Biceps tenodesis is a surgical procedure that addresses issues with the biceps tendon at the shoulder. It involves detaching the tendon from its original attachment and securing it to a new location on the upper arm bone (humerus). The goal is to alleviate pain and restore function by stabilizing the biceps muscle’s connection. This procedure is often recommended when non-surgical treatments have not provided sufficient relief.
Understanding Biceps Tendon Issues
The biceps muscle, located in the front of the upper arm, has two tendons that attach it to bones in the shoulder and one at the elbow. The long head of the biceps tendon, connecting to the top of the shoulder socket (labrum), is often involved in injuries causing shoulder pain. This tendon courses through a groove in the humerus and is susceptible to irritation and damage.
Common problems include biceps tendonitis, which is inflammation of this tendon, often from overuse or wear. Repetitive overhead motions, common in certain sports or occupations, can contribute to its development. As tendonitis progresses, the tendon can become frayed, swollen, and thickened.
Tears, either partial or complete, can also occur in the long head of the biceps tendon, often with sudden, sharp pain and sometimes an audible pop or snap. A complete tear may lead to a visible bulge in the upper arm, sometimes called a “Popeye muscle,” due to the muscle retracting. These issues can cause pain, tenderness, weakness, and difficulty with arm movement.
The Bicep Tenodesis Procedure
The procedure detaches the long head of the biceps tendon from its original attachment in the shoulder joint. The surgeon then reattaches it to a new, stable location on the humerus, typically just below the shoulder joint. This relocation removes the damaged portion of the tendon from the shoulder joint, reducing pain and restoring function.
Various techniques are used for reattachment, often involving sutures, screws, or other anchoring devices to secure the tendon firmly to the bone. The procedure can be performed using either an an open or an arthroscopic approach. An arthroscopic procedure is minimally invasive, utilizing small incisions, a camera (arthroscope), and miniature instruments.
Alternatively, an open procedure involves a larger incision to directly access the tendon for detachment and reattachment. Both methods stabilize the biceps tendon. The choice of technique depends on the specific condition of the tendon and the surgeon’s preference.
What to Expect During Recovery
Following a bicep tenodesis procedure, patients experience an initial recovery phase focused on protection and pain management. A pain block may be administered to keep the shoulder numb for several hours, and oral pain medication will be prescribed. The arm is usually immobilized in a sling for four to six weeks to protect the healing tendon and limit movement.
Physical therapy usually begins within one to two weeks post-surgery, initially focusing on gentle, passive range of motion exercises to prevent stiffness. During this early period, active elbow flexion and supination are avoided to minimize stress on healing tissues. As healing progresses, typically around four to eight weeks, patients gradually advance to active range of motion exercises and light strengthening under a physical therapist’s guidance.
The rehabilitation program is important for regaining full strength, flexibility, and function of the shoulder and arm. More advanced strengthening exercises are introduced around 10 to 12 weeks, with a gradual return to normal activities. Complete recovery typically takes four to six months, though it can extend up to a year, depending on individual healing rates and the extent of the initial injury.