The biceps muscle has two origins; the short and long head of biceps (LHB). Although the origin of the short head of biceps is outside the shoulder, the long head of biceps originates from within the shoulder and is therefore prone to injury.
Long head of biceps instability, SLAP tears, attritional tears and ruptures can all occur such that intervention is necessary. Indeed, although a normal long head of biceps tendon can rupture, it usually ruptures when it is associated with advanced rotator cuff disease. If the LHB ruptures it can result in the LHB tendon becoming more prominent in the upper arm such that it is called a ‘Popeye Sign”.
If the symptoms related to the long head biceps do not settle with non-operative measures then surgery may be necessary. Sometimes a tenotomy is all that is necessary, in which case the LHB is cut so that it retracts away from the shoulder joint thereby easing the symptoms associated with it. However, a tendodesis may also be considered. In such cases the long head of biceps is surgically fixed to the upper part of the humerus, just outside the shoulder joint. Although this procedure can be performed as an arthroscopic procedure, if the LHB has previously ruptured, it will often retract into the upper arm and therefore the tenodesis will usually have to be undertaken as an open operation. If there is an associated rotator cuff tendon tear, then a rotator cuff repair might also be needed.
Information for patients / operative Information
Risks and complications
- Nerve injury
- Residual discomfort
- Failure of fixation; Popeye sign
- Please bring any X-rays or scans with you to the hospital. This will usually be on a CD disc. These will not be needed if it was Mr Falworth who organised the investigations.
- No food for 6 hours, or drink for 4 hours, prior to surgery.
- Please avoid smoking for 12 hours prior to surgery
- A biceps tenodesis is usually performed as a day case or as a single overnight stay.
- If undertaken as an open operation, usually a 10cm incision is needed in the front of the arm to retrieve and fix the tendon rupture. Alternatively, it will be undertaken as an arthroscopic procedure through three small 1cm long incisions. The surgical wound is closed with dissolving sutures and Steri-strips.
- Splash proof dressings will be applied but the wound should remain dry for 10 days.
- Prior to your discharge from hospital, a physiotherapist will demonstrate some simple exercises as part of your rehabilitation protocol. These exercises should be undertaken when you’re at home and will help your shoulder recover from the surgery before your outpatient physiotherapy commences.
What to Expect
- Swelling; immediately after any arthroscopic or open procedure there can be quite a lot of swelling around the shoulder but this settles after approximately 24 hours. A Cryocuff or alternative cold therapy compress, can be helpful in minimising swelling and inflammation. The Cryocuff will usually be issued to you upon discharge
- Pain; an Interscalene Block is often used to reduce immediate post-operative pain. If any discomfort arises once the block has worn off, simple oral analgesics can be taken to manage this. These will be provided to you upon discharge.
- Bleeding; there may be some oozing through the bandages but this should settle soon after the operation.
- A sling will be provided to help rest the shoulder. This is usually used for 4-6 weeks post surgery. When you exercise out of the sling, you will have to take care not to fully straighten your elbow or activate your biceps muscle. If you do, you could threaten the tenodesis fixation. Furthermore, to prevent the development of undue shoulder stiffness, the belt that is attached to your sling can also be removed 24 hours after your operation.
- The wound should be kept dry for 10 days.
- At ten days the dressing and paper Steristrips can be gently removed. If the wound is ‘dry’ then it is all right to wash the wound, if not consult Mr Falworth.
- The most important part of your post-operative care is to start an early exercise programme, which the ward physiotherapist will have commenced prior to discharge from hospital. This will maximise the benefit of your operation and will continue as an outpatient.
- You will be reviewed in clinic approximately 3 weeks following your surgery.
Return to Functional activities
- Driving 6 weeks
- Light duties 6 weeks
- Return to work Usually 2 weeks but depends on occupation
- Heavy Lifting 12 weeks
- Repetitive overhead activity/sport 12-16 weeks