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Biceps Tenotomy
Biceps Tenotomy or Tenodesis
Upper Biceps Surgery
Your biceps muscle has two heads and two tendons at the top end attach it to bone. The larger (short-head) tendon inserts onto the coracoid process of your shoulder blade outside your shoulder joint. This tendon very rarely causes any problems. The smaller long head takes a path right through the front of your shoulder and inserts at the top of your socket. This tendon commonly becomes degenerate, frayed and painful.
Tenotomy
If you are having a tenotomy, your biceps tendon is cut at its base by the top of your shoulder socket and the tendon is allowed to retract out of the joint. In about half of patients they will notice the contour of their biceps muscle changes (this is called a Popeye sign). Performing a tenotomy is safe and effective. In young men who do a lot of heavy lifting or gym work, sometimes the altered tension in the biceps muscle causes cramping, but this is rare. They may however not like the idea of an altered muscle contour and request a tenodesis.
Tenodesis
If you are having your biceps tendon re-fixed, the best way to do this is below your Pectoralis major muscle: this is called a sub-pectoral tenodesis and it involves a small cut just at the front outside edge of your armpit fold. The tendon is fixed to bone using sutures that are secured to bone by a small titanium button or an anchor.
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What is my recovery after tenodesis surgery?
You will go home a few hours after your operation. Please take your prescribed painkillers regularly for the first few days. Take down any bulky padded dressings on day 2 after surgery. Keep your wound dry and covered with a dressing for 12 days. You can shower after 4 days if your waterproof dressings are on.
You will need to wear a sling for the first four weeks to protect the fixation of the tendon. You will come out of your sling after four weeks and increase your range of movement. Strengthening will begin at ten weeks. All restrictions will be removed by six months.
Patients vary in their symptoms after surgery, but in general you can expect to return to:
Office work after two weeks (in a sling)
Light physical work after eight to twelve weeks
Heavier labour may take 16-24 weeks
Contact sport usually takes six months
Driving is allowed once you are competent and confident to control a car both for routine and emergency manoeuvres. It will probably take six to eight weeks for you to be ready.
Which should I have - tenotomy or tenodesis?
Both options are effective at removing the pain caused by a degenerate or damaged long head of biceps tendon. Objective strength outcomes are not significantly different between patients who’ve had a tenotomy or tenodesis. The complication rate of tenodesis is slightly higher than for tenotomy. However the tenodesis minimises the chance of a Popeye sign (altered muscle contour) and also the chance of cramping with heavy biceps loading.
For most patients with biceps pain a tenotomy is a good option. If however you are a very high-demand athletic person, especially a younger man, then you may choose to have a tenodesis over a tenotomy.
When will I be followed up?
You will be seen at two weeks after your operation. Depending on your progress, your on-going follow up will vary, but many patients can be discharged between three months and nine months after surgery