Is a Biceps Tenodesis the Answer?

I read a lot of stuff on the internet.  I like to keep up with a ton of blogs, websites, and journals to make sure I am on top of recent trends, but also to share with my readers.  I recently came across an article at Science Direct entitled Getting Athletes Back in the Game Sooner Following Shoulder Injuries.  Nice headline, right?  It made me want to click.

Interestingly, they were talking about how a biceps tenodesis can cut down the rehabilitation time from SLAP tears in comparison to a SLAP repair.  That wasn’t what I was expecting!

OK, would a tenodesis cut down (no pun intended…) the rehab time in comparison to a SLAP repair?  No doubt, I agree with that.  But I am not sure if this is what we want to do, especially in athletes, as the title of the article suggested.  Let’s dig into this deeper, but first, let’s discuss SLAP tears and what the biceps tenodesis surgery actually does.

 

What is a SLAP Tear and Biceps Tenodesis?

biceps labral complexI’ve covered superior labral tears, or SLAP tears extensively in the past.  If you don’t know much about SLAP tears, start there, but essentially a SLAP tear is a superior labral tear at the junction of where the long head of the biceps comes in and attaches to the superior labrum.  SLAP tears are common, and can be especially troublesome for overhead athletes.  (Photo from Wikipedia)

A biceps tenodesis is a surgical procedure that detaches the biceps attachment from the superior labrum and reattaches it to the humerus.  Here is a surgical demonstration from Smith and Nephew:

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By removing the biceps, this essentially eliminates the patient’s pain from the SLAP lesion or biceps tendonitis, however at what consequence?  By performing a tenodesis, you are changing the anatomy of the shoulder and the function of the biceps.  This procedure has become more popular in older individuals, essentially those that chose a decrease in function for a decrease in pain.  But what about athletes, as the paper I mentioned above proposed was happening, can they return to sports faster by simply cutting the biceps off instead of trying to repair it?

One of the most popular studies on this subject was in AJSM in 2009.  The authors reported that the results of biceps tenodesis were superior to SLAP repairs in athletes with superior labral tears.  The authors mention both “overhead athletes” and “return to sport” in the paper, though they report the age range of subjects was 24-69 years old.  Furthermore, significant differences in age existed between the two groups, with the mean age of 37 years old in the SLAP repair group and mean age of 52 years old in the biceps tenodesis group.  One could certainly argue that the level of “sport” participation was different between the groups and could certainly influence their subjective satisfaction.

 

What is the Function of the Biceps?

Biomechanical studies have shown that the biceps labrum complex has a role in providing both translational and rotational stability, and that repair of a SLAP lesion restores this ability to provide static stability.  This is especially true in overhead athletes who need to use their arm in the abducted and externally rotated position.  Contraction of the long head of the biceps in this position has been shown to reduce anterior humeral head displacement, a functional that is critical in preventing throwing injuries.  In fact, peak biceps EMG activity has been shown to occur during this cocking phase of throwing, and has been shown to be higher in pitchers that have anterior instability.

Also, don’t forget that release of the long head of the biceps has been shown to increase superior humeral head migration by over 15%.

As all my readers know, superior humeral head migration is disadvantageous and causes many of the dysfunctions we see with the shoulder.  Our whole goal of most shoulder rehabilitation programs is to train the rotator cuff to dynamically stabilize to resist superior humeral head migration.  I’ve written about the role of rotator cuff fatigue in shoulder mechanics and how rotator cuff fatigue increases superior humeral head migration.

So if the biceps is involved with translational and rotational glenohumeral stability and helps prevent superior humeral head migration, is this something you want to sacrifice just to reduce pain?  How will this impact function, and more importantly, future injuries?

 

Is a Biceps Tenodesis the Answer?

Is there a role for biceps tenodesis?  I am sure there is.  I like the recommendations my friend Brian Busconi reports in this paper, stating that he likes to perform SLAP repairs, but will consider biceps tenodesis in patients over the age of 45.  This serves a different purpose and return to high level athletics is probably not as important to the patient than reducing their pain.  I have heard Dr. Altchek from New York report in meetings that he thinks biceps tenodesis may be an option, but one he reserves for those who fail a SLAP repair.   Still, I have to wonder what the long term effects of the biceps tenodesis will do on this patient population as well.  Will the increased superior humeral head cause rotator cuff pathology or degenerative changes?  Only time will tell.

There is also recent chatter about the use of the biceps tenodesis procedure in overhead athletes and the risk of humeral head fracture.  This is a consequence that must be considered.

Noted orthopedist, Dr. James Andrews was recently asked about the biceps and the potential for biceps tenodesis, to which he replied “The biceps is there for a purpose — it’s too intrinsically associated with the shoulder joint.  Until we know what the real function of it is, we’re stabbing in the dark.”  When asked if a biceps tenodesis is the answer to athletes returning to sport, similar to a Tommy John procedure, he replied “With Tommy John surgery, we’re actually restoring anatomy. In the case of biceps tenodesis, you’re deleting anatomy.”

SEE ALSO: Dr. Lyle Cain from Dr. Andrews’ American Sports Medicine Institute discusses some of the facts and fiction related to the biceps tenodesis surgery.

So, sadly, I don’t think we all learned a great new way “get athletes back in the game sooner following shoulder injuries” like the Science Direct title would suggest.  Perhaps I’m wrong, but I would have to agree with Dr. Andrews, I always prefer procedures that restore anatomy when possible.  Don’t get me wrong, a biceps tenodesis has it’s place.  But I’m not sure if it is the magical secret to getting athletes back faster, there just has to be some consequences.

What has your experience been?  Have you seen many athletes opt for a biceps tenodesis rather than a SLAP repair?

 

 

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70 Responses to “Is a Biceps Tenodesis the Answer?”

  1. Trevor Winnegge PT,DPT,MS,OCS,CSCS October 25, 2012 at 7:29 pm

    I agree 100% Mike! Our sports doc always repairs first. He reserves biceps tenodesis for the older “athletes” who want to return to recreational activity. All high school and college athletes get repaired. With proper rehab, they do well without compromising the anatomy of the joint. We are in the preserve anatomy rather than delete it camp!

  2. Good article, wish I had read this a couple years ago. I was diagnosed and treated for biceps tendonitis as a freshman in high school. While recovering, I was out for the entire spring and summer baseball season and it took me much longer than that to fully recover. After my recovery I continued pitching, but never experienced a real increase in velocity. I wonder if restoring the problem would have provided better future results.

  3. Nicholas St John Rheault October 31, 2012 at 7:54 pm

    Mr. Reinold,

    It’s great to read the articles you post. Was at the 1st Annual Cressey Performance Clinic in Hudson this past Sunday. It was nice to pick up the Optimal Shoulder Performance and Functional Stability Training of the Core DVD’s from Eric Cressey. You guys combined and individually are a great resource and asset to your respective industries. I thank you on behalf of others who value your expertise….

    Respectfully,

    Nicholas

  4. I found that the biceps tenodesis I had done neither relieved my shoulder pain nor helped me get back faster. I had mine done almost 2 years ago now, before some of the “anti-BT” info came out. Now, I’m a bit stuck with the new anatomy and trying to figure out how to move around it. The largest problem has been getting IR back. Everything that purports to help with IR just causes more inflammation. Anyhow, another great post Mike. I hope more folks considering BT surgery read this first.

  5. I respect both sides of the fence on this issue. Personally, I am a 38-year-old athlete who chose the biceps tenodesis route, but I also had biceps tendonosis in addition to the labral tear. I am 58 days out so far and am back to work full-time and generally feel good. Shoulder is still sore, but I understand the pain could hang around for 3-6 months, no matter which shoulder surgery was performed. I feel I made the right decision… I am not going back to any “throwing sports”, and am doing everything I can do keep my RTC muscles and tendons strong to stabilize the shoulder as best as possible.

  6. Kevin McLoughlin January 8, 2013 at 10:33 am

    This has been a very interesting article to read. I am a 29 y/o, healthy male who, while playing college baseball, had a SLAP tear repair. The original surgery date was done in March of 2003. I was rather agressive in my rehab, returning to pitching within 6 months following the surgery. Needless to say, I didn’t play at that competitive level much longer and throughout the nearly 10 years since the surgery, I have dealt with considerable pain while playing recreational hardball.

    My personal goal to suffice my competitive nature is to switch to endurance sports such as running races, triathlons, and surfing since I am in a coastal town.

    I met with an ortho surgeon last week and am undergoing bicep tenodesis on February 11. While I want to remove the pain, I do still want to be a competitive athlete.

    Any thoughts or opinions is greatly appreciated as what I am hearing here is with the biceps tenodesis- I am at risk of having an improperly functioning shoulder.

  7. Wow I wish I had read what you had to say about biceps tenodesis three days sooner. I had arthroscopic surgery on my right shoulder yesterday. The pre-op diagnosis was a SLAP tear but MRI did not clearly reveal the extent of the tear. This injury occurred at work (I am a paramedic for a very busy emergency service and spend at least 48 hours per week on the ambulance). It was a lifting/jerking/pulling motion that caused the injury. I have done the same movement sequence literally thousands of times over my 16 year career without any shoulder discomfort. But, for reasons I cannot figure out, this time was different. I felt an awful tearing sensation, popping, and very intense pain. To make a long comment shorter…the ortho surgeon to whom I was referred recommended arthroscopy to determine the extent of injury and to do a SLAP repair if indicated. Well, when I woke up from anesthesia, I discovered he had performed a biceps tenodesis, removed bone spurs, and decompression of subacromioclavicular space. Not until reading this post after surgery is done, did I understand that tenodesis was done instead of SLAP repair. Okay, so I just turned 40 about a month ago, which, it seems is pretty old in reference to shoulder repair work. But I have two sons, the older is 4 years old and the baby is 16 months. I have a career that I absolutely love but it is very physically demanding. I am not a competitive athlete but the factors listed above are just as important. So I’m wondering why I was not offered a choice of whether to have the tenodesis or the SLAP repair. It seems the surgeon decided for me while I was under anesthesia. Feeling a little cheated now. Also wondering about potential future shoulder injury because of the anatomical modification of the tenodesis. Does it make me more prone to rotator cuff tears or a Bankart lesion or some other pathology? And does tenodesis limit what types of treatment can be done for future injuries? It really seems like I should have been given a choice between the two options in this case. Thank you, sir, for any insight you can provide on this matter.

    • If you are not an athlete, than a biceps tenodesis may be a great option for you.

      • I am 52 and looking at having the tenodesis done as part of a repair to a fully ruptured supraspinatus tendon, partially torn infraspinatus, and a LHBT that appears to be split axially. I swim for recreation/fitness and do many manual things around home, garden and garage. Will the tenodesis increase shoulder instability or reduce my shoulder function?

    • I had a tenodesis performed on my left shoulder in 2009, after a pulling/jerking injury similar to yours. Only I’d been jerking and pulling on tools associated with automotive frame repair for close to 25 years. It was about two years before I took a full time job after having been told not to return to frame work. I now run a CNC router for a large plastics company and have for about two years. It’s fast past and often enough I’m loading 4×8 foot sheets of .177 thick material by hand onto the machine. About 6 months ago my shoulder started to bother me, now and the at first, then the pinky side of my hand started to get numb, the deep pain in my shoulder and upper arm. Long story short, the pain is the same as prior to my surgery. I had an mri last week which show nothing significant, (it didn’t show the partial tear I had the first time). I’m wondering if the problem is where the tendon is attached being the pain is identical. The Dr’s aren’t sure whats up yet, I’ve thrown out my thought. I had an injection today and will be refered to the ortho in 6 weeks if there is no improvement. I’ll try to up date you as I learn more.

      • Bill, hard to say over the internet but if you have numbness in your hand, you should get that checked out. That is more neurological. SLAPs and biceps injuries dont cause that.

  8. Hi

    I am a 26 year old from South Africa. I used to play rugby competitively at a high level. When I was 21 I injured my left shoulder during a game and was told there was not much that could be done then to fix the issue. So I had to retire from the sport I loved. In 2011 I was really struggling with pain in both my left and right shoulders and after an MRI scan, it was confirmed both had severe SLAP lesion tears which were repaired due to new surgical procedures.

    In total I had 3 operations, one left and 2 on the right side as one of the anchors fitted pulled out and broke 6 months after the first operation. Now 2 years later I was still having severe pain in the left shoulder and was unable to do much weight training. So I returned to the doc and another MRI scan to discover one of the anchors had pulled out from the previous op.

    Anyway, 3 weeks ago I underwent my 4th op to have the SLAP repaired, only to wake up and find that the doc had removed the anchor and done a bicep tenodesis – naturally without asking me.

    What I want to know is was this the right move with me being so young still? All I want to do is get back into the gym to lift some weights, heavy weights. What is your opinion on this?

    Thanks and sorry for the long winded message.

    Regards from South Africa

    • Greg, it sure could have been the right procedure for you. Difficult to say over the internet but if the surgeon thought that I bet it was. Sometimes a tenodesis is the best option, different for everyone.

  9. Thanks Mike. It will be interesting to see once I get back into the gym how the training and rehab goes.

    • Thanks Mike for this Forum.

      Greg – I am 27 and play tons of basketball. I was advised a BT was the answer just this morning – have had 10 months of pain in my right arm. Anyway, I’m really hoping you post your status here going forward. If you recover fine I’ll likely go your route. All this stuff about changing my anatomy is scary, advil seems to work after a game. But like all here, I want my arm back as I remember it. I don’t want something bad to get worse..

      But haha, I want to lift heavy weights too. Bench press has been off my workout list for a year now – and pullups for a few months.

      Thanks for the tips and stories all!

      Sean

  10. Thanks Sean, I will keep you all updated with my progress. I’m into week 4 after the surgery and my shoulder feels pretty good. A lo more mobile and pain free than my other 3 operations. The bicep does feel weak but I haven’t loaded it at all as the doc warned me not to until at least 6 weeks after the op.

    To give you an idea, I used to single arm bicep curl 45kg (+- 100 pounds) that was before my ops with SLAP lesion tears. So if after these ops I cannot get to that weight then I would definitely consider it all a failure.

    I do believe that surgery should be the last option though, I lived with my problem for 4 years and I used to do some very heavy weights, bench included. With correct rotator cuff strengthening and training you can get away with it to a degree.

    • Hi Greg,

      How is the rehab going?

      Like you I lifted big weights until I couldn’t live with the pain anymore – bench 1.6 x BW, squat 2.6 x BW and deadlift 3.2 x BW at 82kg and 24 years old. I now wonder whether I was naive with my aspirations to get in to regional strongman competitions or if it was poor judgement that led my desire to find my limits – but that’s what lifting weights is about right?

      To cut a long story short I seen a physio who ordered CT and MRI that came back showning no issues. Then after 9 months of traditional physio I forcifully requested a referral to a consultant surgeon. The surgeon diagnosed a SLAP tear and found significant debridement at the labrum and a very lax anterior capsule. I had many anchors inserted at the labrum March 13 with the anterior capsule being tightened but last month I felt the bicep slip from the groove and now feel the arm slipping again.

      I’ve booked in to visit my OS 14th Jan but I suspect that he’ll push for a tenodesis or cut the LHBT and let it fly.

      Any insight in to your experience would be massively appreciated as I doubt a further SLAP repair is on the cards for me.

      Regards,

      Ad

  11. Dr. Mike, 2 years ago I had a biceps tenodesis, which was unexpected as it was 80% torn, and this was unknown prior to surgery. Prior to my injury I was an avid weight lifter. I have never recovered from having this surgery. I was an athlete growing up and weight lifting was the last activity I had left. 2 years later after 3 surgeries I have not been able to return to the gym, because of the pain and instability. I cannot throw a baseball to my young son because of the pain. My shoulder continues to dislocate Anterosuperiorly, exactly where the biceps tendon crosses the shoulder. My question is, is there no procedure yet conceived that can replaced this structure. Can a cadaver tendon not be joined to the distal portion of the biceps tendon and placed in the supraglenoid tubercle or can the coracobrachialis origin be translocated to this area, or even the short head of the biceps. I feel as though my surgeon may as well have just amputated my right arm.

    • I should add that like you, I am a physical therapist, and after my experience I would never recommend a tenodesis to anyone, regardless of age.

      • No there isnt a way to replace, however I am not sure you are experiencing these issues because the biceps. Sounds like you have some capsular issues you should get checked out.

        • My last surgery was to reattach my superior labrum which was completely detached and scarred down to the cuff. Superior instability is my biggest issue, and since the rotator cuff and the superior joint capsule are contiguous there is really no way to tight the capsule in this area. Not that I know of anyway. Just yesterday a simple shoulder abduction exercise caused me a dislocate anterosuperiorly.

          • You need to get checked out, you should not be dislocating.

            • Already made my appointment request with Dr. Andrews.

            • Mike,

              I am a 47 year old male. I saw the surgeon today; he recommended the tenodesis on my left shoulder. He mentioned that, upon completion of the surgery, there will be between 1-2 centimeter redaction of the bicep (making it more defined than the right bicep) I havent read any posts mentioning a noticeable difference. My goal is to be able to swim and participate in all the cross fit workouts I am accustomed to. My “End Goal” (if I have the tenodesis) is to be able to function normally well into my golden years 70’s through 90’s. My surgery is on the 20th of June, so I have a couple of weeks to decide. Do you have knowledge of anyone in their 60’s or 70’s that had this procedure previously?

              • Mark, it’s all an equation of how much your symptoms limit you and what you want your activity level to be. If you explained all this to your doc, they should have considered all this when they came to the conclusion.

  12. Hello Mike,
    Great article, this really helped me understand these procedures and my predicament. When I was 31, 4 1/2 years ago, I had surgery for a SLAP tear and Arthroscopic Subacromial Decompression. After 2 years of PT my shoulder did not get any better. I still have pain on the front side of my shoulder, loss of range of motion, cannot do pull ups or hang from a bar, and have occasional pain or numbness in my biceps tendon. An odd vibration shoots down that tendon. It was suggested by a ortho that I have this procedure done – Biceps Tenodesis. He thinks my shoulders have also moved forward. So when I throw, the humeral head pushes against that area causing pain. I play a little softball (can’t throw with any velocity without significant pain on front side of shoulder). I am past my prime but would like to be able to throw with my 2 boys. Any suggestions?
    Thanks
    Rob

    • Rob, if you havent yet, I would get a full evaluation and give rehab a try, perhaps with a different PT?

      • Thanks Mike. I have tried 2 different physical therapists and worked my butt off doing the exercises with no significant improvement. Leads me to believe there is something else going on in my shoulder. :)

        Rob

  13. I’m currently 40 years old. I originally started feeling pain in my shoulder when I was twenty. I ended up quitting playing sports due to the pain. About 5 years ago I finally went and had surgery on it. After the surgery (slap) my surgeon at the Hospital for Special Surgery told me that many doctors perform tenodesis on every shoulder they repair but that he didn’t agree with it. He then told me that he felt that I was likely to have problems in the future with what he saw in my shoulder and said that I was the first patient that he had seen that he felt actually needed the tenodesis due to the anatomy of my shoulder. He didn’t perform the tenodesis because he had never discussed it as a possibility with me before the surgery. Post surgery my shoulder eventually was better on a day to day basis but once I started playing racquetball and going to the gym I ended up having to get cortisone shots once a year to help with the pain. I finally decided to go back and I just had the tenodesis performed last Wednesday. I was told that my shoulder looked really good but that my tendon was “shredded”. I am very hopeful that this is going to finally fix my shoulder issues. I’m hoping that it won’t eventually cause other problems in the future but hopefully it ended up being the right option for me.

  14. I am 46 years old,.. I am not a professional athlete but do sports forfun and fitness. I was diagnosed with a slap tear in left shoulder. Because of the pain, I can not swim, do yoga, weight lift, or pick up my grand nephew.the doctor I am seeing recommended bicep tenodesis. H said that was recommended due to my age and because he thinks physical therapy will not work.

    I will be getting some more opinions, but looking here for any insights. I just want to get back to swimming, yoga and weight training pain free.

  15. Hey Mike, I posted a while back about problems I had encountered following my tenodesis. I was dislocating superiorly. Since then my surgeon performed a transfer of my biceps short head from the coracoid process to the origin of my long head. The goal is obviously to compensate for the lack of a biceps long head.

    In addition I should say that about a year ago I was diagnosed with Ehlers-Danlos Syndrome hypermobility type. My surgeon explained to me that while patients with normal anatomy usually do fine with tenodesis people with my diagnosis rely much more heavily on tendons for joint stability than ligaments and that tenodesis is a very poor option for patients like me.

  16. I just cancelled my acromioclavicular re-section and biceps tenodesis because I couldn’t get two surgeons to agree the two procedures were necessary.

    I’m 50 and my shoulder acted up due to a more aggressive workout routine. That lead to X-Rays and a diagnosis of aromial arthritis and bicep tendinitis.

    I saw two surgeons – the younger guy recommended the aromial re-section with bone spur grinding, and bicep tenodesis.

    The older surgeon said the acromioclavicular re-section wold destabilize the shoulder and would not recommend it, saying he hasn’t done the procedure in a while because he thinks it’s not necessary. Older Surgeon also said the MRI didn’t show any tears in the bicep, just a flattened tendon shape. That alone wasn’t reason enough for a BT. He recommended more PT and anti-inflammatory meds.

    Now I am wondering about the long term – I want to keep working out…

  17. DR. Mike,
    I am 40yrs old in the military, I had an MRI done receintly showing a post and antiror labrum tear. I also have a partial rotator cuff tear and two bone spirs with some degrenerative arthritus in the shoulderand bicep was unremarkable. I am active with sports like softball, archery and swimming to name a few. I had a civilian surgon look at it and recommended the slap repair and to clean up the rest of the problems previously stated. Also two military surgons say they will do a BT and that was pretty much it. Stating that people my age dont recover from slap repairs that well. I have had a co worker get the BT and has lost strength in his arm and can not do some of the this he used to due. Looking fo r a like guidance about this. The civilian surgon said the BT would be the wrong rout for me to go but that is all the military ones want ot do. confused

    • Sean,

      Get the slap repair done. I am 42 and just had a slap repair, and I am doing fine so far. You will have to be careful with it and rehab slowly, but it can be done. My surgeon also proposed a BT, but we did not do the procedure because my tendon was not damaged. People over 40 can have good results. Hope this is encouraging. I hate the “now that you’re over 40″ doctor lectures! :) Good luck!

  18. I am 34yo judo athlete that was injured during sports. I had diagnosed to have slap and bankard lesion on my dominant hand. Doctor said that i could imporove it by repairing the tears. Finaly doctor proceed to bicep tenodesis echept baral repair. I also wonder why doctor never informed me about the possibility of doing it.
    If i was discussing about it, I would ask more. I did not complain about permanent pain on my shoulder I only complaint for having instability (i have only one or two dislocation in 5 years). Please let me know your view about it.

  19. After years of whitewater canoeing skiing etc,I developed severe pain in right shoulder.My surgeon suggested a bicep tenoesis.THATbicept was pretty shredded from spurs and the bicep tendon was pretty damaged, be in sling for 6 weeks I am primary care taker of MY MOM There are things that have to be done. SURGERY SIX WEEKS IH SLING. NO THERAPEUTIC CARE OR…CLOSE To TO 3 MONTHS THERE WERE EASY EXCERCIZES TO RROTRECT THE ROTATOR //TO PREVENT FROM FROXEN ShOUDER BUT NO MASSAGE FINALLY SOME TREATMENT, FEELING A MITE BETTER BUT THE EAST COAST Hurricane sandy 2012 I WORKED VERY HaRd protecting myPROPERTY..After that we lost power.amd 85y/o mom = devastating fall …Never lost the pain but on a daily basis I jeopardized my shoulder. The mrii show triangle shape unconnected to the attach point. My Doc does not know about sx fail as he uninterested in establishing what was causeing pain year out rom sx Catherine suggestd remedy build up surrounding muscle

  20. Hello all,

    I see many people questioning a biceps tenodesis as a reasonable solution, especially for active people. While my results may not be typical, I would like to share a biceps tenodesis success story. I suffered an acute sports injury (fall) resulting in a SLAP tear several years ago while I was in my mid-30s. I was active in basketball and several recreational sports. I underwent a biceps tenodesis due to the severity of the injury. While I was not guaranteed a return to full range of motion and use, I wasn’t left with too many options in my case. The recovery was admittedly longer than I would have predicted, taking 12-18 months to reach what I would have called a full recovery, though recovery was delayed somewhat by a follow-up procedure for frozen shoulder. I have since attained what I would say is a nearly 100% recovery. I feel some very mild discomfort and aching at times, and have some uncomfortable tingling sensations at times due to what I would assume is scar tissue, though my range of motion is back and I feel the strength has returned to normal. Most of my issues when returning to sports was mental rather than physical, as I was much more protective of my shoulder than I probably needed to be. I have had no complications with the surgery or the resulting anatomy. I returned to playing basketball and do not feel the surgery has inhibited me in any way to date. I wish similar success stories for others who are attempting to recover from SLAP tears.

    • Hi All-

      Sean from back in April (with a minor tear) checking in. I never did get the surgery. I just forced myself to rest for a full month, not doing anything other than jogging. I can play basketball pretty much pain free now, though playing in the post with my right forearm on someone’s back, having to do “bushwackers”, isn’t fun. Playing back to back days is definitely dangerous, and sometimes it can be sore for a few days after. I suppose: Advil occasionally > surgery.

      I can do chest (usually just a variety of pushups) and pullups again, but 100lbs curls I never try! I basically just realized I’m getting older and don’t go HAM in the weight room anymore. I shifted to just being lean and ripped rather than bulky — which just aggravates it.

      So my final two cents:
      Surgery should be avoided at all cost. Rest for a while, we know you are addicted to working out — which combined with flexibility and posture are the reasons it probably happened in the first place.

      Thanks everyone
      Sean

  21. I had SLAP surgery on Oct 2010 with famous Dr Andrews.. I flew to see him despite his poor bedside manner. The surgery didnt fix the pain and the tear. As a matter of fact, i got rotator cuff tear in addition.. I have met a wonderful doc who explained, it is common to get complications since the labrum and biceps insertion point might create that and how loose the anchors were placed.. Too tight might create other problems, it can compress the other end causing tears. He said BT is very common in europe but the sucess rate is not too good according to the study because the age range is disproportinately. Different ages have different tissue cells..personally, i dont think there is a clear solution to these problems. Best bet is to avoid any strenous sports whatsover..All i wanted is to go back to my daily activities which i cant do anymore. Just dressing up is painful..My left shoulder is aching and will probably need surgery too.. i am really distressed because surgery might not repair the problem. This has been a tremendous setback to my life..Maybe better surgeons are outside of US..Who knows.

  22. HI All~
    I had a SLAP repair and bicep tendonesis on Sept 18, 2013. Prior to surgery, I was a power lifter, did crossfit, and was very active. Since surgery, I’ve struggled with recovery, and now they’re saying I have a frozen shoulder and “extreme” inflammation despite icing and multiple NSAIDS (I’m currently on Diclofenac). I’m struggling with even simple things like getting dressed in the morning. Still going to PT twice weekly, and now adding soft tissue work to PT sessions. Running and biking seem to flare it up. Anyone go through this and have any suggestions? I’ve gained a ton of weight, my workouts have obviously been pretty much non-existant, and I’m sick of being on pain meds, anti-inflammatories, and anti-spasm meds. I’m at my wits end. Help please!!

    • If it is true adhesive capsulitis it is going to be some time. If your PT seems ineffective it doesnt hurt to try to switch to another PT and see their approach. I would be looking for someone that is really hands on.

  23. I woke up after what was supposed to be removal of a calcium deposit in my shoulder and found that I had a rotator cuff repair and a BT. Unfortunately, I also suffered a brachial plexus injury due to traction that I am still struggling with 14 months later. Aside from the nerve damage, I can definitely feel a difference in how my shoulder feels – especially when reaching across my body, and while I cannot say for sure it was the BT, I had RCR only on opposite shoulder 6 months ago and it does not feel that way.

    It seems that like myself, many patients really did not get a full explanation of this procedure and I urge everyone to ask your surgeon a lot of questions about every possible outcome of your surgery.

  24. Hi Mike

    I’m a 64 year old who has been experiencing pain in the front of my shoulder for many years. I have gone from basketball to running and now, for about 10 years, a daily one mile swim. I got to the point where the pain was nearly constant and interfering with my sleep so I went to an orthopod. I’m doing an MRI tomorrow but in the preliminary exam he feels it a good bet that I have a torn long bicep tendon. He said if that is the case I should consider a tenotomy. I realize this post is about tenodesis but I thought I’s ask for some feedback.

    thanks

  25. I am 26 year old teacher and softball coach. 5 years ago I was in a bicycle accident that cause some injury to my shoulder. After 20 months, 2 rounds of physical therapy, and very little improvement, I ended up having surgery on my shoulder. I had a coracoplasty done and I don’t think anything else. About 3 months post-op I started having a terrible pain that started in my shoulder and shot down my arm. My doctor thought it would get better through continued PT. It didn’t get better, but it only happened a few times a month and would last a few hours at a time. About a year ago, the pain got more frequent so it was occurring 4-5 days each week. I returned to PT and did that for 4 months. The pain didn’t get better, and after 3 months started getting significantly worse. I’ve done to cortisone injections with no relief. Now I can’t move my arm away from my body more than to about 45 degree (not even to shoulder level) without sever pain. My doctor recommended bicep tenodesis as well as exploratory surgery to see what else is going on. I’m schedule to do that in June, once softball season ends, but after reading your article, I’m a little nervous. Any thoughts?

  26. HI,
    I am an active CrossFit athlete. I tore my labrum form 11-4. I tried to rest and do pt for 3 months but was unsuccessful. One dr recommended a slap repair and one a bicep tenodesis saying I would most likely re-tear the slap repair with all the lifting I do. I am apprehensive about the BT as it is major reconstruction and am scared there is not return after this. Any advice? Will slap repair not give me enough support and ROM to do CrossFit? I am 28 years old.

  27. Mike,
    I am a 27 year old male, and have enjoyed golf recreationally since I was 8 years old. In January of 2013 I had a Bicep Tenodesis due to unbearable pain in right my shoulder, to which Richard Hawkins of Steadman Hawkins felt the Bicep Tendon was the issue. 6 months later the pre-surgery pain returned, and he had no answers as to why. As a result, I sought a second opinion and this surgeon performed a second MRI, to which this time my AC joint showed an issue. So, in September of 2013 I had a Distal Clavicle Resection. Four months after that surgery, I feel some better, am able to sleep on my right side again, but still have a lot of pain, and any activity overhead, or across my body still hurts like crazy. Do you see this being something that will improve, just with all my shoulder has been through in a year, it could be a slower process? Or does this sound like something that could be a lifelong problem? At this point I feel defeated, and do not know that either surgery was really worth it.

  28. Wow! I am VERY glad I ran across this blog. Thanks Mike!

    As background, I am 51 y.o. male. A very active 51. Gym 3-4 days per week, lift weights for strength (curl 55 per arm), bench 245 with reps, etc. Surf, golf, play soccer, etc. In other words, I don’t want anyone telling me “at your age, BT is the best option.” I at least HOPE to continue what I do today and not lose strength, capacity, range of movement, and so on.

    My left shoulder started aching 3 months ago. Pops, grinds, etc. Got an MRI, was told I have a SLAP tear. I was told it was not from injury, but “degenerative.” Surgeon’s recommendation was SLAP tear repair and removal of bone spurs. As I dug further, he said that in almost all cases, he “finds” that he needs to “release” the bicep tendon.

    Watch out for that word – “release.” If I had not pushed for definition, he would have left it at that and I would have gone to surgery and found I had a BT performed. “Released” means “CUT” – changing anatomy. Then attaching the long head tendon into the humerus as shown in video above. I would not have been happy to come out with that degree of alteration to my anatomy, at least if I were not mentally prepared for it.

    So, this is where I am stuck. My surgeon seems to be of the mind that in “most” cases (I think he means virtually all cases) repairing a SLAP tear requires releasing the long head biceps tendon. Then patient’s choice is BT or to leave it unattached. I don’t understand that. Are there any surgeons that are good that will commit to repairing the Labral tear without releasing the bicep tendon?

    This surgeon also said that PT will not help. I don’t know what to make of that.

    Finally, if you have BT, do you lose strength? If so, what % on average? Meaning, my 55 lb curls with my left arm will likely go down to what? 20? 30? 40? Or no reduction after recovery, PT, and giving some time to get back into shape?

    This entire topic is very frustrating. I don’t want to complain too much, because medicine is so much more advanced than our grandparents could ever dream of. And much worse things can happen. But I do sort of feel unlucky that I have this SLAP Tear and there does not appear to be a clear path forward from here.

    Any thoughts would be much appreciated!

    • Mark,
      I had a biceps tenodesis one year ago almost to the day. Just 4 months ago I had a second shoulder surgery, a distal clavicle resection, on the same shoulder. I experienced the ache, and the other kinds of pain you mentioned, and my surgeon didn’t want to do just a slap repair. He also wanted to do the biceps release, and left it up to me on whether I wanted it loose, or attached to the humerus, I chose the latter. Between the time of the first surgery and second, I would say my strength never got close to what it was before the surgery. Now after two surgeries I know I’m less than 50% of my strength beforehand, still having the same pain, and have had my surgeon completely dumbfounded as to why I’m not improving. I’m no medical professional, but as Mike’s argument paraphrased said, fix the issue without changing the anatomy, I wish I had come across this blog before my first surgery a year ago, and would have pursued a doctor that would have repaired my slap tear without messing up the anatomy of my shoulder, as I now feel my shoulder will never be the same again. I’d keep pressing the surgeon for more answer as to why he wants to cut the biceps loose, and is it not possible to repair the problem without disrupting something else. Best wishes!

      • Hi Brandon – Thanks for the info!

        What you express seems to be a recurring theme in several blogs on this topic on the Internet. I guess that those with bad outcomes are more likely to need an outlet for expressing their frustration than those with good outcomes (or those that are not physically active and just don’t know the difference as long as the pain is gone).

        I’m not sure what that second surgery is that you had, but sounds pretty dramatic.

        I agree with you that I can’t see why it is necessary to change anatomy in order to repair a tear of the Labrum. Bio-mechanically, I can see how perhaps removing the biceps tendon takes some pressure off of the Labrum, allowing it to reattach more easily. And perhaps with less time in a sling, etc. Still, I don’t like it.

        I also do not like the idea of a large decrease in biceps strength. I would notice even a small decrease, because my two arms are pretty much of equal strength in most upper body exercises I do. There is very little information about loss of strength available.

        In any case, I am not rushing into surgery! Your comment and others have made me take a step back and carefully consider this. Including talking to more shoulder specialists. So, I really do appreciate it!

        And, I hope that you find some relief!

  29. Hi Mike, I spoke with you back in September when I spent a few days training at Cressey Performance. I’m a 26 year old male in the army, had a SLAP repair done back in Nov 2012. Did rehab religiously with multiple PT’s but could never get back to high volume push ups, or basically any weighted press (horizontal or vertical). Same as before the surgery!! Now I’m 7 weeks post-op Biceps Tenodesis. How long does it usually take for your patients to get ROM back?

  30. Hi!
    I’ve been reading up a lot on SLAP repairs and BT for about a year now. I’m a 22 year old female who had a SLAP repair done about 2.5 years ago to fix damage done from falling on my outstretched arm on an ice rink. I was doing fantastic for about 1.5 years. Just in the last year, my shoulder started burning and aching mostly while I was leaning on it or studying. My surgeon said it was bicep tendonitis, a rare side effect from the SLAP repair. We tried the steroid injections and Meloxicam with little improvement. I’m 8 weeks post-op now from a bicep tenodesis and unsure as to if I made the right decision regarding a second surgery. My ROM has come back really well, besides the behind the back things. However, I still experience some burning (from the original spot of the tendon) and especially on days I have PT, I feel extremely sore. I understand things take time to heal, as much as to a year, but it’s so hard to be patient! My PT says around 6 months I should really start to feel better, but I guess I just didn’t realize how much shoulder surgery impacts your life. The good news is, the original pain I was feeling is much decreased.

  31. Read this post and the comments before my BT and got a little nervous. Here’s my story for what it’s worth to those looking for info/testimonials: 39 y/o IT professional (desk job). Suffered from pretty severe arm/shoulder pain for the last 2 years, sometimes requiring pain killers just to carry grocery bags. Main physical activity is golf. Tried cortisone injection but pain returned after 2 months. BT performed on 2/7/2014, including bone spur removal, distal clavicle excision and some cartilage repair. First PT session was 3 days later 2/10/2014. At just over 2 weeks post-op I have almost full range of motion, including being able to reach between shoulder blades behind my back. Shoulder is a little stiff when I wake up but warms up quickly with light stretching. So far it’s great and I have ZERO regrets as the pain from before is already gone. For what it’s worth…

  32. Hi I’m 48, extremely active and work as a police officer so job on the street is often demanding. Shoulder painafter weight lifting and feeling a sharp pain like i tore my bicep. Mri showed a torn labrum. Rest and therapy and then i resumed lifting. I did this for a full year before deciding to have bicep tenodesis surgery. I modified my lifting to exercises that didnt hurt but eventually I decided I just didnt want to live like that and needed to have full strength for my job and athletic endeavors. I am currently at 9 weeks post op and lifting again ,although still fairly light. i regained full range of motion around 6 weeks or so. Minimal pain. A point of interest to help others- I too was concerned about changing my “anatomy” but my surgeon is a team doctor for Chicago Bulls/White sox and assured me this was a good choice for athletes. Also, post surgery he informed me my bicep was shredded and there was also a bone spur that was shaved down. I feel at least so far that this was a complete success. Perhaps doing the tenodesis is not a clear choice in all cases, but I feel it would be indicated if during the surgery the surgeon sees that the bicep is torn up. Hope this helps!

  33. Mike,

    I’ve mostly seen SLAP repairs but I’ve had one pitcher that has had a BT. He had it in April of 2012. He was very good about rehab and was able to return to pitching at the collegiate level in Spring of 2013. He ended up having a set-back that year and developing internal impingment. Besides the internal impingment, he c/o pec soreness/tightness. He had a successful fall 2013 season and has been performing well this spring. I am very aware and address the fact he needs more dynamic stability and his pec’s tend get tight. He throws uppper 80’s and I feel like he has returned to at least the same level as before. This is a successful case so far but I don’t believe his return was quicker than just a SLAP repair.

  34. 34 yo female. Primary physical activity is cycling, far from what I’d describe as an athlete but I’m not sure that negates the desire for a fully functional shoulder. I had a capsular shift procedure about 2 years ago and never got completely pain free. I’m told that capsular shifts sometimes predispose to chronic biceps tendonitis, and if refractory to conservative therapy, biceps tenodesis is preferred treatment. Surgery scheduled for April 8th. I’d like to hear any thoughts about BT after a capsular shift and chronic biceps tendonitis. Thank you for the information you have provided!

  35. hi, after reading all this i get the impression that if you want to keep lifting weight or doing pull up etc, BT is a no no?

  36. Hello, when I was 26 I had my first SLAP repair, when I was 28 I had my second SLAP repair, and now i’m 29, and 11 months ago I had my 3rd shoulder surgery which was an open subpectoral bicep tenodesis. I have to get regular injections for the pain im always in and was just wondering if anyone has had multiple failed SLAP repairs? Also I really feel that same deep aching pain that comes from a SLAP and i’m not sure how that is possible since I was told that after a tenodesis slap pain is eliminated becuase the bicep is no longer pulling on the torn area??

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