Biceps tenotomy versus tendinitis.

Posted by heyjoe415 @heyjoe415, 2 days ago

I had an anatomical total shoulder replacement two months ago. I'm a 70 y/o male and very active in the gym. The recovery is going very well. This was done on my left shoulder.

During the surgery, the Dr detached the long biceps tendon and did not re-attach it (tenotomy). He said this practice is common and results are about the same as if the tendon were re-attached (tendonesis) As a result, my left biceps has a bulge due to the detachment of the long biceps head.

My surgeon tells me that this "popeye deformity" is not uncommon, and other than a cosmetic change, does not significantly affect the strength of my left arm once I've recovered fully (6 months to one year).

Has anyone gone through this, and can you confirm that strength does return to the affected biceps? Is this bulge permanent, or will it decrease with time?

Thank you in advance for any help you can provide. Joe

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shark | @shark | 1 day ago

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.