I want to update biceps tenodesis as the treatment of some conditions has evolved over time. Studies show that this procedure is a very reliable procedure for people with SLAP (superior labral anterior-posterior) tears, biceps labral complex tears, or even biceps tendonitis that has not improved with conservative measures. People who have pain in the front of the shoulder over the biceps tendon radiating down the arm to the muscle belly are ideal candidates for this. Notice the tendon is a long structure in front of the shoulder.
This can help, especially if conservative measures have not, such as physical therapy, activity modification, and cortisone injections or PRP injections. Here is a photo of the biceps tendon as it enters the joint with tearing of the tendon.
Previous studies have shown that people with SLAP tears that were treated with biceps tenodesis did better than people who had a SLAP repair, especially over the age of 30. People with SLAP repairs did not do as well-meaning they had pain or stiffness in their shoulder even after the repair was healed. When someone comes in for evaluation, I will recommend this if the above criteria have been met, and they continue to have pain. The surgery is relatively simple, taking about 45 minutes as a day surgery and arthroscopic procedure. The surgery involves removing the diseased biceps and tear and reattaching it to the arm with an anchor. Here is a picture of the diseased tendon.
The tendon and the bone have to grow together over the next six weeks.
Here is what a tenodesis looks like with anchoring the tendon into the bone.
After surgery, the arm is protected with a sling. People are allowed to come out of the sling, remove their elbow, and use their hand. I don’t recommend carrying anything more than a coffee cup in the arm for six weeks. The sling is there to remind people and protect the repair. People can start exercising after 1 to 2 weeks with limited activity on the operated arm. Running with the arm protected is okay, and swinging can begin at six weeks. After about three months of physical therapy, people are usually feeling much better. The pain they had before surgery is usually gone, and they are strengthening their arm. For heavy, heavy lifting, it can take up to four or five months. I have had people go to the CrossFit Games after a biceps tenodesis, so lifting weights and gymnastics maneuvers are certainly well tolerated after this surgery.