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 www.advocareorthosportsmed.com or follow us at facebook.com/johnvitolomd.

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 facebook.com/johnvitolomd.

The Biceps

Located in the front of the upper arm between the shoulder and elbow, the function of the biceps is to keep the shoulder stable. The biceps also helps to bend and flex the arm at the elbow joint. Composed of tendons and muscles, the tendons attach the biceps muscle to the bone. The upper portion of the biceps muscle has two tendons that attach to the shoulder. The long head attaches to the top of the shoulder or glenoid, while the short head attaches to a portion of the shoulder blade referred to as the coracoid. 

Picture courtesy of http://www.shoulderdoc.co.uk

The long head of the biceps tendon is more commonly injured. Common injuries include full and partial tears of biceps tendon and result from overuse or acute injury. These injuries often occur in conjunction with other injuries of the shoulder, such as Rotator Cuff Tears.

Symptoms of Biceps Tears:

• Weakness of the shoulder/elbow
• A bulge or deformity in the upper arm
• Difficulty turning palm up and down
• Sharp/sudden pain in upper arm
• Cramping of the biceps muscle
• Pain or tenderness in the shoulder/arm

Treatment of biceps tears can be non-surgical or surgical, depending on the severity of the injury. Non-surgical treatment includes ice, rest, anti-inflammatories and physical therapy. Surgical intervention is often needed, especially with athletes and physical laborers.

Surgery is most commonly performed arthroscopically. Two surgical procedures used to repair the biceps tendon are referred to as Biceps Tenodesis and Biceps Tenotomy. In Tenodesis, the biceps is repaired arthroscopically and the tendon is reattached to the bone. In Tenotomy, the biceps is cut and not repaired. Each procedure has advantages, depending on the patient and nature of the injury. A future blog post will review both procedures in greater detail.