What is Biceps Tenodesis Surgery?

The bicep muscle has two tendon attachments in the shoulder region, the long head and the short head. The tendon of the bicep long head attaches in the shoulder joint whereas the tendon of the bicep short head attaches just outside the shoulder joint. The tendon portion of the long head of the bicep commonly tears and can cause shoulder pain.  Biceps tenodesis surgery is a surgical technique used to repair a torn long head of bicep tendon. This surgical repair can be done arthroscopically or through a small, minimally invasive incision.

Dr. Cunningham is a shoulder surgeon at Vail Summit Orthopedics and Neurosurgery. He is an expert at diagnosing and treating biceps tendon injuries for patients in Vail, Summit County, Aspen, and Denver, CO.

When is Biceps Tenodesis Surgery Needed?

Bicep tendon tears are most often seen in throwing and overhead athletes and also in people who perform repetitive overhead work, such as carpenters and painters. Inflammation, instability, or tearing of the bicep tendon is a common source of shoulder pain. Pain is localized in the front of the shoulder. Some patients also report a snapping or catching sensation with shoulder range of motion.

Treatment for biceps tendonitis consists of rest, ice, activity modification, formal physical therapy, and perhaps an oral anti-inflammatory or corticosteroid injection around the inflamed tendon.  These measures can often be effective in cases of biceps tendonitis, but if there is tearing of the bicep tendon, then these treatments typically only provide temporary relief.

If there is a suspicion for a tear in the bicep tendon, then a good history and physical exam by an orthopedist should be performed. An MRI of the shoulder may be done to evaluate for a bicep tendon tear or subluxation of the bicep tendon. With subluxation of the bicep tendon, a small ligament that normally holds the bicep tendon in its bone groove fails, and the bicep tendon then slips out of the bone groove. If the biceps tendon is torn or subluxated, then patients often come to surgery as the tendon will not heal. Furthermore, a subluxated bicep tendon can cause further damage, namely causing tearing of the adjacent rotator cuff tendon, the subscapularis.

How is Biceps Tenodesis Surgery Performed?

Bicep tendon tearing is similar to a rope fraying and tearing on just one end of where the rope is attached. There is not an effective way to repair the frayed, partially torn part of the rope. In biceps tenodesis surgery, the bicep tendon is secured to the bone further down along its normal course where the tendon is normal and not frayed, and then the frayed end of the biceps tendon is removed and discarded.

Biceps tenodesis can be performed through a small open incision about an inch long or it can be done arthroscopically.  In cases where the tendon is significantly frayed and damaged, an open, subpectoral biceps tenodesis technique may be performed. In this technique, a one inch incision is made down near the armpit, the biceps tendon is retrieved from where it sits underneath the pectoralis muscle, and the diseased part of the tendon is resected and discarded, a small bone socket is drilled in the upper part of the humerus, and the remaining healthy portion of the tendon is threaded into this bone socket and secured. The tendon will grow into this new attachment site and the patient will regain all strength and should not have any pain as the diseased portion of the tendon has been removed.

Biceps tenodesis surgery can also be performed arthroscopically. It is very similar to the open surgery described above, but the surgery is done utilizing the arthroscope and securing the tendon up in the shoulder joint. However, if there is tearing of the bicep tendon that extends further down the arm, then an open technique may be used in order to remove all areas of the diseased, torn tendon.

Finally, in an older, less active patient, consideration can be given to simply surgically releasing the long head of bicep tendon from its attachment in the shoulder joint and letting the tendon fall down the arm 1-2 inches where it will then scar in and heal.  This procedure is called an arthroscopic biceps tenotomy.  The recovery from this is fast, as there is no repair to protect after surgery. However, there may be a small cosmetic deformity as the biceps muscle belly will sit slightly lower than its normal position. There is also a slight loss of strength with this procedure, but studies show that the majority of older patients do well with no long-term pain and good function.

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What is the Recovery After Biceps Tenodesis Surgery?

Post-operative recommendations following a biceps tenodesis surgery involve immobilization of the upper extremity in a sling for 4 weeks to protect the tendon repair.  Patients may require a short course of pain medication for comfort, particularly to help with sleep.  Gentle range of motion exercises are initiated immediately and later formal physical therapy is started.  Most patients do very well following this procedure and are able to restore full, pain-free shoulder range of motion and ultimately return to doing the activities they enjoy. Dr. Cunningham is a shoulder surgeon at Vail Summit Orthopedics and Neurosurgery. He is an expert at diagnosing and treating biceps tendon tears for patients in Vail, Summit County, Aspen, and Denver, CO.

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