T Nation

Biceps Tenodesis

Let me start by saying for give the length of my post, but I feel I need to give some background. In December of 2010, I woke up with excruciating pain in my shoulder. I took a couple of weeks off after trying to workout, but I could not endure the pain. Finally when the pain was gone I was working out and I noticed that when I did triceps pushdowns I could feel a clicking in the superior, anterior part of my shoulder. Prior to the injury this never happened. About two months later I really damaged my shoulder benching.
Doctor decided to scope it and he found a bankhart legion detached anterior labrum, and an 80% torn Biceps tendon.
He repaired everything and then performed a biceps tenodesis. This was all done back in June 2011. I finally started working out again and that Goddamn clicking in my shoulder is still there, and I am convinced it is from the the absence of an intact biceps tendon. I think this was the source prior to surgery, and since it was not actually repaired, but rather cut and translocated.

I would never have allowed my MD to do this prior to surgery, but we didn’t know about it prior to surgery. Its my theory that the lack of an intact Biceps tendon led to the instability that caused me to further injure the shoulder, and now that it’s repaired the lack of any biceps at all will simply lead to another injury. I already feel the superior migration with crepitis and downward clunking when I get beyond 90 degrees of overhead lifting, and of course the clicking with certain movements.

Is anyone else having this problem? And are there any doctors out there that actually reconstruct the long head biceps tendon rather than obliterate it. This is depressing the shit out of me. I haven’t had a meaningful training session in 10 months!, and I’m afraid I will be injured again if I start hitting the weights the way I want to. I would travel to anywhere in the country to get this thing fixed the right way.

I’m facing a possible biceps tendonesis or tenotomy in May if I don’t turn a corner soon with my rehab from SLAP surgery. From everything that I have heard and read, I think I’m going to pass on the surgery and deal with what I have now.

Did they reattach the tendon or just cut it?

I’m interested to see the responses you get from your post.

Best of luck.

They reattached it, that’s what a tenodesis is, if they just cut it its called a tendonotomy. When they relocate it they cut it, and drill a hole into the upper humerus, usually under the pectorals major insertion, and they thread the biceps tendon through it. Then they wedge it in with a plastic screw/cap.

My recommendation to you would be to not go through with the tenodesis. Your biceps tendon crosses the shoulder, because that’s the way nature intended it. Good luck with your rehab dude, it is a long slog.

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bushidobadboy, did you even read my post. At no point did I ever mention tendonitis nor did I even have tendonitis. My biceps tendon had an 80% full thickness tear and was no longer functioning as a stabilizer to my shoulder. My Surgeon followed what is standard procedure when this happens and performed a tenodesis. This is the practice of relocating the biceps tendon prior to a complete tear in order to preserve the function of the muscle, without restoring its shoulder stabilizing function.

Now with that said we (my surgeon and me) did not expect to find this issue when he went in as it did not show up on MRI or on the Arthrogram. In my prior post I said that if I had known this prior to surgery I would not have authorized it.

Now most surgeons will tell you that the biceps tendon is not a major stabilizer to the shoulder, but people like you and me and others who follow this forum know better.

So my question remains, are their any people out there who are experiencing this problem, and are their any surgeons out there who do proximal biceps reconstructions rather than tenodesis?

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Yes I did read it and yes I did read ‘tenodesis’ not tendonitis, but for some reason (minor brain fart) I typed out a long (and useless wrt this thread) reply.

One slightly relevant question though: what do you think caused the tear? Was there pain leading up to the injury or was it an ‘out of the blue’ situation?

BBB[/quote]

Not that is matters at this point, but to keep the conversation going. It was traumatic. I was in bed with my arm abducted to 90 and my shoulder externally rotated. My upper arm was resting on a pillow with nothing supporting my lower arm. Then my 2 year old jumped on my outstretched hand and POP. It didn’t hurt right away but the next morning holy shit it hurt. I know what you getting at, and it had nothing to do with posture. My posture is excellent.

I had the re-attachment surgery in 2009. This is my post from another thread.

I ruptured the left bicep tendon at the shoulder in August 09 and had a re-attachement surgery about a month later. I was 46 and in my 23rd year of training. I did not require any additional work to the shoulder other than the removal of the small piece of tendon left after the rupture. I did no upper body training for the first 16 weeks and another 4 before direct bicep work.

I lost a noticeable amount of muscle from my left pec, shoulder, and tricep. My pressing was affected more than anything else and it took two years to restore pre-injury strength levels and muscle. I am very happy with my choice.

Biceps Tenotomy
In a ‘biceps tenotomy’ procedure the long head of biceps tendon is released from it’s attachment in the shoulder joint, allowing it to fall down into the upper arm and out of the shoulder joint. This removes the damaged, inflamed tissue by releasing it from the joint.

tenotomy is a quick and simple arthroscopic procedure, but can result in some biceps weakness and occasionally discomfort in the biceps muscle. A ‘popeye’ biceps deformity may occur.
This is generally minimal and does not inconvenience the sedentary person. It can be a problem for active and athletic people, where a biceps tenodesis is generally preferred.

As I mentioned it took a while(8-10 months) for that shoulder to feel stable after I returned to training, but I have had no problems with it since.

I am a powerlifter, had biceps tendonesis done July '11, and some clean up of the labrum.
Dec '11 competed in a bench rep contest, won pressing 1/2 bw for 37 reps
Feb '12 did a raw bench only comp pressing 185#, only 30#s from my all time raw bench 7.5 months post surgery.
Squat is at all time high and dl is still blah, but the surgery hasn’t hurt me much. Yes, it’s painful sometimes but as stable as it was prior to surgery.

lil power and BlueCollarTr8n I’m hearing you, and I believe you when you say that other than the length of time it took to get yourselves back to where you were before you are happy with the procedure. All I can say is that the superior, anterior instability is still there as well as the clicking that was there just prior to the big injury. Your posts give me hope though, and Im going to look at other possible causes like something I found called a SLAC (Superior Labral Anterior Cuff) injury when I googled superior, anterior shoulder instability. In the mean time I am trying to ease myself back into training at least with regard to weight, but not intensity. Glad you are both doing well.