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Biceps Tendonopathy-Tenotomy versus Tenodesis

April 25th, 2007

When the biceps tendon is torn, degenerative, thickened, frayed or merely inflammed, pain can occur in the front of the shoulder. This finding--Biceps Tendonopathy--for lack of a better term, is the single easiest cause of shoulder pain to cure.

There are 2 schools of thought regarding treatment--but when the biceps is more than just "synovitic"-- both agree that the biceps tendon needs to be removed from the inside of the joint. Not to worry though, the biceps muscle has 2 proximal tendons, and so, release will not affect function, diminish the ability to flex the elbow, or weaken strength of flexion.

Biceps tenotomy simply lets the tendon slip out of joint--although it usually gets stuck and scars to the intertubercular groove, and there will be no visible evidence that it has been tenotomized. However, there is a 30% chance that it will slip further, resulting in a "popeye-like" deformity. Ofcourse, for those of us without sculpted biceps muscles, this will not be visible. For those of us that do care about this potential cosmetic consequence--a biceps tenodesis can be performed.Biceps tenodesis can be performed arthroscopically without difficulty. The tendon is sutured to the bone--outside the joint--after tenotomy.

It has been my experience, however, that recovery following Acromioplasty for Impingement is slightly longer when a tenodesis is performed, as compared to when tenotomy alone is performed. I think this is related to the inflammatory process in the front of the shoulder--related to the tendon healing to the bone--even though it is occurring outside of the joint.

Based on personal scrutiny of the literature which compares tenodesis and tenotomy, I have the following opinion/recommendation:
1.If the biceps is a potential cause of pain, tenotomy should be performed.
2.Unless you really will be disturbed by a slight deformity in the muscle, which occurs about 30% of the time, there is no advantage associated with tenodesis.
3.If you absolutely want a normal looking biceps, tenodesis should be performed--but there is still a 10-15% chance that the muscle will not look entirely normal.
4.Some cramping may accompany tenotomy, but this usually resolves by around 3 months.
5.If my long head biceps tendon was a source of pain, I would elect tenotomy--not tenodesis.

The biceps will only be addressed with either of these 2 options if it is degenerative, thickened or torn----all in the interest of pain relief.

Related Photos:

Inflammed biceps long head tendon (red streaks represent synovitis)

Related Videos:

Biceps tendinosis/tendinopathy
Biceps tenotomy
Tenodesis.Biceps exposed in rotator interval
Tenodesis.Intertubercular groove is decorticated/burred
Tenodesis.Bioabsorbable suture anchor is placed
Tenodesis.Spectrum suture shuttle is placed through biceps tendon
Tenodesis. Suture is shuttled through the biceps tendon with a 2.0 prolene
Tenodesis. Knot is tied
Tenodesis.Biceps tendon is released in the joint after tenodesis
Tenodesis. Completed tenodesis