A bicep tenotomy is a surgical procedure designed to alleviate chronic shoulder pain caused by issues with the long head of the biceps tendon (LHB). The LHB is one of the two tendons that anchor the biceps muscle to the shoulder joint. When this tendon becomes inflamed, frayed, or partially torn—conditions known as tendinitis or tendinopathy—it generates persistent pain that may not respond to physical therapy or injections. Performing a tenotomy involves intentionally cutting the LHB at its attachment point to release it from the shoulder joint. This action removes the damaged tissue from the joint space, eliminating the source of pain and instability. The core question for many patients is whether this deliberate surgical alteration of the anatomy can ever be undone.
Understanding the Bicep Tenotomy Procedure
The bicep muscle is composed of two heads, the short head and the long head, which both connect to the forearm but originate at different points in the shoulder. A tenotomy specifically targets the long head of the biceps tendon (LHB), which travels through the shoulder joint. This tendon’s course within the joint makes it highly susceptible to wear and tear.
During the procedure, typically performed arthroscopically through small incisions, the surgeon severs the LHB from its attachment inside the shoulder. Once cut, the tendon is allowed to retract down the arm, settling into the bicipital groove of the upper arm bone (humerus). This release eliminates the painful rubbing or impingement of the tendon inside the joint. The short head of the biceps remains fully functional, preserving the majority of arm strength and movement.
The Direct Answer: Is a Tenotomy Anatomically Reversible?
The definitive answer is that a bicep tenotomy is not reversible in the sense of restoring the tendon to its original anatomical position and function. The procedure is, by its nature, an intentional and permanent detachment of the tendon from the shoulder socket. The impossibility of reversal is rooted in the biological and mechanical changes that occur immediately after the tendon is cut.
The biceps muscle belly, which is attached to the released tendon, is under constant tension and contracts, pulling the severed tendon end down the arm. This process, known as tendon retraction, moves the tendon several inches away from its original anchor point. Over time, the retracted tendon end and the surrounding tissue will heal and form scar tissue, making it impossible to simply stretch the tendon back up to the shoulder joint.
Furthermore, the original attachment site inside the shoulder joint is a delicate area that is not designed to accept a re-anchored tendon after the initial tissue has healed. Even if the retracted tendon could be surgically retrieved, the biological environment and the length-tension relationship of the muscle would be too altered for a successful reattachment to the original spot. Therefore, any subsequent procedure must be a form of reconstruction, not a simple restoration.
Corrective Surgery Following a Tenotomy
While true reversal is not possible, patients who experience undesirable side effects following a tenotomy have a reconstructive option known as a Biceps Tenodesis. This procedure is often performed when a patient is dissatisfied, typically due to the cosmetic change known as the “Popeye” deformity or persistent cramping in the biceps muscle. The Popeye deformity occurs because the released muscle belly retracts and bunches up lower in the arm, creating a noticeable bulge.
Tenodesis is a reconstructive surgery where the retracted long head of the biceps tendon is surgically reattached to a new, stable location on the humerus bone. The primary goal of this procedure is to re-establish proper tension on the biceps muscle, which helps eliminate muscle bunching and reduces the risk of muscle spasms and cramping. The reattachment site is usually located lower on the humerus, either suprapectoral (above the pectoralis major muscle) or subpectoral (below the pectoralis major muscle).
By fixing the tendon to the bone with screws, sutures, or anchors, the natural contour of the arm is typically restored, and functional issues are often resolved. The key distinction is that tenodesis is a secondary reconstruction that stabilizes the tendon at a new location, rather than a reversal to the original anatomical attachment. The success of this corrective measure depends on the timing of the surgery and the condition of the retracted tendon tissue.