title: Rotator Cuff-Sparing Approach for Antegrade Humeral Nailing With Biceps Tenodesis: A Technical Trick With Clinical Implications.
abstract: Antegrade intramedullary nails are an established, effective method of fixation for humeral shaft fractures. One significant limitation of this technique is chronic postoperative shoulder pain, which is likely related to the standard approach that involves splitting the rotator cuff to gain access to the nail starting point. Furthermore, mounting evidence suggests that both the intra-articular portion of the biceps tendon and the extra-articular portion in the bicipital groove can scar down after trauma, causing pain and limiting shoulder range of motion. We describe an approach through the rotator interval with tenodesis of the biceps tendon and resection of the intra-articular portion. Using a rotator cuff interval instead of a rotator cuff insertion approach allows access to the optimal humeral nail starting point while avoiding damage to intra-articular structures of the shoulder, potentially decreasing sources of postoperative shoulder pain.
authors: *Hospital for Special Surgery, New York, NY; †New York Presbyterian Hospital, Weill Cornell Medical College, New York, NY; and ‡New York Presbyterian Hospital, Weill Cornell Medical College, New York, NY.
authors: Alexander B
authors: AB
authors: Christ
authors: Elizabeth B
authors: EB
authors: Gausden
authors: Stephen J
authors: SJ
authors: Warner
authors: Andrew M
authors: AM
authors: Nellestein
authors: Ryan R
authors: RR
authors: Thacher
authors: Dean G
authors: DG
authors: Lorich
mesh_terms: D003131:Combined Modality Therapy / Q000379:methods; D005260:Female; D005594:Fracture Fixation, Intramedullary / Q000009:adverse effects / Q000379:methods*; D017102:Fracture Healing; D000070632:Hamstring Tendons / Q000601:surgery*; D006801:Humans; D006810:Humeral Fractures / Q000175:diagnosis / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D059351:Organ Sparing Treatments / Q000379:methods*; D000070636:Rotator Cuff Injuries / Q000209:etiology / Q000517:prevention & control*; D053656:Tenodesis / Q000379:methods*; D016896:Treatment Outcome