Tenodesis or Tenotomy For Long Head of Biceps Pathology – What’s Effective For Pain Relief?

Shoulder pain is a common complaint, however identifying the exact cause or source of the pain can at times be difficult and often unreliable. One of the known causes of pain in the shoulder is the long head of biceps tendon that connects the outer or lateral head of the biceps muscle in your upper arm deep into the shoulder joint. Pain originating from the biceps can progress to the point where surgical intervention is required to try and alleviate symptoms. Two common treatment methods used in this situation are either a soft tissue tenodesis or a biceps tenotomy.

A tenodesis is a surgery method where the biceps tendon is removed from its attachment at the cartilage of the shoulder joint and placed on the humerus. This method aims to alleviate pain by removing the biceps tendon from the shoulder joint and decreasing the forces across the tendon. (Gartsman & Hammerman, 2000)

A biceps tenotomy is a similar procedure where the biceps tendon is cut from the attachment point but not reattached. This procedure is easier than a soft tissue tenodesis and boasts a better recover time and less post operation pain. (Diamond, Osbahr, & Speer, 2002)

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A recent study, retrospectively observed 104 patients presenting with isolated lateral (long) head of bicep pathology who were surgically treated between 2004 and 2007. Of these 104 subjects 48 received a tenotomy, while 56 received a soft tissue tenodesis. Patients were followed up post operatively over a two year period using questionnaires measuring shoulder pain, arm function, strength and range of motion.

Both subject groups scored well post operatively, with significant improvement noted in both the tenotomy and tenodesis recipients. Strength and range of motion improved by an average of 36 points and 39.5 points in the tenodesis and tenotomy groups respectively, as measured by the Constant Score outcome measure.

Chronic pain, measured out of 10 using a Visual Analogue Scale (VAS) was lowered from 8.4 – 1.5 in the tenotomy group and 8.8 to 1.4 in the tenodesis group.

Functional shoulder movement measured using the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, improved by 28.9 points in the tenotomy group and 44.4 points in the tenodesis group, however the final scores were quite a bit closer at 13.6 and 11.4 points respectively.

While both surgical methods were effective in the treatment of long head of biceps pathology. However, a Popeye sign (a cosmetic defect where the bicep appears permanently contracted) appeared in 37.5% of tenotomy recipients and 5.3% of tenodesis recipients. Bicep cramps were present for up to 1 month post operatively in 16.6% of tenotomy patients. In was concluded from the final results of the questionnaires that biceps tenodesis is an effective way to treat chronic pain associated with long head of biceps pathology with good results and limited cosmetic defects, however post op rehabilitation is more extensive than that required of tenotomy patients.

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References:

Borroni, M., Delle Rose, G., Garofalo, R., & Silvestro, A. (2012). The long head of biceps as a source of pain in active population: tenotomy or tenodesis? A comparison of 2 case series with isolated lesions. MUSCULOSKELETAL SURGERY, 47-52.

Diamond, A. B., Osbahr, D. C., & Speer, K. P. (2002). The cosmetic appearance of the biceps muscle after long-head tenotomy versus tenodesis. Arthroscopy: The Journal of Arthroscopic & Related Surgery, 483–487.

Gartsman, G. M., & Hammerman, S. M. (2000). Arthroscopic biceps tenodesis: Operative technique. Arthroscopy, 550-552.