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Elbow fracture - Orthopaedics SA

Biceps tenodesis & tenotomy

Biceps tenodesis and biceps tenotomy are two similar surgical procedures used to treat chronic pain and tendonitis in the long head biceps tendon. It may also be used to treat SLAP tears.

Tenodesis involves cutting the biceps tendon and attaching it to the upper arm bone, whereas tenotomy involves severing the tendon and letting it retract back into the arm. Both procedures have benefits and disadvantages, and your Orthopaedics SA surgeon will recommend one based on your lifestyle needs and recovery goals.

Tenotomy has a higher risk of Popeye deformity (where the biceps muscle bulges) and muscle spasms after recovery. However, it is also quicker to perform and has a shorter average recovery period.

You may be able to undergo biceps tenotomy after a failed biceps tenodesis, though a successful tenodesis following a tenotomy is unlikely.

Biceps tenodesis may be recommended as a treatment option if:

·      The biceps is unstable due to a rotator cuff tear

·      You are less than 60 years of age

·      You want to return to sports or manual work

·      The long head biceps tendon is inflamed or only partially torn

Biceps tenotomy may be recommended if:

·      You are over 60 years of age

·      You do not intend to return to high levels of physical activity (such as manual work or sport)

·      You are not worried about cosmetic deformities in the arm

·      A tenodesis procedure is not likely to succeed

Tenodesis is a surgical procedure used to reattach a torn or cut tendon. In most cases, it is performed arthroscopically through one or more small incisions in the arm and shoulder.

Under a general anaesthetic, the orthopaedic surgeon inserts an arthroscope (small camera) inside the joint. This allows a clear view of the operating site.

The surgeon then threads a small needle through the biceps tendon, preventing it from retracting when it is cut. The damaged part of the tendon is then removed and the remaining section is secured to the upper arm bone (humerus) using a specialised bone screw.

After the procedure, the incisions are stitched or taped closed and you will return to a recovery room to wake up.

Biceps tenodesis can be performed as a day procedure in many cases. This means you will be discharged from the hospital on the same day as the procedure and will not need to stay overnight.

You will need to wear a sling for about three weeks after surgery. This supports the arm and shoulder as the tendon heals. You should only take the sling off to get dressed, bathe, and complete activities or exercises recommended by your physiotherapist.

Most patients can return to sedentary work and driving within three weeks of their biceps tenodesis. Jobs requiring manual labour or repetitive overhead motions may need a rest period of 6-12 weeks, while contact sports should be resumed only under your surgeon’s guidance.

Like biceps tenodesis, biceps tenotomy involves cutting away the damaged part of the biceps tendon. The difference is that instead of being affixed to the upper arm bone, the tendon is released and allowed to retract into the arm.

This does not compromise shoulder stability, though about half of all patients will develop a Popeye deformity (a change to the contour of the biceps muscle). The procedure is performed under a general anaesthetic and usually does not require an overnight hospital stay.

Recovery from biceps tenotomy is generally quicker than recovery from biceps tenodesis. This is because the tendon is left loose in the arm and does not need to heal to another surface.

You will need to wear a sling for 2-4 days after your biceps tenotomy surgery. This is for comfort only and should be taken off as soon as possible, though you may still wear it while sleeping if the shoulder feels tender.

Most patients can return to driving and sedentary work around a week after the procedure, though you may need three or more months to recover before resuming sports. Complete recovery can take 4-6 months, with some patients noticing improvements up to 12 months after their tenotomy.

· – biceps tenotomy

· – biceps tenodesis

·      Orthoinfo.aaos – biceps tendinitis

· – Surgical indications for long head biceps tenodesis: a systematic review

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