Your biceps muscle has two heads and two tendons at the top end attach it to bone. The larger (short-head) tendon inserts onto the coracoid process of your shoulder blade outside your shoulder joint. This tendon very rarely causes any problems. The smaller long head takes a path right through the front of your shoulder and inserts at the top of your socket. This tendon commonly becomes degenerate, frayed and painful.
Your long head of biceps tendon can be cut if it is causing you pain. The tendon is divided by keyhole surgery (often as part of another procedure e.g. subacromial decompression or rotator cuff repair). If your tendon is to be re-fixed, this normally involves a 3cm scar near the armpit crease. It is performed under General anaesthetic +/- regional nerve block
If you are having a tenotomy, your biceps tendon is cut at its base by the top of your shoulder socket and the tendon is allowed to retract out of the joint. In about half of patients they will notice the contour of their biceps muscle changes (this is called a Popeye sign). Performing a tenotomy is safe and effective. In young men who do a lot of heavy lifting or gym work, sometimes the altered tension in the biceps muscle causes cramping, but this is rare. They may however not like the idea of an altered muscle contour and request a tenodesis.
If you are having your biceps tendon re-fixed, the best way to do this is below your Pectoralis major muscle: this is called a sub-pectoral tenodesis and it involves a small cut just at the front outside edge of your armpit fold. The tendon is fixed to bone using sutures that are secured to bone by a small titanium button or an anchor.
You will go home a few hours after your operation. Please take your prescribed painkillers regularly for the first few days. Take down any bulky padded dressings on day 2 after surgery. Keep your wound dry and covered with a dressing for 12 days. You can shower after 4 days if your waterproof dressings are on.
You will need to wear a sling for the first four weeks to protect the fixation of the tendon. You will come out of your sling after four weeks and increase your range of movement. Strengthening will begin at ten weeks. All restrictions will be removed by six months.
Patients vary in their symptoms after surgery, but in general you can expect to return to:
Office work after two weeks (in a sling)
Light physical work after eight to twelve weeks
Heavier labour may take 16-24 weeks
Contact sport usually takes six months
Driving is allowed once you are competent and confident to control a car both for routine and emergency manoeuvres. It will probably take six to eight weeks for you to be ready.
Both options are effective at removing the pain caused by a degenerate or damaged long head of biceps tendon. Objective strength outcomes are not significantly different between patients who've had a tenotomy or tenodesis. The complication rate of tenodesis is slightly higher than for tenotomy. However the tenodesis minimises the chance of a Popeye sign (altered muscle contour) and also the chance of cramping with heavy biceps loading.
For most patients with biceps pain a tenotomy is a good option. If however you are a very high-demand athletic person, especially a younger man, then you may choose to have a tenodesis over a tenotomy.
You will be seen at two weeks after your operation. Depending on your progress, your on-going follow up will vary, but many patients can be discharged between three months and nine months after surgery
Keyhole Shoulder surgery is generally very safe, but specific risks of upper biceps surgery include:
Stiffness (5%), rarely needs surgery
Humeral fracture is a very rare risk following tenodesis, where the fixation slightly weakens the bone. If the humerus does break, it may require surgery to fix it
Nerve injury is very rare
Popeye sign (discussed above) - this is expected in tenotomy in 50% of cases, but uncommon after tenodesis
Cramping is occasionally reported in high-demand patients after a tenotomy, and rarely after a tenodesis procedure. This is an ache felt in the upper arm on endurance loading of the biceps muscle.
Scarring - a sub pectoral tenodesis has to be done through a small (3cm) incision at the front of your armpit crease. This usually heals well, but may occsionally create an unsightly or widened scar.
Mr Granville-Chapman was very polite and his examination and explanation of my symptoms and expected treatment was thorough
I found Mr Granville-Chapman to be very knowledgeable and professional. He put me very much at ease and explained all the options that I have thoroughly. He also told me to look for further information on the condition and procedures that I needed on his website, which gave lots of information and detail. It was also easy to understand for those without a medical background. I would highly recommend his services to anyone that has shoulder problems and requires a solution.
I attended for a repair of my right bicep tendon. After a thorough examination, Mr Granville-Chapman arranged an operation to be undertaken within 2 days which was extremely quick; he explained his reasoning which was both thorough and reassuring, explaining both the options of undergoing surgery and deciding to undertake conservative management.On the day of the surgery Mr Granville-Chapman was again very reassuring as although this is minor surgery I was still somewhat apprehensive. He came to fully explain the procedure and afterI woke up was quick to check on how I was doing.Overall I am very happy with the careMr Granville-Chapman
I have been very pleased with my treatment so far. Mr Granville-Chapman combines brisk efficiency with a pleasant, sympathetic manner. My operation, however, is still to come ...
From the initial consultation, through surgery on a fractured wrist, and now post-operative follow up, it has been a very positive and reassuring experience with Mr Granville-Chapman. I would have no hesitation in recommending him to someone else.
A first class clinician. A skilled surgeon with an excellent bedside manner.
A very pleasant Consultant who knows exactly how to make pain go away.
Mr Granville - Chapman has an excellent bedside manner. He engaged with my 12 year old son at an appropriate level and took the time to ensure that he understood the procedure and answer all his questions. He is thoroughly professional and I would not hesitate to recommend him.
I have been very pleased with the attention I have received. Mr. Granville-Chapman has reassured me that my symptoms are normal. It is very easy to make appointments that suit me.
Mr Granville chapman I found be caring informative and professional I would recommend him to all if you have a problem don't hesitate to contact him you won't be disappointed.
I recently broke my right clavicle in a mountain bike accident and it was repaired by Mr Granville-Chapman by adding a plate on top of the bone. Having just finished the last post-op consultation, I can confirm that I have been very happy with the process all along. In particular, Jeremy took time to explain in detail why a plate was needed, what the procedure would entail, and also was very patient answering my questions comprehensively beforehand and after during the recovery phase. Would certainly trust this competent surgeon to fix any future fractures I might sustain.
Mr Granville-Chapman has looked after my 15 year old son brilliantly, explaining the surgery, recovery and best way forward, and Kate has been very supportive helping with logistics etc, thank you so much.
So far my experience with Mr Jeremy Granville-Chapman has been personal and informative with regard to the operation I will be having. I feel confident that my operation will be a success and for this reason I am very happy to have Mr Jeremy Granville-Chapman as my consultant.
Very knowledgeable and helpful. Takes the time to make sure you're getting the treatment you need.
Mr Jeremy Granville -Chapman is not only a highly skilled consultant but is able to put you straight away at ease .My appointments were arranged very swiftly which was great, when you are experiencing severe pain. I am very happy with my treatment so far . many thanks to everyone who was involved in my treatment.
Polite, helpful, professional. Makes an effort to ensure full understanding of issues and procedures to be done. Highly satisfied
Very pleasant. Clear, careful explanations & options/possibilities. I feel well informed, and happy that my concerns are being well addressed, with a plan of review of the symptoms.
Excellent advise with everything explained clearly and a successful treatment which has benefited be greatly.
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