Proximal (Long Head) Biceps Repair
Overview
Proximal (Long Head) Biceps Repair is a surgical procedure aimed at fixing a biceps tendon tear, specifically the long head of the biceps tendon, which is located near the shoulder. A tear in this region of the biceps is often less problematic than a biceps tear at the elbow.
Individuals who frequently engage in repetitive overhead activities, such as athletes, manual labourers, and older adults with degenerative tendon conditions, are more prone to needing this surgery.
Shoulder Anatomy
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The long head of the biceps tendon is one of two tendons that attach the biceps muscle (biceps brachii) to the shoulder and elbow. The biceps brachii muscle, located in the upper arm, is responsible for flexing the elbow and rotating the forearm. The long head of the biceps tendon runs over the top of the shoulder and attaches to the glenoid, the shallow socket of the shoulder blade (scapula). The rotator cuff muscles, a group of muscles and tendons surrounding the shoulder joint, contribute to its stability and movement. These structures are crucial for various shoulder and arm movements, including lifting, pulling, and rotating the arm.
What is Proximal (Long Head) Biceps Repair?
Proximal (Long Head) Biceps Repair is a surgical intervention aimed at restoring the function and integrity of the long head of the biceps tendon. This procedure involves reattaching the torn tendon to its original position or anchoring it to a different part of the shoulder. Tears can be partial, where the tendon is frayed or damaged but not completely severed, or full, where the tendon is completely detached from its attachment point.
The main sign of a tear in the long head of the biceps tendon is usually pain in the shoulder and upper arm, often accompanied by a visible bunching of the muscle, known as a “Popeye” sign. It is rare for other signs or symptoms to be associated with the tear. The initial pain may improve over time, and typically, a proximal biceps tear does not result in any long-term change in arm strength. However, it can cause earlier fatigue or cramping in the muscle.
Surgery may be required to reduce pain or address significant fatigue or cramping. Additionally, a tear in the proximal biceps tendon is often present alongside other shoulder injuries, allowing for the simultaneous repair of accompanying problems during the same surgical procedure.
Types of Proximal (Long Head) Biceps Repair Techniques
Dr. Chua will assess the best method for performing your surgery, depending on the nature of the injury. There are several techniques for Proximal (Long Head) Biceps Repair, each tailored to the specific needs of the patient and the extent of the injury (these surgeries may be performed as keyhole surgeries or with a small incision):
- Biceps Tenodesis: This technique involves anchoring the biceps tendon to a different part of the shoulder, often lower down to the humerus (upper arm bone), to relieve pain and restore function.
- Biceps Tenotomy: In cases where the patient is less active or the tendon damage is extensive, Mr Soong Chua may opt to simply release the tendon (tenotomy), allowing it to retract and alleviate symptoms without reattachment.
Conditions that may require this surgery
Several conditions might lead to a biceps tendon tear and may necessitate a Proximal (Long Head) Biceps Repair, including:
- Biceps Tendon Tear: A partial or complete tear of the biceps tendon, which can occur from sudden injury or chronic wear and tear. Complete tears often require surgical intervention.
- Biceps Tendonitis: Inflammation of the biceps tendon, often due to overuse or repetitive motions. This condition can lead to weakening and tearing of the tendon.
- Shoulder Impingement: When the shoulder tendons are intermittently trapped and compressed during shoulder movements, leading to inflammation and potential tearing of the biceps tendon.
- Rotator Cuff Tears: Tears in the rotator cuff muscles can often coexist with biceps tendon injuries, necessitating repair to restore full shoulder function.
- Labral Tears: Tears in the labrum (the cartilage around the shoulder socket) can sometimes involve the biceps tendon, requiring surgical repair.
Benefits and Risks
The primary benefits of Proximal (Long Head) Biceps Repair include the relief of pain and the restoration of shoulder function. Patients often experience an improved range of motion, allowing them to return to daily activities and sports. The minimally invasive nature of arthroscopic techniques can lead to faster recovery times and reduced scarring.
While Proximal (Long Head) Biceps Repair is generally safe, there are some risks associated with the surgery. These include the potential for infection, nerve damage, stiffness or loss of motion in the shoulder, re-tear of the tendon, and complications related to anaesthesia. It is important for patients to discuss these risks with Mr Soong Chua prior to the procedure.
What to Expect
Before the Procedure
Prior to surgery, patients will have a consultation with Mr Soong Chua, which may include imaging tests such as MRI or ultrasound to assess the injury. Patients should discuss their medical history, current medications, and any concerns with Mr Soong Chua. Pre-surgery instructions, such as fasting and arranging for post-surgery transportation, will be provided.
During the Procedure
The surgery is typically performed under general anaesthesia. Mr Soong Chua makes incisions based on the chosen technique (biceps tenodesis or biceps tenotomy). Once the surgery is finished, the incisions are closed with sutures or staples.
After the Procedure
Following the surgery, patients will be monitored in the hospital before being discharged. The surgery can be performed as a day procedure, or the patient may be required to stay overnight.
Pain management will be provided through medications. Depending on the type of surgery that Mr. Chua performs, the arm may need to be immobilised for 4 weeks in a sling or brace. The arm should not be used for strenuous activity for at least 12 weeks.
Mr. Chua will advise you in regards to the introduction of resistance exercises within your rehabilitation plan. The plan will involve a slow introduction of movement to the arm, and physiotherapy may be prescribed.
Follow-up appointments with Mr Soong Chua will ensure proper healing and address any concerns.
Frequently Asked Questions
- How long is the recovery period?
Recovery typically spans 3 to 6 months, involving gradual rehabilitation to regain strength and function. Initial phases focus on protecting the repair, gradually increasing range of motion, and introducing strengthening exercises. - Can I return to sports after surgery?
Yes, with proper rehabilitation, many patients can resume sports and physical activities. Rehabilitation includes specific exercises to improve muscle coordination and safely reintroduce functional movements. Mr Soong Chua will advise you on when it is safe to return to sports and physical activity. - Is Proximal (Long Head) Biceps Repair always necessary for a torn biceps tendon?
Not always. Less severe injuries may respond well to non-surgical treatments like rest, ice, medications, and physical therapy. Surgical repair is considered if conservative treatments do not provide adequate relief or if there’s significant impairment in daily activities or sports performance.