What is Proximal Biceps Tenodesis?
Introduction:
Proximal biceps tenodesis is a surgical procedure that involves the reattachment (or “fixation”) of the biceps tendon to a different part of the upper arm bone (humerus). This procedure is typically performed to treat conditions related to the biceps tendon, such as tendonitis, tears, or damage at its attachment point near the shoulder (called the “proximal” biceps tendon).
The goal of the surgery is to relieve pain, improve function, and prevent further damage to the biceps tendon or surrounding structures, including the shoulder.
Why is Proximal Biceps Tenodesis Needed?
Proximal biceps tenodesis is commonly recommended when:
- Biceps tendonitis: Inflammation of the tendon due to overuse or repetitive motions, which can cause pain and limited shoulder movement.
- Biceps tendon tears: A partial or complete tear of the tendon at its attachment to the shoulder joint.
- Biceps tendon instability: When the tendon moves out of place, causing discomfort and limited shoulder function.
- Slap tears: Tears of the labrum (the cartilage ring around the shoulder socket) often involving the biceps tendon, leading to pain or instability.
This surgery is usually considered when nonsurgical treatments such as rest, physical therapy, or anti-inflammatory medications do not relieve symptoms or when the tendon is severely damaged.
How is Proximal Biceps Tenodesis Performed?
Proximal biceps tenodesis can be performed using open surgery or more commonly, through arthroscopy, which is a minimally invasive technique that uses small incisions and a camera (arthroscope) to guide the surgeon.
- Preparation: The patient is placed under general anesthesia, and the shoulder area is cleaned and sterilized.
- Incision: The surgeon makes small incisions around the shoulder area to access the damaged biceps tendon.
- Tendon Release: The damaged or inflamed biceps tendon is identified and freed from its original attachment point in the shoulder (the “labral” area).
- Reattachment: The tendon is then reattached (or “fixed”) to a new location on the upper arm bone (humerus). The tendon is typically anchored with screws, buttons, or other fixation devices to ensure a secure attachment.
- Closure: After securing the tendon, the incisions are closed with sutures, and a bandage is applied to the area.
The procedure typically takes about 10-20 minutes, depending on the complexity of the case
Post-Surgery Care:
After the procedure, patients are usually moved to a recovery room for observation. The recovery process typically includes:
- Pain management: You may experience soreness and swelling in the shoulder, which can be managed with prescribed pain medications and ice packs.
- Immobilization: A sling or shoulder brace may be used for a few weeks after surgery to keep the arm stable and allow the tendon to heal.
- Physical therapy: A rehabilitation program is critical for regaining strength and range of motion in the shoulder. Physical therapy usually begins after a few weeks to help you gradually regain function.
- Activity restrictions: You will be advised to avoid heavy lifting or overhead activities during the initial healing phase (typically 6-12 weeks).
Recovery Timeline:
- Immediate Post-Surgery (0-2 weeks): During the first two weeks, you will likely wear a sling or brace to support the shoulder. Most of the focus will be on managing pain and reducing swelling.
- Rehabilitation (2-6 weeks): Physical therapy begins to restore movement and strength. Initially, exercises will focus on gentle range of motion and stretching.
- Functional Recovery (6-12 weeks): Gradual return to activities, with a focus on building strength and stability in the shoulder.
- Full Recovery (4-6 months): Full recovery can take up to 6 months. During this time, you can expect continued improvement in strength, mobility, and shoulder function.
Potential Risks and Complications:
As with any surgical procedure, proximal biceps tenodesis carries some risks, including:
- Infection: Though rare, infections can occur at the incision site.
- Nerve or blood vessel injury: The shoulder contains sensitive nerves and blood vessels that could be affected during surgery.
- Tendon re-rupture or failure: In some cases, the tendon may not heal properly or the fixation may fail.
- Shoulder stiffness: It’s important to follow the rehabilitation program to avoid stiffness and limited range of motion.
- Weakness or discomfort in the biceps: Although biceps function may improve, some patients may experience mild weakness or cramping after the tendon is relocated.
Benefits of Proximal Biceps Tenodesis:
- Pain Relief: The primary benefit of this surgery is the relief from chronic pain and discomfort caused by biceps tendon problems.
- Improved Function: With proper rehabilitation, the shoulder’s strength and function can be significantly improved, allowing you to return to normal daily activities.
- Prevention of Further Injury: By securing the biceps tendon to a new attachment point, you can prevent further damage to the tendon or other parts of the shoulder joint.
Long-Term Outlook:
Most patients experience significant improvement after proximal biceps tenodesis. However, the recovery process can be gradual, and it may take several months for full strength and function to return. Long-term success largely depends on rehabilitation and adhering to the surgeon’s recommendations for activity restrictions and physical therapy.
When to Contact Your Surgeon:
You should contact your surgeon if you experience:
- Signs of infection (fever, increased redness or drainage at the surgical site)
- Persistent or worsening pain despite taking prescribed pain medication
- Difficulty moving the arm or shoulder
- New or unusual sensations such as numbness or tingling in the arm or hand
Conclusion:
Proximal biceps tenodesis is a highly effective procedure for treating issues related to the biceps tendon in the shoulder. It provides relief from pain, restores shoulder function, and helps prevent future tendon damage. If you are experiencing chronic shoulder pain or dysfunction due to a damaged biceps tendon, this procedure may offer you significant improvement.
If you have any further questions or concerns, be sure to discuss them with your orthopedic surgeon to determine if proximal biceps tenodesis is right for you.