A bicep tenotomy is a surgical procedure that addresses issues with the biceps muscle’s long head tendon, performed to relieve pain and improve shoulder function. It involves releasing the problematic tendon from its attachment point in the shoulder joint.
Understanding the Biceps and Its Tendons
The biceps brachii, commonly known as the biceps, is a large muscle located on the front of the upper arm, extending between the shoulder and the elbow. This muscle plays a primary role in flexing the elbow, bringing the forearm closer to the upper arm, and supinating the forearm, which involves rotating the palm upwards.
The biceps muscle has two distinct heads, a short head and a long head, each with its own tendon. The short head originates from the coracoid process of the scapula, which is part of the shoulder blade, and rarely causes problems. The long head, however, originates from the supraglenoid tubercle, an area just above the shoulder socket, and its tendon travels through the shoulder joint. This long head of the biceps tendon is more susceptible to wear and tear, inflammation, and injury due to its course within the shoulder joint.
Why a Bicep Tenotomy is Performed
A bicep tenotomy is typically considered when chronic pain and dysfunction stem from issues with the long head of the biceps tendon, and conservative treatments have proven ineffective. These non-surgical approaches usually include rest, physical therapy, anti-inflammatory medications, and steroid injections.
Common indications for a bicep tenotomy include severe and chronic biceps tendinitis, which is inflammation of the tendon. Another reason is a superior labrum anterior to posterior (SLAP) tear, an injury to the cartilage rim of the shoulder socket where the long head of the biceps tendon attaches. This procedure is often chosen for SLAP tears, especially in patients over 35 or 40 years old, where repairing the tear might be less effective. Biceps instability, where the tendon moves abnormally or dislocates within the shoulder joint, can also necessitate a tenotomy.
The Tenotomy Procedure Explained
The tenotomy procedure involves detaching the long head of the biceps tendon from its attachment point within the shoulder joint. This allows the problematic tendon to retract, removing the source of pain and inflammation. It is commonly performed using an arthroscopic approach, which is minimally invasive.
During arthroscopy, a surgeon makes small incisions to insert a tiny camera, called an arthroscope, into the shoulder joint to visualize the area. Specialized instruments are then inserted through other small incisions to precisely release or cut the long head of the biceps tendon from its insertion point. After the tendon is released, it is allowed to retract into the upper arm, where it naturally scars down. While tenotomy is a simpler and quicker procedure, an alternative called tenodesis involves reattaching the tendon to a different location, usually on the humerus, to maintain its length and tension.
Life After Bicep Tenotomy
After a bicep tenotomy, patients undergo a recovery period with post-operative care and structured rehabilitation. A sling may be used initially for comfort, and pain is managed with prescribed painkillers. Recovery from tenotomy is typically quicker than from tenodesis, as no reattachment is involved.
Physical therapy plays a role in regaining range of motion and strength in the shoulder and elbow. The rehabilitation protocol typically progresses through phases, starting with passive range of motion exercises to minimize pain and inflammation. As recovery advances, active range of motion and gradual strengthening exercises are introduced, with light lifting potentially allowed after six weeks.
Many patients experience pain relief and improved shoulder mechanics, often returning to sports and daily activities. A common cosmetic change after a tenotomy is the “Popeye deformity,” where the biceps muscle may bulge in the lower arm due to the released tendon retracting. This occurs in about half of patients and is generally not problematic, though active individuals may consider its impact. Adherence to rehabilitation protocols is important for optimal results.