Bicep tenodesis is a surgical procedure that treats painful conditions of the long head of the biceps tendon by detaching it from the shoulder joint and relocating it further down the humerus bone. This relocation removes the source of inflammation and pain from the shoulder joint while preserving the muscle’s contour and function. The success of this operation relies completely on the patient’s strict adherence to post-operative restrictions, which are designed to protect the healing tendon-to-bone fixation site. Non-compliance, particularly during the initial phases, risks failure of the repair, known as a pull-out, which would require further intervention.
Immediate Post-Operative Restrictions
The immediate period following surgery, typically the first four to six weeks, involves the most stringent limitations to ensure the repaired tendon is not prematurely loaded. You must wear the prescribed sling or immobilizer at all times, including while sleeping, to keep the arm protected and prevent accidental movements that could compromise the fixation. The sling may only be removed for specific hygiene tasks or for performing gentle, physician-approved exercises, such as pendulum swings or controlled hand and wrist movements.
Driving is strictly prohibited, especially if the surgery was performed on your dominant arm, as you cannot safely control the steering wheel or react quickly in an emergency. This restriction remains until your surgeon clears you to discontinue the sling and regain sufficient strength, and while taking narcotic pain medication. A major restriction during this phase is the prohibition of supporting your body weight with the surgical arm, which means you cannot push yourself up from a chair or bed, or use the arm to brace yourself.
Maintaining a clean and dry incision site is important to prevent infection. While you may be allowed to shower within a few days, you cannot soak the shoulder in a bathtub, pool, or hot tub until the surgical wounds are fully healed and your surgeon gives clearance. When performing personal hygiene tasks, you must avoid reaching across your body or reaching behind your back, as these motions can place undue stress on the repair. All dressing and undressing must be done carefully, typically by dressing the surgical arm first.
Weight and Load Limitations
The concept of a “no-lift zone” is instituted immediately after surgery and is the single most important restriction to prevent tenodesis failure. For the first several weeks, you cannot lift anything heavier than a small cup of coffee, which is often quantified as zero to one pound. This restriction is necessary because the biceps muscle acts as a primary elbow flexor and forearm supinator, and any active contraction pulls directly on the fresh tendon repair site.
This initial, near-zero weight limit is maintained for up to eight weeks, depending on the surgeon’s protocol and the quality of the tendon fixation. Even if the arm feels good, you must not suddenly or heavily lift objects.
As rehabilitation progresses into the intermediate phase, typically around eight to twelve weeks, weight limits are gradually increased. The first introduction of light resistance may be limited to five to eight pounds. You must also avoid forceful pushing or pulling motions, such as opening a heavy door or starting a lawnmower, as these actions generate excessive tension across the healing tendon.
Movements to Avoid During Rehabilitation
Once past the initial immobilization phase, the focus shifts to controlled movements while strictly avoiding others that strain the repair. You must avoid any form of active elbow flexion against resistance for the first six to eight weeks, which means no biceps curls or lifting with the elbow bent. Similarly, resisted supination, the twisting motion of the forearm used for turning a doorknob or opening a jar, is prohibited during this early rehabilitation period.
Specific shoulder movements are also restricted to protect the repair and surrounding structures. You must not perform forceful or aggressive passive stretching, as this can over-tension the newly fixed tendon. Movements that combine external rotation of the shoulder with abduction, such as reaching for a seatbelt or reaching high into a cupboard, are often restricted for the first four to six weeks.
Ballistic or sudden movements, which involve quick acceleration or deceleration of the arm, are also strictly prohibited during the entire rehabilitation period. This includes throwing, swinging a golf club, or performing any activity that involves jumping or jerking the arm. Even when performing prescribed exercises, any movement that causes a sharp, sudden pain must be immediately stopped, as pain is a signal that the healing structures are being overloaded.
Timeline for Returning to Full Activity
The return to unrestricted activity is a staged process, with activities that require high force or overhead motion remaining off-limits the longest. The initiation of resistance training for the shoulder and biceps typically begins around twelve weeks post-operation, but this is done with very light weights and high repetitions to build endurance, not maximal strength. You will not be cleared to begin heavy weightlifting, such as bench pressing or overhead shoulder presses, until at least four to six months after surgery.
High-impact sports, especially those involving throwing, swimming, or contact, are generally prohibited until the four-to-six-month mark, or until a physical therapist and surgeon confirm the return of near-normal strength and range of motion. Even upon clearance, a patient should avoid attempting to lift their absolute maximum weight or performing activities with maximal effort for the first full year.