Biceps tenotomy is a surgical procedure that addresses shoulder pain and dysfunction by releasing the long head of the biceps tendon from its attachment inside the shoulder. It aims to alleviate pain and improve shoulder function when conservative treatments have not provided sufficient relief.
Understanding the Biceps Tendon
The biceps muscle, located on the front of the upper arm, has two tendons at its upper end: the short head and the long head. The long head of the biceps (LHB) tendon is particularly relevant to shoulder health as it travels through the shoulder joint. This tendon originates from the superior labrum, a rim of cartilage within the shoulder socket, and helps stabilize the humeral head within the shoulder joint.
Conditions Requiring Tenotomy
Tenotomy is considered when the long head of the biceps tendon causes persistent pain or dysfunction within the shoulder. One common indication is biceps tendinopathy, which is inflammation or degeneration of the tendon, often stemming from chronic wear and tear. This condition can lead to pain at the front of the shoulder, often worsened by overhead or twisting movements.
Another reason for considering a tenotomy is a Superior Labrum Anterior-Posterior (SLAP) tear, an injury to the cartilage rim where the biceps tendon attaches. When non-surgical approaches, such as physical therapy, anti-inflammatory medications, or corticosteroid injections, have not provided adequate relief, tenotomy may be recommended. This procedure is also sometimes performed in conjunction with other shoulder surgeries, such as rotator cuff repairs, to address associated biceps issues. It is often a treatment option for older individuals or those who do not require high levels of overhead activity.
The Tenotomy Procedure
Biceps tenotomy is typically performed using an arthroscopic, or “keyhole,” technique, a minimally invasive surgical approach. The surgeon makes small incisions around the shoulder. An arthroscope, a thin tube with a camera and light, is inserted through one of these incisions, allowing the surgeon to visualize the inside of the shoulder joint on a monitor.
Through additional small incisions, specialized surgical instruments are introduced. The surgeon detaches the long head of the biceps tendon from its attachment point on the superior labrum within the shoulder joint. Unlike a tenodesis, the detached tendon is not reattached; it is allowed to retract into the upper arm. This removes the damaged or inflamed portion of the tendon from the shoulder joint, which helps alleviate pain. The procedure is often performed on an outpatient basis, meaning patients can typically go home the same day.
What to Expect After Surgery
Following a biceps tenotomy, patients typically experience pain relief. A nerve block may be administered during the operation to manage initial post-operative pain, which can keep the shoulder numb for several hours. Pain medication and ice packs are commonly used to control any remaining discomfort after the block wears off.
A sling may be worn for comfort and support for a few days to a few weeks, though duration can vary. Rehabilitation, guided by a physical therapist, is an important part of recovery and typically begins soon after surgery with gentle range-of-motion exercises. Patients can often resume driving within about a week and return to sedentary work within approximately three weeks. A common cosmetic change after a biceps tenotomy is the “Popeye deformity,” a visible bulge in the upper arm where the biceps muscle has retracted, which occurs in about half of patients. While noticeable, this change is typically cosmetic and does not lead to significant functional limitations, though some individuals may experience mild biceps weakness or cramping.