The Procedure
Biceps Tenodesis surgery is a procedure that treats biceps tendon tears, usually caused by injury or strain. The surgery involves detaching the damaged tendon from the labrum and reattaching it to the humerus.
The surgery is usually done arthroscopically. It can be done as a standalone procedure, however it is frequently performed with other major surgeries, including rotator cuff repair and shoulder joint replacement.
Complications
General risks of surgery include:
- Bruising & haematoma: this will vary foreach patient. Bruising is a normal side effect of surgery and usually resolves in a short time.
- Infection: infection is a rare but possible risk and is usually treated with antibiotics.
- DVT and PE: deep vein thrombosis and pulmonary embolism are blood clots that form in either the lower limbs or lungs. If left untreated, DVT and PE can have serious effects, however if treated promptly, the risks are significantly lowered. More information can be found here.
- Anaesthetic risks: general anaesthetic (GA)carries a number of risks, which will be discussed in detail with your anaesthetist prior to surgery. Fortunately, Australia is one of the safest places to undergo a GA. In Australia, the risk of mortality from GA is around 1in 100,000. For context, the risk of death in a car accident in Queensland is around 1 in 10,000 per year.
- Wound issues: some superficial issues can develop in surgical wounds postoperatively, however most will require a small intervention to resolve the problem.
Specific risks of Biceps Tenodesis include:
- Nerve injury
- Pain and stiffness
- Deformity: the biceps tendon can bunch up after surgery, resulting in a bulge in the upper arm, often called a Popeye Deformity
- Attachment issues where the tendon is reattached to the bone
Pre Op
Whilst you wait for your surgery date, there are a few things to do:
- Speak to your health fund to confirm if the hospital fee for your surgery is covered on your policy
- Speak to your anaesthetist to confirm their fees Register your details with the hospital
- Read through, complete and return your paperwork to my office
- Plan your transport to and from the hospital. You won’t be able to drive yourself home after the surgery, so make sure you have a travel plan in place
- If required, arrange any recommended pre op physio appointments
- If required, get any pre op pathology tests (e.g., blood tests)
- Use benzoyl peroxide 5% wash on your shoulder for 5 applications: twice a day for two days, and then again on the morning of the surgery. This will help reduce your risk of infection from Cutibacterium acnes.
- Pack a bag for your hospital stay including regular medications in the original packaging, a loose button-up shirt to wear after surgery, nightwear, personal items including toiletries. If you have sleep apnoea, you must bring your CPAP machine.
- If you are on any blood thinners, ring my office and confirm when to stop taking them before the operation.
- If you are on any diabetic tablet medications, ring your anaesthetist and confirm whether you need to stop taking them before the operation.
- Confirm your admission details with my office one to two business days prior to surgery.
Though this can seem overwhelming, you will be provided with detailed instructions on what needs to be done so your surgery journey can be as smooth as possible.
Day of Surgery
Your admission details will be confirmed one to two business days prior to surgery. You will need to make note of your admission time and your fasting time. Your admission time may be as early as 6am. If you aren’t local to Brisbane, it is usually recommended that you stay the night before in case your admission is early.
When you arrive at the hospital, you will go through the admissions process and then be taken through to the surgical waiting area. Your anaesthetist will have a short consultation with you before you go into theatre and under general anaesthetic. I will say hi to you before the surgery in the anaesthetic bay of the operating theatre and mark your operation site with you.
Your hospital stay will usually be one night. You will be discharged usually around 10am. I will see you before your discharge. I will provide you with a folder containing a detailed postoperative pack including a letter telling you what I found at surgery and exactly what I did in your operation along with information about your rehabilitation and postoperative care. Remember to have someone available to take you home from the hospital.
Post Op Recovery & Healing
The recovery after biceps tenodesis surgery requires lots of rest. A sling is required full time for the first 6 weeks after surgery, with no driving, work and physical activities allowed. For 12 weeks postop, arm movements must also be limited, therefore driving is typically not permitted during this period.
Full recovery takes around 6 months, and normal physical activities require a gradual return.
Rehabilitation
Rehabilitation following biceps tenodesis surgery focuses primarily on regaining strength and shoulder function.
Physiotherapy Guidelines
Day 1 Physiotherapy Guidelines
The hospital physio will demonstrate how to fit your sling and how to eat, shower & dress whilst in your sling. Please make sure you go through these things with the physio so that you get them really clear in your mind before you leave hospital.
Day one (PHASE ONE – Early Healing Protective Phase):
- Education and precautions – protective phase for biceps, no active biceps contraction
- ADL (activities of daily living) advice – sling for 6 weeks. Shoulder pendulum for axilla hygiene
- Pain management advice – correct sling fit is paramount, ice
Patient seen day one in hospital:
- Education and precautions - protective phase for biceps
- No active elbow flexion. No loading of biceps tendon
- Ensure good fit of sling, patient able to don/doff correctly, if incorrect size then new sling needs to be arranged
- Shoulder active-assisted movements to minimise chances of excessive GH (glenohumeral) stiffness
- Pendulum, OK to perform small circular motion
- Forward lean
- External rotation
- Wriist/hand ROM (range of motion) – care noforceful grip
- C spine ROM (cervical spine range of motion)
- Gentle scapular neutral exercises / general posture
Follow up:
- See local physiotherapist week 1-2 with good understanding of post op rehab guidelines and precautions
Results After Surgery
Biceps tenodesis surgery generally has positive long-term outcomes, with reduced pain and improved shoulder function. It has a low complication rate, however compliance with rehabilitation and physiotherapy protocols, as well as individual factors, will influence outcomes.