Biceps Tenotomy & Repair

A biceps tenodesis is a type of surgery used to treat a tear in the tendon that connects your biceps muscle to your shoulder. The tenodesis may be performed alone or as part of a larger procedure on the shoulder.

A tendon attaches muscle to bone. Your biceps tendons attach the biceps muscle of your upper arm to the elbow on one end and to the shoulder on the other. On the shoulder end, the biceps tendon divides into two strands, known as the long head and the short head.

The most common type of biceps tendon injury is in the long head biceps tendon (sometimes abbreviated as LHB).

What are the symptoms?

Biceps tendon tears may happen quickly from a traumatic injury or develop over time from repetitive motions of the shoulder.

Symptoms include:

• a sudden, sharp pain in the upper arm, sometimes accompanied by a popping or snapping sound
• cramping of the biceps during or after heavy use
• pain or tenderness at the shoulder and elbow, or weakness in those areas
• appearance of bruises from the middle of the bicep down toward the elbow
• difficulty rotating the arm to a palm upward (or downward) position
• a bulge in the upper arm, known as a “Popeye muscle”

What are the risk factors?

Your risk factors for tearing a biceps include:

• Age: Simple wear and tear can increase the likelihood of a tear.
• Overuse of the shoulder: Sports requiring repeated overhead arm motion, such as swimming, tennis, and baseball, can worsen the wear on the biceps tendon. Some types of physical labor can do the same. Reduce your risk of injury by stretching the area regularly.
• Corticosteroids: these drugs, used for many medical conditions including joint aches, have been linked to the risk of a biceps tear.
• Smoking: Nicotine can reduce the proper supply of nutrients to the tendon and cause it to weaken. These apps may make it easier to quit smoking.

SHow will I know if I need surgery?

Many people with a biceps tendon tear can still function well. They may only need simple treatments, like icing, aspirin or ibuprofen (Advil), and rest. Physical therapy and cortisone injections may also help.

If these measures don’t relieve your pain, or if you must have a complete recovery of strength, then you may need surgery. Your doctor can perform a number of different manipulations of your arm and shoulder to help determine how severe your injury is.

A biceps tenodesis is often done along with other shoulder surgery. This may include treatment of a labral tear (SLAP) or rotator cuff surgery. These procedures involve repair to the tendons or fibrocartilage that hold the upper arm into the shoulder.

How is the surgery performed?

For three days before biceps tenodesis surgery, you must not take any aspirin or nonsteroidal anti-inflammatories, such as ibuprofen (Advil) and naproxen (Aleve). Your doctor will inform you of any other special procedures you should follow.

The long head of the biceps tendon attaches to the top of the shoulder socket, known as the glenoid. During a biceps tenodesis procedure, a surgeon inserts a special type of screw or anchoring device into the upper part of the humerus (the upper arm bone). The surgeon then clips off the end of the long head of the biceps, and sews the remaining portion of the tendon onto the screw or anchoring device so that it’s reattached to the humerus instead of the glenoid.

Biceps tenodesis is performed under general anesthesia. This procedure may be done through a small, open incision. The surgeon will first look inside the shoulder joint with a small camera called an arthroscope.

If the tenodesis is part of a larger operation, open surgery on the shoulder may be used instead.

Possible complications

Complications from biceps tenodesis surgery are rare, but they can occur. Possible complications of any surgery include infection, bleeding, and adverse reaction to anesthesia, including heart attack, stroke, and death.

If the tenodesis is part of a larger shoulder operation, possible complications include:

• injury to nerves surrounding the shoulder
• stiffness, or “frozen shoulder”
• damage to the cartilage of the shoulder joint, known as chondrolysis

Recovery timeline

Recovery from biceps tenodesis is a long process. It involves rest, wearing a sling, and physical therapy. Most people have a functional range of motion and adequate strength by four to six months after surgery. Complete recovery may take up to a year.

A pain block is often used to keep the shoulder numb for about 12 to 18 hours after surgery. Resting at home for one to two days is advised. You’ll be given a sling to wear for about four to six weeks.

Physical therapy progresses through the following phases:

1. Passive range of motion starts within the first or second week after the operation.
2. Active range of motion starts approximately at week four.
3. Strengthening phase begins about six to eight weeks after the operation.
4. Advanced strengthening phase begins about week 10. No heavy lifting should be done before this phase.

Be sure to tell your doctor and physical therapist of any unusual pain or other symptoms.

Are there alternatives to biceps tenodesis?

If your doctor determines that surgery is needed, there’s still an alternative to biceps tenodesis. The alternative surgery is called biceps tenotomy.

Biceps tenotomy is a simpler operation with a quicker recovery time.

Instead of inserting a screw to reattach the long head of the biceps tendon, the long head is simply released from its natural anchoring point on the shoulder. This method provides excellent pain relief.

One study of 80 people with an average age of 58 years compared the outcomes of the two operations. The study found no significant difference in the likelihood of getting a “Popeye muscle,” muscle spasms, or shoulder pain.

Another study of people with an average age of roughly 50 years found a greater likelihood of the “Popeye muscle” effect in those who had a tenodesis versus a tenotomy. Strength wasn’t significantly different.