Introduction This article describes our biceps suspension procedure for painful inferior subluxation of the glenohumeral joint in hemiparetic patients.
Step 1: Position Patient and Expose the Biceps TendonPosition the patient supine and expose the long head of the biceps tendon.
Step 2: Create TunnelUse a curet to connect holes drilled at the superior and inferior aspects of the lesser tuberosity.
Step 3: Prepare Biceps Tendon Incise the tendon at the musculotendinous junction to preserve as much length of the biceps tendon as possible.
Step 4: Create SuspensionCreate a loop with the tendon, and suture the distal end to the proximal end.
Step 5: Postoperative Protocol Use a sling for three months, followed by active range-of-motion exercises.
Results In summary, all patients noted pain relief after surgery, ten (of eleven) noted decreased deformity, and nine were “very satisfied” with the outcome.
What to Watch For Indications
Pitfalls & Challenges
This article describes our biceps suspension procedure for painful inferior subluxation of the glenohumeral joint in hemiparetic patients.
After upper motor neuron injury, including stroke, traumatic brain injury, encephalitis, and brain tumor, patients typically experience a period of muscle flaccidity followed by a pattern of spasticity, weakness, impaired motor control, and rigidity. During this initial period of flaccid paralysis, patients often develop inferior subluxation of the shoulder1. Glenohumeral subluxation is commonly self-limited and painless, but it can be painful in some patients. Often, these patients complain of pain that is worse with sitting or standing or at any time that the arm is unsupported.
Shoulder contractures are common, and the shoulder often has an adducted and internally rotated posture at rest2. If a patient's symptoms are relieved by manual reduction of the glenohumeral subluxation, the pain is considered mechanical in nature and potentially amenable …
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