The long head of the biceps tendon travels through the shoulder joint to attach to the glenoid, or socket. This tendon is susceptible to chronic inflammation, fraying, or tearing due to repetitive motion or injury, resulting in persistent pain and weakness in the front of the shoulder. When non-surgical treatments fail to resolve symptoms, biceps tenodesis becomes necessary. This surgery aims to alleviate pain and restore proper arm function by addressing the damaged tendon.
Understanding Bicep Tenodesis
Biceps tenodesis is a surgical technique designed to eliminate shoulder pain caused by pathology in the long head of the biceps tendon. The procedure involves detaching the tendon from its painful attachment point inside the shoulder joint at the superior labrum. The surgeon then re-anchors the detached tendon to a new, stable location lower down on the humerus, which is the upper arm bone. This re-routing removes the damaged tendon from the high-friction environment of the shoulder joint while maintaining the length and function of the biceps muscle.
The procedure prevents the cosmetic deformity known as a “Popeye muscle” bulge that can occur with a complete tendon tear or an alternative procedure called tenotomy. Tenotomy involves simply cutting the tendon and allowing it to retract into the arm without reattachment. Tenodesis is generally preferred for younger, more active patients who wish to preserve maximum biceps strength and maintain the muscle’s normal contour. The decision between the two procedures depends on a patient’s age, activity level, and the surgeon’s findings during the procedure.
The Surgical Timeline: Duration and Variables
The actual operating time for a bicep tenodesis procedure typically falls between 45 minutes and one and a half hours. The total time a patient spends in the operating room suite is longer, as it includes the induction of anesthesia, proper positioning, and the application of sterile surgical drapes. The duration of the operation can vary significantly based on the complexity of the patient’s injury.
An isolated bicep tenodesis performed on its own is generally quicker than a procedure combined with other necessary repairs. These combined procedures might include a full rotator cuff repair or a labral tear fixation. The specific surgical approach also influences the timeline, with arthroscopic, or minimally invasive, techniques sometimes being quicker than open procedures. The type of anesthesia used, whether general or a regional nerve block, also contributes to the overall time spent under medical care.
The Procedure: Steps and Techniques
Bicep tenodesis can be performed through two primary methods: an open approach, which uses a small incision, or an arthroscopic technique, which is minimally invasive. Regardless of the approach, the fundamental mechanical steps remain consistent to achieve a secure tendon reattachment. The first step involves the surgeon identifying and detaching the damaged long head of the biceps tendon from its superior attachment on the labrum, inside the shoulder joint.
Once the painful segment is released, the end of the healthy tendon is prepared and secured with strong sutures. The surgeon then prepares a new attachment site by creating a small tunnel or socket in the humerus, typically in the bicipital groove. The detached tendon is then anchored into this prepared bone bed using specialized fixation devices. These devices may include bio-absorbable screws, suture anchors, or a combination of both. This secure fixation allows the tendon to heal directly to the bone in its new location, stabilizing the muscle and relieving the pain that originated in the shoulder joint.
In the arthroscopic method, the surgeon uses a tiny camera and instruments inserted through small incisions to perform the internal work. The open technique may involve a small incision lower on the arm to pull the tendon out and perform the fixation directly.
Post-Operative Expectations and Recovery Milestones
Recovery from bicep tenodesis is a structured, multi-phase process that prioritizes protecting the healing tendon-to-bone attachment. Immediately following the procedure, the arm is immobilized in a sling, which is worn continuously for approximately four to six weeks. This ensures the repair is not stressed, and the patient focuses on pain management during this initial phase.
Physical therapy typically begins within the first week or two, starting with gentle, passive range of motion exercises. During this phase, the therapist moves the arm without the patient activating the biceps muscle. The progression to active range of motion, where the patient begins to move the arm independently, usually starts around four to six weeks post-surgery. This transition marks the point where initial tendon-to-bone healing is sufficiently progressed to allow controlled motion.
The next phase introduces light resistance and strengthening exercises, generally beginning between eight and twelve weeks after the operation. This period is focused on rebuilding strength and muscular endurance in the shoulder and arm. Full functional recovery, including a return to sports or heavy manual labor, requires a dedicated rehabilitation program and often takes a total of four to six months. Continued minor improvements are possible for up to a year.