3 Reasons Why Biceps Tenodesis is Better Than Tenotomy

Introduction

Many people ask the question. Why is biceps tenodesis is better than tenotmy?

The answer is unclear.  There have been a few recent articles that help us answer that question.  Everyone has a different tolerance to surgery. Everyone’s body heals in a different time frame. Each person’s perception of recovery is different. This post is specifically is going to answer the question about a biceps tenodesis versus tenotomy.  Many people have more than one procedure done on their shoulder,  not just biceps tenodesis.  So some of the data is difficult to interpret.  In short the biceps tenodesis is better.  The real question is why and what makes it better?

Biceps Tenodesis or Tenotomy By Itself is Rare

In this discussion we are talking specifically about having a biceps tenodesis verus biceps tenotomy.  Trying to isolate just these results.  Surgery alone for the biceps is not the norm. Most people have additional procedures including rotator cuff repair, subacromial decompression, debridement of the rotator cuff, and/or distal clavicle excision.

Bicep Tenotomy

A biceps tenotomy is a relatively simple procedure.  Usually it is performed arthroscopically.  While in the joint the diseased tendon is released from its attachment to the labrum.  The tendon is the long head of the biceps muscle.  The short head attaches to a different area of the shoulder called the coracoid.  The short head is rarely injured.  Once the biceps is released from the labrum the long head of the biceps tendon retracts out of the shoulder and gets “stuck” in the bicipital groove in the front of the proximal humerus.  It then heals in its new position.

The different types of biceps tenodesis

Also to some degree, what type of biceps tenodesis can determine the length of your recovery. As described in previous videos and a future blog posts, there are three major types of biceps tenodesis. 

Arthroscopic

The first is the arthroscopic biceps tenodesis.  This creates a secure fixation of the biceps within the  bicipital groove. 

Suprapectoralis

The second is securing the biceps above the pectoralis major tendon.  This is called a suprapectoral biceps tenodesis.  In this case the biceps is secured just below the bicipital groove.  This is just above the superior aspect of the  pectoralis major insertion therefore it is call Suprapectoralis biceps tenodesis. 

Subpectoralis 

Lastly this is a biceps tenodesis just below the pectoralis major tendon insertion.  Because it is below the pectoralis insertion it is called subpectoralis biceps tenodesis. 

The Research

So we return to the question.  Why is a biceps tenodesis better than a biceps tenotomy?

The short answer, as we discussed above, is biceps tenodesis.  It doesn’t seem to matter where it is tenodesed.  So the technique used for biceps tenodesis seems less important.  What does seem to be important is that it is retensioned and reattached.  Re-tension means to try to get the tension of the biceps back to a relatively normal level.  If it is not retention 3 things can happen and do happen more often in biceps tenotomy.  

Popeye Deformity

Just like it sounds a popeye deformity looks like you biceps muscle as dropped.  Giving you a short bulging  biceps muscle.  This may not be a big deal if someone is obese, as you may not be able to see it.  For thinner people or people with a more athletic build it is quite obvious. Now that may not be a big deal to some, but this also leads to our second problem. -Cramping

Cramping 

Because the tension on the biceps has changed the muscle length shortens.  When the muscle length shortens we have increased cramping in the biceps.  This can be at rest but more common when using the biceps muscle. 

Supination Strength

The biceps helps with supination.  Supination is turning your palm up.    In a position of bent elbow and  then turn your palm up  this is supination..  The biceps contracts  assisting in this motion.   When a biceps tenotomy  is performed the strength of supination is decreased.

Shoulder Function Satisfaction

When specific tests researchers use to determine The function of the shoulder we see a decreased after biceps tenotomy. Two specific tests one called the simple shoulder test  and the other called constant score is more often decreased in biceps tenotomy vs biceps tenodesis.

The simple shoulder test is a 12 question test.   This test asks the patient about the function of the shoulder.  Including how well the shoulder moves and how strong the shoulder feels  to the patient.

 The constant score is more of a research level test.  It combines patient subjective function as well as some specific range of motion and strength testing by the researcher.

Conclusion

Both  bicep  tenodesis as well as biceps tenotomy are performed routinely in shoulder surgery. Typically these are not done without other procedures in the shoulder such as rotator cuff repair. The data available today demonstrates that there is improved function as well as cosmesis if a shoulder biceps tenodesis is performed.   Specifically improvements in Popeye deformity, the strength of supination, as well as overall function.   This is in comparison to a simple biceps tenotomy.   If you are getting ready for surgery on your shoulder and there’s a possibility of surgery on your biceps, please discuss the benefits and risks a biceps tenotomy vs biceps tenodesis with your surgeon. www.mybodyprotector.com

Reference

• PMC8071980