Biceps tenodesis is a surgery to repair the biceps tendon. This procedure is typically used when the biceps tendon causes pain in and around the shoulder.
Inflammation and wear and tear to the tendon due to injury, overuse, and aging are some of the common reasons for this type of shoulder pain.
Torn tissues or problems with the rotator cuffs are among other causes, often occurring in athletes.
In this article, learn more about biceps tenodesis and the possible risks and complications.
Biceps tenodesis is usually used to treat shoulder pain caused by inflammation of the biceps tendon.
If inflammation is not present, most people with throbbing pain in the front of their shoulders have difficulties with their rotator cuffs or torn shoulder issues along with bicep problems.
These kinds of injuries are most common in young athletes, such as swimmers, gymnasts, and those involved in throwing or contact sports.
Pain from the biceps tendon is usually in the front part of the shoulder and at the top of the humerus bone, which runs from the shoulder to the elbow.
The pain, which can be worse at night, may radiate to other parts of the arm and back. People may also experience cramping, tingling, swelling, and have difficulty moving their shoulders or arms.
A person may also be experiencing injuries to the top edge of the shoulder, where the upper arm bone fits into the joint. These injuries are known as Superior Labrum Anterior and Posterior or SLAP tears. They can also involve the biceps tendon.
Overuse, powerful pulling on the arm, falling with an outstretched arm, and other accidents can all cause SLAP tears.
The different forms of biceps tenodesis are all done using general anesthesia. They include soft tissue techniques or hardware fixation techniques.
The two main soft tissue techniques are:
- Open keyhole procedure: Surgeons create an opening or keyhole in the humerus. Using tiny instruments, they stitch a rolled up end of the bicep into place.
- The Pitt technique: Surgeons use two needles to develop an interlocking pattern of sutures and then tie the tendon to a shoulder ligament.
In hardware fixation techniques, the biceps tendon is first severed and then re-attached to the bone.
The two main hardware fixation techniques are:
- The crew fixation technique: Surgeons create a hole at the top of the arm bone, place one end of the cut tendon in it, and secure the tendon in place by screwing it to the bone.
- The endobutton technique: Surgeons attached the tendon to a button that they slide into a hole at the top of the arm bone.
Recovery from biceps tenodesis takes place in stages.
For about 4 to 6 weeks, individuals need to wear a sling to restrict the use of their arm and let the tissues heal.
After 6 weeks, individuals can begin to expand their range of motion. Under the guidance of a trained physical therapist, they can gradually ease into resistance and strength training.
Through regular rehabilitation and training sessions, people can continue to increase the amount of effort they can exert with their hands, arms, and shoulders, and expand their range of motion.
Complete recovery and a full return to all activities can take around 20 weeks. As many people who go through biceps tenodesis are athletes, the later phases of recovery will be tailored to help them return to their individual sports.
Cardiovascular exercise, such as walking or riding a stationary bike, is permitted even within the first 4 to 6 weeks after surgery, as long as the individual wears a sling.
Swimming and throwing sports are the last activities to be re-introduced.
The exact recovery time will depend on:
- severity of the original injury
- presence of other injuries
- a person's age
- health status before the injury
- whether a rehabilitation program is followed
Biceps tenodesis has a high success rate, with most people who undergo the procedure reporting less pain, better use of their shoulders, and the ability to return to sports and activities.
One small study found that 90 percent of people had excellent outcomes, but some did experience a recurrent rupture.
Doctors usually consider biceps tenodesis to be most effective if done within 3 months of the initial injury. However, the research indicates that positive outcomes are possible even if the surgery is done later than 3 months after the injury.
Complications after biceps tenodesis are uncommon. Over a 3-year period, researchers studied 353 people who had gone through the procedure and found only 2 percent experienced complications.
Documented complications after biceps tenodesis include:
- re-injury to the tendon or nearby bones
- continuing pain
- problem with attachment to the bone
- nerve injury
- change in the arm's appearance
One of the complications can be a condition known as Popeye's deformity, named after the muscled cartoon character.
If a tendon is injured, torn, or otherwise becomes unattached from the shoulder joint, it can bunch up. It can then create a bulge along the arm, which looks like one of Popeye's muscles.
It is reported that 15 percent of individuals who undergo biceps tenodesis eventually need to have additional surgery.
Doctors usually treat the above injuries with rest, ice, physical therapy, and non-steroidal anti-inflammatory medications (NSAIDS), such as ibuprofen, before progressing to more invasive methods. They may also try using steroid injections to reduce inflammation.
If these treatments do not succeed in reducing the pain and restoring freedom of movement, a person may need surgery.
If surgery is decided upon, individuals and their doctors will choose between biceps tenodesis and a procedure called a tenotomy. Tenotomy is considered a simpler procedure than biceps tenodesis.
But, doctors who advocate for the use of biceps tenodesis say it can help prevent distortion in the appearance of the biceps and help maintain arm strength. Biceps tenodesis tends to be recommended more often for younger people and athletes.
However, a study comparing the results of biceps tenodesis and tenotomy in 42 people under age 55 did not find a significant difference between the two procedures, regarding strength, endurance, and physical appearance of the affected arm.
The outlook is normally favorable after biceps tenodesis. People may experience a loss of strength when bending their arm, but this should not interfere with everyday activities.
Individuals should speak to a doctor if they have questions or concerns after their surgery.