Nanoscopic Long Head of the Biceps Tendon Tenotomy with Suprascapular Nerve Block: A Feasibility Study

Nanoscopic Long Head of the Biceps Tendon Tenotomy with Suprascapular Nerve Block: A Feasibility Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Nanoscopic Long Head of the Biceps Tendon Tenotomy with Suprascapular Nerve Block: A Feasibility Study Jędrzej Lesman, Błażej Wójtowicz, Michał Szufnara, Cezary Błoch, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7372125/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 02 Feb, 2026 Read the published version in European Journal of Medical Research → Version 1 posted 12 You are reading this latest preprint version Abstract Background: Pathology of the long head of the biceps tendon (LHBT) is a common indication for tenotomy. Needle arthroscopy (NA) has emerged as a minimally invasive alternative to conventional shoulder arthroscopy. The suprascapular nerve block (SSNB) is a promising yet underutilized method of analgesia in orthopedic shoulder procedures. This prospective feasibility study aimed to evaluate the safety, efficiency, and functional outcomes of nanoscopic LHBT tenotomy performed under SSNB in elderly patients. Materials and Methods: Five patients (mean age >70) with isolated anterior shoulder pain and confirmed LHBT pathology were enrolled. All procedures were performed by a single experienced shoulder surgeon using the Arthrex NanoScope system. SSNB was administered preoperatively to minimize discomfort and facilitate muscle relaxation. Visual Analogue Scale (VAS) and Constant Score (CS) assessments were conducted 1 day preoperatively, and at 1 day, 2 weeks, and 6 weeks postoperatively. Results: All procedures were completed without complications. Mean surgical time was 12 minutes. Preoperative VAS averaged 7.8 and CS 51.5. At 1 day postoperatively, mean VAS improved to 4.2 and CS to 68.4. Continued improvements were observed at 2 weeks (VAS 4.0; CS 70.2) and 6 weeks (VAS 3.4; CS 71.8). Conclusion: Nanoscopic LHBT tenotomy under SSNB appears to be a feasible and well-tolerated outpatient procedure in a select group of elderly patients. The addition of SSNB may reduce procedural discomfort and facilitate better visualization by promoting muscle relaxation. Further studies on larger populations are needed to validate these findings. Level of evidence: IV Trial registration: RNN/60/25/KE long head of the biceps tendon needle arthroscopy suprascapular nerve block Visual Analogue Scale Constant Score Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Introduction The long head of the biceps tendon (LHBT) is a common source of shoulder pain and dysfunction, particularly among older adults and patients with degenerative rotator cuff conditions [ 1 , 2 ]. Indications for surgical intervention include tendinopathy, partial tears, instability, and lesions associated with rotator cuff disease. Tenotomy is a widely accepted treatment, especially in patients with low functional demands, offering pain relief and simplifying surgical intervention compared to tenodesis [ 3 , 4 ]. Needle arthroscopy (NA), or in-office needle arthroscopy (IONA), has emerged as a valuable tool in minimally invasive diagnostics and therapeutic procedures of the shoulder. The use of NA in performing biceps tenotomy was pioneered in clinical settings with promising outcomes, reducing cost, anesthesia risk, and recovery time [ 5 – 7 ]. Studies have highlighted its technical feasibility and patient acceptability when conducted under local anesthesia. Complementing NA, the suprascapular nerve block (SSNB) is increasingly recognized for its role in perioperative and intraoperative pain control in shoulder surgery [ 8 , 9 ]. SSNB targets the suprascapular nerve, which innervates approximately 70% of the shoulder joint, including the supraspinatus and infraspinatus muscles. When administered properly, it provides effective analgesia and muscle relaxation, aiding visualization during arthroscopy [ 10 ]. Despite its benefits, SSNB remains underused, possibly due to technical familiarity or reliance on general anesthesia. Combining nanoscopic LHBT tenotomy with SSNB in an outpatient setting may offer a synergistic approach by optimizing patient comfort, surgical efficiency, and recovery. This study explores the feasibility of this method in elderly patients with isolated anterior shoulder pain, unresponsive to conservative treatments. Materials and Methods Patient Selection Five patients aged 70 or older with isolated anterior shoulder pain and ultrasonographic or Magnetic Resonance Imaging (MRI)-confirmed LHBT pathology were included. Patients with massive rotator cuff tears, frozen shoulder, systemic anticoagulation, or high anesthetic risk were excluded. Written informed consent was obtained from all participants prior to their inclusion in the study. The Bioethical Commission of the Medical University of Łódź approved the study protocol (RNN/60/25/KE). All methods were carried out following the ethical guidelines of the 1975 Declaration of Helsinki (latest revision, 2013). Anesthesia and Setup Procedures were conducted in a minor procedure room. SSNB was performed using an in-plane posterior approach under ultrasound guidance with 10 mL of 0.5% ropivacaine and 2 mL of 1% lidocaine. Local anesthetic was infiltrated into skin and subcutaneous tissues along the posterior and anterior portal tracts. Surgical Technique Patients were seated in the beach-chair position. The posterior viewing portal was established using the 0° Arthrex NanoScope. A second anterior portal was introduced for instrumentation (Fig.1). After diagnostic inspection, the LHBT was identified and released at its glenoid attachment using a nanoscopic biter or scissors. The procedure was completed with lavage and assessment of tenotomy completeness. Figures 2-7 provide the visualization of the operated area via 0° Arthrex NanoScope. Outcome Measures Pain and function were assessed using VAS and Constant Score (CS) at 4 timepoints: 1 day before surgery, and 1 day, 2 weeks, and 6 weeks after surgery. Results All five procedures were completed successfully. There were no intraoperative complications. Mean operative time was 12 minutes. The mean preoperative VAS score was 7.8, which decreased to 4.2 one day postoperatively, and further to 4.0 at 2 weeks, and 3.4 at 6 weeks. The CS improved from a baseline mean of 51.5 to 68.4 (1 day), 70.2 (2 weeks), and 71.8 (6 weeks). No adverse effects related to the SSNB were reported. All patients tolerated the procedure well, and early functional recovery was consistent with or superior to prior reports of similar interventions [ 8 , 9 ]. Discussion Our findings confirm the technical feasibility and initial clinical efficacy of nanoscopic LHBT tenotomy combined with SSNB in elderly patients with anterior shoulder pain. The results are consistent with those of Gauci et al. and Rosso et al., who demonstrated satisfactory functional outcomes in similar NA-guided procedures without SSNB [ 5 , 6 ]. The integration of SSNB offers additional advantages, such as improved visualization via supraspinatus and infraspinatus muscle relaxation and enhanced patient comfort during awake procedures [ 8 , 11 ]. Importantly, biceps tenotomy in elderly patients appears to be particularly well-suited for widespread application. Multiple studies have demonstrated that tenotomy in patients over 65 is not only effective but also associated with high satisfaction and low complication rates. Veen et al. performed a study that showed significant improvement in pain and function scores in elderly patients post-tenotomy, with low incidence of cosmetic deformity concerns and minimal cramping [ 12 ]. Moreover, a 2017 meta-analysis comparing tenotomy and tenodesis found no significant difference in outcomes between these techniques, supporting the notion that tenotomy is a safe, efficient, and resource-sparing alternative in the older population [ 13 ]. Our approach stands in contrast to percutaneous LHBT tenotomy performed solely under ultrasound guidance. While ultrasound-guided procedures offer a minimally invasive alternative, they lack the intra-articular visualization that NA provides. Recent data on ultrasound-guided tenotomy in patients averaging 73 years of age demonstrated promising functional improvements [ 14 ]. However, the absence of direct visual control increases the risk of incomplete tenotomy, iatrogenic injury, or missing concomitant intra-articular pathology. The nanoscopic approach offers the best of both worlds — minimal invasiveness with direct visualization, and when combined with SSNB, improves patient comfort and intraoperative efficiency [ 15 ]. The simplicity and minimally invasive nature of the procedure may significantly benefit elderly or comorbid patients [ 16 ]. The elimination of general anesthesia or interscalene block-related complications, such as phrenic nerve palsy or hypotension, makes SSNB a safer and more comfortable alternative for ambulatory surgery [ 9 , 17 ]. Additionally, by limiting the required staff and instrumentation, such procedures may reduce operational costs and increase procedural accessibility, especially in resource-limited settings [ 7 ]. Pain relief and functional outcomes in our study were in line with those observed in prior studies using conventional arthroscopy, suggesting that NA and SSNB do not compromise efficacy. In fact, patients showed notable improvement in CS as early as one day after surgery. This early benefit may be linked not only to effective LHBT decompression but also to the superior analgesia provided by SSNB [ 18 ]. Such immediate improvements support findings by Cho et al. and others advocating for SSNB's analgesic role in rotator cuff and labral procedures [ 8 ]. Another noteworthy feature is the novel use of SSNB in this setting. Compared to traditional interscalene blocks or general anesthesia, SSNB significantly reduces the required anesthetic dose, avoids common complications like phrenic nerve palsy, and enhances muscle relaxation. Studies in both shoulder and hand surgery populations have shown that local infiltration and peripheral nerve blocks reduce anesthetic load and may offer better safety profiles, especially in older or comorbid patients [ 19 , 20 ]. The SSNB facilitated excellent tolerance in our cohort, with no reported adverse events. Finally, this study contributes to the sparse but growing body of literature on therapeutic applications of shoulder nanoscopy beyond diagnostic use. Most prior reports have focused on IONA for visualization or lavage. Our findings add evidence for its efficacy in performing surgical interventions such as tenotomy. As the field of needle arthroscopy evolves, we anticipate broader applications in outpatient orthopedics, particularly when paired with nerve blocks to enhance tolerability. An additional point of interest aspect is the potential for broader procedural use. With increasing surgeon familiarity, SSNB could be combined with other nanoscopic techniques, including subacromial decompression or diagnostic evaluations in the awake patient. The technology's ability to facilitate real-time, patient-guided feedback during diagnostic NA has also been emphasized in recent literature [ 21 ]. Limitations of this study include its small sample size, limiting the statistical power and generalizability of results. The lack of a control group (e.g., NA without SSNB or traditional arthroscopy) restricts the ability to isolate the benefit of SSNB. The short-term follow-up of only 6 weeks does not capture long-term complications or recurrence of symptoms. Additionally, the study was conducted by a single surgeon in a specialized setting, which may not reflect outcomes in broader clinical practice. Finally, patient-reported outcomes beyond VAS and Constant Score (e.g., satisfaction, shoulder-specific Patient Related outcomes) were not assessed. Future research should include randomized controlled trials with larger cohorts, longer follow-up, and comparison arms to better elucidate the value of SSNB in NA-guided procedures. Investigating cost-effectiveness, patient satisfaction, and applicability in diverse clinical settings would further clarify its role. Conclusion Nanoscopic LHBT tenotomy with suprascapular nerve block is a safe, efficient, and minimally invasive option for treating anterior shoulder pain in elderly patients. The technique combines the diagnostic and therapeutic advantages of NA with the analgesic benefits of SSNB. Larger, controlled studies are warranted to confirm these findings and determine optimal patient selection. Abbreviations CS Constant Score IONA in-office needle arthroscopy LHBT long head of the biceps tendon MRI Magnetic Resonance Imaging NA Needle arthroscopy SSNB suprascapular nerve block VAS Visual Analog Scale Declarations Ethics approval and consent to participate: Written informed consent was obtained from all participants prior to their inclusion in the study. The Bioethical Commission of the Medical University of Łódź approved the study protocol (RNN/60/25/KE). All methods were carried out following the ethical guidelines of the 1975 Declaration of Helsinki (latest revision, 2013). Consent for publication: Written informed consent was obtained from all participants prior to their inclusion in the study. Availability of data and material: The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Competing interests: The authors declare that they have no competing interests. Funding: Not applicable. Authors' contributions: JL designed study; JL, BW, CB, MS conducted the procedures; JL and BW collected the data; JL, BW and MS edited the text, MD coordinated and andvised the study Acknowledgements: Not applicable. References Boileau P, Baqué F, Valerio L, Ahrens P, Chuinard C, Trojani C (2007) Isolated arthroscopic biceps tenotomy or tenodesis improves symptoms in patients with massive irreparable rotator cuff tears. J Bone Joint Surg Am 89:747–757. doi:10.2106/JBJS.E.01097 Tashjian RZ, Shin J, Broschinsky K, Yeh CC, Martin B, Chalmers PN, Greis PE, Burks RT, Zhang Y (2020) Minimal clinically important differences in the American Shoulder and Elbow Surgeons, Simple Shoulder Test, and visual analog scale pain scores after arthroscopic rotator cuff repair. J Shoulder Elbow Surg 29:1406–1411. doi:10.1016/j.jse.2019.11.018 Kim JY, Kang MW, Lee HW, Noh KC (2021) Suprascapular nerve block is an effective pain control method in patients undergoing arthroscopic rotator cuff repair: a randomized controlled trial. Orthop J Sports Med 9:2325967120970906. doi:10.1177/2325967120970906 Frost A, Zafar MS, Maffulli N (2009) Tenotomy versus tenodesis in the management of pathologic lesions of the tendon of the long head of the biceps brachii. Am J Sports Med 37:828–833. doi:10.1177/0363546508322179 Gauci MO, Monin B, Rudel A, Blasco L, Bige B, Boileau P (2021) In-office biceps tenotomy with needle arthroscopy: a feasibility study. Arthrosc Tech 10:e1263–e1268. doi:10.1016/j.eats.2021.01.022 Rosso C, Grezda K, Heuberer PR (2022) Long head of the biceps intra-articular tenotomy using needle arthroscopy under local anesthesia: preliminary results and technical note. J Exp Orthop 9:70. doi:10.1186/s40634-022-00508-5 Daggett MC, Stepanovich B, Geraghty B, Meyers A, Whetstone J, Saithna A (2020) Office-based needle arthroscopy: a standardized diagnostic approach to the shoulder. Arthrosc Tech 9:e521–e525. doi:10.1016/j.eats.2019.12.003 Cho N, Kang RS, McCartney CJL, Pawa A, Costache I, Rose P, Abdallah FW (2020) Analgesic benefits and clinical role of the posterior suprascapular nerve block in shoulder surgery: a systematic review, meta-analysis and trial sequential analysis. Anaesthesia 75:386–394. doi:10.1111/anae.14858 Boekel P, Brereton SG, Doma K, Grant A, Kippin A, Wilkinson M, Morse L (2022) Efficacy of surgeon-directed suprascapular and axillary nerve blocks in shoulder arthroscopy: a 3-arm prospective randomized controlled trial. JSES Int 7:307–315. doi:10.1016/j.jseint.2022.12.011 Zhao J, Xu N, Li J, Liang G, Zeng L, Luo M, Pan J, Yang W, Liu J (2021) Efficacy and safety of suprascapular nerve block combined with axillary nerve block for arthroscopic shoulder surgery: a systematic review and meta-analysis of randomized controlled trials. Int J Surg 94:106111. doi:10.1016/j.ijsu.2021.106111 Ahmed AF, Toubasi A, Mahmoud S, Ahmed GO, Al Ateeq Al Dosari M, Zikria BA (2021) Long head of biceps tenotomy versus tenodesis: a systematic review and meta-analysis of randomized controlled trials. Shoulder Elbow 13:583–591. doi:10.1177/1758573220942923 Veen EJD, Boeddha AV, Diercks RL, Kleinlugtenbelt YV, Landman EBM, Koorevaar CT (2021) Arthroscopic isolated long head of biceps tenotomy in patients with degenerative rotator cuff tears: mid-term clinical results and prognostic factors. Eur J Orthop Surg Traumatol 31:441–448. doi:10.1007/s00590-020-02787-z Shang X, Chen J, Chen S (2017) A meta-analysis comparing tenotomy and tenodesis for treating rotator cuff tears combined with long head of the biceps tendon lesions. PLoS One 12:e0185788. doi:10.1371/journal.pone.0185788 Sconfienza LM, Albano D, Messina C, Gitto S, Guarrella V, Perfetti C, Taverna E, Arrigoni P, Randelli PS (2020) Ultrasound-guided percutaneous tenotomy of the long head of biceps tendon in patients with symptomatic complete rotator cuff tear: in vivo non-controlled prospective study. J Clin Med 9:2114. doi:10.3390/jcm9072114 Hartland AW, Islam R, Teoh KH, Rashid MS (2022) Clinical effectiveness of tenotomy versus tenodesis for long head of biceps pathology: a systematic review and meta-analysis. BMJ Open 12:e061954. doi:10.1136/bmjopen-2022-061954 Meeks BD, Meeks NM, Froehle AW, Wareing E, Bonner KF (2017) Patient satisfaction after biceps tenotomy. Orthop J Sports Med 5:2325967117707737. doi:10.1177/2325967117707737 Qawasmi F, Best PD, Andryk LM, Grindel SI (2023) Assessment of two distinct anatomical landmarks for suprascapular nerve injection: a cadaveric study. J Shoulder Elbow Surg 32:2376–2381. doi:10.1016/j.jse.2023.03.029 Aflatooni JO, Meeks BD, Froehle AW, Bonner KF (2020) Biceps tenotomy versus tenodesis: patient-reported outcomes and satisfaction. J Orthop Surg Res 15:56. doi:10.1186/s13018-020-1581-3 Şener A, Demircan A, Keleş A, Bildik F, Karakurt K (2015) Comparison of local infiltration anesthesia and peripheral nerve block: a randomized prospective study in hand lacerations. Turk J Med Sci 45:694–699 Updegrove GF, Stauch CM, Ponnuru P, Kunselman AR, Armstrong AD (2020) Efficacy of local infiltration anesthesia versus interscalene nerve blockade for total shoulder arthroplasty. JSES Int 4:357–361. doi:10.1016/j.jseint.2019.12.007 Peach C, Davies R, Phillips N (2021) Wide-awake shoulder nanoscopic long head of biceps tenotomy. Arthrosc Tech 10:e909–e912. doi:10.1016/j.eats.2020.11.010 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 02 Feb, 2026 Read the published version in European Journal of Medical Research → Version 1 posted Editorial decision: Revision requested 29 Nov, 2025 Reviews received at journal 08 Nov, 2025 Reviewers agreed at journal 28 Oct, 2025 Reviews received at journal 26 Oct, 2025 Reviews received at journal 26 Oct, 2025 Reviewers agreed at journal 26 Oct, 2025 Reviewers agreed at journal 04 Oct, 2025 Reviewers agreed at journal 03 Oct, 2025 Reviewers invited by journal 30 Sep, 2025 Editor assigned by journal 29 Aug, 2025 Submission checks completed at journal 28 Aug, 2025 First submitted to journal 14 Aug, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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02:39:04","extension":"xml","order_by":24,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":59114,"visible":true,"origin":"","legend":"","description":"","filename":"ce511c9b58104a2fa51c41edec3df8841structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7372125/v1/b91476d66f0372b17e138c74.xml"},{"id":93542616,"identity":"3567cb01-d726-4236-b59d-1c4cec430e0c","added_by":"auto","created_at":"2025-10-15 02:39:04","extension":"html","order_by":25,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":70524,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7372125/v1/ca8770b67c354d04acdfb1e7.html"},{"id":93543958,"identity":"eab146e9-6ee5-4dc0-b45c-ed5aab877edf","added_by":"auto","created_at":"2025-10-15 02:47:04","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":2456346,"visible":true,"origin":"","legend":"\u003cp\u003ePortal Placement for Nanoscopic LHBT Tenotomy: Posterior Viewing with 0° Arthrex NanoScope and Anterior Instrumentation Access\u003c/p\u003e","description":"","filename":"Figure11.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7372125/v1/a2b094b7de51956dcaa5de54.jpg"},{"id":93543957,"identity":"cb9a7e1a-6524-4509-85bd-1787e300dfd8","added_by":"auto","created_at":"2025-10-15 02:47:04","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":23535,"visible":true,"origin":"","legend":"\u003cp\u003eVisualization of LHBT Tenotomy via 0° Arthrex NanoScope\u003c/p\u003e","description":"","filename":"Figure21.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7372125/v1/1b4a4787aa6446478aae561c.jpg"},{"id":93542603,"identity":"b5b8e35f-89ed-493b-8569-a5ea93c11616","added_by":"auto","created_at":"2025-10-15 02:39:04","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":25201,"visible":true,"origin":"","legend":"\u003cp\u003eVisualization of LHBT Tenotomy via 0° Arthrex NanoScope\u003c/p\u003e","description":"","filename":"Figure31.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7372125/v1/0faa9a836c1a7f12194d9f67.jpg"},{"id":93543956,"identity":"7512a708-71db-4593-b81a-540f615e7a39","added_by":"auto","created_at":"2025-10-15 02:47:04","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":24920,"visible":true,"origin":"","legend":"\u003cp\u003eVisualization of LHBT Tenotomy via 0° Arthrex NanoScope\u003c/p\u003e","description":"","filename":"Figure41.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7372125/v1/e4374e3d0c6c48b9904fce47.jpg"},{"id":93542605,"identity":"dfe71167-3042-421f-a9bc-f2906f13088a","added_by":"auto","created_at":"2025-10-15 02:39:04","extension":"jpg","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":21720,"visible":true,"origin":"","legend":"\u003cp\u003eVisualization of LHBT Tenotomy via 0° Arthrex NanoScope\u003c/p\u003e","description":"","filename":"Figure51.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7372125/v1/32cf7f0f83e55053b28ae5ea.jpg"},{"id":93543959,"identity":"0e1a6160-cb9d-4b9b-9c04-babc12c8b454","added_by":"auto","created_at":"2025-10-15 02:47:04","extension":"jpg","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":25767,"visible":true,"origin":"","legend":"\u003cp\u003eVisualization of LHBT Tenotomy via 0° Arthrex NanoScope\u003c/p\u003e","description":"","filename":"Figure61.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7372125/v1/826e88e3f79ba332c97d09fd.jpg"},{"id":93542618,"identity":"38251f2f-389b-4be6-b800-8d40a7cbeeb9","added_by":"auto","created_at":"2025-10-15 02:39:04","extension":"jpg","order_by":7,"title":"Figure 7","display":"","copyAsset":false,"role":"figure","size":25053,"visible":true,"origin":"","legend":"\u003cp\u003eVisualization of LHBT Tenotomy via 0° Arthrex NanoScope\u003c/p\u003e","description":"","filename":"Figure71.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7372125/v1/85cddadcb5f50ba66665e748.jpg"},{"id":102234841,"identity":"de99e8c1-780d-4d81-ae08-aa05d93045e6","added_by":"auto","created_at":"2026-02-09 16:13:39","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":19564956,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7372125/v1/1516d826-a1e2-4ba4-94fe-846a3a505845.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Nanoscopic Long Head of the Biceps Tendon Tenotomy with Suprascapular Nerve Block: A Feasibility Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe long head of the biceps tendon (LHBT) is a common source of shoulder pain and dysfunction, particularly among older adults and patients with degenerative rotator cuff conditions [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Indications for surgical intervention include tendinopathy, partial tears, instability, and lesions associated with rotator cuff disease. Tenotomy is a widely accepted treatment, especially in patients with low functional demands, offering pain relief and simplifying surgical intervention compared to tenodesis [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eNeedle arthroscopy (NA), or in-office needle arthroscopy (IONA), has emerged as a valuable tool in minimally invasive diagnostics and therapeutic procedures of the shoulder. The use of NA in performing biceps tenotomy was pioneered in clinical settings with promising outcomes, reducing cost, anesthesia risk, and recovery time [\u003cspan additionalcitationids=\"CR6\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Studies have highlighted its technical feasibility and patient acceptability when conducted under local anesthesia.\u003c/p\u003e\u003cp\u003eComplementing NA, the suprascapular nerve block (SSNB) is increasingly recognized for its role in perioperative and intraoperative pain control in shoulder surgery [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. SSNB targets the suprascapular nerve, which innervates approximately 70% of the shoulder joint, including the supraspinatus and infraspinatus muscles. When administered properly, it provides effective analgesia and muscle relaxation, aiding visualization during arthroscopy [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Despite its benefits, SSNB remains underused, possibly due to technical familiarity or reliance on general anesthesia.\u003c/p\u003e\u003cp\u003eCombining nanoscopic LHBT tenotomy with SSNB in an outpatient setting may offer a synergistic approach by optimizing patient comfort, surgical efficiency, and recovery. This study explores the feasibility of this method in elderly patients with isolated anterior shoulder pain, unresponsive to conservative treatments.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003e\u003cstrong\u003ePatient Selection\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFive patients aged 70 or older with isolated anterior shoulder pain and ultrasonographic or Magnetic Resonance Imaging (MRI)-confirmed LHBT pathology were included. Patients with massive rotator cuff tears, frozen shoulder, systemic anticoagulation, or high anesthetic risk were excluded. Written informed consent was obtained from all participants prior to their inclusion in the study. The Bioethical Commission of the Medical University of Ł\u0026oacute;dź approved the study protocol (RNN/60/25/KE). All methods were carried out following the ethical guidelines of the 1975 Declaration of Helsinki (latest revision, 2013).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAnesthesia and Setup\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eProcedures were conducted in a minor procedure room. SSNB was performed using an in-plane posterior approach under ultrasound guidance with 10 mL of 0.5% ropivacaine and 2 mL of 1% lidocaine. Local anesthetic was infiltrated into skin and subcutaneous tissues along the posterior and anterior portal tracts.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSurgical Technique\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePatients were seated in the beach-chair position. The posterior viewing portal was established using the 0\u0026deg; Arthrex NanoScope. A second anterior portal was introduced for instrumentation (Fig.1). After diagnostic inspection, the LHBT was identified and released at its glenoid attachment using a nanoscopic biter or scissors. The procedure was completed with lavage and assessment of tenotomy completeness. Figures 2-7 provide the visualization of the operated area via 0\u0026deg; Arthrex NanoScope.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOutcome Measures\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePain and function were assessed using VAS and Constant Score (CS) at 4 timepoints: 1 day before surgery, and 1 day, 2 weeks, and 6 weeks after surgery.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eAll five procedures were completed successfully. There were no intraoperative complications. Mean operative time was 12 minutes. The mean preoperative VAS score was 7.8, which decreased to 4.2 one day postoperatively, and further to 4.0 at 2 weeks, and 3.4 at 6 weeks. The CS improved from a baseline mean of 51.5 to 68.4 (1 day), 70.2 (2 weeks), and 71.8 (6 weeks).\u003c/p\u003e\u003cp\u003eNo adverse effects related to the SSNB were reported. All patients tolerated the procedure well, and early functional recovery was consistent with or superior to prior reports of similar interventions [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eOur findings confirm the technical feasibility and initial clinical efficacy of nanoscopic LHBT tenotomy combined with SSNB in elderly patients with anterior shoulder pain. The results are consistent with those of Gauci et al. and Rosso et al., who demonstrated satisfactory functional outcomes in similar NA-guided procedures without SSNB [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. The integration of SSNB offers additional advantages, such as improved visualization via supraspinatus and infraspinatus muscle relaxation and enhanced patient comfort during awake procedures [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eImportantly, biceps tenotomy in elderly patients appears to be particularly well-suited for widespread application. Multiple studies have demonstrated that tenotomy in patients over 65 is not only effective but also associated with high satisfaction and low complication rates. Veen et al. performed a study that showed significant improvement in pain and function scores in elderly patients post-tenotomy, with low incidence of cosmetic deformity concerns and minimal cramping [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Moreover, a 2017 meta-analysis comparing tenotomy and tenodesis found no significant difference in outcomes between these techniques, supporting the notion that tenotomy is a safe, efficient, and resource-sparing alternative in the older population [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eOur approach stands in contrast to percutaneous LHBT tenotomy performed solely under ultrasound guidance. While ultrasound-guided procedures offer a minimally invasive alternative, they lack the intra-articular visualization that NA provides. Recent data on ultrasound-guided tenotomy in patients averaging 73 years of age demonstrated promising functional improvements [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. However, the absence of direct visual control increases the risk of incomplete tenotomy, iatrogenic injury, or missing concomitant intra-articular pathology. The nanoscopic approach offers the best of both worlds \u0026mdash; minimal invasiveness with direct visualization, and when combined with SSNB, improves patient comfort and intraoperative efficiency [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe simplicity and minimally invasive nature of the procedure may significantly benefit elderly or comorbid patients [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. The elimination of general anesthesia or interscalene block-related complications, such as phrenic nerve palsy or hypotension, makes SSNB a safer and more comfortable alternative for ambulatory surgery [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Additionally, by limiting the required staff and instrumentation, such procedures may reduce operational costs and increase procedural accessibility, especially in resource-limited settings [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e\u003cp\u003ePain relief and functional outcomes in our study were in line with those observed in prior studies using conventional arthroscopy, suggesting that NA and SSNB do not compromise efficacy. In fact, patients showed notable improvement in CS as early as one day after surgery. This early benefit may be linked not only to effective LHBT decompression but also to the superior analgesia provided by SSNB [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Such immediate improvements support findings by Cho et al. and others advocating for SSNB's analgesic role in rotator cuff and labral procedures [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAnother noteworthy feature is the novel use of SSNB in this setting. Compared to traditional interscalene blocks or general anesthesia, SSNB significantly reduces the required anesthetic dose, avoids common complications like phrenic nerve palsy, and enhances muscle relaxation. Studies in both shoulder and hand surgery populations have shown that local infiltration and peripheral nerve blocks reduce anesthetic load and may offer better safety profiles, especially in older or comorbid patients [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. The SSNB facilitated excellent tolerance in our cohort, with no reported adverse events.\u003c/p\u003e\u003cp\u003eFinally, this study contributes to the sparse but growing body of literature on therapeutic applications of shoulder nanoscopy beyond diagnostic use. Most prior reports have focused on IONA for visualization or lavage. Our findings add evidence for its efficacy in performing surgical interventions such as tenotomy. As the field of needle arthroscopy evolves, we anticipate broader applications in outpatient orthopedics, particularly when paired with nerve blocks to enhance tolerability.\u003c/p\u003e\u003cp\u003eAn additional point of interest aspect is the potential for broader procedural use. With increasing surgeon familiarity, SSNB could be combined with other nanoscopic techniques, including subacromial decompression or diagnostic evaluations in the awake patient. The technology's ability to facilitate real-time, patient-guided feedback during diagnostic NA has also been emphasized in recent literature [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eLimitations of this study include its small sample size, limiting the statistical power and generalizability of results. The lack of a control group (e.g., NA without SSNB or traditional arthroscopy) restricts the ability to isolate the benefit of SSNB. The short-term follow-up of only 6 weeks does not capture long-term complications or recurrence of symptoms. Additionally, the study was conducted by a single surgeon in a specialized setting, which may not reflect outcomes in broader clinical practice. Finally, patient-reported outcomes beyond VAS and Constant Score (e.g., satisfaction, shoulder-specific Patient Related outcomes) were not assessed.\u003c/p\u003e\u003cp\u003eFuture research should include randomized controlled trials with larger cohorts, longer follow-up, and comparison arms to better elucidate the value of SSNB in NA-guided procedures. Investigating cost-effectiveness, patient satisfaction, and applicability in diverse clinical settings would further clarify its role.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eNanoscopic LHBT tenotomy with suprascapular nerve block is a safe, efficient, and minimally invasive option for treating anterior shoulder pain in elderly patients. The technique combines the diagnostic and therapeutic advantages of NA with the analgesic benefits of SSNB. Larger, controlled studies are warranted to confirm these findings and determine optimal patient selection.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eCS\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eConstant Score\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eIONA\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003ein-office needle arthroscopy\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eLHBT\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003elong head of the biceps tendon\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eMRI\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eMagnetic Resonance Imaging\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eNA\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eNeedle arthroscopy\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eSSNB\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003esuprascapular nerve block\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eVAS\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eVisual Analog Scale\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cul type=\"disc\"\u003e\n \u003cli\u003e\u003cstrong\u003eEthics approval and consent to participate:\u0026nbsp;\u003c/strong\u003eWritten informed consent was obtained from all participants prior to their inclusion in the study. The Bioethical Commission of the Medical University of Łódź approved the study protocol (RNN/60/25/KE). All methods were carried out following the ethical guidelines of the 1975 Declaration of Helsinki (latest revision, 2013).\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eConsent for publication:\u0026nbsp;\u003c/strong\u003eWritten informed consent was obtained from all participants prior to their inclusion in the study.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eAvailability of data and material:\u0026nbsp;\u003c/strong\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eCompeting interests:\u0026nbsp;\u003c/strong\u003eThe authors declare that they have no competing interests.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003eNot applicable.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eAuthors' contributions:\u0026nbsp;\u003c/strong\u003eJL designed study; JL, BW, CB, MS conducted the procedures; JL and BW collected the data; JL, BW and MS edited the text, MD coordinated and andvised the study\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eAcknowledgements:\u0026nbsp;\u003c/strong\u003eNot applicable.\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eBoileau P, Baqu\u0026eacute; F, Valerio L, Ahrens P, Chuinard C, Trojani C (2007) Isolated arthroscopic biceps tenotomy or tenodesis improves symptoms in patients with massive irreparable rotator cuff tears. J Bone Joint Surg Am 89:747\u0026ndash;757. doi:10.2106/JBJS.E.01097\u003c/li\u003e\n\u003cli\u003eTashjian RZ, Shin J, Broschinsky K, Yeh CC, Martin B, Chalmers PN, Greis PE, Burks RT, Zhang Y (2020) Minimal clinically important differences in the American Shoulder and Elbow Surgeons, Simple Shoulder Test, and visual analog scale pain scores after arthroscopic rotator cuff repair. J Shoulder Elbow Surg 29:1406\u0026ndash;1411. doi:10.1016/j.jse.2019.11.018\u003c/li\u003e\n\u003cli\u003eKim JY, Kang MW, Lee HW, Noh KC (2021) Suprascapular nerve block is an effective pain control method in patients undergoing arthroscopic rotator cuff repair: a randomized controlled trial. Orthop J Sports Med 9:2325967120970906. doi:10.1177/2325967120970906\u003c/li\u003e\n\u003cli\u003eFrost A, Zafar MS, Maffulli N (2009) Tenotomy versus tenodesis in the management of pathologic lesions of the tendon of the long head of the biceps brachii. Am J Sports Med 37:828\u0026ndash;833. doi:10.1177/0363546508322179\u003c/li\u003e\n\u003cli\u003eGauci MO, Monin B, Rudel A, Blasco L, Bige B, Boileau P (2021) In-office biceps tenotomy with needle arthroscopy: a feasibility study. Arthrosc Tech 10:e1263\u0026ndash;e1268. doi:10.1016/j.eats.2021.01.022\u003c/li\u003e\n\u003cli\u003eRosso C, Grezda K, Heuberer PR (2022) Long head of the biceps intra-articular tenotomy using needle arthroscopy under local anesthesia: preliminary results and technical note. J Exp Orthop 9:70. doi:10.1186/s40634-022-00508-5\u003c/li\u003e\n\u003cli\u003eDaggett MC, Stepanovich B, Geraghty B, Meyers A, Whetstone J, Saithna A (2020) Office-based needle arthroscopy: a standardized diagnostic approach to the shoulder. Arthrosc Tech 9:e521\u0026ndash;e525. doi:10.1016/j.eats.2019.12.003\u003c/li\u003e\n\u003cli\u003eCho N, Kang RS, McCartney CJL, Pawa A, Costache I, Rose P, Abdallah FW (2020) Analgesic benefits and clinical role of the posterior suprascapular nerve block in shoulder surgery: a systematic review, meta-analysis and trial sequential analysis. Anaesthesia 75:386\u0026ndash;394. doi:10.1111/anae.14858\u003c/li\u003e\n\u003cli\u003eBoekel P, Brereton SG, Doma K, Grant A, Kippin A, Wilkinson M, Morse L (2022) Efficacy of surgeon-directed suprascapular and axillary nerve blocks in shoulder arthroscopy: a 3-arm prospective randomized controlled trial. JSES Int 7:307\u0026ndash;315. doi:10.1016/j.jseint.2022.12.011\u003c/li\u003e\n\u003cli\u003eZhao J, Xu N, Li J, Liang G, Zeng L, Luo M, Pan J, Yang W, Liu J (2021) Efficacy and safety of suprascapular nerve block combined with axillary nerve block for arthroscopic shoulder surgery: a systematic review and meta-analysis of randomized controlled trials. Int J Surg 94:106111. doi:10.1016/j.ijsu.2021.106111\u003c/li\u003e\n\u003cli\u003eAhmed AF, Toubasi A, Mahmoud S, Ahmed GO, Al Ateeq Al Dosari M, Zikria BA (2021) Long head of biceps tenotomy versus tenodesis: a systematic review and meta-analysis of randomized controlled trials. Shoulder Elbow 13:583\u0026ndash;591. doi:10.1177/1758573220942923\u003c/li\u003e\n\u003cli\u003eVeen EJD, Boeddha AV, Diercks RL, Kleinlugtenbelt YV, Landman EBM, Koorevaar CT (2021) Arthroscopic isolated long head of biceps tenotomy in patients with degenerative rotator cuff tears: mid-term clinical results and prognostic factors. Eur J Orthop Surg Traumatol 31:441\u0026ndash;448. doi:10.1007/s00590-020-02787-z\u003c/li\u003e\n\u003cli\u003eShang X, Chen J, Chen S (2017) A meta-analysis comparing tenotomy and tenodesis for treating rotator cuff tears combined with long head of the biceps tendon lesions. PLoS One 12:e0185788. doi:10.1371/journal.pone.0185788\u003c/li\u003e\n\u003cli\u003eSconfienza LM, Albano D, Messina C, Gitto S, Guarrella V, Perfetti C, Taverna E, Arrigoni P, Randelli PS (2020) Ultrasound-guided percutaneous tenotomy of the long head of biceps tendon in patients with symptomatic complete rotator cuff tear: in vivo non-controlled prospective study. J Clin Med 9:2114. doi:10.3390/jcm9072114\u003c/li\u003e\n\u003cli\u003eHartland AW, Islam R, Teoh KH, Rashid MS (2022) Clinical effectiveness of tenotomy versus tenodesis for long head of biceps pathology: a systematic review and meta-analysis. BMJ Open 12:e061954. doi:10.1136/bmjopen-2022-061954\u003c/li\u003e\n\u003cli\u003eMeeks BD, Meeks NM, Froehle AW, Wareing E, Bonner KF (2017) Patient satisfaction after biceps tenotomy. Orthop J Sports Med 5:2325967117707737. doi:10.1177/2325967117707737\u003c/li\u003e\n\u003cli\u003eQawasmi F, Best PD, Andryk LM, Grindel SI (2023) Assessment of two distinct anatomical landmarks for suprascapular nerve injection: a cadaveric study. J Shoulder Elbow Surg 32:2376\u0026ndash;2381. doi:10.1016/j.jse.2023.03.029\u003c/li\u003e\n\u003cli\u003eAflatooni JO, Meeks BD, Froehle AW, Bonner KF (2020) Biceps tenotomy versus tenodesis: patient-reported outcomes and satisfaction. J Orthop Surg Res 15:56. doi:10.1186/s13018-020-1581-3\u003c/li\u003e\n\u003cli\u003eŞener A, Demircan A, Keleş A, Bildik F, Karakurt K (2015) Comparison of local infiltration anesthesia and peripheral nerve block: a randomized prospective study in hand lacerations. Turk J Med Sci 45:694\u0026ndash;699\u003c/li\u003e\n\u003cli\u003eUpdegrove GF, Stauch CM, Ponnuru P, Kunselman AR, Armstrong AD (2020) Efficacy of local infiltration anesthesia versus interscalene nerve blockade for total shoulder arthroplasty. JSES Int 4:357\u0026ndash;361. doi:10.1016/j.jseint.2019.12.007\u003c/li\u003e\n\u003cli\u003ePeach C, Davies R, Phillips N (2021) Wide-awake shoulder nanoscopic long head of biceps tenotomy. Arthrosc Tech 10:e909\u0026ndash;e912. doi:10.1016/j.eats.2020.11.010\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"european-journal-of-medical-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ejmr","sideBox":"Learn more about [European Journal of Medical Research](http://eurjmedres.biomedcentral.com)","snPcode":"40001","submissionUrl":"https://submission.nature.com/new-submission/40001/3","title":"European Journal of Medical Research","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"long head of the biceps tendon, needle arthroscopy, suprascapular nerve block, Visual Analogue Scale, Constant Score","lastPublishedDoi":"10.21203/rs.3.rs-7372125/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7372125/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Pathology of the long head of the biceps tendon (LHBT) is a common indication for tenotomy. Needle arthroscopy (NA) has emerged as a minimally invasive alternative to conventional shoulder arthroscopy. The suprascapular nerve block (SSNB) is a promising yet underutilized method of analgesia in orthopedic shoulder procedures. This prospective feasibility study aimed to evaluate the safety, efficiency, and functional outcomes of nanoscopic LHBT tenotomy performed under SSNB in elderly patients.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMaterials and Methods:\u003c/strong\u003e Five patients (mean age \u0026gt;70) with isolated anterior shoulder pain and confirmed LHBT pathology were enrolled. All procedures were performed by a single experienced shoulder surgeon using the Arthrex NanoScope system. SSNB was administered preoperatively to minimize discomfort and facilitate muscle relaxation. Visual Analogue Scale (VAS) and Constant Score (CS) assessments were conducted 1 day preoperatively, and at 1 day, 2 weeks, and 6 weeks postoperatively.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e All procedures were completed without complications. Mean surgical time was 12 minutes. Preoperative VAS averaged 7.8 and CS 51.5. At 1 day postoperatively, mean VAS improved to 4.2 and CS to 68.4. Continued improvements were observed at 2 weeks (VAS 4.0; CS 70.2) and 6 weeks (VAS 3.4; CS 71.8).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e Nanoscopic LHBT tenotomy under SSNB appears to be a feasible and well-tolerated outpatient procedure in a select group of elderly patients. The addition of SSNB may reduce procedural discomfort and facilitate better visualization by promoting muscle relaxation. Further studies on larger populations are needed to validate these findings.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLevel of evidence:\u003c/strong\u003e IV\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTrial registration: \u003c/strong\u003eRNN/60/25/KE\u003c/p\u003e","manuscriptTitle":"Nanoscopic Long Head of the Biceps Tendon Tenotomy with Suprascapular Nerve Block: A Feasibility Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-15 02:38:59","doi":"10.21203/rs.3.rs-7372125/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-11-29T13:53:21+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-08T14:41:37+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"115139254823223112732440883284559447093","date":"2025-10-28T05:49:45+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-26T15:56:19+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-26T04:29:48+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"281155206439210905634149042278384213806","date":"2025-10-26T04:04:39+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"238700216520218326204910012094451389426","date":"2025-10-04T04:20:32+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"80111420781663591724827915849122375339","date":"2025-10-03T16:44:54+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-30T18:56:20+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-08-29T07:20:07+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-08-28T09:04:35+00:00","index":"","fulltext":""},{"type":"submitted","content":"European Journal of Medical Research","date":"2025-08-14T09:08:54+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"european-journal-of-medical-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ejmr","sideBox":"Learn more about [European Journal of Medical Research](http://eurjmedres.biomedcentral.com)","snPcode":"40001","submissionUrl":"https://submission.nature.com/new-submission/40001/3","title":"European Journal of Medical Research","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"7d62757c-0d19-447e-b9fa-5c399c6a80fd","owner":[],"postedDate":"October 15th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-02-09T16:10:25+00:00","versionOfRecord":{"articleIdentity":"rs-7372125","link":"https://doi.org/10.1186/s40001-026-03924-w","journal":{"identity":"european-journal-of-medical-research","isVorOnly":false,"title":"European Journal of Medical Research"},"publishedOn":"2026-02-02 15:57:27","publishedOnDateReadable":"February 2nd, 2026"},"versionCreatedAt":"2025-10-15 02:38:59","video":"","vorDoi":"10.1186/s40001-026-03924-w","vorDoiUrl":"https://doi.org/10.1186/s40001-026-03924-w","workflowStages":[]},"version":"v1","identity":"rs-7372125","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7372125","identity":"rs-7372125","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}