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Why do I need a biceps tenodesis for a labrum tear?

Based on your physical exam and after reviewing your MRI, we’ve come to conclusion that you have a superior labrum (SLAP) tear in your shoulder. Now what? There are many different ways to go about treating this condition. If you have been dealing with your symptoms for several months and have tried all conservative treatments (rest, ice, anti-inflammatories, physical therapy, cortisone injections) with no relief, then surgery may be your next best option. In order to determine what the most beneficial surgical option is for you, there are several important factors we take into account.  Unfortunately, one of the most important is your age. If you are 40 or older, recent research shows that the best treatment method is a biceps tenodesis. Patients older than 40 who have an arthroscopic labrum repair, tend to have difficulty restoring their normal range of motion, have more pain, and are less likely to return to their pre-injury activities when compared to similar patients who undergo biceps tenodesis. Young athletes and patients who have a single injury where they hurt their shoulder are usually better off with a labrum repair.   Now you’re probably thinking, why would you fix my biceps if my labrum is torn? This will make more sense after discussing the anatomy of your shoulder. To begin with, the shoulder is a ball and socket joint. The ball is the humeral head and the socket is the glenoid. Around the edge of the glenoid is the labrum, which helps deepen the socket and allows your shoulder to glide smoothly in all different ranges of motion. The biceps tendon then attaches at the top of the labrum. When you have a labrum tear sometimes your biceps tendon can be involved as well and be partially torn. If the biceps tendon is not involved and you only have a labrum tear, it can still be contributing to your pain by pulling on the labrum. With a biceps tenodesis, the biceps tendon is cut out of the shoulder joint from the top of the labrum and is reattached to the humerus (which ends up being right near your armpit).  The most common question we get once we describe this to patients is “Will my biceps work normally after this procedure?”  The answer is an unequivocal yes.  There is very little functional role for the biceps tendon in the shoulder joint.  But reattaching it assures that you will not lose any strength or range of motion. You will only be in a sling for about 3-4 weeks and will get started in physical therapy (PT) several days after surgery. You can expect to be in PT for about 3 months where they will work on restoring your range of motion and strength. After 3 months of PT you will be finished with treatment and back to mostly everything that you want to be doing. Overall patients do very well after this type of surgery but it is important to keep in mind that every patient is different and treated according to his or her condition. There can be several other issues with your shoulder that may need to be addressed at the time of surgery but this is something that will be discussed with you at your office visit. Before surgery we take everything into consideration (your diagnosis, age, activity level, lifestyle, etc.) to determine what treatment options are best for you. If you have any questions regarding your shoulder pain or about the biceps tenodesis procedure please call our office to make an appointment 201-493-8990.

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