Long head of biceps tenotomy

This leaflet will advise you about undergoing a long head of biceps tenotomy and outline the recovery of your shoulder following surgery. 

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The long head of biceps tendon 

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 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 the rotator cuff. The rotator cuff often becomes worn out and can tear as it degenerates. 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 and the pain is usually worsened by shoulder movement. 

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The operation 

A tenotomy means simply "to cut a tendon". In isolation this is quick procedure with a quick recovery and involves putting a camera in the shoulder joint, identifying the biceps tendon and releasing it at the point where it inserts into the socket. The tendon will then retract out of the joint towards the muscle, and become redundant and painless. The biceps muscle will still function because it is still attached at the shoulder joint by another tendon (the short head). The only difference is that some forearm movement may be slightly weakened and the biceps muscle may slightly drop down the arm towards the elbow. The majority of patients do not notice these changes. 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 (subacromial decompression). 

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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 rotator cuff repair: 

Biceps muscle spasm this is a result of the biceps muscle contracting down. It is usually mild and resolves after 9 to 12 months. 

Stiffness if you are just having a tenotomy without another procedure then the stiffness should be minimal stiffness is usually because of other associated procedures 

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 

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

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Length of hospital stay: Normally done as a day case 

Arm immobilisation: Simple sling for comfort (usually 1 week) 

Total recovery period: 6 weeks 

Return to driving: 2-4 weeks 

Return to work: Desk based job - 1 weeks Manual job - 6 weeks 

Return to sports: From 4 weeks 

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