Diseases and injuries of the long biceps tendon, SLAP repair, arthroscopic biceps tendon tenodesis

Preliminary remarks

Due to its location within the glenohumeral joint the long biceps tendon is subject to painful diseases and injuries. It originates at the upper rim of the glenohumeral joint cavity, extends over the surface of the head of humerus, penetrates the rotator cuff and transfers into the muscle belly at the upper third of the humeral shaft. The long biceps tendon transmits about 15% of the biceps muscle power.

Fig. 14: Intraarticular course of the long head of the biceps tendon (arrow).

Common diseases:

The merely inflammatory disease of the long biceps tendon may be treated conservatively.
The isolated spontaneous tear of the long biceps tendon progresses almost painlessly and does not need any treatment.
In connection with other diseases of the glenohumeral joint, damage and partial tears of the long biceps tendon can be observed. In such cases, cutting of the tendon at its attachment may be required. If the tendon is cut only (tenotomy), it glides back into its canal and adheres to the adjacent tissue. An alternative is to cut the tendon at its attachment and suture it to the joint capsule in an arthroscopic way (tenodesis).
Rarely the so-called SLAP lesion occurs where the biceps tendon anchor becomes detached from the cavity rim and must be fixed again arthroscopically.

Treatment objective

Detachments of the biceps tendon may be sutured arthroscopically (so-called SLAP repair). In case of irreversible damage, the tendon is cut at its attachment and sutured back to the capsule arthroscopically (so-called biceps tendon tenodesis). With older patients without the need of much power, the mere cutting of the biceps tendon is sufficient (so-called biceps tendon tenotomy). The tendon glides out of the joint, gets stuck and scars over - the pain is eased.

Arthroscopic SLAP repair

Fig. 15: Screwing the suture anchor into the superior glenoid rim and perforation of the SLAP-complex.

Fig. 16: Completely refixed SLAP complex using two suture anchors.

Arthroscopic biceps tendon tenodesis

Fig. 17: Detachment of the longhead of the biceps tendon from its origin after the fixation of the tendon using a suture through the capsule.

Fig. 18: Stable tenodesis of the long head of the biceps tendon against the joint capsule after knot tying.

Inpatient treatment

The patient is treated at the clinic for about 4 - 5 days.

Follow-up treatment

After a temporary immobilization of the shoulder (as a rule 24 hours), the glenohumeral joint is treated by means of physiotherapy at an early time. In case of biceps tendon tenodesis and SLAP repair, the biceps muscle must not be strongly flexed for 6 weeks. After SLAP repair, the arm is immobilized using an abduction splint for 3 weeks. Therapy takes between 10 and 12 weeks. The earliest time to resume a sport-specific training is 12 weeks after the SLAP repair.

Inability to work

In case of office, teaching, management or similar work, a return to work is reasonably possible after 3 - 6 weeks. Patients performing heavy physical work will need the full rehabilitation time before returning to work.
Driving is possible after 6 - 8 weeks.