Biceps tenotomy, tenodesis and transfer surgery
Biceps tenotomy, tenodesis and transfer are surgical procedures that repair damaged bicep tendons. Strong cord-like structures of fibrous tissue, the tendons connect the bicep muscle in your upper arm to bones in the shoulder. The upper end of the bicep muscle has two tendons — the long head and the short head, which attach the biceps to the bones in the shoulder joint. The long head bicep tendon connects the bicep muscle to the top of your shoulder socket (glenoid). The short head tendon attaches to the small bump on the shoulder blade known as the coracoid process and is less commonly associated with tearing.
The bicep muscles control arm rotation and the bending of the elbow. A combination of muscles and tendons provides support for the upper arm bone, and keeps it centered properly in the socket of the shoulder blade. The long head tendon is more susceptible to injury due to its placement in the shoulder joint. The short-head tendon of the biceps rarely tears. Fortunately, it can serve as a functioning joint if the long-head tendon is damaged.
When the long head of the biceps muscle is torn or detaches from the shoulder due to injury or overuse, your doctor may suggest one of the three surgical procedures to repair it, depending on your lifestyle and injury: tenotomy, tenodesis or transfer surgery.
- Tenotomy – During a biceps tenotomy, the surgeon releases the injured biceps tendon from its attachment to the shoulder joint. This allows the tendon to fall down into the upper arm area completely away from the shoulder joint, and can significantly reduce pain and symptoms. Since there still remains another intact tendon in the biceps region, this release should not affect overall function in the shoulder. However, since the tendon is no longer attached, it can possibly slip out of its groove and create a deformity referred to as “Popeye-like." This deformity is more noticeable in people with sculpted muscles, and in younger patients can be avoided with biceps tenodesis surgery.
- Tenodesis – Using a minimally invasive shoulder arthroscopy procedure, the tendon can be released and then sutured into place, particularly in younger, more active patients. Your orthopaedic surgeon begins by making a few very small incisions in your shoulder. An arthroscope is a thin, flexible scope containing a lens, camera and a lighting system which sends real-time video to a video monitor by the operating table. The arthroscope is inserted into one of the incisions and very thin surgical tools are inserted into one or more of the other incisions. Using the magnified video images as a guide, your surgeon detaches the torn tendon from the shoulder joint and then reattaches it to the bone outside of the joint. The procedure also can be performed with a combination of arthroscopic and open incisions and so can be “arthroscopic-assisted.” This prevents the tendon from slipping down and creating any unwanted deformity during recovery. The recovery process is significantly longer for this surgery than for a biceps tenotomy.