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SLAP at Patolohiya ng Biceps

Superior labral (SLAP) tears and disorders of the long head of biceps — assessment and treatment.

Updated Jun 2026

Illustrasyon ng isang baseball pitcher na nasa gitna ng paghagis, nakakunot ng mukha dahil sa sakit sa balikat na ginagamit sa paghagis. — Ang mga problema sa SLAP at sa anchor ng biceps ay madalas na nagdudulot ng malalim na sakit sa balikat habang nagtatapon sa itaas at sa ibang mga gawain na nangangailangan ng pagtaas ng kamay. Kieran Hirpara 4.0

Ano ang nararamdaman mo¶

Maaaring maranasan mo ang sakit sa harap ng iyong balikat. Karaniwang nasa malalim na bahagi ng kasu-kasuan ang sakit na ito. Maaari rin itong lumipat pababa sa iyong itaas na braso. Maraming tao ang naglalarawan nito bilang isang matinding sakit na nagiging matulis kapag gumagalaw. Maaaring mapansin mo na lumalala ang sakit kapag itinataas mo ang iyong braso sa itaas ng iyong ulo. Maaaring mahirapan kang umabot sa mga bagay sa mga mataas na shelf. Maaaring mag-trigger ng matinding hindi komportableng pakiramdam ang pagtatapon ng bola o ang paglalaro ng mga isport na gamit ang racquet.

Maaaring maramdaman mo na hindi matatag ang iyong balikat o parang ito ay magwawala. Ilang pasyente ang nag-uulat ng pakiramdam ng pagkakadikit o pagkakalock. Nangyayari ito kapag nakakulong ang naputol na tissue sa kasu-kasuan. Maaaring marinig mo ang tunog ng pag-click o pag-pop kapag gumagalaw ka ng iyong braso. Madalas na nagmimimito ang mga sintomas na ito sa ibang mga problema sa balikat. Maaaring maramdaman mo ang sakit na parang pamamaga ng rotator cuff o pangkalahatang kawalan ng katatagan. Karaniwan ang pakiramdam ng stiffness, lalo na sa umaga.

Naging hamon ang mga gawain sa araw-araw kapag kailangan mong gamitin ang parehong kamay. Maaaring masakit ang pag-abot sa likod ng iyong likod upang i-fasten ang bra. Ang pagtutukoy ng isang shirt ay nangangailangan ng nakakahiwalay na pag-ikot na nagpapalala sa putol. Madalas na hindi posible ang pagtulog sa apektadong gilid dahil sa presyon at sakit. Maaaring gisingin ka ng madalas dahil sa hindi komportableng pakiramdam.

Karaniwang lumalala ang sakit pagkatapos ng aktibidad. Maaari itong manatili hangga't gabi o maaari itong gisingin ka sa gabi. Karaniwang tumutulong ang pahinga upang bawasan ang agarang matinding sakit, ngunit bumabalik ang stiffness kapag walang aktibidad. Maaaring makita mong iwasan mo ang paggamit ng iyong braso upang protektahan ito. Maaari itong magdulot ng kahinaan sa loob ng panahon.

Mahalagang malaman na ang mga pagsusuri sa pisikal na eksaminasyon lamang ay hindi sapat upang kumpirmahin ang diagnosing na ito. Titingnan ng iyong surgeon ang iyong kasaysayan at imaging upang maunawaan kung ano ang nararamdaman mo. Kung mayroon kang calcification sa biceps tendon, maaari itong kaugnay sa putol na ito. Ang pag-unawa sa iyong tiyak na mga sintomas ay tumutulong sa iyong surgeon na pumili ng tamang landas para sa iyo. Kung kailangan mo ng repair o tenodesis (paglilipat ng tendon), ang layunin ay bawasan ang sakit na ito at ibalik ang function.

Ano ang nangyayari talaga¶

Ang iyong balikat ay isang ball-and-socket joint. Ang socket ay may lining na isang singsing ng cartilage na tinatawag na labrum. Isipin ang singsing na ito bilang isang gasket o shock absorber. Pinapanatili nito ang ball na nasa gitna at stable. Ang biceps tendon ay nakakabit sa itaas ng singsing na ito. Gumagana ito bilang isang lubid na tumutulong sa pagtaas ng iyong braso.

Ang SLAP tear ay nangangahulugang ang attachment na ito ay umalis o napunit. Ang salitang SLAP ay para sa Superior Labrum Anterior to Posterior. Ipinapahiwatig nito ang lokasyon at direksyon ng tear. Nangyayari ito sa itaas ng socket.

Ang pinsalang ito ay maaaring maramdaman bilang maraming iba't ibang problema. Madalas itong nagmumukhang impingement o rotator cuff issues. Maaari rin itong maramdaman bilang shoulder instability. Ginagawa nitong mahirap mag-diagnose. Minsan, mahirap malaman kung ano ang eksaktong problema base sa iyong mga sintomas lamang.

Kapag nangyari ang tear na ito, nagbabago ang mekaniks ng iyong balikat. Maaaring lumipat ang ball nang sobra sa loob ng socket. Ang karagdagang galaw na ito ay nagdadagdag ng stress sa biceps tendon. Dagdagan nito rin ang pressure sa loob ng joint. Sa paglipas ng panahon, maaaring magwan ang mga surface ng joint dahil sa karagdagang load na ito.

Sinusubukan ng iyong katawan na harapin ang instability na ito. Maaaring mag-contract ang iyong mga muscle sa ibang oras kaysa sa karaniwan. Halimbawa, maaaring mag-activate nang mas maaga ang isang muscle na tinatawag na serratus anterior. Posibleng ito ay isang protective strategy upang istabilize ang iyong shoulder blade at joint. Gayunpaman, maaaring maramdaman ang pagbabago sa timing na ito bilang awkward o mahina.

Ipinapaliwanag ng mga pagbabagong ito ang iyong sakit at limitadong galaw. Ang tear ay nagdudulot ng pagkagambala sa makinis na pag-slide ng joint. Ang biceps tendon ay nahihila o na-strain sa paggalaw. Ito ang nagdudulot ng matulis na sakit, lalo na kapag nagtaas o umaabot sa itaas. Maaari rin nitong magdulot ng pakiramdam ng pagkakadikit (catching sensation).

Ang pag-unawa sa sitwasyong ito ay tumutulong sa iyong surgeon na pumili ng tamang pag-aayos. Para sa ilang pasyente, ang pag-aayos ng labrum ang pinakamainam. Para sa iba, mas epektibo ang paglipat ng attachment ng biceps tendon (tenodesis). Ang desisyong ito ay nakadepende sa iyong edad, antas ng aktibidad, at tiyak na uri ng tear. Gabayin ka ng iyong surgeon upang pumili ng opsyon na magre-restaura ng stability at magbabawas ng sakit.

Mga maitutulong namin dito¶

Ang iyong manggagamot ay magrekomenda muna ng non-operative na paggamit na may angkop na regimen. Ang pamamaraang ito ay nagbibigay ng sapat na klinikal na resulta sa mga pasyenteng nasa katamtamang gulang na may symptomatic na SLAP lesions. Dapat mong isaalang-alang ang hakbang na ito bago irekomenda ang operative na paggamot. Ang layunin ay bawasan ang sakit at ibalik ang galaw sa pamamagitan ng mga target na ehersisyo. Isang clinical prediction model ang makakatulong na mag-predict ng pagkabigo ng pamamahala na ito na may katamtamang katumpakan, batay sa iyong mga partikular na sintomas at mga nakaraang paggamot. Gayunpaman, ang desisyon na mag-operate ay hindi dapat gawin batay lamang sa mga clinical assessment tests. Kailangan mo ring isaalang-alang ang iyong antas ng sakit, antas ng overhead na aktibidad, at kung paano ka tumugon sa nakaraang non-operative na pamamahala.

Kung mananatiling may sakit, maaaring kasama ng medical management ang gamot pang-alis ng sakit o anti-inflammatories. Sa ilang kaso, maaaring isaalang-alang ng iyong manggagamot ang mga injection tulad ng cortisone, hyaluronic acid, o PRP. Layunin ng mga opsyong ito na bawasan ang pamamaga at magbigay ng pansamantalang ginhawa. Kung may hinala na calcific tendinitis ng long head ng biceps brachii sa kanyang pinagmulan, maaaring makatulong na isaalang-alang ang pagkakaroon ng concurrent na SLAP lesion at ang kanyang pamamahala. Tandaan na ang mataas na prevalence ng superior labral tears na nadiagnose sa MRI sa mga pasyenteng nasa katamtamang gulang na may asymptomatic na balikat ay nagbibigay-diin sa pangangailangan ng suporta sa clinical judgment kapag gumagawa ng mga desisyon sa paggamot. Huwag umasa lamang sa imaging; iko-correlate ng iyong manggagamot ang mga natuklasan sa iyong mga physical na sintomas.

Kapag naabot na ng conservative care ang kanyang hangganan, itinuturing ang operasyon. Madalas itong pinapagana ng pagkakaroon ng sakit at ng iyong pagnanais na bumalik sa aktibidad. Para sa mga pasyenteng nasa ilalim ng 30 taong gulang na may symptomatic na isolated na SLAP tear, ang open subpectoral na biceps tenodesis ay maaaring maging maaasahang alternatibo sa arthroscopic repair. Ang primary na biceps tenodesis ay nagbibigay ng mas mahusay na functional na resulta sa mga aktibong pasyenteng nasa ilalim ng 30 taong gulang kumpara sa SLAP repair sa minimum na 2 taong follow-up. Ito rin ay isang ligtas, epektibo, at teknikal na simpleng alternatibo sa primary na SLAP repair sa mga pasyenteng may type II at IV na SLAP tears. Sa isang batang aktibong populasyon, ang biceps tenodesis ay maaaring magpasigla ng mas maagang pagbabalik sa aktibidad kumpara sa repair. Para sa nabigo na type II na SLAP repair, ang subpectoral na biceps tenodesis bilang isang salvage procedure ay nagpapakita ng mas mahusay na resulta. Ang desisyon ay huling ginagawa nang indibidwal kasama ang pasyente, binibigyang-balansya ang mga partikular na bentahe at disbalante.

Ano ang inaasahan¶

Ang iyong balikat ay malamang na magpakita ng pagpapabuti pagkatapos ng operasyon, ngunit ang daan patungo sa buong pag-andar ay nangangailangan ng oras. Karamihan sa mga pasyente ay nakakakita ng malaking pagbaba ng sakit at malinaw na pagpapabuti sa kakayahan ng kanilang balikat na gumana. Inaasahan mong talakayin ng iyong doktor kung ang biceps tenodesis o SLAP repair ang angkop na pagpipilian para sa iyo. Ang desisyong ito ay nakadepende sa iyong edad, antas ng aktibidad, at tiyak na katangian ng iyong sugat.

Para sa mga aktibong pasyenteng nasa ilalim ng 30 taong gulang, madalas na nagbibigay ang biceps tenodesis ng mas magandang resulta sa pag-andar kaysa sa SLAP repair. Sa pamamaraang ito, ililipat ng iyong doktor ang tendon ng biceps sa isang bagong lokasyon sa itaas na buto ng braso. Ang pamamaraang ito ay ligtas, epektibo, at maunawaan. Ito rin ay isang maaasahang pagpipilian kung mayroon kang nakaraang SLAP repair na hindi gumaling nang maayos. Kahit na mabigo ang iyong unang operasyon, maaaring ibalik ng pagwawasto na ito ang pag-andar at bawasan ang sakit.

Kung ikaw ay isang kompetitibong overhead athlete, ang iyong pangkalahatang pananaw ay positibo. Humigit-kumulang 81% ng mga pasyente ay bumabalik sa kanilang nakaraang antas ng paglalaro pagkatapos ng subpectoral biceps tenodesis. Ang pagbabalik na ito ay karani nang nangyayari sa isang average na 4.1 buwan pagkatapos ng operasyon. Inaasahan mong mataas ang antas ng kasiyahan at maganda ang mga resulta kung ikaw ay maingat na napili para sa pamamaraan. Ang mga babaeng pasyente ay nagpapakita ng katulad na mga resulta sa mga lalaking pasyente sa mga aspeto ng pagpapagaan ng sakit, pag-andar, at kakayahang bumalik sa mga isports pagkatapos ng minimum na dalawang taong pagsubaybay.

Kung pipili kang hindi magkaroon ng operasyon, o kung ikaw ay nasa higit sa 40 taong gulang, ang trend sa paggamot ay nagbabago. Mayroong pagbaba sa mga SLAP repair at pagtaas sa mga biceps tenodesis para sa mga pasyenteng higit sa 40 taong gulang. Habang ang ilang tao ay nakakaabot nang walang operasyon, ang iba ay maaaring harapin ang patuloy na sakit o limitadong pag-andar. Ang mga risk factor para sa pangangailangan ng revision surgery ay kinabibilangan ng pagiging higit sa 40 taong gulang, pagiging babae, obesity, pagsusuka, o pagkakaroon ng biceps tendinitis.

Sa pangkalahatan, ang pananaw ay nakaka-encourage. Paano man ikaw ay bata at aktibo o nasa gitnang yugto ng buhay, ang mga modernong teknika ay nag-aalok ng maaasahang paraan upang pamahalaan ang iyong mga sintomas. Ang iyong doktor ay tutulong sa iyo na bigyang-kahulugan ang mga benepisyo ng maagang pagbabalik sa aktibidad kumpara sa oras ng paggaling na kinakailangan. Sa tamang pag-aalaga, ang karamihan sa mga pasyente ay muling nakakakuha ng paggamit ng kanilang balikat at bumabalik sa mga aktibidad na kanilang minamahal.

Kailan kumonsulta sa doktor¶

Maghingi ng pagsusuri ng espesyalista kung mayroon kang patuloy na sakit sa balikat na hindi gumagaling kahit pahinga. Maghanap ng medikal na tulong kung mapansin mo ang kahinaan, kawalan ng katatagan, o kung nakakabara o bumabagsak ang iyong balikat. Pumunta sa iyong doktor kung ang mga sintomas ay nakakaapekto sa iyong tulog o trabaho. Biglaang paglala ng sakit ay dahilan din upang humingi ng tulong. Magkaroon ng kaalaman na ang mga sugat sa SLAP ay maaaring magmukhang iba pang isyu tulad ng impingement o mga problema sa rotator cuff. Ang diagnosis ay hindi dapat umasa lamang sa mga klinikal na pagsusuri. Kung inaakala na may calcific tendinitis, susuriin ng iyong doktor ang kasamang sugat sa SLAP. Ang maagang pagsusuri ay tumutulong upang matukoy kung ang mga prosedura tulad ng biceps tenodesis ay angkop para sa iyong tiyak na sugat.

Evidence & references

Overview¶

Both arthroscopic repair and biceps tenotomy and tenodesis interventions had benefits in type II SLAP lesions [1].
Biceps tenodesis is a safe, effective, and technically straightforward alternative to primary SLAP repair in patients with type II and IV SLAP tears [4].
SLAP repairs are generally favored in younger, active patients [6].
Treating the biceps is preferred in lower-demand patients aged >30 years [6].
Biceps tenodesis has been increasingly used for the management of SLAP lesions [7].
Recent studies report high rates of return to sport, high satisfaction, and good to excellent patient-reported outcomes with biceps tenodesis in carefully selected athletes [7].
SLAP repair and biceps tenodesis both present viable treatment options but come with specific advantages and disadvantages [8].
The decision between SLAP repair and biceps tenodesis is ultimately made individually with the patient [8].
Primary subpectoral open biceps tenodesis for SLAP tears or pathology of the long head of the biceps tendon provides significant improvement in shoulder outcomes [9].
Primary subpectoral open biceps tenodesis for SLAP tears or pathology of the long head of the biceps tendon provides a reliable return to activity level with low risk for complications [9].
Biceps tenodesis is a predictable, safe, and effective treatment for failed arthroscopic SLAP tears at a minimum 2-year follow-up [10].
Treatment of proximal biceps pathology is largely based on expert opinion and patient preferences rather than robust randomized evidence [20].
Primary biceps tenodesis offers increased effectiveness when compared with both primary SLAP repair and nonoperative treatment [24].
Primary biceps tenodesis has lower costs than primary SLAP repair [24].
The indications and technique of biceps tenodesis in the elite pitcher still need to be defined [26].
High-demand patients with biceps tendonitis in the setting of a SLAP lesion with labral instability who undergo combined tenodesis and labral repair have significantly worse outcomes than patients who undergo either isolated labral repair for type II SLAP tears or isolated biceps tenodesis for a SLAP tear and biceps tendonitis [44].

Anatomy & Pathophysiology¶

Understanding the function and pathology surrounding the teres minor is paramount in comprehensive management of patients with shoulder pathology [12].
In the context of rotator cuff disease, the etiology of anterior shoulder pain with macroscopic changes in the biceps tendon is related to the complex interaction of the tendon and surrounding soft tissues, rather than a single entity [17].
Biomechanical studies indicate that the long head of the biceps contributes to stability of the glenohumeral joint in all directions [28].
In vivo studies have not yet established the stabilizing effect of the long head of the biceps on the glenohumeral joint [28].
The physiologic load required for the long head of the biceps to stabilize the glenohumeral joint remains unknown [28].
The long head of the biceps has a pertinent biomechanical role in glenohumeral stability regardless of the condition of the superior labrum [32].
Validity for strength testing of the serratus anterior muscle is optimal with subjects in a seated position and the shoulder flexed at 90° in the scapular plane [33].
Treatment of scapular dyskinesis is directed at managing underlying causes and restoring normal scapular muscle activation patterns by kinetic chain–based rehabilitation protocols [35].
Both proposed superior labral reconstruction techniques increased the force needed for humeral head superior migration in the setting of a labral tear [36].
The long head of the biceps tendon serves as a source of local autograft with biological and biomechanical properties that aid outcomes of complex primary and revision shoulder surgery procedures [40].
Potential prognostic variables associated with final subscapularis strength remain elusive [42].
The ultimate load to failure and stiffness for unicortical button fixation and the compared method in proximal subpectoral biceps tenodesis were not different [43].

Classification¶

Arthroscopic repair and biceps tenotomy/tenodesis both provide benefits for type II SLAP lesions [1].
Calcific tendinitis of the long head of the biceps brachii at its origin may be associated with a concurrent SLAP lesion [2].
A positive subpectoral biceps test is associated with gross pathologic changes of the biceps in 93% of patients [3].
Biceps tenodesis is a safe, effective, and technically straightforward alternative to primary SLAP repair for type II and IV SLAP tears [4].
Biceps tenodesis yields consistent and reliable results for operative treatment in overhead athletes, whereas return to play after SLAP repair can be unpredictable [5].
SLAP repair and biceps tenodesis are both viable treatment options with specific advantages and disadvantages, with the decision made individually with the patient [8].
Appropriate treatment for biceps pathology, whether conservative or surgical, should be based on established pathology [11].
There is no single pattern of pain that distinguishes biceps conditions from other shoulder abnormalities [16].
In the context of rotator cuff disease, the etiology of anterior shoulder pain with macroscopic changes in the biceps tendon is related to the complex interaction of the tendon and surrounding soft tissues rather than a single entity [17].
Biceps tenodesis may be considered a valid primary or revision surgery for symptomatic type II SLAP tears due to no detrimental effect on glenohumeral stability [21].
Biceps tenodesis remains a reliable treatment for pathologic abnormality of the long head of the biceps [50].

Clinical Presentation¶

A positive subpectoral biceps test was associated with gross pathologic changes of the biceps in 93% of patients [3].
There is no single pattern of pain that distinguishes biceps conditions from other shoulder abnormalities [16].
In the context of rotator cuff disease, the etiology of anterior shoulder pain with macroscopic changes in the biceps tendon is related to the complex interaction of the tendon and surrounding soft tissues, rather than a single entity [17].
Diagnosis of long head biceps tendon and subscapularis pathology in association with shoulder rotator cuff pathology can be challenging due to limitations in MRI and arthroscopic visualization [22].
Surgeons should maintain a high level of suspicion and utilize specific techniques to prevent missing pathology when diagnosing long head biceps tendon and subscapularis pathology in association with shoulder rotator cuff pathology [22].
The concomitant presence of SLAP and pulley lesions is significantly rare, occurring in only about 10% of all patients with SLAP and pulley lesions [25].
If calcific tendinitis of the long head of the biceps brachii at its origin is suspected, it may be helpful to consider the presence of a concurrent SLAP lesion and its management [2].
A 10.1% incidence of subsequent surgery after isolated SLAP repair was identified, often related to an additional diagnosis [14].
Clinicians should consider other potential causes of shoulder pain when considering surgery for patients with SLAP lesions [14].

Investigations¶

A positive subpectoral biceps test was associated with gross pathologic changes of the biceps in 93% of patients [3].
There is no single pattern of pain that distinguishes biceps conditions from other shoulder abnormalities [16].
Biceps tendon pain in the absence of tears is associated with microscopic changes consistent with tendinopathy, which are often missed by MRI [46].
MRI and intraoperative assessment did not show significant structural abnormalities within the tendon despite significant histopathologic changes in patients with chronic long head biceps tendinopathy undergoing open subpectoral tenodesis [19].
Most abnormal MRI findings were not different in frequency between symptomatic and asymptomatic shoulders [47].
Bicipital groove morphology measured by MRI has no correlation to intra-articular biceps tendon pathology [48].
Preoperative MRI scans of the shoulder interpreted by orthopaedic surgeons with a systematic approach resulted in improved accuracy in diagnosing subscapularis tendon tears compared with previous studies [51].
Diagnosis of long head biceps tendon and subscapularis pathology in association with shoulder rotator cuff pathology can be challenging due to limitations in MRI and arthroscopic visualization [22].
In approximately 80% of intra-articular biceps tears evaluated, a 'hidden lesion' was observed going beyond the bicipital groove and extending to the distal extra-articular portion [55].
The myotendinous junction (MTJ) of the biceps begins further proximal than may be appreciated intraoperatively [56].
If calcific tendinitis of the long head of the biceps brachii at its origin is suspected, it may be helpful to consider the presence of a concurrent SLAP lesion [2].
Clinicians should consider other potential causes of shoulder pain when considering surgery for patients with SLAP lesions, as there is a 10.1% incidence of subsequent surgery after isolated SLAP repair often related to an additional diagnosis [14].

Treatment¶

Operative Management: SLAP Repair vs. Biceps Tenodesis/Tenotomy¶

Both arthroscopic repair and biceps tenotomy and tenodesis interventions had benefits in type II SLAP lesions [1].
Biceps tenodesis is a safe, effective, and technically straightforward alternative to primary SLAP repair in patients with type II and IV SLAP tears [4].
For operative treatment, biceps tenodesis has consistent and reliable results, whereas return to play after SLAP repair can be unpredictable [5].
SLAP repairs are generally favored in younger, active patients, whereas treating the biceps is preferred in lower-demand patients aged >30 years [6].
Biceps tenodesis has been increasingly used for the management of SLAP lesions, with recent studies reporting high rates of return to sport, high satisfaction, and good to excellent patient-reported outcomes in carefully selected athletes [7].
SLAP repair and biceps tenodesis both present viable treatment options but come with specific advantages and disadvantages, with the decision ultimately made individually with the patient [8].
Increased patient age correlates with the likelihood of treatment with biceps tenodesis or tenotomy versus SLAP repair [13].
Primary biceps tenodesis offers increased effectiveness when compared with both primary SLAP repair and nonoperative treatment and lower costs than primary SLAP repair [24].
The treatment option of biceps tenodesis is an appealing alternative to SLAP repair, but the indications and technique of biceps tenodesis in the elite pitcher still need to be defined [26].

Biceps Tenodesis vs. Tenotomy¶

Treatment of proximal biceps pathology is largely based on expert opinion and patient preferences rather than robust randomized evidence [20].
Patients undergoing treatment for LHBT or SLAP pathology with either biceps tenodesis or tenotomy can be expected to experience similar improvements in patient-reported and functional outcomes [23].
Patient age should not be used as the sole criterion when deciding between biceps tenotomy and tenodesis [49].

Subpectoral Biceps Tenodesis Outcomes¶

Primary subpectoral open biceps tenodesis for SLAP tears or pathology of the LHBT provides significant improvement in shoulder outcomes with a reliable return to activity level with low risk for complications [9].
Short-term follow-up of 20 procedures has not shown any failure of fixation or residual biceps discomfort [15].
Subpectoral biceps tenodesis utilizing a dual suture anchor technique is a treatment option for SLAP lesions, partial thickness tears, subluxation, and tenosynovitis of the long head of the biceps with high rates of postoperative patient satisfaction, a low failure rate, and improved outcome scores [31].
Biceps tenodesis is a predictable, safe, and effective treatment for failed arthroscopic SLAP tears at a minimum 2-year follow-up [10].
Although revision to subpectoral biceps tenodesis may be an effective strategy to address failed prior biceps surgery, the potential complication of persistent pain must be emphasized [54].

Nonoperative Management¶

Appropriate treatment for biceps pathology, whether conservative or surgical, should be based on established pathology [11].
Diagnosis and nonoperative management of long head of biceps tendon disorders are categorized as inflammation, instability, and rupture, requiring specific protocols [41].

Associated Pathology¶

If calcific tendinitis of the long head of the biceps brachii at its origin is suspected, it may be helpful to consider the presence of a concurrent SLAP lesion and its management [2].

Complications¶

A positive subpectoral biceps test was associated with gross pathologic changes of the biceps in 93% of patients [3].
The incidence of subsequent surgery after isolated arthroscopic SLAP repair is 10.1% [14].
Subsequent surgery after isolated SLAP repair is often related to an additional diagnosis [14].
Risk factors for revision surgery after SLAP repair include age >40 years [18].
Risk factors for revision surgery after SLAP repair include female sex [18].
Risk factors for revision surgery after SLAP repair include obesity [18].
Risk factors for revision surgery after SLAP repair include smoking [18].
Risk factors for revision surgery after SLAP repair include diagnosis of biceps tendinitis or long head of the biceps tearing [18].
Short-term follow-up of 20 procedures using an all-suture anchor fixation for subpectoral biceps tenodesis has not shown any failure of fixation [15].
Short-term follow-up of 20 procedures using an all-suture anchor fixation for subpectoral biceps tenodesis has not shown any residual biceps discomfort [15].
In patients with chronic long head biceps tendinopathy undergoing open subpectoral tenodesis, MRI and intraoperative assessment did not show significant structural abnormalities within the tendon despite significant histopathologic changes [19].

Recovery¶

Arthroscopic repair and biceps tenotomy/tenodesis both provide benefits for type II SLAP lesions [1].
Biceps tenodesis is a safe, effective, and technically straightforward alternative to primary SLAP repair for type II and IV SLAP tears [4].
Biceps tenodesis yields consistent and reliable results for operative treatment in overhead athletes, whereas return to play after SLAP repair can be unpredictable [5].
Biceps tenodesis is increasingly used for SLAP lesions, with recent studies reporting high rates of return to sport, high satisfaction, and good to excellent patient-reported outcomes in carefully selected athletes [7].
SLAP repair and biceps tenodesis are both viable treatment options with specific advantages and disadvantages, with the decision made individually with the patient [8].
Primary subpectoral open biceps tenodesis for SLAP tears or long head of the biceps pathology provides significant improvement in shoulder outcomes, reliable return to activity level, and low risk for complications [9].
Biceps tenodesis is a predictable, safe, and effective treatment for failed arthroscopic SLAP tears at a minimum 2-year follow-up [10].
Increased patient age correlates with the likelihood of treatment with biceps tenodesis or tenotomy versus SLAP repair [13].
There is a 10.1% incidence of subsequent surgery after isolated SLAP repair, often related to an additional diagnosis [14].
Short-term follow-up of 20 procedures using an all-suture anchor fixation for subpectoral biceps tenodesis showed no failure of fixation or residual biceps discomfort [15].
Risk factors for revision surgery after SLAP repair include age >40 years, female sex, obesity, smoking, and diagnosis of biceps tendinitis or long head of the biceps tearing [18].
Biceps tenodesis may be considered a valid primary or revision surgery for symptomatic type II SLAP tears due to no detrimental effect on glenohumeral stability [21].
Superior clinical outcomes are seen in nonsmokers, those with only 1 tendon affected, and those who undergo tenotomy instead of tenodesis for a damaged long head of biceps tendon [58].

Key Evidence¶

[L1] Both arthroscopic repair and biceps tenotomy and tenodesis interventions had benefits in type II SLAP lesions. [1] (10.1186/s13018-019-1096-y)
[L4] The authors conclude that if calcific tendinitis of the long head of the biceps brachii at its origin is suspected, it may be helpful to consider the presence of a concurrent SLAP lesion and its management. [2] (10.1007/s00167-007-0323-y)
[L3] A positive subpectoral biceps test was associated with gross pathologic changes of the biceps in 93% of patients. [3] (10.1016/j.arthro.2019.02.017)
[L4] Based on these results, biceps tenodesis is a safe, effective, and technically straightforward alternative to primary SLAP repair in patients with type II and IV SLAP tears. [4] (10.1177/0363546514540273)
[L5] For operative treatment, biceps tenodesis has consistent and reliable results, whereas return to play after SLAP repair can be unpredictable. [5] (10.1016/j.csm.2015.08.009)
[L5] SLAP repairs are generally favored in younger, active patients, whereas treating the biceps is preferred in lower-demand patients aged >30 years. [6] (10.1016/j.jse.2024.09.040)
[L5] Biceps tenodesis has been increasingly used for the management of SLAP lesions, with recent studies reporting high rates of return to sport, high satisfaction, and good to excellent patient-reported outcomes in carefully selected athletes. [7] (10.5435/jaaos-d-21-01199)
[L5] SLAP repair and biceps tenodesis both present viable treatment options but come with specific advantages and disadvantages, with the decision ultimately made individually with the patient. [8] (10.1016/j.arthro.2019.02.026)
[L4] Primary subpectoral open biceps tenodesis for SLAP tears or pathology of the LHBT provides significant improvement in shoulder outcomes with a reliable return to activity level with low risk for complications. [9] (10.1016/j.arthro.2019.06.035)
[L4] Biceps tenodesis is a predictable, safe, and effective treatment for failed arthroscopic SLAP tears at a minimum 2-year follow-up. [10] (10.1177/0363546513520122)
[Paper] The article outlines that appropriate treatment for biceps pathology, whether conservative or surgical, should be based on established pathology. [11] (10.1016/j.csm.2009.12.003)
[L5] Understanding the function and pathology surrounding the teres minor is paramount in comprehensive management of the patient with shoulder pathology. [12] (10.5435/jaaos-d-15-00258)
[L3] Increased patient age correlates with the likelihood of treatment with biceps tenodesis or tenotomy versus SLAP repair. [13] (10.1177/0363546514534939)
[L3] We identified a 10.1% incidence of subsequent surgery after isolated SLAP repair, often related to an additional diagnosis, suggesting that clinicians should consider other potential causes of shoulder pain when considering surgery for patients with SLAP lesions. [14] (10.1016/j.arthro.2016.01.053)
[L5] Short-term follow-up of 20 procedures has not shown any failure of fixation or residual biceps discomfort. [15] (10.1007/s00167-014-3348-z)
[L5] There is no single pattern of pain that distinguishes biceps conditions from other shoulder abnormalities. [16] (10.1016/j.csm.2015.08.004)
[L4] In the context of rotator cuff disease, the etiology of anterior shoulder pain with macroscopic changes in the biceps tendon is related to the complex interaction of the tendon and surrounding soft tissues, rather than a single entity. [17] (10.1016/j.jse.2008.05.044)
[L3] Risk factors for revision surgery after SLAP repair include age >40 years, female sex, obesity, smoking, and diagnosis of biceps tendinitis or long head of the biceps tearing. [18] (10.1177/0363546517691950)
[L4] In patients with chronic long head biceps tendinopathy who underwent open subpectoral tenodesis, MRI and intraoperative assessment did not show significant structural abnormalities within the tendon despite significant histopathologic changes. [19] (10.1016/j.arthro.2018.01.021)
[L5] Treatment of proximal biceps pathology is largely based on expert opinion and patient preferences rather than robust randomized evidence. [20] (10.1097/corr.0000000000002448)
[L5] Biceps tenodesis may be considered a valid primary or revision surgery for patients suffering from symptomatic type II SLAP tears due to no detrimental effect on glenohumeral stability. [21] (10.1016/j.jse.2013.07.036)
[L5] Diagnosis of long head biceps tendon and subscapularis pathology in association with shoulder rotator cuff pathology can be challenging due to limitations in MRI and arthroscopic visualization; surgeons should maintain a high level of suspicion and utilize specific techniques to prevent missing pathology. [22] (10.1016/j.arthro.2017.09.005)
[L1] Patients undergoing treatment for LHBT or SLAP pathology with either biceps tenodesis or tenotomy can be expected to experience similar improvements in patient-reported and functional outcomes. [23] (10.1016/j.jse.2020.11.012)
[L3] Primary biceps tenodesis offers increased effectiveness when compared with both primary SLAP repair and nonoperative treatment and lower costs than primary SLAP repair. [24] (10.1016/j.arthro.2018.01.029)
[L4] The concomitant presence of SLAP and pulley lesions is significantly rare, occurring in only about 10% of all patients with SLAP and pulley lesions. [25] (10.1016/j.arthro.2011.01.005)
[L5] The treatment option of biceps tenodesis is an appealing alternative to SLAP repair, but the indications and technique of biceps tenodesis in the elite pitcher still need to be defined. [26] (10.1016/j.arthro.2018.01.001)
[L5] Biomechanical studies indicate that the long head of the biceps contributes to stability of the glenohumeral joint in all directions, though in vivo studies have yet to establish this stabilizing effect and the physiologic load required remains unknown. [28] (10.1016/j.arthro.2010.10.014)
[L4] Subpectoral biceps tenodesis utilizing a dual suture anchor technique is a treatment option for SLAP lesions, partial thickness tears, subluxation, and tenosynovitis of the long head of the biceps with high rates of postoperative patient satisfaction, a low failure rate, and improved outcome scores. [31] (10.1007/s00402-017-2810-z)
[L5] The long head of the biceps has a pertinent biomechanical role in glenohumeral stability regardless of the condition of the superior labrum. [32] (10.1016/j.arthro.2025.05.022)
[L4] Validity for strength testing of the serratus anterior muscle is optimal with subjects in a seated position and the shoulder flexed at 90° in the scapular plane. [33] (10.1186/s12891-019-2741-7)
[L5] Treatment is directed at managing underlying causes and restoring normal scapular muscle activation patterns by kinetic chain–based rehabilitation protocols. [35] (10.5435/00124635-200303000-00008)
[L5] Both proposed superior labral reconstruction techniques increased the force needed for humeral head superior migration in the setting of a labral tear. [36] (10.1016/j.arthro.2018.08.049)
[L5] This review examines the role of the LHBT as a source of local autograft, with biological and biomechanical properties, in aiding outcomes of complex primary and revision shoulder surgery procedures. [40] (10.1016/j.jse.2023.04.009)
[L5] Diagnosis and nonoperative management of long head of biceps tendon disorders are categorized as inflammation, instability, and rupture, requiring specific protocols. [41] (10.1016/j.csm.2015.08.006)
[L4] Potential prognostic variables associated with final subscapularis strength remain elusive. [42] (10.1016/j.jse.2014.06.042)
[L5] The ultimate load to failure and stiffness for the two methods were not different. [43] (10.1007/s00167-013-2775-6)
[L3] High-demand patients with biceps tendonitis in the setting of a SLAP lesion with labral instability who undergo combined tenodesis and labral repair have significantly worse outcomes than patients who undergo either isolated labral repair for type II SLAP tears or isolated biceps tenodesis for a SLAP tear and biceps tendonitis. [44] (10.1007/s00167-015-3774-6)
[L5] Biceps tendon pain in the absence of tears is associated with microscopic changes consistent with tendinopathy, which are often missed by MRI. [46] (10.1016/j.csm.2015.08.002)
[L3] Most abnormal MRI findings were not different in frequency between symptomatic and asymptomatic shoulders. [47] (10.1016/j.jse.2019.04.001)
[L1] We do not find any value in bicipital groove morphology measured by MRI as a predictor of biceps tendon or rotator cuff pathology at the time of surgery. [48] (10.1016/j.jse.2010.04.044)
[L4] Patient age should not be used as the sole criterion when deciding between biceps tenotomy and tenodesis. [49] (10.1016/j.arthro.2016.04.022)
[L3] Biceps tenodesis remains a reliable treatment for pathologic abnormality of the long head of the biceps. [50] (10.1177/0363546515570024)
[L3] Preoperative MRI scans of the shoulder interpreted by orthopaedic surgeons with the described systematic approach resulted in improved accuracy in diagnosing subscapularis tendon tears compared with previous studies. [51] (10.1016/j.arthro.2012.04.142)
[L4] Although this may be an effective strategy to address failed prior biceps surgery, the potential complication of persistent pain must be emphasized. [54] (10.1177/0363546519892922)
[L4] In approximately 80% of the intra-articular biceps tears evaluated in this study, a 'hidden lesion' was observed going beyond the bicipital groove and extending to the distal extra-articular portion. [55] (10.1177/0363546514554193)
[L5] The MTJ of the biceps begins further proximal than may be appreciated intraoperatively. [56] (10.1177/0363546513482297)
[L4] Superior clinical outcomes are seen in nonsmokers, those with only 1 tendon affected, and those who undergo tenotomy instead of tenodesis for a damaged long head of biceps tendon. [58] (10.1016/j.jse.2019.12.011)

References¶

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