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.

Case Study: Shoulder Biceps Tenodesis

A 58 year old male came into the office for a second opinion approximately one year after shoulder surgery in Florida. The previous surgery entailed “shaving” of a labral tear, but no evidence of repair. The labrum is soft, fibrous tissue that surrounds the shoulder joint. Despite the previous surgery, he continued to experience pain with overhead activities, was unable to lift and had trouble sleeping due to the pain. The pain was not relieved with cortisone injections. 

Our first goal was to determine the exact source of the patient’s pain. An MRI of his shoulder revealed a labral tear and damage to his biceps tendon. The biceps tendon is attached to the labrum, which is located between the ball and socket joint. Following injury, this biceps tendon can pull the labrum off the shoulder joint and create constant tension and pain. Once this tension is released by cutting the biceps tendon, the labrum returns to its normal position and pain is reduced. The biceps can then be placed in another anatomic location so that it will function properly and not cause pain.

 

We then performed an ultrasound guided biceps tendon sheath injection. If the injection provided relief, we would be able to confirm that pain was coming from the biceps tendon. The patient experienced relief from the pain after the injection; therefore our suspicion was confirmed.  

For treatment, opted to perform an outpatient shoulder arthroscopy and perform a biceps tenodesis.  In this procedure, the biceps tendon is released and then reattached arthroscopically. One week after surgery, the patient stated his pre-operative pain had significantly improved and he was sleeping well at night. He started physical therapy 3 weeks after surgery and wore a sling for 4 weeks to protect the repair. 9 weeks post-op, the patient stated his pain was absent, his range of motion was almost completely restored, and his strength was improving. He was discharged in excellent condition 15 weeks after surgery. 

Dr. Vitolo, who specializes in shoulder and knee arthroscopy, performs a unique arthroscopic biceps tenodesis. This arthroscopic procedure eliminates the need for a large incision, metal anchors, or significant soft tissue trauma. This arthroscopic biceps tenodesis is the latest advancement in shoulder arthroscopy performed by Dr. Vitolo for specific injuries. 

For more information on Dr. Vitolo and shoulder injuries, please visit http://www.advocareorthosportsmed.com or check us out on facebook: facebook.com/johnvitolomd.