Biceps Tenotomy

proximal biceps tendon anatomy

biceps tendonitis picture
 CPT Technique
Indications Complications
Contraindications Follow-up Care
Alternatives Outcomes
Pre-op Planning / Special Considerations Review References

synonyms:

Biceps Tenotomy Indications

  • Biceps tendonitis in elderly low demand patients.

Biceps Tenotomy Contraindications

  • Biceps tendonitis in a younger, physically active patient.

Biceps Tenotomy Alternatives

  • Biceps Tenodesis
    Typically used for elderly patients with low physical demands.
  • Quicker recovery and earlier return to function than arthrodesis.
  • Non-operative management

Biceps Tenotomy Pre-o p Planning / Special Considerations

  • Arthroscopic tenodesis with absorbable interference screw (Boileau Arthroscopy 2002:18:1002-1012)
  • Percutaneous Intra-articular Trans-tendon technique: (Sekiya JK, Arthroscopy 2003;19:1137). Easily performed and does not require any supplemental hardware.
  • Other techniques include: suture anchors, screw and soft tissue washer, keyhole technique.
  • Arm postion for biceps tenodensis = 30 degrees flexion, 30 degrees IR, 30 degrees abduction.  Elbow flexed to 90 degrees.

Biceps Tenotomy Technique

  • Pre-operative antibiotics, +/- regional block
  • General endotracheal anesthesia
  • position. All bony prominences well padded.
  • Examination under anesthesia.
  • Prep and drape in standard sterile fashion.Perform Shoulder Arthroscopy.
  • Perform tenotomy of the tendon at is BLC insertion using an arthroscopic biter, or hooked cautery probe.
  • Tendon is allowed to retract out of the glenohumeral joint.
  • If biceps does not retract as a result of enlargement or attritional changes, the intraarticular portion of the biceps is resected allowing retraction out of the glenohumeral joint.
  • Any associated pathology should be fixed concomittantly: RTC tear, Subacromial impingement, AC arthritis.
  • Irrigate.
  • Close.

Biceps Tenotomy Complications

  • Patients may develop cosmetic deformity (Popeye muscle) post-operatively.
  • Pain

Biceps Tenotomy Follow-up care

  • Post-op: sling, immediate passive elbow and shoulder ROM, pendulum exercises, active wrist/hand ROM.
  • 7-10 days: Continue sling. Started PT. Begin active shoulder motion without resistance. Avoid any resisted active elbow flexion / supination.
  • 6 weeks: start muscle strengthening, active elbow flexion / supination.
  • 3-6 months: Return to full activites

Biceps Tenotomy Outcomes

  • 87% satisfied or very satisfied with the result in patients with full-thickness RTC tears(elderly or unrepairable tears). (Walch G JSES, 2005;14:238).

Biceps Tenotomy Review References