Biceps Tenodesis

Rotator Cuff Tear is often associated with the pain in the front of the shoulder which is often due to the long head of the biceps tendon not being supported well enough in the groove in the humerus (the arm bone). The biceps tendon may also get torn due to repetetive strain and lead to the appearance of the Popeye muscle and / or weakness of the biceps muscle. 

Ultrasound: Ultrasound scan may help us to understand the presence or absence of the biceps tendon in the groove of the humerus. However, it may not help to understand if there are any additional pathologies. 

MRI Scan: Helps us understand whether the biceps tendon is torn / retracted. In addition, the status of the rotator cuff muscles needs to be understood before the treatment plan can be outlined. 

Biceps long head instability:

A lot of patients may not experience any problems with the long head of biceps not functioning. In those, there may not be a need for any surgical procedure. 

Biceps Tenodesis Procedure

• Arthroscopic Tenodesis: This gets performed entirely through small camera portals in the shoulder. This is usually done in addition to the rotator cuff repair surgery.  The tendon gets released intra-articularly followeed by securing it within the joint (suprapectoral) using specialized suture passing and knotless anchors.
• Open & Mini-Open Subpectoral Tenodesis: This is often performed through a small incision near the axillary crease below the pectoralis major muscle. The tendon is retrieved, externalized, and rigidly fixed to the bone. 
• The fixation techniques:
• Interference Screws: The tendon is pushed into a prepared bone socket and secured using a metallic or bioabsorbable screw.
• Suture Anchors & All-Suture Anchors: Anchors are placed into the bone, and their sutures are taken through the tendon (e.g., the Loop 'N' Tack technique) to securely tack it down on-lay fashion.
• Cortical Buttons: The tendon is whip-stitched and fixed to the humerus using an endobutton technique. 

Rehabilitation

​Post-surgery, for the first 4 weeks using a broad arm sling is recommended. Gentle passive stretches are started early. Upto 6 weeks high intensity activities are avoided. Return to non-contact sports by around 4 months and for contact sports by 6 months.