Tenotomy and tenodesis of the biceps

Tenotomy is the section of the long biceps tendon flush with the upper bead in the shoulder. that in general retracts into the anterior box of the arm and can result in a non-exceptional way (especially in humans, depending on muscular volume and arm morphology) to a muscle ball nicknamed ‘Popeye muscle’, corresponding to the fleshy body muscle of the long portion of the biceps. the biceps having 2 tendons (see anatomy), there is no loss of flexion of the elbow because the muscular body dependent on the short portion of biceps still works but also the main flexor muscle of the elbow (the anterior brachialis muscle) is unhurt.

In the forced worker it is possible however that there is a small loss of strength related to this rupture or that muscle pain on the retracted bundle (stabbing or cramping) remain troublesome a few weeks to month, usually these symptoms disappear with time.

Tenodesis of the long biceps tendon

Tenodesis is the fixation of a tendon (on another tendon or on a bone). The tenodesis of the biceps is to fix the tendon of the biceps on the humerus in the bicipital groove or underneath. The first step is a tenotomy as explained above then the tendon:

is most often fixed by means of an anchor identical to a tendon reinsertion of the cap (see chapter),

or introduced into a bone tunnel and fixed in the gutter by an ‘interference’ screw (a technique commonly used to attach a cruciate ligament to the knee), a technique used by Dr. GUINAND, see video.

or still stuck in a bone hole under the gutter after having sutured into a ball on itself (technique of ‘keyhole’ popularized under arthroscopy by Dr. KANY, see video keyhole tenodesis)

The indications are still debated between surgeons, whether on the need to perform a gesture on the biceps tendon and whether a gesture is decided that it is a simple tenotomy or a tenodesis.

We can summarize our philosophy as follows:
Systematic response during an intervention concerning rotator cuff tendinitis with or without tendinous lesion or perforation, or during instability of this tendon.

No strict tenotomy / tenodesis rule, but tenodesis is considered for the forced worker or patients with a higher risk of Popeye effect.

The vast majority of patients who have been treated are relieved of their painful symptoms in both techniques, but there are patients equally in the two groups who remain genital on the tendon route or by muscular pains.

Benefits of Tenodesis:

  • persistence of a lowering effect of the humeral head (importance mainly in the case of completely unrepairable cuff). Interest discussed …
  • decreased risk of Popeye muscle (cramps, muscle pain, muscle retraction)

Disadvantages of tenodesis

  • cost when using an anchor or screw
  • duration of realization during a repair of tendons of the rotator cuff (intervention already long …)
  • sometimes remains painful …