What is Biceps Tenodesis?
Biceps Tenodesis is medical procedure that involves correction of biceps tendon tears, severe biceps tendonapathy, and instability. A shoulder injury is also an indication for biceps tenodesis. Biceps tendonitis (or bicipital tendonitis is an inflammation of the tendon that connects the biceps and the shoulder) is the corresponding shoulder injury that commonly requires the procedure. Another indicated condition for a biceps tenodesis is SLAP tear. SLAP tear occurs when there is a detachment of the biceps tendon from the shoulder socket.
Picture 1 : Biceps Tenodesis – “Balled up” muscle with bruising
image source: MMC 2003
Picture 2 : Biceps Tenodesis
Image source : MMG 2003
Biceps Tenodesis Procedure (Technique)
In simple definition, this procedure aims to remove the increasing pressure of the biceps by cutting the attachment of the biceps tendon from the shoulder socket and attaching it to the long bone of the arm (humerus). Biceps tenodesis can be an outpatient surgery or may need hospital admission, depending on the presented case. The amount of time for the procedure can be an as short as an hour or more. Once the benefits and risks of the procedure have been discussed, patient must agree to everything before the actual procedure takes place.
The patient shall be placed in a lateral position, exposing the affected shoulder. Arthroscopic biceps tenodesis is a surgical technique that is highly recommended to those who suffer from severe biceps tendonopathy, extensive biceps tendon tears and rotator cuff tear. This method has fewer complications as there will be reduced tissue trauma. With the use of an arthroscope, a device that enables the surgeon to do the procedure through a small incision, less damage shall be attained. The device will be used to grab a portion of the biceps tendon and shall be removed from its origin (shoulder socket) with the use of an arthroscopic scissor.
The shoulder shall be incised in order to expose the biceps tendon which will later be trimmed to make a tunnel opening to the humerus. The biceps tendon shall then be attached to the humerus (below the actual shoulder joint) with the use of a special interference screw. An open keyhole technique shall include the use of the biceps tendon as a mass sutured into a groove of the humerus. The biceps mass shall be safely secured in the keyhole by insertion and by pulling downward.
Another technique is called the Pitt technique which makes use of two needles and sutures to connect and secure the biceps tendon to the transverse ligament of the shoulder instead of linking it to the humerus.
After the surgery, the condition should be regularly checked before bringing the patient to the room. Checking the client for any possible post-surgical complications is a required hospital etiquette. Regular checking for the vital signs, for signs of bleeding, and for impending infection is practiced to make sure proper care has been rendered.
Rehabilitation after biceps tenodesis is vital in order to attain full recovery. This will help the patient gain strength and make the shoulders go back to its normal function. During recuperation period, the patient shall be required to wear a shoulder sling to provide protection and facilitate tissue healing.
There are four phases of rehabilitation after a biceps tenodesis.
- Phase I: In the first few weeks (4 to 6 weeks after surgery), the rehabilitation program shall proceed with passive range of motion exercises. This is done in order to avoid straining the client and tearing the surgical site. It is also advisable that active range of motion exercises is done to the elbow and wrist, just to avoid joint stiffness and prolonged immobility. The motion exercises should be done in a gentle manner to gradually regain the client’s full health. The shoulder sling should be worn at most time in order to facilitate the healing process of the tissues and that straining activities should be avoided.
- Phase II: Six to eight weeks after the surgery, the client may proceed with gentle shoulder exercises. Bicep exercises are to be proceeded gradually. Scapular squeezes are done in a gentle manner. This is performed by pinching ones shoulder blades together, while the chest area sticks outwardly. Ball squeezes are also performed which can help exercise the muscle arms.
- Phase III: After 8 to 12 weeks, full active range of motion exercises is practiced. This can somehow regain the full range motion of the affected extremity and to increase strength and good stability. Walking and biking are not restricted in this phase.
- Phase IV: After Phase III (approximately 12 weeks after surgery), the impact of the rehabilitation must be seen evident to the patient confirming that the affected shoulder have gained full strength. By the end of this phase, the client must attain complete stability with high paced movements. Physical and cardiovascular strength by this time should be fully attained. Instability should be absent and that cardiovascular endurance has been recovered. The doctor and therapist shall be in communication to approve of a possible sport that the patient would want to embark on. Full recovery has been attained and the criteria have been met in this phase.
The physiotherapy shall proceed as the doctor would organize for the rehabilitation process weeks after the surgery. It is highly expected that a number of physical restrictions are enumerated to patients. That’s why the surgeon shall assign a physical therapist in managing the progressive rehabilitation. In the early phases of physical rehabilitation, some normal day to day activities may be temporarily restricted as to attain goals.
Weeks after surgery, complete recovery is expected to the patient. Most patients would attain recovery after four to six weeks. On the other hand, severe cases that need more time in recovery would expect to attain full recovery after 6 weeks.
It is common to question your doctor, “When will it be possible for one to start working?” The answer to that question would entirely depend on the patient’s type of work. In three weeks time, one can go to work, but with consideration. However, when one does a heavy duty work, there’s a possibility that it may take months (probably even 6 months) before the doctor shall advise you to proceed to work again.
There is a need for you to seek professional help prior undergoing any form of treatment. To ensure that only the best care will be provided, go to an eligible doctor and seek advice.