title: Biceps muscle fatty infiltration and atrophy. A midterm review after arthroscopic tenotomy of the long head of the biceps.
abstract: OBJECTIVE
  Pathology of the long head of the biceps (LHB) tendon is commonly treated by tenotomy. High levels of clinical function and patient satisfaction are reported in the short-term. The purpose of this study was to investigate the midterm effects of tenotomy on biceps fatty infiltration and atrophy in active working-age male patients.
  
  
  METHODS
  Twenty-five men (mean age, 57 years) were evaluated at a mean follow-up of 6.7 years after tenotomy. Bilateral magnetic resonance imaging (MRI) was performed, and fatty infiltration of the biceps was assessed relative to the ipsilateral triceps. Seventeen participants had an intact contralateral LHB tendon. To assess atrophy, anterior muscle compartment volume was measured by serial cross-sectional area measurements on MRI. The tenotomized side was then compared to the healthy side in these 17 participants. Clinical scores were obtained using the QuickDASH and Oxford Elbow Score, and the occurrence of a Popeye sign and residual pain were recorded.
  
  
  RESULTS
  Good clinical function was maintained at a mean follow-up time of 6.7 years (range, 4 to 10 years) (QuickDASH score of 7.1; standard error [SE], 1.8) and Oxford Elbow Score of 97.9 [SE 1.2]). Eleven of the 25 participants had a Popeye deformity. Four participants showed signs of fatty infiltration, and all were minor (grade 1). The mean decrease in total volume of the anterior musculature was 3.6%. In participants without a Popeye deformity, it was 3.3%, whereas it was 4.1% in participants with a Popeye sign (P = .8).
  
  
  CONCLUSIONS
  In the midterm, LHB tenotomy in active men of working age does not result in fatty degeneration or substantial atrophy in the anterior musculature of the arm. Clinical function remains good.
  
  
  METHODS
  Level IV, therapeutic case series.
authors.affiliation: Department of Orthopaedic Surgery, Sir Charles Gairdner Hospital, Perth, Australia. Electronic address: bertramthe@hotmail.com.
authors.forename: Bertram
authors.initials: B
authors.lastname: The
authors.affiliation: School of Sport Science, Exercise and Health, University of Western Australia, Perth, Australia.
authors.forename: Mike
authors.initials: M
authors.lastname: Brutty
authors.affiliation: Department of Orthopaedic Surgery, Sir Charles Gairdner Hospital, Perth, Australia; School of Sport Science, Exercise and Health, University of Western Australia, Perth, Australia; Saint John of God Hospitals, Perth, Australia.
authors.forename: Allan
authors.initials: A
authors.lastname: Wang
authors.affiliation: SKG Radiology, Perth, Australia.
authors.forename: Nicholas D K
authors.initials: ND
authors.lastname: Wambeek
authors.affiliation: Saint John of God Hospitals, Perth, Australia.
authors.forename: Peter
authors.initials: P
authors.lastname: Campbell
authors.affiliation: Saint John of God Hospitals, Perth, Australia.
authors.forename: Michael J C
authors.initials: MJ
authors.lastname: Halliday
authors.affiliation: School of Sport Science, Exercise and Health, University of Western Australia, Perth, Australia.
authors.forename: Timothy R
authors.initials: TR
authors.lastname: Ackland
mesh_terms: D000273:Adipose Tissue / Q000473:pathology*; D000328:Adult; D001132:Arm; D001182:Arthroscopy; D001284:Atrophy; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D018482:Muscle, Skeletal / Q000473:pathology* / Q000601:surgery; D009135:Muscular Diseases / Q000209:etiology / Q000473:pathology*; D013710:Tendons / Q000601:surgery; D058971:Tenotomy / Q000009:adverse effects*