The biceps has two tendons around the shoulder and one tendon around the elbow. One of the bicep tendons around the shoulder runs between the rotator cuff tendons. Therefore, conditions that affect the rotator cuff frequently involve the biceps tendon. However, the biceps tendon can also cause pain without involving the rotator cuff. Pain from the biceps often begins on the front of the shoulder and radiates down the front of the arm. Inflammation of the biceps (tendinitis) frequently responds to activity modification, physical therapy, cortisone injections, oral nonsteroidal anti-inflammatories, and topical pain relievers. When the biceps tendon does not respond to treatment surgical procedures to address the tear are very effective.
The two options are tenotomy and tenodesis. During a tenotomy procedure the biceps tendon is cut. This procedure is very effective because the biceps tendon is removed from the area of the shoulder where it was causing the problem. Many patients are concerned because they are afraid that they won't be able to bend their arm after a tenotomy. It is important to remember that one of the bicep tendons is still attached. In addition, there are other muscles that flex the elbow. Tenotomies have been very effective for professional athletes.
During a tenodesis, the biceps tendon is cut at the level of the shoulder. It is then reattached further down the humerus. This bypasses the area of pain and is also very effective.
The decision to proceed with a tenotomy or tenodesis surgery is based on a number of factors. Some of those are determined preoperatively (before surgery), but the final decision is made intraoperatively (during surgery).