Monday, February 17, 2014

Case Study: Biceps Tenodesis for Biceps Repair

A 52 year old male presented to our office for a second opinion after suffering a proximal biceps rupture at work. The patient had undergone a repair with another surgeon, but 8 days post-op he noticed that his biceps still looked deformed as it did before surgery.

Upon examination of the patient, we diagnosed him with a “Popeye Deformity”, a sagging deformity of the biceps. The previous surgeon had performed a bicipital groove repair, which did not repair the deformity. We discussed the options with the patient. We felt that a revision biceps tenodesis would be the best option. By performing this procedure, we could re-attach the biceps muscle at the proper length, eliminate the Popeye Deformity and restore function.

In this case, the surgical procedure selected involves a special technique referred to as the subpectoral biceps tenodesis (SPBT). In this specialized technique, the biceps is placed just beneath the pectoralis major tendon on the humerus. The procedure is performed using a small incision. The incision is placed at a discrete location near the inner fold of the arm pit.

SPBT was indicated in this case because of the failure of the previous surgery. Primarily, the SPBT guarantees that the biceps is brought back to its functional length. Also, in this procedure, the biceps is returned to its original anatomic state and will look and function in the same manner as the uninjured side. As an added benefit, cosmetically, the incision for the tenodesis is smaller and more discrete. A bicipital groove repair involves an incision in front of the shoulder and is a viable option in certain cases, but for some a biceps tenodesis yields better overall results.

SPBT is performed with a bio-absorbable anchor that will grow into the bone; metal anchors are never used in this repair. Recovery includes a sling for 4 weeks to protect the repair, followed by 6 to 8 weeks of physical therapy, which will help restore range of motion and strength. In this case, the patient recovered beautifully, is back to work and has regained the ability to perform all activities. When we spoke to the patient recently he stated that he has no pain or spasms, is back to working out at the gym every other day and is working hard at his autobody business. According to the patient, “I feel great and have no issues with my biceps.” A complete success in our opinion.

For more information or to schedule an appointment with John Vitolo, M.D., please call 973-300-1553, visit our website or follow us at