Thursday, November 14, 2013

To Cut or Not to Cut: Biceps Tenodesis vs Biceps Tenotomy

Recently, we discussed injuries and anatomy of the biceps muscle and tendons. If surgery is needed when an injury occurs to the biceps tendon, two procedures are commonly performed: biceps tenodesis and biceps tenotomy. In this post, we will review each and discuss the positives and negatives to each.

Biceps Tenodesis
With biceps tenodesis, the biceps is first released and then re-attached to the bone in a minimally invasive arthroscopic procedure. To do this, anchors or biotenodesis screws are drilled into the bone and the tendon is reattached. 

This procedure can also be used for labral injuries. The labrum is attached to the biceps tendon and can pull the labrum off and place the labrum under constant tension. Here, the tension is released by cutting the biceps tendon and allowing the labrum to return to its normal position, relieving the pain. The biceps tendon is then reattached to another anatomic position, where it will function properly and not cause pain. Patients that benefit most from tenodesis are younger and more active.

Biceps Tenotomy

In a biceps tenotomy, the biceps muscle is cut from the shoulder. By doing this, the pain is relieved. A tenotomy is performed arthroscopically and is a relatively simple procedure. A tenotomy is normally performed in less active individuals who lead a more sedentary life. Side effects with a tenotomy are weakness in the biceps muscle and a deformity referred to as ‘popeye arm’ sometimes occurs. 

To cut or repair?
The decision to perform a tenodesis or tenotomy is based on many factors. Each individual must be evaluated by a qualified orthopedic surgeon. Factors such as age, activity level, overall health, other injuries and occupation are considered. In younger and more active patients, a tenodesis is preferred. Also, people returning to physical labor often do better with a tenodesis.

Tenodesis restores the arm to a more anatomic state, therefore allowing the arm to heal and continue to function the way nature intended. Tenotomy is often the best option for older patients who lead more sedentary lives. The main goal with a tenotomy is to relieve pain and discomfort. Each option has advantages and disadvantages. If you feel you have a biceps injury, John Vitolo, MD is available to help. Contact our office, Advocare Orthopedic and Sports Medicine Center at 973-300-1553 or find us on