Is Biceps Preservation Recommended For Younger Patients?
Yes, biceps preservation (biceps tenodesis) is usually recommended for younger patients. Unlike biceps tenotomy, this surgical procedure reattaches the damaged biceps tendon to the humerus (upper arm bone) instead of cutting it. Therefore, surgeons prefer it for young, active individuals to preserve arm strength, prevent muscle deformity, and reduce the risk of cramping or fatigue during lifting and overhead activities.
At Total Orthopedics and Sports Medicine, we perform detailed shoulder examinations, review imaging studies, and assess your activity demands to determine if biceps preservation is appropriate for your condition. If surgical treatment is required, our orthopedic surgeons use advanced arthroscopic techniques to repair or stabilize the biceps tendon while minimizing tissue trauma. Contact us now to book your appointment.
Does Age Affect the Success of Biceps Preservation?
Yes, age can affect the success rate of biceps preservation. With aging, tendons become thinner, lose blood supply, and undergo degenerative changes, which can impair tissue healing and increase the risk of retear. Similarly, loss of muscle mass and strength in older adults can also delay postoperative rehabilitation and limit functional recovery.
Despite these age-related structural and biological changes, postoperative complication rates are not significantly higher in older patients compared with younger individuals. For example, a study published in BMC Musculoskeletal Disorders examined two groups of patients aged 27-64 years and 65-77 years. At a 2.5-year follow-up, younger, active patients reported complication rates of 5.4%, compared to 8.7% in older individuals. This represents an overall difference of only 3.3% between the two age groups.
How Does Capsular Laxity or Instability Affect Eligibility for Biceps Preservation?
Capsular laxity or shoulder instability disrupts normal joint mechanics, making it difficult to maintain stable biceps fixation. These mechanical issues may cause persistent postoperative pain and recurrent subluxation, which can increase the risk of surgical failure.
In these situations, surgeons first reattach the biceps tendon to the superior labrum via an SLAP repair to restore stability. If multidirectional instability is present, they may also recommend capsular tightening via capsular plication to reduce excessive joint laxity before performing preservation surgery. However, if joint stability cannot be safely restored, they prefer biceps tenotomy over biceps preservation, particularly in older or less active patients.
Can Biceps Preservation Reduce the Risk of “Popeye” Deformity?
Yes, biceps preservation can minimize the risk of the Popeye deformity (a bulge that affects upper-arm appearance). Popeye formation occurs when the long head of the biceps tendon detaches from its original attachment, causing the biceps muscle to shift downward toward the elbow. Biceps preservation helps prevent this displacement by maintaining normal muscle tension and tendon positioning.
A study published in the Journal of Shoulder and Elbow Surgery also reported that biceps tenodesis carries a lower risk of Popeye deformity than biceps tenotomy. The study included 114 patients, divided into two groups. One group of 42 patients underwent biceps tenodesis, while the remaining patients were treated with biceps tenotomy. During a 2-year follow-up, researchers found that the risk of Popeye deformity was 4.3 times higher in the tenotomy group compared with the tenodesis group.
Does Prior Shoulder Surgery Affect Biceps Preservation Outcomes?
Yes, prior surgical repair can affect biceps preservation outcomes as previous procedures often alter normal tissue quality and bone structure. For example, it may lead to scar tissue formation that can limit tendon mobility, making it difficult for surgeons to reposition and secure the biceps tendon effectively. Similarly, prior use of sutures, anchors, or bone tunnels can also affect bone quality and limit available fixation sites.
Here are some other factors related to previous shoulder surgeries that can affect the clinical outcomes of biceps preservation:
- Reduced capsular flexibility due to postoperative stiffness
- Weakened surrounding soft tissues that reduce overall shoulder stability
- Ongoing inflammation due to incomplete healing of previous surgical repairs
- Loss of labral tissue from previous debridement
At Total Orthopedics and Sports Medicine, our team carefully reviews your surgical history before proceeding with biceps preservation. If preservation is not suitable, we recommend other surgical options, such as revision SLAP repair or combined rotator cuff repair with biceps treatment, to relieve pain and restore shoulder function. In addition to comprehensive surgical consultation, our team assists with insurance coordination, referrals, and co-pays, so you can focus on your recovery. Call 855-321-6784 to book your appointment.
How Long Does It Take to Recover After Biceps-Preserving Procedures?
After biceps-preserving procedures, you can regain shoulder mobility within 4 to 6 months. However, full recovery often takes 6 to 12 months, depending on your age, tendon healing capacity, and consistency with rehabilitation. Generally, the recovery period involves 3 stages: the initial healing phase, the intermediate recovery, and the return to activity.
The initial healing phase lasts up to 6 weeks, during which you must wear a soft sling to protect the repaired tendon. At this stage, surgeons also restrict strenuous activities such as lifting, pushing, and pulling. However, they may recommend gentle, guided range-of-motion exercises to prevent stiffness. In addition, surgeons may prescribe anti-inflammatory medications to control pain and inflammation during this phase.
After initial healing, you will progress to the intermediate recovery phase, which lasts for 4 to 12 weeks. During this period, your surgeon will recommend strengthening exercises to help restore shoulder strength and control. As healing progresses, they focus on improving shoulder movement and stability through functional training, which continues until you achieve a full range of motion with minimal pain.
Is Gentle Stretching Safe After Biceps Preservation Surgery?
Yes, gentle stretching is safe after biceps preservation surgery. When performed under medical guidance, it reduces stiffness and helps maintain shoulder mobility during early recovery. These movements also promote healthy circulation, prevent scar tissue formation, and prepare the shoulder for progressive strengthening exercises.
Here are some tips to perform stretching after biceps preservation surgery:
- Perform all stretches slowly and within a pain-free range
- Avoid sudden, jerking, or bouncing movements
- Follow the exact range and timing recommended by your surgeon
- Keep your shoulder relaxed, maintain an upright torso, and support the operated arm with your opposite hand during stretching
- Stop immediately if you experience severe biceps-related pain or a pulling sensation
Quick Tip: Use a warm compress for a few minutes before stretching to improve tissue flexibility and reduce stiffness.
What Are the Common Causes of Biceps Preservation Failure?
Chronic degenerative changes, poor tendon blood supply, early shoulder overuse, and untreated conditions such as rotator cuff tears or shoulder impingement may result in biceps preservation failure. In many cases, lifestyle factors like smoking or long-term steroid use can also weaken healing tissue and increase the risk of distal biceps tendon rupture.
Here are some other common causes of biceps tenodesis failure:
- Technical issues such as knot slippage, bone tunnel failure, or improper tensioning of the suture anchor
- High-strength sutures that may cut through the tendon, especially during early strenuous activity
- Poor bone quality affecting anchor or interference screw fixation
- Metabolic conditions, such as diabetes or thyroid disorders
In addition, patient gender may also affect the success rate of biceps tenodesis. According to a study published in the Orthopaedic Journal of Sports Medicine, male patients had a 38% higher risk of requiring revision surgery after biceps tenodesis compared with female patients.
Book an Appointment With Dr. Charles Ruotolo at Total Orthopedics & Sports Medicine for Biceps Preservation Surgery!
While biceps preservation has lower complication rates than biceps tenotomy, it can still lead to persistent pain, stiffness, cramping, or failed fixation. These complications often occur when the procedure is performed without a thorough pre-surgical assessment based on your tendon quality, shoulder stability, and prior surgical history.
To minimize these risks, Dr. Charles Ruotolo at Total Orthopedics and Sports Medicine performs focused physical examinations and orders X-rays or MRIs before recommending biceps preservation. As a board-certified surgeon and Fellow of the American Academy of Orthopaedic Surgeons, he also uses minimally invasive techniques and provides detailed postoperative rehabilitation guidance to support faster recovery. Contact us or visit Sheepshead Bay Rd., Brooklyn, to consult Dr. Charles.
FAQs
Can a Bicep Tenotomy Be Reversed?
Yes, a biceps tenotomy can often be reversed by converting it to a biceps tenodesis. During this procedure, surgeons reattach the previously released tendon to the humerus, which can reduce the Popeye deformity and help restore arm strength. Surgeons usually recommend this revision if you develop persistent shoulder pain or muscle cramping after the initial tenotomy.
What Is the Success Rate of Biceps Tenodesis?
Biceps tenodesis has a high success rate, often around 90% or higher. After this surgical procedure, most patients experience significant pain relief, improved shoulder function, and reduced activity-related discomfort. However, outcomes can vary depending on factors such as patient age, tendon quality, activity level, and underlying shoulder conditions.
Why Do You Need a Biceps Tenotomy?
Your surgeon may recommend biceps tenotomy if shoulder pain originates from damage to the long head of the biceps tendon. This biceps injury commonly occurs due to SLAP tendon tears or advanced biceps tendinitis that no longer respond to non-surgical treatment. To relieve pain in such cases, surgeons perform tenotomy, which releases the tendon and removes the damaged tissue.
Can Biceps Preservation Lower the Risk of Cramping After Surgery?
Yes, biceps preservation can significantly lower the risk of postoperative muscle spasms and cramping. The procedure aims to maintain normal tendon attachment and the natural length-tension relationship of the biceps muscle. This approach prevents excessive muscle retraction, which is a common cause of painful cramping and the Popeye sign.
Does Biceps Preservation Improve Shoulder Stability?
Yes, biceps preservation can help improve shoulder stability, particularly when performed with rotator cuff repair. The long head of the biceps contributes to shoulder stabilization, especially during abduction and external rotation movements. By preserving this tendon, surgeons help maintain dynamic control of the shoulder joint.
Is Biceps Preservation Better for People Who Do CrossFit?
Yes, surgeons often recommend preserving the biceps for people involved in high-intensity activities such as CrossFit. This approach helps maintain normal biceps tension and shoulder mechanics, which are important for lifting, pulling, and gymnastic movements. It also supports elbow stability, reduces compensatory strain on surrounding muscles, and helps preserve forearm supination strength.
Can Biceps Preservation Reduce Clicking or Catching in the Shoulder?
Yes, biceps preservation can reduce clicking or catching in the shoulder. These sensations often occur when a damaged or inflamed tendon moves abnormally and impinges on surrounding structures during shoulder motion. Surgeons address this instability by securing the tendon in a stable position. Besides addressing instability, biceps preservation also reduces inflammation that contributes to shoulder clicking or catching.
