humerus fracture after biceps tenodesis

Humeral Fracture Following Biceps Tenodesis in a Baseball Pitcher

At this year’s ASMI Injuries in Baseball course, one of the topics that we discussed at length was the use of biceps tendodesis in baseball pitchers.  Over the years, our understanding of SLAP lesions has evolved and many are advocating a biceps tenodesis procedure.  While this may be a viable option for older individuals, I have never been a fan of this in athletes that need to use their shoulder at maximum range of motion and velocity.  I just don’t think the concept of “if it hurts just cut if off” makes the most sense to me.

SEE ALSO: Is Biceps Tenodesis the Answer?

A recent case report in AJSM actually describes one of the biggest reasons why I am think we really need to question the use of biceps tenodesis in baseball pitchers: A humeral fracture.

humerus fracture after biceps tenodesis

The white arrow is the drill hole from the biceps tenodesis.  This came up at the ASMI course with the panel of surgeons, including Dr. James Andrews, Dr. Lyle Cain, and Dr. Xavier Duralde of the Braves.  The rotational torque observed on the humerus while pitching are extremely high.  Putting a screw in there scares me a bit.

SEE ALSO: Dr. Lyle Cain from the American Sports Medicine Institute discusses some facts and fiction related to the biceps tenodesis surgery.

What do you think?  Does this x-ray of a humeral fracture following a biceps tenodesis in a baseball pitcher scare you a little too?

8 replies
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  2. Stephen Thomas, PhD, ATC
    Stephen Thomas, PhD, ATC says:


    I agree with you, I’m not in favor of biceps tenodesis in throwing athletes or even older individuals with chronic rotator cuff tears that want to remain active. Not to get all religious but God put it there for a reason! The biceps clearly has a role at the shoulder and when it is detached the arthrokinematics are altered permanently.

    As far as the x-ray you presented, it looks to me like that tenodesis was performed much to inferior. They are typically placed within the bicipital groove near the humeral head. What do you think?

  3. Rod Y PT (MN)
    Rod Y PT (MN) says:

    too bad this patient did not listen to his health care team about playing year round baseball to begin with.
    “46-year-old, right hand–dominant
    man who was a pitcher for a year-round adult baseball league”

    Another factor would be size of the pin hole “guide pin was then overreamed using an 8-mm reamer, taking care to not penetrate the far, or opposite,
    cortex of the humerus.” I do not know if 8mm is standard for this procedure. Previous study show that drilling into the clavicle with too large of holes will obviously lead to higher rates of clavicle fx. Thanks for posting this article Mike!

  4. David
    David says:

    Mike, What about the instability ramifications of the tenodesis in an overhead athlete? Why is this surgical technique being considered when the biceps is so vital to stability with this population?

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