The biceps originates from the shoulder in two tendons, the long head and the short head of the biceps. The short head is rarely injured and does not commonly cause pain or impairment. The long head of the biceps can very commonly cause pain in the shoulder region. This can occur in young athletes, particularly those doing overhead activities such as throwing and may be associated with a superior labral injury (SLAP tear) or a rotator cuff injury/tear. Pain is often in the front of the shoulder and may radiate into the biceps region and forearm. The symptoms are commonly worse with rotation of the shoulder and overhead activities. If conservative management failed, Dr. Lenarz may perform an outpatient arthroscopic procedure for the biceps injury called a biceps tenodesis.
The arthroscopic procedure can be done at the hospital or an outpatient surgical center. Through very small incisions, Dr Lenarz inserts small instruments into the shoulder including a camera. The entire shoulder is inspected under direct visualization with this camera and any damage that may not have been noted on an MRI will be addressed appropriately.
After completion of the arthroscopic examination of the shoulder joint, the biceps is then detached from the cup at the superior labrum and the damaged areas are removed. The biceps is then re-attached to the arm bone (humerus) using an anchor. This is what is known as a biceps tenodesis. At times, this is also necessary for patients with superior labral anterior posterior tears (SLAP tears) in conjunction with the repair of the SLAP tear.
After the surgery, the patient will wake in the recovery room in a sling. If a “nerve block” was performed by the anesthesia doctor before the operation the arm will remain numb for 12-24 hours. This is usually done for post-operative pain control. Once the block wears off, mobilization of the arm may begin. The dressing may be removed and the patient may shower the day following surgery. The patient is asked to NOT scrub the incisions but allow water to wash over them. If an isolated biceps tenodesis was performed the arm may be removed from the sling and moved to tolerance. The only limitation initially is a lifting restriction of 5 pounds with the biceps on the operative arm. This restriction should be observed for the first 6 weeks post-operatively. If a rotator cuff repair or labral repair was performed, the activity should be restricted as stated on the rotator cuff repair or labral repair instructions.