Bicep Tenodesis

Biceps Tenodesis is a surgical procedure that is typically used to treat injuries to the biceps tendon in the shoulder. These injuries may occur due to an unstable or dislocating tendon, tendonitis, or tears in the tendon itself. The biceps is a major pain generator in the shoulder.

There are two main parts to the biceps tendon, the long head and the short head of the biceps. The long head is the portion that resides within the shoulder joint and is usually the one involved in shoulder issues. A tendon is the flexible cord of tissue that connects muscles to bones. Tendon problems may occur anywhere in the body, but are more common in certain joints including the shoulder because of its wide range of motion.

Candidates for Tenodesis

Patients may be considered for tenodesis surgery if they have been experiencing considerable pain and weakness in the shoulder due to a biceps tendon injury. This is often determined by a medical history, physical examination and imaging tests such as an X-ray or MRI scan of the joint. In addition, an arthroscopic evaluation of the joint may be necessary. A tenodesis procedure can be performed on patients of any age if they are experiencing biceps pain that has not responded to nonsurgical management.

The Tenodesis Procedure

Tenodesis is performed as an outpatient procedure that takes between 60 and 90 minutes to complete. After general anesthesia has been administered, the tenodesis procedure begins with the surgeon accessing the joint in the shoulder area. It is often performed arthroscopically, using a minimally invasive technique that involves making several small incisions into which a fiber-optic device and tiny surgical instruments are inserted, offering patients the benefits of less tissue damage and shorter recovery periods.

The surgeon removes damaged tissue around the biceps tendon and detaches the tendon from its connection with the labrum. Any bone or cartilage fragments or bone spurs found that may irritate the tendon will be removed. The tendon is then attached to the humerus bone near the shoulder joint using anchors and strong sutures to hold it in position. This serves to decrease the stress placed on both the tendon and the labrum.

Recovery from Tenodesis

No hospital stay is generally required following a tenodesis procedure. Patients will need to wear a sling for several weeks after the surgery to provide support and protection for the healing shoulder joint. Physical therapy aids the recovery process as it helps to strengthen and restore function to the shoulder. Most patients can return to work in sedentary jobs after a few days, but it usually takes three to six months before more strenuous activities may be permitted.

Risks of Tenodesis

Tenodesis is considered a safe procedure, however, all forms of surgery may carry some risk. The risks typically associated with tenodesis may include:

Infection
Blood clot
Damage to a nerve or blood vessel
Bleeding
Biceps tendon tearing

In some cases, individuals may continue to experience pain, stiffness, muscle weakness and numbness in the affected arm and shoulder.

Rotator Cuff Injuries

Four muscles in the shoulder that when injured or damaged can lead to sleepless nights, pain, and weakness.

The most common ways of injury to the rotator cuff are trauma, such as a fall on the outstretched hand, repetitive overload to the tendon by activity, or bone spurs cutting into the tendon.

Symptoms commonly begin with pain over the upper arm that is worse with reaching overhead, lying on your side, reaching behind your back, and weakness.

The rotator cuff has a very limited capacity to heal on its own and therefore treatment is often required to improve symptoms. This usually begins with a short period of rest, followed by a rehabilitation program focused on mobility, and strength to improve function. Steroid injection can be used if significant inflammation is present and interferes with the ability to engage in the exercise program. Two thirds of patients will improve with these modalities alone, and thus this is the first phase of treatment.

If symptoms persist, MRI is utilized to evaluate the rotator cuff for tears. Most commonly injured is the supraspinatus tendon. This is the muscle that allows you to put on a jacket, reach into the kitchen cabinet and get out the dishes, put a gallon of milk in the refrigerator, or pour a pot of coffee. Because the tendon is spring loaded, full tears commonly separate or retract. The more the retraction, the more serious the tear. If these tears are not addressed, atrophy will ensue and the tears will frequently get larger over time.

Surgical repair is performed arthroscopically and consists of stretching the tendon back out to it’s attachment point and repairing it back to the humerus greater tuberosity that it pulled off from. Traditionally, the shoulder was immobilized in a sling for up to 6 weeks before starting physical therapy to protect the repair. The downside of this approach was a high rate of postop stiffness, called frozen shoulder. We pioneered an accelerated rehab program for rotator cuff 25 years ago that reduced this immobilization down to just 5 days and actually lowered to postop stiffness rate.

Quality of the rotator cuff tissue has been a major determinant of success of the surgery, as well as the recurrent tear rate. The larger the tear and degree of separation, the higher the recurrent tear rate – that can approach 50 percent!

Innovation in rotator cuff surgery revolves around the use of biologics to reduce the risk of recurrent tears. CuffMend is an acellular, dermal allograft that is placed upon the repair to effectively double the thickness of an atrophic tendon and reduce the risk of recurrent tears. We have been effectively utilizing this technology over the past 2 years with great success to enhance patient outcomes for the most serious tears.

We remain committed to utilizing the best technology to remain innovators in rotator cuff surgery.