Purpose
The long head of the biceps can develop tendonitis and tendinosis, which can lead
to pain in the bicipital groove. The use of bicortical button fixation allows for
a smaller defect in the humerus compared with tenodesis screws, reducing the risk
of fracture. Our objective is to evaluate the exit location of our bicortical button
and its relation to relevant posterior nervous structures.
Methods
We performed anatomic dissection of 6 fresh-frozen cadaveric upper extremities. At
the level of the inferior border of the pectoralis major tendon, the musculotendinous
junction of the long head of the biceps was identified. At the base of the bicipital
groove, a 3.2-mm guidewire was advanced perpendicularly through both the anterior
and posterior cortex. Posteriorly, the radial and axillary nerves were carefully dissected.
For each dissection, we recorded the closest distance from the posterior cortical
hole created by our drill to both the axillary and radial nerves using digital calipers.
Results
The mean distance from the axillary nerve to the posterior drill hole was 25.1 mm
(95% confidence interval, 21.6 to 28.6 mm). The mean distance from the radial nerve
to the posterior drill hole was 30.3 mm (95% confidence interval, 27.2 to 33.4 mm).
Conclusions
With placement of the tenodesis at the inferior aspect of the bicipital groove in
conjunction with the musculotendinous junction, open subpectoral tenodesis of the
long head of the biceps can be performed using bicortical button fixation without
risk to the posterior nervous structures.
Clinical Relevance
This cadaveric study suggests that posterior proximal humerus nervous structures can
be avoided with proper tenodesis placement.
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Article Info
Publication History
Published online: May 25, 2014
Accepted:
March 21,
2014
Received:
December 26,
2013
Footnotes
The authors report that they have no conflicts of interest in the authorship and publication of this article.
Identification
Copyright
Published by Elsevier Inc.
