Surgical treatment

If the conservative therapy does not work, the inflammation is called refractory to therapy and the biceps tendon has to be operated. In this case a so-called endoscopic operation is performed. For the endoscopy, only several very small incisions have to be made, through which the endoscopes are inserted into the arm.

Endoscopes are tools that are needed during the operation, including a camera through which the surgeon can see what he is doing. This is known as the key-lock principle. Two different procedures are available for biceps tendonitis: Firstly, tenodesis, in which the part of the tendon located inside the shoulder joint is partially removed and the remaining stump is fixed in a bone canal above the gliding trough using a fixation screw.

The approximately thirty-minute operation is usually performed under general anesthesia. The other option is tenotomy. In tenotomy, a part of the tendon is also removed, namely the part located at the upper glenoid rim of the shoulder joint.

The remaining part of the tendon can then slide within the canal located there, the bicipital sulcus. In the bicipital sulcus, the tendon can then heal and stabilize. Tenotomy involves the risk of the tendon slipping deeply into the gliding channel.

This is then noticeable by a bulge of the biceps abdomen. In some cases, muscle cramps can also subside on their own. Under certain circumstances, the bending strength of the biceps may be reduced by about 15%, but this usually does not affect the person affected in everyday life.

Young, slim men in particular often find the visual change in the biceps during tenotomy disturbing, which is why tenodesis is performed more often in them. However, tenotomy achieves better results overall and causes fewer problems. In addition, especially with tenodesis, sports and strenuous activities must be avoided until about three months after the operation.

If the surgeon discovers during the operation that the endoscopic operation does not provide sufficient vision, it can be extended to open surgery. Frequently, the inflammation of the long biceps tendon is not the only problem, but there is also a clinical picture, for example, in the area of the rotator cuff. These operations usually involve an anesthetic of the nerve plexus, which runs in the arm; this is called a scalenus block.

One to two days after the operation, the patient is usually discharged from the hospital. After the operation, the patient must continue with physiotherapy. This takes place directly on the day of the operation and then extends over a period of four to six weeks. After two to three weeks, sports that do not put any strain on the shoulders, such as jogging, can be practiced again. Sports that involve shoulder strain or strength training with the shoulder should only be resumed after six to twelve weeks in consultation with the surgeon.