A Technique for Endoscopic-Assisted Subpectoral Biceps Tenodesis

Shoulder pain associated with the proximal biceps or biceps anchor labral injuries is a common and often debilitating problem. While a number of conservative treatment options exist, when these fail, operative management with tenodesis or tenotomy of the long head of the biceps in appropriate patient populations can provide excellent clinical outcomes. While both procedures offer excellent pain relief, tenodesis provides cosmetic benefits and may improve some degree of cramping, soreness, and weakness in supination. A number of techniques, including all-arthroscopic suprapectoral and open subpectoral tenodesis, have been well-described. While there is some debate over the contribution of groove pain to patient symptomatology, subpectoral tenodesis is lauded as a technique which can eliminate this potential pain source. There are some concerns with incision size and location as well as risks of iatrogenic fracture or tendon pullout with traditional techniques of open subpectoral tenodesis. Here we describe a novel endoscopic-assisted technique that can improve visualization and tendon insertion in a minimally invasive manner.