Tenodesis is a form of surgery that is typically used to treat injuries to the biceps tendon in the shoulder. These injuries may occur due to tendonitis, an inflammation or irritation of a tendon or from overuse or a trauma to the shoulder area. A tendon is the flexible cord of tissue that connects muscles to bones. Tendon problems can occur anywhere in the body, but are more common in certain joints including the shoulder because of its wide range of motion. A severe tendon injury can lead to a rupturing of the tendon and may require surgery.
The biceps muscle is found at the front of the upper arm. The biceps has two tendons that attach it to the bones of the shoulder. One of these, the long head biceps tendon, runs from the muscle to the labrum, which is the layer of cartilage that cushions and deepens the socket to help stabilize the shoulder joint. Biceps tendon injuries can result in a partial or complete tear of either the tendon or the labrum or a detachment of the tendon from the shoulder bones, causing pain and weakness in the shoulder.
In some cases, biceps tendon injuries can be managed by resting the affected arm and using anti-inflammatory medications. However, many of these injuries do not resolve on their own and may require a tenodesis procedure to relieve pain and restore full function to the arm.
Patients may be deemed good candidates for undergoing tenodesis surgery if they have been experiencing considerable pain and weakness in the shoulder due to a biceps tendon injury. This is often determined by a medical history, physical examination and imaging tests such as an X-ray or MRI scan of the joint. In addition, an arthroscopic evaluation of the joint may be necessary. A tenodesis procedure can be performed on patients of any age, but it is much more commonly used for those who are younger and lead an active, athletic lifestyle.
Tenodesis is typically an outpatient procedure that takes between 60 and 90 minutes to complete. After general anesthesia has been administered, the tenodesis procedure begins with the surgeon accessing the joint in the shoulder area. It is often performed arthroscopically, using a minimally invasive technique that involves making several small incisions into which a fiber-optic device and tiny surgical instruments are inserted, offering patients the benefits of less tissue damage and shorter recovery periods. In other cases, however, a traditional open procedure may be necessary, in which case a single longer incision is created in order to approach the joint.
The surgeon removes damaged tissue around the biceps tendon and detaches the tendon from its connection with the labrum. Any bone or cartilage fragments or bone spurs found that may irritate the tendon will be removed. The tendon is then attached to the humerus bone near the shoulder joint using anchors and strong sutures to hold it in position. This serves to decrease the stress placed on both the tendon and the labrum.
No hospital stay is generally required following a tenodesis procedure. Patients will need to wear a sling for several weeks after the surgery to provide support and protection for the healing shoulder joint.
Physical therapy aids the recovery process as it helps to strengthen and restore function to the shoulder. Most patients can return to work in sedentary jobs after a few days, but it usually takes three to six months before more strenuous activities may be permitted.
Tenodesis is considered a safe procedure, but all types of surgery carry some risk. The risks typically associated with tenodesis may include infection, formation of a blood clot, damage to a nerve or blood vessel, bleeding, pain and stiffness, muscle weakness and numbness in the affected arm.