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When suffering a rotator cuff tear or damage to the long head of the biceps, there are several surgical procedures which may help to alleviate pain to the biceps muscle and minimize any associated shoulder pain.
Such treatments include bicep tenodesis and biceps tenotomy.
Your biceps tendon is a very strong structure that connects from the upper end of your biceps muscle to your shoulder joint.
Recommended Reading – Bicep Pain After Rotator Cuff Surgery : 6 Critical Causes
Degeneration of the tendon or injuries such as slap tear can be treated with both these surgeries if deemed suitable by your doctor.
In this article, we’ll consider both treatment options in more detail, along with the benefits and drawbacks of each procedure.
Bicep Tenodesis VS Tenotomy
Both bicep tenodesis and tenotomy are a type of keyhole surgery performed under a general anaesthetic which involves separating the damaged part of the tendon from its attachment point at the shoulder.
In the case of tenodesis, the tendon is reattached to the upper arm bone.
However, for tenotomy, the tendon is not reattached to any other structure and is allowed to retract into the upper arm.
When it comes to choosing between arthroscopic biceps tenodesis and biceps tenotomy this depends on several factors, including your age, activity level, the extent of biceps-related symptoms, and any other pre-existing shoulder conditions you may have.
Your orthopaedic surgeon or practitioner can assess your specific case and recommend the most suitable option based on your needs and goals.
Surgery tends to be a last resort when other forms of pain management, such as physical therapy, application of ice packs and cortisol injections have not been successful.
Which Is Better, Tenotomy Or Tenodesis?
A systematic review has concluded that a bicep tenodesis procedure is not necessarily better when compared to tenotomy, especially for those under 55 years of age.
A constant score is used after both tenotomy and tenodesis.
This is a scoring system used to determine the clinical outcomes post-surgery and will measure things such as pain, function and shoulder range of motion and can help determine the effectiveness of the surgery.
Previous studies, along with scoring systems including the constant score and the American shoulder and elbow surgeons score (ASES), have shown very little in the way of functional outcomes.
Patient-reported outcomes for both forms of treatment result in less pain for the patient with the main differences being complexity of the procedure and recovery time.
In both cases, a positive outcome is expected along with a full recovery.
When it comes to cramping, this tends to be more common in those who’ve undergone tenotomy.
Conversely, post operative pain is more likely following on from tenodesis.
It’s generally viewed that which treatment you choose is down to personal preference and after factoring in any potential risks with each type of surgery.
| Advantages of Tenotomy | Disadvantages of Tenotomy | Advantages of Tenodesis | Disadvantages of Tenodesis | |
| Faster Recovery | Cosmetic Bicep Deformity | Good Cosmetic Appearance | Longer Recovery Times | |
| Less Post Pain Surgery | Reduced Bicep Function | Preserves Bicep Function | Non Reversible | |
| Lower Risk Of Complications | Reduced Supination Strength | Reduced Risk Of Deformity | ||
| Better For Older Patients | Cramping | |||
| Decreased Elbow Flexion Strength |
What Are The Disadvantages Of Tenotomy?
There are several risk factors associated with a biceps tenotomy, which are noted below.
That being said, older patients who may not use their biceps as much compared to younger patients may find a tenotomy more suitable due to it being less invasive with a shorter recovery time.
Cosmetic Deformity
When the long head of the biceps is developed through strength training, this results in a larger biceps peak and gives your upper anterior arm their muscular appearance.
When a tenotomy is performed, this can result in a shortening of the long head bicep tendon which causes a bulge to develop.
This condition is sometimes referred to as the popeye deformity.
The rate of Popeye deformity following on from the procedure is more than four times greater when compared to the tenodesis procedure.
Loss Of Biceps Function
Post surgery the biceps muscle’s original function in terms of shoulder flexion (lifting the arm) and supination (turning the palm upward) can be affected.
While other muscles can compensate to some extent, there may be a reduction in overall strength and function in these particular movements.
Less Supination Strength
Forearm supination is when you rotate your lower arm so that your palm faces up.
This engages the biceps muscle.
Post tenotomy you may notice less supination strength.
Chronic Cramping
Muscle cramping of the bicep is typically due to a shortening of the biceps muscle post treatment.
As mentioned above, the risk of Popeye deformity is enhanced which prevents full range of movement to the biceps.
It takes time for the biceps to fully loosen up and this is what may cause excessive cramping.
It’s worth noting that cramping is rare and is more likely in those who undertake heavy lifting as part of their job or regularly strength train using weights.
Decreased Elbow Flexion Strength
As your biceps muscle plays a big part in flexing your elbow joint, post-surgery you may notice a reduction to your elbow flexion strength.
The extent of which will depend on several factors such as your initial muscle strength along with the function of surrounding muscles.
What Are The Advantages Of Tenotomy?
​There are several benefits to tenotomy surgery when compared to tenodesis as listed below:
Faster Recovery Time
With a tenotomy procedure you don’t need to wait for a reattached tendon to teal.
This makes a tenotomy a better choice for those who want to resume normal activities much sooner with a little downtime as possible.
Less Pain Post Surgery
As a tenotomy procedure is less invasive this typically means that you can expect less pain afterwards.
Tenodesis involves attaching the tendon using specific fixation methods such as sutures or screws, this is likely to result in more soreness and pain post-surgery.
Lower Risk Of Complications
There potentially less risk of complications such as anchor placement, fixtures, and sutures.
This is because there is no need to reattach the tendon once it has been cut.
Better Option For Older Patients
If you’re over the age of 55 or have lower physical demands, then a tenotomy could be a better choice of surgery due there being less chance of complications and less downtime with a faster recovery.
What Are The Disadvantages Of Tenodesis?
Due to the more complex nature of surgery when compared to tenotomy, there are several drawbacks that should be considered as below.
Longer Recovery Time
In biceps tenodesis, the detached biceps tendon is reattached to a new location on your shoulder bone.
This takes time for the tendon to heal at its new attachment site and in some instances can take several weeks.
Non-Reversible
Biceps tenodesis is a permanent procedure, and the original attachment of the tendon cannot be restored.
Once the tendon is reattached to its new location, it cannot be reversed.
What Are The Advantages Of Tenodesis?
Less Risk Of Popeye Deformity
A tenodesis procedure minimizes the chance of Popeye sign when compared to a tenotomy.
The risk of developing deformity to the bicep contour is around 50% post operation.
So, if this is something of a concern then a tenodesis operation would reduce this risk significantly.
Preservation Of Biceps Function
As the biceps tendon is reattached to the humerus to complete the procedure, this allows for a better degree of biceps function and strength.
Furthermore, tension to the bicep remains intact which could be important if you perform a lot of heavy lifting or strength training at the gym.
Better Cosmetic Outcome
There is less chance of any untoward cosmetic deficiency following on from a tenodesis procedure.
The muscle stays in its normal position, meaning that there is less risk of visible changes in the appearance of the arm.
Can You Lift Weights After Bicep Tendon Surgery?
After a bicep tenodesis or tenotomy procedure you could typically expect to return to heavy weightlifting anywhere between 3 and 9 months post operation.
It’s important to remember that the exact timeline for resuming weightlifting after biceps tendon surgery will vary based on several factors.
These include the type of surgery that you’ve had (tenotomy or tenodesis), the extent of the procedure, your overall health, and any recommendations by your surgeon.
In general, here’s a rough outline of the recovery time for returning to weightlifting after surgery:
Phase 1 – Initial Recovery Phase (1-2 Weeks):
During this period, the focus is on allowing the surgical site to heal.
You’ll likely need to wear a sling in order to keep your arm immobilized and will not be able to perform your usually daily activities.
Phase 2 – Early Rehabilitation Phase (2-6 Weeks):
As healing of the bicep progresses, a physical therapist may have you perform some mobility and range of motion exercises.
At this stage you probably won’t be lifting any weight.
Phase 3 – Intermediate Rehabilitation Phase (6-12 Weeks):
Depending on your progress, you may be able to perform resistance-based exercises using light weights or resistance bands.
However, this will be a gradual process, and all exercises will be performed under the guidance of a physical therapist.
Phase 4 – Advanced Rehabilitation Phase (3-6 Months and beyond):
At this stage, you might be able to resume more intense weightlifting, but it’s essential to progress slowly and listen to your body.
Gradually increase the weights and intensity, focusing on proper form and avoid any exercises that cause pain or discomfort.
Remember that returning to weightlifting after biceps tendon surgery is a gradual process that requires patience and adherence to your medical team’s advice.
Rushing the process or attempting heavy lifting too soon can lead to complications, setbacks, or re-injury.
Before resuming any weightlifting activities, always consult your surgeon and follow their guidance.
They will provide recommendations based on your specific procedure, progress, and health.
Final Thoughts
When it comes to bicep tenodesis vs tenotomy each procedure offers distinct advantages and considerations, so be sure to factor in your needs and lifestyle before choosing which one is right for you.
Biceps tenodesis is the better option if you’re seeking a balance between preserving biceps function and relieving pain, particularly if you have an active lifestyle and rely heavily on shoulder strength.
Conversely, biceps tenotomy, with its simplicity and faster recovery, could be more beneficial if you have more modest demands on shoulder performance or pain relief is more of a priority.
No matter which you choose, both have favorable outcomes when it comes to decreasing pain and helping to fix your long head of the biceps tendon.
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