Biceps Tenotomy
Shoulder Surgery -
Adelaide Orthopaedic Specialist
Biceps tenotomy may be used to release a damaged long head tendon, reducing pain. Dr James McLean is able to provide this procedure using a minimally-invasive arthroscopic approach.
What is a biceps tenotomy?
The biceps muscle has two tendons which attach it to the labrum. While the larger (short head) tendon rarely causes problems, the long head tendon is prone to wear and tear. If it becomes frayed, painful or degenerate, a biceps tenotomy can be performed to reduce pain by releasing it from its anchor point at the shoulder. Biceps tenotomy may also be performed to treat a SLAP lesion or tear.
Alternatives to biceps tenotomy
A biceps tenotomy may be performed as an alternative to biceps tenodesis, which involves severing the tendon and reattaching it below the pectoralis major muscle. The main difference in outcomes is cosmetic: by anchoring the tendon to a new point (rather than letting it hang freely), the risk of Popeye deformity to the biceps muscle is reduced.
What is involved in an arthroscopic biceps tenotomy?
In a biceps tenotomy, the biceps tendon is cut free from the labrum and allowed to retract into the upper arm. It is not reattached to any structure in the shoulder, and is allowed to heal on its own.
Dr James McLean is able to perform biceps tenotomy using an arthroscopic approach. This allows him to operate through a series of small incisions, rather than creating a large wound.
The arthroscopic approach to biceps tenotomy involves inserting a small camera into the joint to gain a clear view of the area. Specialised tools are then inserted through another small incision and used to release the tendon from its anchor point. The tools are then removed and the small wounds are stitched closed.
Surgical outcomes
As biceps tenotomy involves releasing the long head tendon, change to the contour of the biceps muscle may occur. This often not noticeable; however, some patients may request an alternative procedure to avoid the risk of deformity.
The arthroscopic approach to biceps tenotomy has the advantage of causing minimal disruption to the surrounding tissue, which may result in a faster recovery time and reduced scarring.
In the majority of cases, there is no noticeable reduction in strength or motion following the procedure. Most patients who undergo biceps tenotomy report better use of the shoulder, less pain, and the ability to return to sports following the recovery period.
Recovery from biceps tenotomy
As there is no reattachment involved, recovery from biceps tenotomy tends to be quicker than recovery from biceps tenodesis.
Typically speaking, your shoulder will remain immobilised in a sling for four to six weeks post-procedure. This will be followed by specialised exercises to help restore movement and strength to the shoulder joint, and a gradual return to normal activity. However, your individual recovery process will be influenced by your own health and the nature of your condition.
Following your biceps tenotomy, you may experience occasional muscle cramping and spasms. This is particularly common following strenuous activities or repetitive turning motions, such as lifting weights or turning a screwdriver.
Patient Post-operative information
Shoulder Conditions
Browse the links below for more information on specific shoulder conditions, including the main causes, symptoms and treatments.
Shoulder Arthritis
Shoulder arthritis can cause deep joint pain, stiffness, grinding and reduced movement. It may affect the main ball and socket joint or the smaller AC joint at the top of the shoulder. Treatment could include physiotherapy, medication, injections and surgery.
Shoulder Instability
A shoulder that repeatedly slips, gives way or dislocates may have chronic instability. This can develop after a previous dislocation or from loose supporting tissues. Treatment may include rehabilitation or surgery based on the injury and level of instability.
Shoulder Fractures
A shoulder fracture can involve the upper arm bone, collarbone or shoulder blade. Falls, sports injuries, cycling accidents and direct impacts are common causes. Some fractures heal with a sling and rehabilitation, though displaced or unstable fractures may require surgery.
Frozen Shoulder
Frozen shoulder causes progressive pain and stiffness as the capsule around the shoulder joint tightens. Daily tasks such as dressing, washing your hair or reaching behind your back become difficult. Treatment may include physiotherapy, injections or hydrodilatation, and surgery.
Shoulder Replacement
Shoulder replacement is considered for severe arthritis, some complex fractures or shoulder damage linked with a poorly functioning rotator cuff. Different forms of replacement are used for different shoulder problems, including anatomic and reverse shoulder replacement.
Shoulder Dislocation
A shoulder dislocation happens when the upper arm bone moves out of the socket, usually during sport, a fall or other traumatic injury. After the shoulder is relocated, further review may be needed to assess ligament, labral or bone damage and the risk of another dislocation.
Rotator Cuff Injuries
The rotator cuff is a group of muscles and tendons that helps lift and rotate the arm. Problems can include tendinitis, bursitis and partial or full-thickness tendon tears. Common signs include pain when raising the arm, weakness, difficulty reaching behind your back and pain when lying on the affected shoulder.
Bursitis and Impingement
Bursitis and impingement can cause pain around the front or side of the shoulder, especially when lifting the arm overhead or sleeping on the affected side. Non-surgical treatments are guided, though shoulder arthroscopy may be discussed for cases where symptoms continue.
Shoulder Treatments and Surgery
Surgical Shoulder Procedures and Treatments
Surgery may be discussed if symptoms remain limiting, there is significant damage or an injury needs repair. Procedures performed for shoulder conditions can include:
- Arthroscopic keyhole surgery
- Arthroscopic debridement
- Subacromial decompression (acromioplasty)
- Rotator cuff repair
- Labral or Bankart repair
- Biceps tenodesis or tenotomy
- AC joint excision
- Capsular release
- Tendon transfer
- Shoulder stabilisation surgery
- Fracture fixation
- Shoulder replacement
If Dr James McLean recommends a procedure, this will be based on the condition, examination and imaging findings and explained clearly before any decisions need to be made.
Non-Surgical Shoulder Treatments
Many shoulder conditions do not need surgery. Non-surgical treatment may include:
- Activity changes
- Physiotherapy and rehabilitation
- Medication where suitable
- Corticosteroid injections
- Hydrodilatation for frozen shoulder
- Manipulation under anaesthesia (MUA) for frozen shoulder
- Monitoring and repeat imaging
Common Shoulder Injuries
Browse the links below for more information on common shoulder injuries, including the main causes, symptoms and treatments.
Biceps Tenotomy
A procedure to relieve pain by releasing the long head of the biceps tendon from its attachment to the shoulder.
Suprascapular Nerve Release
Surgical relief of nerve compression in the shoulder to alleviate pain and restore function.
Labral (Bankart) Repair for Instability
Reconstructive surgery to address shoulder dislocation by repairing the torn labrum.
Subacromial Decompression
A minimally invasive surgery to increase space in the shoulder joint, easing movement and reducing pain.
Post-Operative Shoulder Exercises
Tailored rehabilitation activities designed to strengthen the shoulder and improve the range of motion after surgery.
Biceps Tenodesis
Surgically anchoring the biceps tendon to a stable location to alleviate symptoms associated with tendon tears or inflammation.
Latarjet Procedure for Instability
A surgical technique that transfers a piece of bone to the shoulder socket, providing stability and preventing dislocation.
Shoulder Arthroscopy – Acromioclavicular Joint Excision
Key-hole surgery to remove a small piece of the clavicle, relieving pain from arthritis or impingement.
Shoulder Arthroscopy – Animation
Visualisation technique using animation to demonstrate how arthroscopic shoulder surgery is performed.
Shoulder Arthroscopy – SLAP Repair
Repair of a SLAP lesion, which is a tear of the rim of the shoulder socket where the biceps tendon attaches.
Tendon Transfer for Massive Rotator Cuff Tears
Reconstructive surgery where a tendon is transferred to compensate for irreparable rotator cuff damage.
Scapulothoracic Arthroscopy
Depending on the type and severity of your shoulder injury, surgery might be the best option. Dr James McLean specialises in minimally invasive arthroscopic (key-hole) surgery. His aim is to get you the best possible outcome, taking into account your lifestyle, general health and family situation. Before surgery, Dr McLean will guide you through the process and address any concerns you have.
If you have a sports injury or other shoulder condition, it is best to act quickly. Delaying treatment can cause permanent damage and reduce the potential for a full recovery.
Call our friendly team on 08 7077 0101 to make an appointment or use our handy online booking service. Consultations are available in Dulwich (SA), Bedford Park (SA) and Elizabeth Vale (SA).
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