LHB Tenodesis
If the symptoms related to the long head biceps do not settle with non-operative measures then surgery may be necessary. Sometimes a tenotomy is all that is necessary, in which case the LHB is cut so that it retracts away from the shoulder joint thereby easing the symptoms associated with it. However, a tendodesis may also be considered. In such cases the long head of biceps is surgically fixed to the upper part of the humerus, just outside the shoulder joint. Although this procedure can be performed as an arthroscopic procedure, if the LHB has previously ruptured, it will often retract into the upper arm and therefore the tenodesis will usually have to be undertaken as an open operation. If there is an associated rotator cuff tendon tear, then a rotator cuff repair might also be needed.
At the end of surgery, the wound is closed with dissolvable sutures under the skin. Butterfly stitches, splash proof dressing and a pad is applied, and the arm rested in a sling. If an open tenodesis is performed, then the skin is closed with dissolvable sutures over the skin.
Questions that are often asked
Is the surgery necessary?
- The answer to this question is not always clear. Most of the time patients do function well without the attachment of the LHB in its normal position. There is only mild weakness in the shoulder / arm. If your work involves heavy manual work or if you do not like the cosmetic appearance of the biceps then surgery may be performed to reattach the biceps tendon.
Before Admission:
- No food for 6 hours, or drink for 2 hours, prior to surgery.
- Please avoid smoking for 12 hours prior to surgery.
- Please continue to take all your medication as advised by the preassessment team.
What happens on the day of surgery?
You will need to report to the main reception on arrival. You will be shown to your room where you will be checked in by the nurse and also see Prof. Singh and the anaesthetist. This will give you chance to ask any questions before surgery. You will also be given an approximate time of your procedure. Please read the instructions on ‘Preparing for Surgery’.
What are the possible complications?
- Complications relating to anaesthesia,
- Infection (< 1 in 1000)
- Mild stiffness is quite common but occasionally a full frozen shoulder can develop (5%) which will prolong your recovery by a few months.
- This is common for the first few weeks after surgery but steadily settles. Some patients may have some discomfort at 2-3 months post operatively and may require steroid injection.
- Failure of tenodesis – it doesn’t necessarily mean that your shoulder won’t feel better but there may be an appearance of Pop Eye sign. Some patients may require further surgery.
- Failure to improve. 80% of patients will make a good or excellent recovery. 15% will have some ongoing discomfort but will be satisfied with their outcome. About 5% of patients will have ongoing problems, such as pain and stiffness, and some of these require further
What kind of anaesthesia is used?
A combination of general anesthesia and a nerve block is used for most surgeries. Before the surgery, the anaesthetist will inject numbing medicine around the nerves of the shoulder. This numbs the arm and helps to control your pain after surgery.
How long will I be in the hospital?
Almost all patients are able go home the same day of surgery. Occasionally, patients will be admitted for an overnight stay.
Please review the Post-Operative Instruction After Shoulder Arthroscopy
Sling:After your surgery, you will be fitted with a high arm sling, which is for your comfort, you can discard this as soon as you feel comfortable. Most patients find that they use it for between 1 –3 weeks depending on their pain levels and activity.
Medication: You will be given a prescription for pain medication. Pleasestart your regular medication as soon as possible after the operation.
At home: Using ice on your shoulder for 15 minutes, 2 times per day or after exercise and therapy. Gel packs, frozen peas or a plastic pack of ice can be used. These must be wrapped in a moist towel as direct contact with the skin can cause burns (cover your dressings with cling film or a plastic bag to prevent them getting wet).
Removal of stitches & Wound Care: Usually there are no stitches to be removed. You will have a thick dressing over your wound on your shoulder. The ward staff will advise you when and how it should be removed. This is usually changed at 24 – 48 hours after surgery. The butterfly stitches can be inspected by the practice nurse at your GP surgery. You can get into shower after 3 days with the dressings on and leave the wound free to air after 10 days. If any stitches need to be removed, the team will inform you.
Sleeping can be uncomfortable if you try and lie on your operated arm. We would recommend that initially you lie on your back or on the opposite side. If you lie on your back support the operated arm with a folded pillow under your lower arm. Make sure that your elbow is above your shoulder. If you are on your side then a folded pillow supports your operated arm from your elbow to your wrist.
Follow-up orthopaedic clinic: You will need to be reviewed in clinic after your operation. This is usually 2 –4 weeks after surgery.
Physiotherapy after my operation
A physiotherapist will assess you at the time of your operation and will give you exercises to do before you go home. You will be referred to physiotherapy either in the community or an outpatient department. Rehabilitation typically takes 4 to 6 and in some cases, may take up to a year.
Return to Work
The time that you can return to work will depend on the nature of your work. In sedentary job you may be able to return at 1-2 weeks after surgery. You may be able to assume light duties around 4 – 6 weeks. If your job involves heavy lifting or sustained overhead positions it may take up to 8 – 12 weeks before you can return. Please discuss with your consultant / therapist if you have any queries.
Leisure Activities
You should avoid sustained repetitive overhead activities for up to 12 weeks. You can usually start swimming when you are out of the sling – usually 6 to 8 weeks after surgery breast-stroke is advisable initially. Patients generally return to activities such as Golf at about 8 – 12 weeks. You should avoid physical contact sports like rugby or football for 6 months. For specific guidance regarding sport or DIY please speak to yourconsultant / therapist.
Driving
When you feel comfortable and have a good range of movement you can begin driving, typically at approximately the 5 – 6 weeks’ post-operative stage, after your sling has been removed. It is advisable to check this with your Doctor or Physiotherapist if you are unsure. It is important to advise your Motor Insurance Company that you have had Shoulder Surgery.