The shoulder joint, a complex ball-and-socket mechanism, allows for extensive arm movement. Central to its function are the rotator cuff muscles and their tendons, which surround the humerus and stabilize the joint. The long head of the biceps tendon is also located in this area. Rotator cuff surgery repairs tears or damage to these tendons, and sometimes surgeons also address the long head of the biceps tendon during these procedures.
The Biceps Tendon’s Role in Shoulder Function
The biceps muscle, located on the front of the upper arm, has two heads: a short head and a long head. The long head of the biceps tendon originates from the top of the shoulder socket, specifically the supraglenoid tubercle and superior labrum, and passes directly through the shoulder joint. It then travels down a bony groove in the humerus, known as the bicipital groove, before joining the muscle belly.
This unique anatomical path allows the long head of the biceps tendon to contribute to several shoulder movements. It assists in flexing the elbow and supination. Beyond these movements, it also plays a role in the dynamic stability of the glenohumeral joint, particularly by helping to depress the humeral head within the socket. Its close proximity and functional relationship with the rotator cuff mean that pathology in one often affects the other.
Understanding Biceps Tendon Pathology
The long head of the biceps tendon is a frequent source of pain in the shoulder. Its path through the shoulder joint makes it susceptible to various issues, especially in conjunction with rotator cuff tears or shoulder impingement. Conditions such as biceps tenosynovitis, which is inflammation of the tendon sheath, can develop, causing pain and tenderness in the front of the shoulder.
Mechanical stress from repetitive overhead movements or age-related wear can lead to fraying or partial tears of the tendon. These degenerative changes can result in ongoing pain, clicking sensations, or weakness in the arm. Furthermore, the tendon can become unstable, subluxing or dislocating from its groove, particularly if the soft tissue restraints that hold it in place are damaged, often in association with subscapularis tendon tears. Addressing this tendon during rotator cuff surgery aims to resolve this additional source of pain and improve overall shoulder mechanics.
Surgical Approaches: Tenotomy and Tenodesis
When the long head of the biceps tendon is compromised and causing symptoms, surgeons have two primary methods for intervention during rotator cuff repair: tenotomy and tenodesis. Both procedures aim to alleviate pain from the problematic tendon. The choice between them depends on various factors, including the patient’s age, activity level, the extent of the tendon’s damage, and surgeon preference.
Biceps tenotomy involves cutting the long head of the biceps tendon at its attachment point within the shoulder joint and allowing the remaining portion to retract. This procedure is simpler and quicker to perform. A potential outcome of tenotomy is a cosmetic deformity known as a “Popeye” sign, where the biceps muscle can appear to bulge lower in the arm due to the tendon’s retraction. While this cosmetic change is noted in a significant percentage of tenotomy patients, its functional impact is often minimal, though some patients may experience mild cramping or soreness.
In contrast, biceps tenodesis involves cutting the damaged tendon and then reattaching it to a new location on the humerus, outside the shoulder joint. The goal of tenodesis is to maintain the normal length-tension relationship of the biceps muscle, thereby preserving its function and minimizing the risk of the “Popeye” deformity. This procedure is generally more involved than a tenotomy and may require a slightly longer initial recovery period due to the reattachment process. Studies indicate a lower incidence of the “Popeye” deformity with tenodesis compared to tenotomy.
Post-Surgical Recovery and Functional Impact
Recovery following a biceps tendon procedure involves a structured rehabilitation program. Immediately after surgery, the arm is typically immobilized in a sling for several weeks to protect the healing tissues. Pain management is important in the initial postoperative period, often involving prescribed medications and ice application.
Physical therapy usually begins shortly after surgery, focusing on gentle passive and active-assisted range of motion exercises. The progression of exercises is gradual, with strengthening activities introduced later in the recovery timeline, typically after about three months. Full recovery can vary, often taking four to six months, with some patients continuing to improve for up to a year. Addressing the biceps tendon aims to reduce pain and improve overall shoulder function, allowing patients to return to daily activities with greater comfort and mobility.