Proximal humeral fractures treated with hemiarthroplasty: does tenodesis of the long head of the biceps improve results?

Injury. 2013 Apr;44(4):461-4. doi: 10.1016/j.injury.2012.09.012. Epub 2012 Oct 11.


Introduction: Pathology of the long head of the biceps (LHB) may be the cause of anterior shoulder pain after hemiarthroplasty for treatment of fractures of the proximal humerus. The currently available literature lacks adequate randomised trials examining whether tenodesis of the LHB improves results. The purpose of this study was to evaluate the effects of tenodesis of the LHB on the clinical outcome following hemiarthroplasty for fractures of the proximal humerus.

Methods: This prospective randomised study included 37 patients treated with hemiarthroplasty for four-part fractures, fracture dislocations and head-splitting fractures. The LHB was left intact in 18 patients (group 1) and tenodesis was performed in 19 patients (group 2). The mean age was 51.0 ± 3.7 years and 53.1 ± 4.6 years in group 1 and group 2, respectively. All patients were operated on by the same surgeon in the first 5 days after injury and one type of prosthesis was used. The shoulder was immobilised for 4 weeks before performing the same physiotherapy protocol. Pain and range of motion were assessed by a blinded observer.

Results: Patients were followed up for a mean of 25.1 ± 3.9 months in group 1 and 22.6 ± 3.6 months in group 2. They were evaluated using the Constant score; it had a mean of 69.8 ± 6.6 for group 1 and a mean of 74.4 ± 6.5 points for group 2 (p = 0.04). Shoulder pain affected six patients in group 1 (33.3%) and only affected three patients in group 2 (15.8%) (p = 0.03). There was no significant difference in active anterior elevation of the shoulder between both groups.

Conclusions: The data obtained support the hypothesis to routinely perform a tenodesis of the LHB during hemiarthroplasty for treatment of fractures of the proximal humerus to improve pain and have better results.

Level of evidence: Level I therapeutic.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Female
  • Follow-Up Studies
  • Hemiarthroplasty* / adverse effects
  • Hemiarthroplasty* / methods
  • Humans
  • Male
  • Middle Aged
  • Prospective Studies
  • Radiography
  • Range of Motion, Articular
  • Shoulder Fractures / diagnostic imaging
  • Shoulder Fractures / physiopathology
  • Shoulder Fractures / surgery*
  • Shoulder Pain / diagnostic imaging
  • Shoulder Pain / physiopathology
  • Shoulder Pain / surgery*
  • Tendons / physiopathology
  • Tendons / surgery*
  • Tenodesis* / methods
  • Treatment Outcome