Biceps tenodesis

In a biceps tenodesis, the long-head biceps tendon is released from its attachment inside the shoulder joint — where the painful, intra-articular part of the tendon sits — and is secured to the upper arm bone (the humerus) in a new location a short distance away.

The aim is to remove the symptomatic portion of the tendon from inside the shoulder while maintaining a biceps attachment to the arm, so the muscle stays anchored. Tenodesis is a way of managing a diseased or symptomatic tendon by relocating and fixing it. Whether it is the right choice, and how it is done, is individualized.

There are two common ways to address a symptomatic long-head biceps tendon, and they are not the same:

• Tenotomy releases the long-head tendon from its attachment inside the shoulder and does not fix it to a new location; the tendon is simply released.
• Tenodesis releases the tendon and then secures it to the humerus in a new position.

Each option has trade-offs, and neither is universally better than the other. The choice between tenotomy and tenodesis depends on the individual situation — the symptoms, any associated shoulder pathology, activity, concerns about the appearance of the arm, concerns about cramping, personal preferences, and the surgeon's judgment. This page does not present either option as the right answer for everyone, and it does not set age or activity cutoffs for choosing one over the other.

Biceps tenodesis can be performed with different approaches — arthroscopic (through small portals) or open-assisted (through a small incision) — and the location and method of fixation vary. This page describes the operation only in general terms; it does not name specific implants or compare one fixation device or technique against another, because those choices are individualized and are made by the surgeon.

Biceps tenodesis is also frequently performed together with another shoulder procedure rather than on its own — for example, alongside a rotator-cuff repair. When other procedures are done at the same time, they can change both the operation and the recovery, as described below.

It matters whether the tenodesis is performed on its own or together with another procedure, because that affects which rehabilitation plan applies:

• An isolated biceps tenodesis may follow the dedicated biceps-tenodesis rehabilitation protocol.
• When biceps tenodesis is performed together with a rotator-cuff repair, rehabilitation generally follows the applicable rotator-cuff repair protocol unless the surgeon specifies otherwise.
• Other concurrent procedures — such as a labral repair or a shoulder stabilization — may impose different or more protective restrictions.

Because so much depends on exactly what was done, the operative note and the rehabilitation protocol your surgical team selects take precedence over any general description on this page. If you had more than one procedure, the plan is set by the combination of procedures, not by the biceps tenodesis alone. Always follow the specific protocol you are given.

Rehabilitation after a biceps tenodesis is staged. In broad terms, it moves from an early period that protects the tenodesis, to controlled shoulder motion, to a gradual restoration of active motion and strength, with loading of the biceps itself introduced later, and then a later progression back toward fuller function.

The specifics — including how the arm is protected, how and when motion and loading are advanced, and when particular activities may resume — are set by the protocol your surgical team selects, and they can differ when other procedures are performed at the same time. Those detailed restrictions and timelines are not reproduced here; your surgeon's protocol and operative note take precedence, and rebuilding strength can take time.

As with any surgery, biceps tenodesis carries risks and has limits. The possibilities below are for discussion with your surgeon and are not a complete list; which matter most depends on your situation:

• Infection
• Stiffness or loss of motion
• Persistent pain
• Failure of healing or of the fixation that holds the tendon
• Cramping of the biceps muscle
• Weakness
• A change in the contour of the upper arm
• Nerve injury
• Blood clots
• The possible need for additional surgery

Biceps tenodesis aims to relieve symptoms coming from the long-head biceps tendon by moving its painful portion out of the shoulder while keeping the biceps attached. Recovery is gradual and individual, and no operation guarantees the complete elimination of pain or a full return to preinjury function. A realistic picture for your specific situation — including whether the tenodesis is isolated or part of a larger operation — is best discussed with your surgeon.