Biceps Tenodesis: Indications, Procedure, Recovery & Outcomes
We offer biceps tenodesis—a procedure that relocates and secures the long head of biceps tendon (LHBT) to relieve pain from biceps tendinopathy or degenerative SLAP lesions. Our diagnosis-first approach ensures we treat the true pain driver, often alongside shoulder arthroscopy or rotator cuff repair when indicated.
Who Is Biceps Tenodesis For?
- Degenerative SLAP Type II/IV lesions with biceps anchor pain, especially in patients aged >30–35 or manual workers where repair has lower reliability. See SLAP Lesion.
- Long head of biceps tendinopathy (groove pain, clicking) unresponsive to structured non-operative care.
- Biceps instability (subluxation) with subscapularis pathology or pulley injuries.
- As an adjunct to rotator cuff repair when the biceps is a pain generator or degenerate. See Rotator Cuff Tear.
- Patients who wish to avoid Popeye deformity or cramping sometimes seen after tenotomy alone.
Typical Symptoms
- Front-of-shoulder pain or tenderness in the bicipital groove.
- Clicking/catching with elevation or rotation, pain with pressing or curls.
- Night pain and difficulty with overhead work or sport (throwing, swimming).
- Associated signs of subacromial bursitis/impingement or cuff weakness.
Diagnosis & Imaging
We confirm the pain source through a careful history, targeted examination, and selective imaging.
- Clinical tests: bicipital groove tenderness, Speed/Yergason, O’Brien, labral shear tests; assessment of cuff and scapular control.
- Ultrasound: dynamic assessment for tenosynovitis or subluxation; guides injections.
- MRI (± arthrogram): evaluates the superior labrum, biceps anchor, pulley, and rotator cuff.
- Diagnostic injection: intra-articular or bicipital-groove anaesthetic can help localise symptoms.
Non-Operative Care (First-Line)
Many patients improve without surgery. We tailor a plan with our physiotherapy team:
- Load modification: reduce provocative pressing/curling angles; adjust work tasks and technique.
- Exercise therapy: rotator cuff endurance, scapular control (serratus anterior/lower trapezius), posterior capsule mobility.
- Medications and targeted corticosteroid injection (biceps sheath or subacromial) when irritable.
- Return-to-throw/work progressions with criteria-based milestones.
When to consider surgery: persistent pain or mechanical symptoms despite optimal rehab and injections, or when combined pathology (e.g., cuff tear) needs operative treatment.
How Biceps Tenodesis Is Performed
Biceps tenodesis detaches the long head of biceps from its labral origin and re-fixes it to the humerus outside the joint, removing the painful intra-articular portion while preserving biceps function.
Approaches & fixation
- Arthroscopic suprapectoral tenodesis (keyhole) or mini-open subpectoral tenodesis—chosen based on anatomy, associated procedures, and surgeon preference.
- Fixation with a suture anchor, interference screw, or cortical button, providing secure attachment as the tendon heals to bone.
- Often combined with shoulder arthroscopy to treat bursitis, labral fraying, or cuff tears.
Anaesthesia & hospital stay
- Day surgery in most cases, with general anaesthesia and often a regional nerve block for comfort.
- A sling is used initially for protection and pain relief.
Tenodesis vs Tenotomy
- Tenodesis: maintains contour and strength with lower risk of Popeye deformity or cramping; slightly longer protection phase.
- Tenotomy: quicker procedure, suitable for low-demand patients; higher chance of cosmetic deformity or cramping in some.
Recovery & Timelines
Weeks 0–2
- Sling for comfort; hand, wrist, and elbow range without resistance.
- Early passive/assisted shoulder elevation within comfort; avoid active biceps loading.
- Desk work often resumes in 1–2 weeks (role dependent).
Weeks 3–6
- Progress active shoulder range; begin scapular/cuff strengthening.
- Introduce light biceps activation (no heavy flexion/supination).
Weeks 6–12
- Advance strength and endurance for cuff, scapula, and gradually the biceps.
- Functional progressions for work, gym, and sport skills as criteria allow.
Months 3–4+
- Return to heavy manual duties and overhead/throwing sport when pain-free strength and control benchmarks are met.
- We use criteria-based testing rather than fixed dates to reduce re-injury risk.
Risks & Considerations
- Infection, bleeding, clots (rare), stiffness or residual pain.
- Repair-site discomfort early; usually settles with rehab.
- Nerve irritation (rare); humeral fracture is very uncommon and mitigated by modern technique and sensible progression.
- Lower risk of Popeye deformity and cramping compared with tenotomy, but not zero.
Ready to Take the Next Step?
If biceps or superior labral pain is limiting your work, sleep, or sport, we’ll help you move forward with a precise diagnosis and plan.
Biceps Tenodesis — FAQs
Will I lose strength after biceps tenodesis?
Most patients maintain excellent elbow flexion and supination strength after healing. Early protection is essential; long-term heavy lifting and sport are typically unrestricted once criteria are met.
Is tenodesis better than SLAP repair?
It depends on age, tissue quality, and goals. We favour tenodesis in many patients over 30–35 or with degenerative lesions; SLAP repair may suit younger overhead athletes with acute tears.
Will I get a Popeye deformity?
Tenodesis reduces the risk of cosmetic bulge and cramping compared with tenotomy, but a small risk remains.
When can I go back to the gym?
Lower-body and non-provocative cardio can start early. Upper-body pressing/rows resume gradually from 6–8 weeks, with heavier curls and supination work added after strength criteria are achieved (often 10–12+ weeks).
Can biceps tenodesis be done with rotator cuff repair?
Yes. It is commonly combined when the biceps is a pain generator; rehabilitation timelines are coordinated for both procedures.