In a 'biceps tenotomy' procedure the long head of biceps tendon is released from it's attachment in the shoulder joint, allowing it to fall down into the upper arm and out of the shoulder joint. This removes the damaged, inflamed tissue by releasing it from the joint.
Tenotomy is a quick and simple arthroscopic procedure, but can result in some biceps weakness and occasionally discomfort in the biceps muscle. A 'popeye' biceps deformity may occur.
This is generally minimal and does not inconvenience the sedentary person. It can be a problem for active and athletic people, where a biceps tenodesis is generally preferred.
Arthroscopic scissors inserted via small pucture hole in skin and cutting the LHB (arthroscopic view on the right)
The procedure is done arthroscopically as a day case procedure. You should be able to move your arm after the operation, with no period of immobilisation.
A nerve block is used during the operation which means that immediately after the operation the shoulder and arm may feel numb. This may last a few hours. After this the shoulder may well be sore and you will be given painkillers to help this whilst in hospital. These can be continued after you are discharged home. Ice packs may also help reduce pain. Wrap frozen peas or crushed ice in a damp, cold cloth and place on the shoulder for up to 15 minutes. In order to maintain a dry wound cover the dressing / wound with some cling film before applying the ice pack.
This is a keyhole operation usually done through two or three 5mm puncture wounds. There will be no stitches only small sticking plaster strips over the wounds. These should be kept dry until healed. This usually takes 5 to 7 days.
WEARING A SLING
You will return from theatre wearing a sling and/or Cold compression wrap. This is for comfort only and should be discarded as soon as possible (usually within the first 2 to 4 days). Some people find it helpful to continue to wear the sling at night for a little longer if the shoulder feels tender.
Sleeping can be uncomfortable for a while if you try and lie on the operated arm. We recommend that you lie on your back or on the opposite side, as you prefer. Ordinary pillows can be used to give you comfort and support.
If you are lying on your side one pillow slightly folded under your neck gives enough support for most people.
A pillow folded in half supports the arm in front and a pillow tucked along your back helps to prevent you rolling onto the operated shoulder during the night.
If you are lying on your back, tie a pillow tightly ion the middle (a "butterfly pillow") or use a folded pillow to support your neck. place a folded pillow under the elbow of the operated arm to support that.
Some degree of discomfort is common after surgery. You should not have to 'put up' with pain. You will be given painkillers and anti-inflammatories from the hospital. The Cold compression wrap also helps reduce inflammation and pain.
You may begin driving when you feel able to handle a steering wheel easily with both arms. You should be able to get your arm above shoulder level comfortably and manipulate objects at this level. For most patients this is usually about one week after surgery. If you are unsure, check with your therapist and/or surgeon.
RETURNING TO WORK
This will depend on your occupation. If you are in a sedentary job you may return as soon as you feel able usually after one week.
If your job involves heavy lifting or using your arm above shoulder height you may require a longer period of absence.
You should avoid sustained, repetitive overhead activities for three months. With regard to swimming you may begin breaststroke as soon as you are comfortable but you should wait three months before resuming front crawl. Golf can begin at six weeks. For guidance on DIY and racquet sports you should speak with your physiotherapist.
FOLLOW UP APPOINTMENT
A follow up appointment will be made for approximately three weeks after your operation. The amount of physiotherapy will depend on your individual needs.
This is variable. However experience shows us that by 3 weeks movement below shoulder height becomes more comfortable. By this stage you should have almost full range of movement although there will probably be discomfort when moving the arm above the head and when lying directly on your shoulder.
At three months after your surgery your symptoms should be approximately 80% better. It can take 6 to 9 months to fully recover and you will continue to improve for up to a year following the procedure.
Physiotherapy is essential after the operation, to encourage good movement, help with pain management and rehabilitate the muscles back to normal function. You will need to see a therapist within 2 weeks of the surgery. This should be arranged in advance of the surgery. I list of therapists with an interest in shoulders can be found here.
- Arthroscopic tenotomy of the long head of the biceps in the treatment of rotator cuff tears: Clinical and radiographic results of 307 cases