Biceps Tenodesis

What is Biceps Tenodesis?

Biceps tenodesis is surgery to repair a ruptured biceps tendon. Biceps tendon rupture is a complete tearing away of the tendon from the bone. The majority of biceps tendon ruptures occur at the shoulder and is referred to as proximal biceps tendon rupture. The biceps tendon may also detach from the forearm distally, referred to as distal biceps tendon rupture, however this is less common.

Surgery to repair a ruptured biceps tendon may be performed arthroscopically. Arthroscopy is a surgical procedure in which an arthroscope is inserted into a joint. The arthroscope is a small fiber-optic viewing instrument made up of a tiny lens, light source and video camera. The surgical instruments used in arthroscopic surgery are very small (only 3 or 4 mm in diameter) but appear much larger when viewed through an arthroscope.

The television camera attached to the arthroscope displays the image of the joint on a television screen, allowing the surgeon to look throughout the shoulder or elbow at cartilage, ligaments, and tendons. The surgeon can determine the amount or type of injury, and then repair or correct the problem as necessary.

Arthroscopic surgical procedures are often performed on an outpatient basis and the patient is able to return home on the same day. The benefits of arthroscopy compared to the alternative, open shoulder or open elbow surgery, include:

Smaller incisions

Minimal soft tissue trauma

Less pain

Faster healing time

Lower infection rate

Less scarring

Earlier mobilization

Usually performed as outpatient day surgery

Surgical Treatment

Arthroscopy to repair a proximal ruptured biceps tendon is performed in a hospital operating room under general anesthesia. The surgery is referred to as arthroscopic biceps tenodesis. The surgeon will make several small incisions, about ¼ inch each, to the shoulder area. These incisions result in very small scars, which in many cases are unnoticeable. In one portal, the arthroscope is inserted to view the shoulder joint. Along with the arthroscope, a sterile solution is pumped into the joint which expands the shoulder joint, giving the surgeon a clear view and room to work. The other portal is used for the insertion of surgical instruments. A surgical instrument is used to probe various parts within the joint to determine the extent of the problem. Any bone spurs present that may have contributed to the rupture will be shaved with an instrument called a burr. The surgeon will locate the biceps tendon and debride (remove) any frayed edges that occurred from the rupture. The biceps tendon will then be attached to the humerus bone, the upper arm bone, as opposed to its original location on the labrum within the shoulder. The tendon is secured to the humerus with a special screw.

After treating the problem, the portals (incisions) are closed by suturing or by tape. Arthroscopy is much less traumatic to the muscles, ligaments, and tissues than the traditional method of surgically opening the shoulder with long incisions (open technique).

Post Operative Care

You will wake up in the recovery room and then be transferred back to the ward. A bandage will be around the operated shoulder and the shoulder placed in a soft sling. Once you are recovered your IV will be removed and you will be shown a number of exercises to do. You will be encouraged to move your fingers and wrist often. Your surgeon will see you prior to discharge and explain the findings of the operation and what was done during surgery.

Pain medication will be provided and should be taken as directed. You can remove the bandage in 24-72 hours to shower, depending on your surgeon's preference, and place dressings provided by your surgeon over the area. It is NORMAL for the shoulder to swell after the surgery. Placing ice-packs on the shoulder will help to reduce swelling. (Ice packs on for 20 min 3-4 times a day until swelling has reduced)

Physical therapy will be ordered to restore normal upper arm function and strength. It is imperative that you follow your therapist's instructions to prevent complications. You will be able to drive when you are off pain medications and no longer in a sling, usually about 3 weeks.

You should make an appointment with your surgeon 7-10 days after surgery to monitor your progress. Eating a healthy diet and not smoking will promote healing.

Risks and Complications

As with any surgery, biceps tenodesis may be associated with certain risks and complications such as:

Infection : Infections can occur superficially at the portal insertion sites or in the joint space of the shoulder, a more serious infection.

Nerve damage : Trauma to the nerves can cause numbness, tingling, pain, and weakness.

Hemarthrosis : A condition caused by excess bleeding into the joint after the surgery is completed. This may require additional arthroscopic surgery to irrigate the joint and evacuate the blood.

Reflex Sympathetic Dystrophy: This is an extremely rare condition that is not entirely understood, which can cause unexplained and excessive pain.

The majority of patients however suffer no complications following the procedure