Long head of biceps tenodesis

This leaflet will advise you about undergoing a long head of biceps tenodesis of the shoulder and outline recovery from surgery. 

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Why do you need this operation? 

The biceps muscle has two tendons (the long head and short head) originating from in and around the shoulder joint. The long head of biceps passes into the shoulder joint and attached itself just above the socket. To get into the joint the biceps tendon must pass through a tunnel within the rotator cuff the rotator cuff is a group of specialised tendons that help control the position of the ball part of the shoulder joint. The tunnel is made up of a bony groove in the side of the ball part of the joint with the roof of the groove covered by rotator cuff tendon. The rotator cuff often becomes worn out and can tear as it degenerates. It can also become inflamed by rubbing against a bony prominence above the shoulder joint called a subacromial spur. If the roof the groove tears the biceps tendon can start to move out of its normal position and even completely dislocate. Even if does not dislocate it can become inflamed and degenerative. These changes to the biceps tendon will make it painful which is usually worsened by shoulder movement. Sometimes this operation is done because the point at which the biceps tendon inserts into the bone just above the shoulder joint become degenerative and damaged (a SLAP lesion) 

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The operation 

Tenodesis essentially means to re-attach a tendon in a new position. The biceps tendon can just be released to deal with the pain but it may lead to some mild forearm weakness and change in the appearance of the biceps muscle. The tendon is cut at the point where it inserts into the socket. A hole is then drilled in the floor of the bony groove and the free end of the tendon is inserted into it and held in place using a special plastic screw. This procedure may be combined with another procedure such as a repair of a tear within the rotator cuff or removal of a bony prominence above the shoulder joint (acromioplasty). 

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Potential complications 

Unfortunately any operation has a chance of having a complication. Fortunately the chance of having a complication is small (<5%) and having a significant complication that will have a negative effect on the outcome of surgery is even smaller (<1%). The following are specific complications associated with a long head of biceps tenodesis: 

Tendon rupture - although the device used to hold the tendon in the new position is strong, the tendon itself is often weak and degenerative and occasionally snaps/ruptures - this will cause part of the biceps muscle to drop down the arm causing a small cosmetic defect rather than significant functional loss. Your surgeon may consider re-attaching it but more likely will leave the ruptured tendon as further surgery is complex and the risks are not outweighed by the small benefit of improved cosmesis. 

Stiffness you may be put in a brace soon after surgery to minimise the chance of stiffness but some degree of stiffness should be expected 

Infection this is unlikely to occur. Superficial wound infections are more common and can often be treated with a short course of antibiotics. Deep infections within the joint are rare but would require you to come into hospital to have the shoulder washed out and go on intravenous antibiotics 

Nerve injury this is unlikely to occur as the ports made for the keyhole surgery are place away from the known position of nerves. Sometimes nerves can get compressed or squashed during surgery which will present will numbness and weakness but this is likely to resolve within a few days 

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The shoulder joint after surgery (this may change if this procedure is combined with another) 

Length of hospital stay: Normally done as a day case 

Arm immobilisation: Simple sling for comfort (usually 1 to 2 weeks) 

Total recovery period: 3 to 4 months 

Return to driving: 4-6 weeks 

Return to work: Desk based job - 2 to 4 weeks Manual job - 2 months 

Return to sports: Non-contact from 2 months Contact/overhead from 3 months 

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