Biceps tenodesis is a procedure used to repair the bicep muscle after a full or partial tear from the shoulder. This type of surgical repair can either be a stand-alone procedure or part of a larger shoulder surgery.
There are two primary joints in the shoulder: the glenoid fossa/humerus attachment and the acromioclavicular joint.
Within and around the joints is a group of muscles known as the rotator cuff tendons. A tendon attaches muscle to bone. The long head of the biceps, which is a stabilizer of the shoulder joint, is found within these muscles.
The most common type of biceps injury happens at the long head of the biceps tendon. Lesions at the long head of the bicep tendons often lead to fractures of the humerus bone.
These tendons can easily become unstable and torn, causing pain in the shoulder. A biceps tenodesis can help repair these tendons.
Middle-aged people experience a higher rate of tendonitis and rotator cuff injuries, which often lead to a rupture of the biceps tendon. However, rotator cuff injuries are common in younger people as well, especially athletes.
Risk factors for a bicep tendon rupture include:
Biceps tenodesis is used for both partial and full tendon tears, an unstable joint, or pain caused from overuse of the biceps. A biceps tenodesis is more complicated than a tenotomy procedure, which uses needles to break up scar tissue. Still, tenodesis is the procedure of choice for young athletes because it doesn't cause bicep pain.
Bicep tendon tears may come with the following symptoms:
One specific symptom is known as the “Popeye muscle,” because it involves a prominent bulging in the upper arm area.
Your doctor may suggest other methods to treat the bicep tendon injury, including:
If these methods fail to show improvements, your doctor may recommend you get biceps tenodesis surgery.
Biceps tenodesis surgery is divided into two categories: soft tissue procedures and bone procedures with hardware fixation. Both forms are performed under general anesthesia, and the surgeon may insert an arthroscope (a small tube) to see inside the shoulder joint.
Soft tissue procedures. With an open hole procedure, the surgeon moves the biceps tendon. The end of the tendon is rolled into a ball, then stitched together. A keyhole is made in the humerus bone, then the stitched end is placed in the keyhole and “locked” into place.
Meanwhile, the Pitt technique uses two needles to punch through the bicep tendon in opposing directions. Stitching is then threaded through the needles and repeated to create a locking pattern. A knot is used to lock the stitching to the transverse shoulder ligament.
Hardwire fixation. This technique uses a screw to attach the removed tendon from its place of origin to a hole in the area of the bone. A screen is placed over the tendon into the bone to hold it in place.
It typically takes at least 4 to 6 weeks to recover from biceps tenodesis surgery. However, depending on the extent of damage — or complications during surgery — full recovery could take up to a year.
After surgery, the shoulder is typically kept numb via pain medications. Recovery includes resting, pain control, and physical therapy. The patient must wear a sling for about 4 to 6 weeks.
Physical therapy is crucial for a full recovery of the shoulder joint. Passive range of motion is important during the first two weeks after surgery.
If you experience progress, you can start with active range of motion exercises around the fourth week. You should experience strengthening of the area within 6 to 8 weeks post-surgery. By week 10, you can begin with advanced strength exercises and heavy lifting.
SOURCES: Injury: “Prospective Outcome Analysis Following Tenodesis of The Long Head of the Biceps Tendon Along with Locking Plate Osteosynthesis for Proximal Humerus Fractures.” Journal of Shoulder and Elbow Surgery: “Biceps Tenodesis: a Biomechanical Study of Fixation Methods." Mayo Clinic: “Rotator Cuff Injury.” Medscape: "Complete Ruptures of the Achilles Tendon." The American Journal of Orthopedics: "Biceps Tenodesis: An Evolution of Treatment." University of Wisconsin Sports Medicine: “Rehabilitation Guidelines for Biceps Tenodesis."
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