To Cut or Not to Cut: Biceps Tenodesis vs Biceps Tenotomy

To Cut or Not to Cut: Biceps Tenodesis vs Biceps Tenotomy

Recently, we discussed injuries and anatomy of the biceps muscle and tendons. If surgery is needed when an injury occurs to the biceps tendon, two procedures are commonly performed: biceps tenodesis and biceps tenotomy. In this post, we will review each and discuss the positives and negatives to each.
Biceps Tenodesis
With biceps tenodesis, the biceps is first released and then re-attached to the bone in a minimally invasive arthroscopic procedure. To do this, anchors or biotenodesis screws are drilled into the bone and the tendon is reattached.

This procedure can also be used for labral injuries. The labrum is attached to the biceps tendon and can pull the labrum off and place the labrum under constant tension. Here, the tension is released by cutting the biceps tendon and allowing the labrum to return to its normal position, relieving the pain. The biceps tendon is then reattached to another anatomic position, where it will function properly and not cause pain. Patients that benefit most from tenodesis are younger and more active.

Biceps Tenotomy
In a biceps tenotomy, the biceps muscle is cut from the shoulder. By doing this, the pain is relieved. A tenotomy is performed arthroscopically and is a relatively simple procedure. A tenotomy is normally performed in less active individuals who lead a more sedentary life. Side effects with a tenotomy are weakness in the biceps muscle and a deformity referred to as ‘popeye arm’ sometimes occurs.
To cut or repair?
The decision to perform a tenodesis or tenotomy is based on many factors. Each individual must be evaluated by a qualified orthopedic surgeon. Factors such as age, activity level, overall health, other injuries and occupation are considered. In younger and more active patients, a tenodesis is preferred. Also, people returning to physical labor often do better with a tenodesis.
Tenodesis restores the arm to a more anatomic state, therefore allowing the arm to heal and continue to function the way nature intended. Tenotomy is often the best option for older patients who lead more sedentary lives. The main goal with a tenotomy is to relieve pain and discomfort. Each option has advantages and disadvantages. If you feel you have a biceps injury, John Vitolo, MD is available to help. Contact our office, Advocare Orthopedic and Sports Medicine Center at 973-300-1553 or find us on facebook.com/johnvitolomd.

5 Responses to To Cut or Not to Cut: Biceps Tenodesis vs Biceps Tenotomy

  1. Andrew D. Valencia, PA-C November 4, 2014 at 3:21 pm #

    I am a 67 y/o very active male who has 45 y/o’s can’t keep up with. Recently had a MR arthrogram of rt shoulder. Because of my chronological age, before the arthrogram was done despite my inordinate sustained activity level, they are saying no surgical relief because of my age other than possible tenotomy despite sx’s of slap injury and supraspinatus and infraspinatus involvement (now reflected in MR arthrogram). I am pleading for guidance.

    Andrew

    • JVitoloMD November 7, 2014 at 1:54 pm #

      We recommend calling our office to schedule an appointment – 973-300-1553. During the appointment, we would perform a complete evaluation, review the MRI arthrogram, and discuss your condition and treatment options. We do not age discriminate and have done many different types of shoulder procedures on patients of all ages. Each patient is different and each case is different. However, we cannot provide exact recommendations without full physical examination of the patient, review of studies, and discussion of treatment options (risk/benefit/recovery).

  2. Dennis Briskin January 23, 2015 at 12:11 am #

    I am an active 69-year-old male in California. I play men’s adult baseball, do shovel work in my garden, and use a rowing machine in my garage. i used to go hard doing pushups and pullups.

    I had a rotator cuff repair with biceps tenotomy (that’s what he wrote on the PT Rx) one week ago. My doctor correctly predicted my “pop-eye bulge” in the left biceps but assured me there is no loss of strength. On what basis do you say it leads to weakness?

    For your reference, I had stitches removed from four spots: behind my shoulder, two places on top, one in front. I hope that suggests to you more specifically what he did. My problems included bone spurs, tendonitis/tears, biceps pain and weakness.

    Thank you, Doctor.

    • JVitoloMD March 19, 2015 at 3:02 pm #

      It is documented through many studies that a proximal biceps tear or surgical tenotomy will result in approximately 10 % loss of biceps strength and increased risk of deformity and muscle spasm (www.aaos.org). When indicated, biceps tenodesis is the preferred procedure to treat many biceps conditions, preserve the cosmetic appearance, and maintain the biceps strength. With the biceps tenodesis procedure, it requires a longer immobilization in a sling compared to a simple tenotomy, which for some patient may create a hardship being in a sling for 3-4 weeks after surgery. Each patient is different and each case is different and we cannot provide exact recommendations without full physical examination of the patient, review of studies, and discussion of treatment options (risk/benefit/recovery). Feel free to contact our office for an appointment or obtain a second opinion.

  3. Susan March 2, 2015 at 8:39 pm #

    I, too, am age 64.5, headed for a pre-op appointment tomorrow morning. My surgeon is also recommending a tenotomy, making me also wonder if this is an age-issue. I am a polio survivor with limited mobility–I need to maintain all of my upper body strength. My surgery is slated for Friday morning. I have had hip surgery that created less angst. I am also employed full time and fairly active all things considered. Can you share any opinions about this situation?

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