Biceps tenodesis and tenotomy are two surgical procedures that are used to address problems with the biceps tendon in the shoulder region. Every procedure is characterized by its indications, advantages, and possible complications.

Biceps Tenodesis

What It Is: Biceps tenodesis is a procedure that involves reattaching the biceps tendon to the humerus which is the upper arm bone. This procedure is commonly performed to provide pain relief and improve function when the tendon is injured or irritated, which can be caused by conditions such as biceps tendinitis or a SLAP lesion.

Indications:

·        Ambulatory and younger patients with the need for strength and mobility.

·        Patients with SLAP tears.

·        Biceps tendinitis that has not improved with conservative measures.

Procedure: In tenodesis, the surgeon severs the biceps tendon from its origin on the shoulder and reroutes it to the humerus. This can be done using screws or anchors.

Benefits:

·        Ensures that the biceps muscle is strong and functional.

·        Relieves pain and discomfort.

Drawbacks:

·        More invasive than tenotomy.

·        Longer recovery period.

·        Potential for adverse events like infection or failure of the fixation.

Biceps Tenotomy

What It Is: Biceps tenotomy entails the detachment of the biceps tendon whereby the tendon is left to retract up the arm. This is often a simpler and quicker procedure than tenodesis.

Indications:

·        Elderly or more sedentary patients.

·        Patients with severe biceps tendinitis or tears who do not require full strength in the affected arm.

·        Situations where a fast treatment is desired.

Procedure: In tenotomy, the surgeon severs the biceps tendon and it is allowed to retract without causing pain.

Benefits:

·        Shorter, simpler procedure.

·        Faster recovery time.

·        Less invasive.

Drawbacks:

·        Risk of muscle cramping and Popeye deformity, a condition where there is a visible swelling on the arm due to the retraction of the tendon.

·        Some decreased strength and stamina in the biceps muscle.

Choosing the Right Procedure

The factors that influence the decision between biceps tenodesis and tenotomy include age, activity level, overall health of the patient, and the type of shoulder pathology. Here are some considerations:

·        Age and Activity Level: Tenodesis may be more beneficial for younger and more active patients as it helps to maintain strength and functionality. For instance, older patients or those with lower physical activity requirements might opt for tenotomy due to its relatively less invasive procedure and short recovery period.

·        Severity of Condition: If the tendon injury is severe or if there is chronic inflammation, tenodesis may be recommended for better long-term results.

·        Cosmetic Concerns: Those who are unhappy with the cosmetic aspect of a Popeye deformity may choose to have a tenodesis.

Conclusion

Both procedures are beneficial in managing pain and enhancing function in patients with biceps tendon problems. This decision should be made in conjunction with an orthopedic surgeon, considering the individual needs of the patient and his or her objectives.