Biceps Tendonitis & Tears Specialist in Kirkland, WA
The biceps tendon has two origins at the shoulder. The short head of the biceps inserts on the coracoid process of the scapula, which is outside the shoulder joint. The long head of the biceps inserts in the shoulder joint onto the superior labrum. Because the biceps travels up the arm into the shoulder in a groove and then goes through the shoulder joint it is prone to irritation and damage. This causes pain.
This pain can most often be treated nonoperatively. However, if this is not successful, surgery to address the biceps may be necessary. This can be done releasing the tendon (biceps tenotomy) or releasing and securing the biceps in a new location (biceps tenodesis).
Biceps tenotomy involves releasing the long head of the biceps from its attachment on the labrum. This procedure is performed arthroscopically and greatly improves biceps related pain. Some people may notice asymmetry in their biceps area (a popeye sign) if the biceps retracts in the arm, but this does not occur in everyone. Most people do not notice significant weakness, but the arm may fatigue more easily. Recovery is straightforward with no limitations post-operatively
When biceps tenodesis is performed the biceps is released from its attachment on the superior labrum. It is then reattached further down in the arm. This method avoids the possibility of the tendon slipping down in the arm and creating a popeye deformity. It also preserves strength and avoids the fatigue weakness that may accompany biceps tenotomy. Postoperatively, patients are usually in a sling for 4 to 6 weeks to help them avoid actively flexing the elbow and stressing the repair. Activities are then gradually resumed.