Biceps tenodesis

FAQs on Biceps Tenodesis

 

What is biceps tenodesis?

Biceps tenodesis is a surgical treatment for patients with biceps tendonitis. The biceps muscle has “two tendons that attach to the labrum through the shoulder joint.” Due to a variety of causes, including labrum tears, traumatic injury, rotator cuff damage, and shoulder joint arthritis, the attached tendon are irritated, inflamed, or torn. This leads to pain, weakness, and a variety of shoulder disorders.

The biceps tenodesis involves a two-stage procedure. First, the original tendon-shoulder socket attachment is severed to relieve pressure on the damaged tendon and the labrum. If necessary, a tiny portion of the tendon is also removed. The second stage includes rerouting and reattachment of bicep tendon with the arm bone.

Essentially a biceps tenodesis moves the attachment of the biceps tendon to a position that is out of the way of the shoulder joint.

What are conditions treated with biceps tenodesis?

  • Biceps tendonitis: Biceps tenodesis is independently done to treat bicep tendonitis, a painful condition caused by damage, inflammation, or irritation of the biceps tendons “connecting the top head of the biceps muscle to the shoulder.”
  • Other Conditions: Biceps tenodesis is also used during the surgical treatment of SLAP tears, labral tears, rotator cuff tears, and similar conditions leading to shoulder pain and instability. The procedure forms a part of the arthroscopic or open surgery to alleviate pain and repair such tears.

Who is a candidate for biceps tenodesis?

Biceps tenodesis surgery is most suitable for people with following conditions.

  • Significant biceps tendon pain, inflammation, and shoulder instability
  • MRI and arthroscopic tests indicate major damage to biceps tendon
  • No respite despite months of conservative, non-surgical treatment
  • Need of surgery for SLAP tears, rotator cuff pain, and labrum damage
  • Patients are fit enough to undergo surgery and rehab

How is biceps tenodesis performed?

  • Accessing the Shoulder Joint

The patient is administered general anesthesia and surgeons perform an arthroscopic assessment of the area. An arthroscope camera is inserted through a small incision on the shoulder to examine the extent of tendon damage. Miniature surgical equipments are also put inside through tiny incisions and the surgery is guided by live images generated trough arthroscopic procedure.

In case of extensive damage to the shoulder joint, the biceps tenodesis may form part of an open surgery.

  • Releasing the tendon

Following the injury assessment, the damaged portion of the bicep tendon is removed. Prior to this, the injured tendon is detached from the labrum of the shoulder socket. Surgeons also remove bone spurs and cartilage fragment that lead to space constraint in the joint.

  • Repairing the tendon

The bicep tendon is reattached with the shoulder joint through a new route. It was fixed with the humerus using anchors and strong sutures. The rerouting reduces pressure on both tendon and labrum.

  • End of surgery

Surgeons close the incisions and put a bandage around your shoulder. The patient is observed for a few hours and then discharged.

How long does biceps tenodesis surgery take?

It is an outpatient procedure that takes 60 to 90 minutes when performed independently.

Do I need to stay at the hospital after biceps tenodesis?

There is no need for any additional hospital stay, if you do not develop any complications. You are discharged on the same day.

Do I need rest after biceps tenodesis?

Yes, you have to take rest for 1 to 2 days. The arm is put in a sling for the first three weeks and you are not allowed to stress it. The tendon takes around 8 to 12 weeks to heal and you are advised to have weight bearing restrictions during the same period.

What are the restrictions following biceps tenodesis?

  • Put on a sling and protect shoulder from stress
  • Use sling for three weeks except during sedentary or light activities and prescribed therapy
  • Avoid having shower for 72 hours
  • Avoid lifting or rotating of the arm
  • Keep your shoulder dry and clean
  • Don’t go beyond your activity tolerance level
  • Avoid driving for four weeks
  • No high-impact sports activities for six months

What kind of rehabilitation is needed following biceps tenodesis?           

Follow the below mentioned four-phase rehab process

  • Week 1 and 2: Passive range of motions, including pendulum workouts, ball squeezes, AROM wrist/ hand
  • Week 4 and 5: Active range of motions, including gentle scar massage, active elbow flexion/extension, cross body adduction, sleeper stretch)
  • Week 6 to 10: Light strengthening exercises, light resistance workouts, rhythmic stabilization drills, muscular endurance exercises, open and closed chain activities
  • Week 11 and afterward: Advanced strengthening, such as shoulder stretching, isotonic strengthening (if no pain), upper extremity weight lifting, workout repetitions

How long is the recovery period following biceps tenodesis?

Most patients return to desk jobs within a week, though normal healing requires at least three months. You can join work in three weeks and start lifting and strengthening activities in three months. However, you are not allowed to be engaged in high-impact, strenuous activities for six months until, complete recovery. Patient condition is factor in faster recovery.

What are the potential complications of biceps tenodesis?

As the case with other surgical procedures, biceps tenodesis may cause avoidable surgical complications, such as bleeding, blood vessel rupture, nerve injury, infection, temporary muscle weakness and stiffness, and pain.

References

Kevin Kaplan, eta al. Arthroscopic Biceps Tenodesis to Bone, Publication Date: 9/25/2007, American Academy of Orthopaedic Surgeons

Krupp RJ, et al. Long Head of the Biceps Tendon Pain: Differential Diagnosis and Treatment. Jour Ortho & Sports PT.

Feb 2009; 39(2): 55-70.

Romeo AA, et al. Arthroscopic Biceps Tenodesis. Arthroscopy. Feb 2004; 20(2): 206-213.

Ozalay M, et al. Mechanical Strength of Four Different Biceps Tenodesis Techniques. Arthroscopy: Jour Arthro & Related Surg. Aug 2005; 21(8): 992-998.

Lopez-Vidriero E, et al. Biomechanical Evaluation of 2 Arthroscopic Biceps Tenodesis: Double-Anchor Versus Percutaneous

Intra-Articular Transtendon (PITT) Techniques. Am Jour Sports Med.2010; 38(1): 146-152.

Slenker NR, et al. Biceps tenotomy versus tenodesis: clinical outcomes.Arthroscopy. 2012 Apr;28(4):576-82.

Burns JP, et al. Superiorlabral tears: repair versus biceps tenodesis. J Shoulder Elbow Surg. 2011 Mar;20(2 Suppl):S2-8.

Dines, D., et al. Surgical treatment of lesions of the long head of the biceps. Clin Orthop. 1982;164:165–171.

Berlemann, U., Bayley, I. Tenodesis of the long head of biceps brachii in the painful shoulder: improving results in the long term. J Shoulder Elbow Surg. 1995;4:429–435.

Gartsman, G.M., Hammerman, S.M. Arthroscopic biceps tenodesis: operative technique. Arthroscopy. 2000;16:550–552.

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