Biceps Tenodesis

What does the operation involve?

This is a keyhole operation for treating biceps tendonitis and most SLAP tears to detach the damaged biceps tendon from inside the shoulder joint. Another name for this operation is an arthroscopic biceps tenotomy. It is a keyhole operation, usually performed under a general anaesthetic. It is usually done through two 5mm cuts at the back and front of your shoulder. The surgeon inspects the inside of your shoulder and then detaches your biceps from the inside of the joint. Sometimes, that is all that is required to help with your pain. Often, Mr. Davies will then make a 2-3cm cut at the front of your armpit to remove the damaged section of your biceps tendon and reattach it to the bone further down your arm. This is called a biceps tenodesis and, for some people, can reduce the chance of cramping pain or a bulge appearing at the front of the arm. The operation is usually performed as a daycase procedure, with 90% of people going home within hours of their surgery.

If you have a SLAP tear and your shoulder also dislocates, Mr. Davies will instead perform an arthroscopic SLAP repair. It is a similar operation to an arthroscopic stabilisation for shoulder dislocations. More information about that type of surgery can be found here.

What are the risks and benefits of this operation?

The main benefit of this surgery is to relieve your shoulder pain. Around 90% of people get some benefit from this operation and many of those report essentially normal shoulders after the recovery period. The risks are in line with the general risks of keyhole shoulder surgery, which you can find more about here.

There are also some specific risks of biceps tenodesis, which are shown in the video above. These risks include:

• Biceps bulge: If the biceps is detached from the inside of your shoulder but not reattached, around 1 in 3 people may notice the biceps muscle bulging at the front of their arm. Sometimes, this is referred to as the Popeye sign. It is usually quite harmless and, apart from the change in appearance of your arm, you are unlikely to notice and decrease in strength. There is a lower chance of this happening if you have a tenodesis, where the tendon is reattached to a different part of your bone. Adding this part of the operation does slightly increase the risk of nerve damage, increases pain after surgery and also takes longer to recover from. Even if your biceps is reattached, it may not heal, leading to a bulge appearing further down the line.
• Biceps cramps: Some people feel a cramping sensation in the muscle for several months after surgery while the biceps settles in its new position. This is not usually very painful and may occur when you try to lift something heavy. For most people, it settles by itself over a few months with some massage and stretching exercises given to you by the physiotherapist.

What is the recovery after this surgery?

You will be provided with a sling after surgery, along with instructions from the physiotherapist about how to put on and take off the sling. You are advised to use the sling for only 1-2 days. Most people have little or no pain immediately after surgery due to the nerve block that the anaesthetist puts in. It is vitally important that you start taking painkillers supplied to you before the nerve block wears off so that you keep on top of any pain when the block wears off. Some people also find an ice pack helpful in the first few days. You may also find it more comfortable to sleep slightly propped up. It is advisable to get on your feet and walk around frequently to reduce the risk of blood clots in your legs.

Your physiotherapist will give you some exercises to start. It is important that you do these exercises to prevent stiffness and maximise your chance of a good recovery. Most people are allowed to start using their shoulder straight away, but avoid heavy lifting for 6 weeks after surgery. You will usually be seen in clinic 2-4 weeks after surgery to check that everything is OK. You will notice your shoulder improving over the next few weeks, but it can take several months of work with your physiotherapist to get the full benefit of surgery.