What is Biceps Tenotomy?
Biceps tenotomy is a surgical procedure in which the long head of the biceps tendon (LHB) is deliberately cut and released from its attachment point in the shoulder joint. This procedure is often performed to address pain or dysfunction in the long head of the biceps tendon, which commonly results from inflammation, degeneration, or tears.
Unlike biceps tenodesis, the tendon is not reattached elsewhere after it is cut. This makes tenotomy a simpler and quicker procedure, but it may lead to a cosmetic change known as the “Popeye deformity” in some cases.
Anatomy of the Biceps Tendon
The long head of the biceps tendon originates from the top of the glenoid (socket of the shoulder joint) and runs through the bicipital groove of the humerus. This tendon can become damaged or irritated due to:
- Repetitive overhead motions (e.g., in sports or heavy labor).
- Age-related wear and tear.
- Shoulder joint conditions, such as rotator cuff tears or shoulder impingement.
Why is Biceps Tenotomy Performed?
Biceps tenotomy is typically performed to:
- Relieve Chronic Pain: Especially in cases of biceps tendonitis or rotator cuff arthropathy.
- Address Irreparable Tendon Damage: In cases of severe tendon degeneration or partial tears.
- Treat SLAP Tears: Injuries to the superior labrum where the tendon attaches.
- Simplify Surgical Management: When performed alongside other procedures like rotator cuff repair or shoulder arthroplasty.
Symptoms that might lead to a biceps tenotomy include:
- Pain in the front of the shoulder.
- Weakness or difficulty performing overhead movements.
- Clicking or catching sensations in the shoulder.
Procedure Overview
Biceps tenotomy can be performed arthroscopically (using a small camera and tools) or via open surgery.
Surgical Steps
- Accessing the Shoulder Joint: Small incisions are made to insert the arthroscope and surgical tools.
- Tendon Release: The surgeon identifies the long head of the biceps tendon and cuts it near its attachment point on the glenoid.
- Optional Tendon Trimming: To ensure the remaining portion of the tendon does not cause irritation.
- Closure: The surgical site is closed, and a dressing is applied.
Benefits of Biceps Tenotomy
- Pain Relief: Reduces or eliminates pain caused by inflammation or damage to the tendon.
- Simplicity: A quicker and less complex procedure compared to tenodesis.
- Effective for Non-Athletes: Ideal for older, less active individuals where cosmetic or strength loss is less of a concern.
Potential Drawbacks
While effective, biceps tenotomy has some potential disadvantages:
- Popeye Deformity: A visible bulge in the upper arm due to the retraction of the biceps muscle. This is primarily cosmetic and does not affect function.
- Strength Loss: A small reduction in supination strength (rotating the forearm) and elbow flexion.
- Persistent Pain: Rare cases where the cut tendon can irritate nearby tissues.
Tenotomy vs. Tenodesis
| Feature | Biceps Tenotomy | Biceps Tenodesis |
|---|---|---|
| Procedure | Tendon is cut and left unattached | Tendon is cut and reattached to humerus |
| Cosmetic Appearance | May result in “Popeye deformity” | Usually no visible deformity |
| Strength Loss | Minor strength reduction possible | Better strength preservation |
| Recovery Time | Shorter recovery (6-12 weeks) | Longer recovery (3-6 months) |
| Ideal Candidate | Older, less active individuals | Younger, active individuals needing more strength preservation |
Recovery and Rehabilitation
Post-Surgery Care
- Patients typically wear a sling for comfort for a few days to a week.
- Ice packs and pain medication help manage post-operative discomfort.
Physical Therapy
- Recovery from biceps tenotomy is often quicker than tenodesis.
- Patients can begin light activities almost immediately, gradually progressing to full strength and mobility within 6-12 weeks.
Who is a Candidate for Biceps Tenotomy?
Biceps tenotomy is best suited for:
- Older or less active patients who prioritize pain relief over strength preservation.
- Individuals willing to accept potential cosmetic deformity.
- Cases where simplicity and quicker recovery are preferred over a more complex surgical option.
Risks and Complications
Though relatively safe, potential risks include:
- Infection: Rare but possible at the surgical site.
- Residual Pain: Rarely, the tendon stump can cause irritation.
- Shoulder Weakness: Minor reduction in arm strength, especially during specific movements.
- Popeye Deformity: A cosmetic issue for some patients.
Conclusion
Biceps tenotomy is an effective, straightforward procedure to relieve chronic shoulder pain caused by biceps tendon dysfunction. While it may result in cosmetic changes and minimal strength loss, it is an excellent option for individuals prioritizing quick recovery and pain relief. For those seeking greater strength preservation or improved aesthetics, biceps tenodesis may be a better choice.