Bicep tenodesis is a surgical procedure focusing on the long head of the biceps tendon, which connects the biceps muscle to the shoulder. This surgery addresses problems at the tendon’s attachment point within the shoulder joint. It aims to alleviate pain and restore function when conservative treatments have not been effective. The procedure involves carefully detaching and re-securing the tendon to a different, more stable location.
What Bicep Tenodesis Addresses
The biceps muscle, located on the front of the upper arm, has two tendons that attach it to the shoulder blade. The long head of the biceps tendon, which is more susceptible to injury, connects to the top of the shoulder socket, specifically to a rim of cartilage called the labrum. This tendon acts as a stabilizer for the shoulder joint, but it can also be a source of pain when damaged.
Common issues include inflammation, fraying, or tearing of this tendon. These problems often result from overuse, repetitive overhead motions, injury, or age-related wear and tear. Conditions such as biceps tendonitis, which is irritation and inflammation of the tendon, frequently accompany other shoulder problems like rotator cuff degeneration or tears. A tear in the labrum, known as a SLAP tear, can also involve the biceps tendon attachment.
When the long head of the biceps tendon is compromised, individuals may experience persistent pain in the front of the shoulder, tenderness, and weakness, particularly with arm movements. A complete tear can sometimes result in a visible bulge in the upper arm, often called a “Popeye muscle,” due to the muscle retracting.
The Surgical Approach
The procedure involves detaching the damaged long head of the biceps tendon from its original shoulder joint attachment. It is then reattached to a more stable location, typically on the humerus bone (upper arm bone), moving the problematic segment away from the joint.
The procedure can be performed using different techniques. Arthroscopic surgery involves several small incisions through which a tiny camera and specialized instruments are inserted to visualize and perform the repair. This minimally invasive approach allows the surgeon to assess the extent of the damage and address any co-existing shoulder issues. Alternatively, an open surgical approach may be used, requiring a larger incision to directly access the tendon.
Once detached, the healthy portion of the tendon is prepared and secured to the humerus using various fixation methods. These can include sutures, screws, or other anchoring devices designed to hold the tendon firmly in its new position while it heals. Both arthroscopic and open techniques, along with different fixation methods, aim to achieve stable reattachment and comparable clinical outcomes. The choice of technique often depends on the specific injury, surgeon preference, and patient factors.
Journey to Recovery
Recovery from bicep tenodesis is a phased process that typically spans several months, with full recovery often taking four to six months, or up to a year in some cases. Immediately after surgery, the arm is usually immobilized in a sling for approximately four to six weeks to protect the healing tendon and limit movement. Pain management, often beginning with nerve blocks and oral medications, is an important component of this initial phase.
Physical therapy usually begins within the first few weeks following surgery, sometimes as early as one to two weeks post-operation. Initially, the focus is on passive range of motion exercises, where the arm is moved gently by a therapist or with assistive devices without active muscle engagement from the patient. This helps prevent stiffness and promotes circulation. As healing progresses, active range of motion exercises are introduced, allowing the patient to gradually move their arm independently.
The rehabilitation protocol systematically advances through strengthening phases, typically starting around six to eight weeks post-surgery with light resistance exercises. Strengthening targets the shoulder and arm muscles to regain endurance and function. Return to daily activities, including light computer work, can occur relatively early, often within days or weeks, but heavy lifting, overhead activities, and sports are gradually reintroduced, usually around four to six months or longer, depending on individual progress and the sport’s demands.
Considering Your Options
Deciding whether bicep tenodesis is the right choice often involves evaluating the severity of symptoms and the effectiveness of non-surgical treatments. Many individuals with biceps tendon issues initially try conservative approaches, which can include rest, ice application, and nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce pain and swelling. Physical therapy is also a common first-line treatment, focusing on exercises to improve shoulder mobility, strength, and overall function. Corticosteroid injections into the tendon sheath may also be considered to alleviate inflammation and pain.
If these conservative measures do not provide adequate relief after several months, or if there is significant tendon damage, surgery may become a consideration. Its value is often measured by its ability to provide pain relief and improve shoulder function, enhancing quality of life for suitable candidates. Success rates for bicep tenodesis are generally positive, with many patients achieving good to excellent outcomes. The procedure is particularly considered for those who require complete recovery of strength and function, such as athletes or individuals whose occupations involve physical demands.