The Long Head of Biceps Tendon Tenotomy in Idiopathic Glenohumeral Adhesive Capsulitis Surgery Improves Early Rehabilitation Outcomes.

Abstract

Objective: Idiopathic glenohumeral adhesive capsulitis, known as idiopathic frozen shoulder (IFS) and characterized by pain and limited motion of the shoulder, is often treated by arthroscopic capsule release surgery, though residual symptoms may remain postoperatively. Due to overlapping symptoms and shared anatomical involvement, it is hard to distinguish the source of shoulder pain between concurrent long head of the biceps tendon (LHBT) inflammation and IFS. The study aimed to verify that LHBT tenotomy, compared with leaving it in situ, could provide better pain reduction and shoulder mobility in early rehabilitation of post-arthroscopic IFS capsule release surgery.

Methods: From January 2020 to January 2022, 73 patients with idiopathic adhesive capsulitis were divided into two groups based on the preoperative LHBT lesions and treatment received for LHBT: tenotomy or left in situ. All patients underwent arthroscopic capsular release, coracohumeral ligament release, and subacromial decompression. Outcomes were measured before surgery and at 1, 3, 6, 12, and 24 months and final follow-up postoperatively, including shoulder functional scores, joint range of motion, visual analog scale (VAS) score for pain, and complications. T-test, Chi-square test, and Fisher's test were performed to analyze the data.

Results: This study found that while functional scores and joint range of motion of both groups improved significantly in the final follow-up, the LHBT tenotomy group showed lower VAS scores for pain at 1 (2.2 ± 0.8) and 3 months (2.1 ± 0.6) postoperatively (p < 0.001). Additionally, there was better shoulder mobility in external rotation compared to the LHBT left in situ group at 1-12 months postoperatively (p < 0.001). There was no significant difference in postoperative complications between the two groups.

Conclusion: In idiopathic adhesive capsulitis patients undergoing arthroscopic release, LHBT tenotomy led to significant improvements in joint mobility and pain reduction in early rehabilitation stages compared with leaving LHBT in situ, despite two groups showing no significant difference at the final follow-up postoperatively.