Biceps tenodesis is a minimally invasive keyhole procedure to re-anchor the biceps tendon at the top of the arm bone (subpectoral tenodesis). Patients wear a sling for six weeks and start therapy two weeks after surgery. Strengthening and training for your sport commences at 3 months; full unrestricted contact sport is possible at 3-4 months after surgery.
The Biceps Tendon runs in a narrow groove in the front of your shoulder joint. Either due to acute trauma, repetitive overuse, or chronic degeneration over time, the biceps tendon may become inflamed (tendonitis) and cause pain during certain movements of the shoulder. If the biceps tendon is causing problems in your shoulder it can be either be:
Dr Pant performs a Biceps Tenodesis using the sub-pectoral (under the armpit) position to anchor the tendon. He deploys the button intra-cortical (inside the canal of the arm bone) – this minimises “groove” pain that other techniques may not address.
The key point is to remember which conditions in your shoulder are “time urgent” and which are not. Dr Pant will clearly outline this for you during your consultation.
Biceps tendon dislocation (out of the groove). When the biceps tendon is “subluxed” or “dislocated” out of the groove it can cut into the subscapularis tendon and cause further damage, you should consider surgery sooner rather than later.
Prevent further shoulder damage
There are three essential components to a good outcome from surgery:
Dr Pant utilises the JPL pathway for most patients and this will form the basis of your rehabilitation after surgery; it will be modified to suit your individual circumstance.
The JPL pathway allows for self-directed, early passive shoulder range of movement:
After the surgery you will be in a sling and protect your shoulder to allow the shoulder to heal. At two weeks after the surgery Dr Pant will see you at your review appointment and discuss the JPL rehabilitation protocol with you. This JPL physiotherapy protocol will commence two weeks after your surgery.
The therapy program will focus on flexibility and range of motion exercises initially. These gentle stretches will improve your range of motion and prevent shoulder stiffness. As the shoulder begins to heal you will be able to progress to exercises that strengthen your shoulder muscles. Shoulder strengthening is commenced at 12 weeks post Biceps Tenodesis surgery.
The type of sling is selected specific to you and your shoulder surgery
Driving after shoulder surgery
Showering and getting dressed
Sleeping after Shoulder Surgery
Elbow and hand movement
Surgery is a carefully choreographed process and you are being treated by a sub-specialist shoulder surgeon and a highly experienced team; however, all surgeries inherently carry some risk of complications.
The risk of complications after biceps tenodesis surgery is less than 1% in the Sydney Shoulder Unit experience. General risks include:
Specific risks relating to biceps tenodesis surgery:
There are three areas where your biceps tenodesis surgery may fail:
There are special techniques in tissue management and suture choice to reduce failure rates.
Failure of Biceps Tenodesis (Re-anchoring of the tendon) is reported at between 2-6% (but in the SSU experience it is < 1%)
Patients who smoke, use tobacco products, have diabetes, or are elderly are at higher risk of complications both during and after surgery. They are also more likely to have problems with wound and bone healing.
Most healthy patients, however, cope well with keyhole shoulder surgery and are unlikely to have complications.
With careful patient selection and good surgical technique, the outcome after biceps tenodesis surgery is excellent, with >95% satisfaction in most published studies. An experienced shoulder surgeon will be able to diagnose your biceps tendonitis and also treat any other causes of shoulder pain, such as shoulder impingement or a subscapularis tendon tear. As with any other operation on the shoulder, it is important to be thorough in the assessment and precise during surgery to deliver the best outcomes.
This 53 year old lady presented with right-sided shoulder pain after injuring her shoulder at work. She underwent a period of rest, cortisone injection and 3 months of physiotherapy without improvement.
After a careful history and examination, an MRI scan was undertaken. The MRI showed a Rotator Cuff Tear with Biceps Tendonitis.
The images taken at surgery (key-hole) demonstrate significant biceps tendonitis with inflammation and thickening of the tendon. The biceps tendon was taken out of the shoulder joint and re-anchored under the arm-pit (biceps tenodesis). The bursitis and bone spur was cleaned out and the rotator cuff tear was repaired with 4 anchors with good compression of the tendon foot-print.
She was discharged home the following day after surgery and placed in a sling for six weeks. She underwent JPL rehab which commenced at two weeks post-surgery. Strengthening commenced at months under the guidance of her physiotherapist.
She no longer has her previous shoulder pain and has good power of her rotator cuff.
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