, if there is an inciting event, the patient may describe hearing or feeling a popping or snapping sound. On physical examination, the patient may exhibit a Popeye sign—a bulge in the distal biceps area due to the retracted biceps muscle belly. There is also tenderness along the biceps popeye deformity, and some patients may complain of cosmetic deformity, biceps cramping, and fatigue From the Southern California Orthopedic Institute, Van Nuys, California, cations, and other surgeries after their biceps tenodesis. Study subjects were examined for strength with iso
The Popeye deformity is permanent but the cosmetic deformity has no effect on overall function. Operative. In these cases, your surgeon will perform a biceps tenodesis, reattaching the tendon to a site along the arm bone. The reattachment is not performed at the site of injury at the tendon origin. Treatment Options Dr. Smith determined that the pulling injury had caused the tenodesis procedure to fail. This, in turn had caused a popeye deformity of the right biceps. Dr. Smith considered the effect of this injury to be cosmetic rather than functional. After discussion with Employee, it was determined not to perform an additional surgery METHODS: Patients older than 50 years with a supraspinatus and/or infraspinatus tendon rupture sized smaller than 3 cm, who are encountered with LHB pathology, will be randomized to either LHB tenotomy or LHB tenodesis. Clinical and patient-reported data will be collected pre-operatively, 6 weeks, 3 months and 1 year after surgery A Prospective Randomized Study Comparing the Interference Screw and Suture Anchor Techniques for Biceps Tenodesis Ji Soon Park , Sae Hoon Kim , Ho Jin Jung, Ye Hyun Lee, Joo Han Oh UAE SKS
Importance Arthroscopic suprapectoral biceps tenodesis (ABT) and open subpectoral biceps tenodesis (OBT) are two surgical treatment options for relief of long head of the biceps tendon (LHBT) pathology and superior labrum anterior to posterior (SLAP) tears. There is insufficient knowledge regarding the clinical superiority of one technique over the other. Objective To systematically review the.