The Biceps, Injuries, and Solutions
The biceps tendon has two origins at the shoulder. The short head of the biceps inserts on the coracoid process of the scapula, which is outside the shoulder joint. The long head of the biceps inserts in the shoulder joint into the superior labrum. Due to the nature of the biceps there are two sources of bicep pain: tendinitis and tendon tears.
This pain can most often be treated nonoperatively. However, if this is not successful, surgery to repair the biceps may be necessary. This can be done by repairing and releasing the tendon (biceps tenotomy), or releasing and securing the biceps in a new location (biceps tenodesis).
Biceps tenotomy involves releasing the long head of the biceps from its attachment on the labrum. This procedure is performed arthroscopically and greatly improves biceps related pain. Some people may notice asymmetry in their biceps area (a popeye sign) if the biceps retracts in the arm, but this does not occur in everyone. Most people do not notice significant weakness, but the arm may fatigue more easily. Recovery is straightforward with no limitations post-operation.
When biceps tenodesis is performed the biceps is released from its attachment on the superior labrum. It is then reattached further down in the arm. This method avoids the possibility of the tendon slipping down in the arm and creating a popeye deformity. It also preserves strength and avoids the fatigue weakness that may accompany biceps tenotomy. Postoperatively, patients are usually in a sling for 4 to 6 weeks to help them avoid actively flexing the elbow and stressing the repair. Activities are then gradually resumed.