disclosures, and I want to thank Gus for pulling this off. To know them is to love them. So, can't find my biceps. Well, I have one thing to say this morning, or this afternoon, don't be a hero. The treatment may be worse than the problem. Complications are not uncommon, and I am a very passionate bicep saver. God gave us a bicep for a reason. It's a humor head depressor. I repeat, it is a humor head depressor. It confers stability. Craig Morgan calls it the ACL of the shoulder. Craig Payne has some wonderful anatomic studies showing it's a tension band of the superior labrum. Tenodesis versus tenotomy, it's still controversial. We don't have the answers. You can injure the muscutaneous nerve, I have. You can cause a fracture, I have. And medial retraction, John Dickinson in the audience showed that you can injure all these nerves. Shane Ngo and others have shown you can injure the muscutaneous nerve, brachial plexus, re and sethe, the axillary nerve. These have all been described in literature, so it's nothing to be taken lightly. And beware of medial retraction. This is how I gave someone a neuropraxy early in my career, never again. And this is not one of my patients, but if you put a big hole in a bone with high stress, bad things happen. It's related to cortical hole size. You lessen the risk of screw, and less so with buttons, and even less so with suture anchors, but it still can happen. And don't forget, the jury is still out. We don't have all the answers. We could go to many shoulder conferences, and there was a recent prospective randomized trial, no difference in strength or clinical scores at 12 months, tenodesis versus tenotomy. Belay, prospective trial, no difference in clinical scores, but tenotomy gave earlier pain relief with the Popeye deformity. So the sixth commandment, thou shalt not kill, and this is violated daily by many of us, and I'm a professed bicep saver. I think it makes patients feel better, no question, short term, but so is taking active meniscus. So these are all articles, and this is one of many showing the biceps' role in stability. Mark Radowski, Fatser, Pagnani, others, Jed Kuhn, people who are smarter than me, but this is the one that really grabbed my attention, Craig Bain, the superior labrum is very mobile, and it relies on dynamization of the biceps to become a tension band. It sits off of the glenoid, so when it contracts, it actually dynamizes superior labrum. Mark Radowski showed that the biceps diminish the stress on the IGHL. I'm not making this up. Lee's two or three studies showed that the biceps, if you cut it, you will get superior head migration approximately, Kumar showed about over five millimeters in acromiol distance rising. Here's where it gets really interesting. Tai Lee, two cadaveric studies. You load the biceps in late cocking and follow through. What it really does, it centers the joint. In late cocking, you get posterior translation, the biceps, when it contracted, pushes it forward. In follow through, you get anterior translation. In contraction, it brings it back, so it's a centering device, very important. So, we talk about good slap, bad slap, but the biceps, the anchor of the biceps is important. It is a humor head depressor and stabilizer. And again, Craig Morgan calls it the ACL of the knee, of the shoulder, excuse me. So, Tai Lee says, the function of the biceps has become more important over in throwing athletes. Biceps tenotomy or tenodesis should be approached with caution in these cases, amen. And if you give sheer stress, which we've shown it does cause by cutting it, you have Arthur. This is one of Gus's tenotomies two years out, so I had to throw that in there, Gus. Bless me for I have sinned. And Jed Kuhn, a lot smarter than I am, showed a nice study. Extra rotation of the glenohumeral joint, ligament restraints and muscle effects. Quote, another interesting finding from the study was the role of the biceps tendon, which was found to be significant dynamic restraint near the end of rotation in the abducted position. So, he's saying, well, how do we fail labor repair, biceps? Well, many of those studies were done in cases that shouldn't have been done in the first place. The bumper wasn't restored. The biceps would have been hogtied. You have prominent suture knots. I've trashed shoulders with prominent anchors. The kinetic chain wasn't addressed. This is my case last week. I used horizontal mattress to get the bumper. I don't use suture in the joint. You can trash a joint with just one errant anchor. So, don't be a hero. If you can't find it, go home. Most patients will do well. Complications are real. Been there, done that. Really think about twice of being a biceps killer. Thank you very much.

biceps

shoulder stability

complications

nerve injury

kinetic chain