Biceps Tenodesis Surgery

Biceps tenodesis is a surgery performed to treat a full or partial tear in the tendon that connects your biceps muscle to the shoulder. This type of tendon damage may also be called biceps tendonitis. The surgery can be performed as a stand-alone procedure or as part of a larger procedure on the shoulder. The objective of the surgery is to alleviate shoulder pain associated with inflammation and tendon wear due to overuse, injury, or aging. Biceps tenodesis can be performed as an open surgery or as a minimally invasive arthroscopic surgery.

Disease Overview

The shoulder joint is a ball-and-socket joint with the head of the humerus (upper arm bone) forming the ball, and a cup-shaped depression on the shoulder blade (glenoid fossa) forming the socket. The joint is stabilized by the labrum, a fibro-cartilaginous structure of the glenoid cavity, and the capsule, which is made up of a series of ligaments that enclose the joint.

The biceps tendons attach the biceps muscle of your upper arm to the shoulder on one end, and to the elbow on the other. On the shoulder end, the biceps tendon divides into two strands called the short head and the long head. The long head attaches to the top of the shoulder socket (glenoid). The short head attaches to a bump on the shoulder blade called the coracoid process. The most common type of biceps tendon injury occurs in the long head biceps tendon. During a biceps tenodesis, your surgeon removes the damaged segment of the biceps tendon and reattaches the healthy portion of the tendon to the bone of the upper arm using screws and an anchoring device to restore upper arm and shoulder function and relieve symptoms.

Indications

Biceps tenodesis surgery is indicated for the treatment of a biceps tendon tear at the shoulder when conservative treatment such as rest, anti-inflammatory medications, physical therapy, and steroid injections have failed to resolve the associated painful symptoms. A biceps tendon tear may occur due to conditions such as general wear and tear, lifting something heavy, or overuse of a tendon from repetitive motion, such as during overhead sports activities like baseball, swimming, or tennis.

Preparation

In general, preoperative preparation for biceps tenodesis will involve the following:

• A review of your medical history and routine lab work such as blood testing
• Informing your doctor of current medications or supplements you are taking, or any allergies to medications, anesthesia, or latex
• Disclosing any recent illnesses or other medical conditions you have such as heart or lung disease
• Refraining from certain medications such as blood thinners, which may affect clotting
• Refraining from solids or liquids at least 8 hours prior to surgery
• Abstaining from smoking at least 2 weeks prior to surgery and several weeks after to promote heart and lung function and improve tendon healing
• Arranging for someone to drive you home after the procedure
• Signing an informed consent form

Surgical procedure

Biceps tenodesis can be performed either as an open surgery or an arthroscopic surgery.

Open Surgery: Traditionally, biceps tenodesis has been performed as an open shoulder surgery. In general, the procedure involves the following steps:

• You will be placed in a beach chair or lateral position and administered general anesthesia.
• A 3-5 cm incision will be made in the area where the top of your biceps tendon connects to your labrum.
• The muscles and tendons of the upper arm are moved aside and the torn end of the biceps tendon is identified.
• The biceps tendon is pulled through the incision and released from its attachment site at the labrum.
• A small hole is drilled into your upper arm bone.
• The damaged part of the tendon is removed, and a suture anchor or a special “interference screw” is used to secure the healthy part of the tendon into the hole in your upper arm bone.
• The incision is closed and covered with a bandage.

Arthroscopic Surgery: Whenever possible, surgeons opt for the arthroscopic technique, as only small incisions are required, often resulting in reduced postoperative pain and a faster recovery. In general, the arthroscopic technique involves the following steps:

• You will be given general or local anesthesia and placed in a beach chair or lateral position.
• Three to four small incisions are made around the shoulder joint.
• An arthroscope, a slender tubular device fitted with a light and small video camera, is inserted through one of the incisions into the shoulder joint.
• The video camera transmits the image of the inside of your shoulder joint onto a monitor for your surgeon to view your biceps tendon and labrum.
• Miniature surgical instruments are inserted through the other incisions, and the injured biceps tendon is surgically detached from the labrum (it may already be detached in the case of a complete tear).
• A small hole is drilled in the front of the upper arm bone.
• Your surgeon clips off the damaged end of the biceps tendon and the remaining portion of the tendon is secured into the hole in the upper arm bone using suture anchors or a special “interference screw”.
• The scope and instruments are withdrawn, and the tiny incisions are closed with stitches or small sterile bandage strips.

Postoperative care

After the procedure, your shoulder will be placed in a shoulder sling for at least a month to protect the repair and facilitate healing. You may experience pain, swelling, and discomfort at the surgical site. Medications are provided as needed to address these. Applying ice packs to the area can also help reduce swelling and pain and provide additional comfort. Physical therapy may be recommended after a week or two to maximize range of motion and shoulder strength. You are advised to refrain from strenuous or forceful activities such as lifting heavy weights until 3 months have passed. Instructions on surgical site care and bathing will be provided to keep the wound clean and dry.

Risks and Complications

Biceps tenodesis is a relatively safe procedure; however, as with any surgery, some risks and complications may occur, such as the following: 

• Infection
• Bleeding
• Nerve injury
• Stiffness
• Re-rupture
• Recurring shoulder instability
• Blood clots or deep vein thrombosis (DVT)

Summary

The outlook after biceps tenodesis surgery is generally exceptional with a large percentage of patients achieving a satisfactory outcome. This includes adequate pain relief and improvement of muscle function. Biceps tenodesis surgery can effectively help individuals who are active, who perform physical work, or who want to return to sports with significant pain relief and restoration of functional mobility of the shoulder joint.