The biceps muscle—and the tendons that attach it to the shoulder—are often causes of shoulder pain. Biceps tenodesis and tenotomy are two surgical ways of treating biceps injuries.
The biceps muscle has a long head that is attached to the upper portion of the shoulder socket (glenoid), as well as a short head attached to the shoulder blade. The long head is much more susceptible to strains, tears and inflammation.
Biceps tenodesis involves cutting the biceps tendon off the labrum, which is the pad of cartilage inside the glenoid, and reattaching it to the humerus (upper arm bone). Biceps tenotomy means cutting off one tendon and not reattaching it, allowing it to heal to the humerus over a few weeks. The biceps will still function well after tenotomy, but there may be a change in the appearance of the arm with some flattening of the biceps.
Common Reasons for Biceps Tenodesis and Tenotomy
Both biceps tenodesis and tenotomy are done in response to tendon tears, injury or inflammation—usually of the long head’s tendon. One of these procedures may also be performed when treating a superior labral anterior to posterior (SLAP) lesion or tear.
Candidates for Biceps Tenodesis or Tenotomy
These two procedures are for people who have already tried more conservative approaches—often including anti-inflammatories, corticosteroid injections and physical therapy—and still have pain. The decision to undergo biceps tenodesis versus biceps tenotomy is one that the patient and the surgeon must make together. Often, biceps problems are found during surgery and the surgeon will decide what treatment is best based on the type of tear and characteristics of the patient.
The Biceps Tenodesis and Biceps Tenotomy Procedures
Of the two, biceps tenotomy is the simpler surgery. A biceps tenotomy is simply cutting the tendon of the bicep’s long head off its attachment at the glenoid and letting it hang down the upper arm. This reduces pain and does not affect the shoulder’s stability or integrity, but it does create a cosmetic defect called a Popeye deformity in many cases, which looks like a flattening on top of the biceps and some fullness of the muscle above the elbow. In many arms, this may be barely noticeable.
Strenuous activities like weightlifting and repetitive turning motions (i.e. using a screwdriver) can cause muscle spasms after a biceps tenotomy, so a tenodesis is usually the better option for people who do a lot of heavy lifting overhead, whether recreationally or occupationally. Generally, however, most people have essentially normal biceps function after a biceps tenotomy.
Biceps tenodesis is a minimally invasive surgery in which the surgeon cuts the biceps tendon from the glenoid and reattaches it to the humerus using sutures and screws. This procedure is more often done with younger and more active patients because it is considered to be more stable, and it carries less chance of a Popeye deformity.
Recovery from Biceps Tenodesis and Biceps Tenotomy
Because there is no reattachment, people tend to recover more quickly from biceps tenotomy and have a lower risk of surgical complications like infection. However, there is a greater chance of a Popeye deformity and occasional muscle cramping with a tenotomy.
Recovery from tenodesis varies. Patients may need to wear their arm in a sling for a few weeks, and strenuous activities can be resumed in three months. The procedure carries a small risk of the sutures failing and the tendon becoming unanchored.