Biceps tenotomy versus tendinitis.

Hello, this bicep tenotomy vs. tenodesis is for some reason a "mystery" in many circumstances. I am 68 YOA now. I have read your story as well as some replies; here was my experience: About 10 years ago my shoulder was in pain. I knew something was wrong, I could not do painless bicep curls in the gym, let alone do many shoulder exercises. I went to a well-known and regarded orthopedic medical center. They did MRI and said I had a SLAP tear and also they could not visualize my bicep tendon on the MRI. The surgeon said: let's fix the SLAP tear by arthroscope but with your tendon let's just snip the few strands holding it and your pain, due to that, will be gone. He thoroughly explained the Popeye deformity and so I completely understood it when he said that my recovery would be quicker than if he "fixes" the tendon by cutting and reattaching it, but that I would have the bulge in my arm. I did not want that though! The bulge did not upset me but the fact that the tendon was not secured to bone, did. I am a former weightlifter and I want my tendons functioning! So I went to my small-town ortho and he said "I will bolt it back on for you." I had this Doc do the surgery - he prescribed a very gentle but deliberate recovery period with strict PT. This shoulder recovered 99% IMO! My bicep is back functioning great. What he did was cut the remnants of the bicep tendon out of my shoulder capsule, fixed the SLAP tear as best he could, divide the pec and deltoid down to the bicipital groove, and reattach the end of the snipped bidep tendon using an anchor and a biodegradable interference screw. He did a great job. I religiously followed his (and the PT's) protocol and it was a very successful repair. I am very glad that I took his advice rather than the other surgeon who decided that at my age (over 60) I did not need it repaired. But keep in mind that first month after the repair, passive movement of the arm is all that was allowed, one does not want to pull that anchor out!! Like I said I religiously followed the protocol and it turned out great! I wish everyone the best health and luck dealing with this, or any other issue. But above all, follow your Doc and PT's advice, they can get you better but they need one to follow directions. P.S. The repaired bicep and tendon is no longer in the shoulder capsule so theoretically one will not have the exact strength (due largely to angle of pull) that one had before. But mine still feels fine and I still can curl some pretty good resistance.

Hi Shark - and thanks for helping me realize I am not going crazy!

I'm 71 and my surgeon never talked about severing and not reattaching the long biceps tendon during my aTSR. I talked to him afterward, because I do have a slight popeye bulge, and he said the osteoarthritis on and around the head of my humerus had shredded the long bicep tendon. And the place where it attaches, the supra glenoid - literally "above the glenoid socket" wasn't there after the surgery, so much bone had been removed, and the glenoid was now made of plastic. There wasn't much of the tendon left to attach and the attempt was likely to fail. And I had my subscapularis detached for the surgery, and then stitched back on the scapula and humerus, and I'm still healing.

Bottom line, my surgeon could have tried to reattach the tendon lower on the humerus, but it was unlikely to heal properly and he had to make the decision with me under. I can live with that. I've had both knees replaced and my right hip, and the surgeon doesn't really know what's inside until he looks.

I'm an endurance guy (former marathoner, now I do HIIT/spin 5-6x/week. I don't need strong biceps for that, but I do like for my muscles to have definition. And two months after surgery, I'm doing 10 lb bicep curls, and all that pain pre-op is gone. That's a quick recovery. I will lose a small amount of strength in that arm, but should be able to return to almost all of my pre-op resistance training.

I truly appreciate you explaining what it takes to reattach a severed tendon, and where it started and where it can be reattached. I'm going to live with the popeye bulge (I'm pretty thin but have good muscle definition - resistance training 3x/week). And to appease my vanity, and while wearing a short sleeve t-shirt, the popeye bicep looks pretty good! With my arms hanging at my side, it's very hard to notice. And again, no pain.

But thanks again Shark. Your response was exactly what I was looking for, and from someone who clearly understands shoulder anatomy. Much appreciated, friend.

Joe

@heyjoe415 It is my pleasure to recite my procedure and contribute what I can. Indeed in my case too it was the osteoarthritis that my tendon got ground into day after day, that frayed my LHB tendon. It also sounds like you had an excellent surgeon who is very good at "thinking on his feet" and went with the best solution given the circumstances. Good luck and good healing to you.

Thank you Shark,

I do indeed have a very good shoulder surgeon. I was a little surprised that the popeye deformity was never mentioned to me as a possible outcome. Then again, few patients are as curious as I am. And really, it's hardly noticeable and at least so far, has not affected recovery or strength. The best part is - no more pain. I'm also back to HIIT spinning 5-6x/week, and that makes up 80% of my time in the gym.

Always great to find someone like you who is also curious about these surgeries. Your comments have given me quite a bit of relief, and thanks for that Shark, my friend!

Joe