Biceps tenodesis is a surgical technique used to treat painful issues affecting the biceps tendon near the shoulder joint. The procedure involves redirecting the tendon’s attachment point to a new, more stable location on the upper arm bone (humerus). This surgical relocation removes the damaged or inflamed section of the tendon from the shoulder joint. The goal is to relieve chronic pain and instability while restoring functional strength to the arm and shoulder.
Understanding the Biceps Tendon Problem
The biceps muscle has two heads, but the long head of the biceps (LHB) is typically the source of shoulder problems. This tendon originates from the superior portion of the shoulder socket, attaching to the labrum (the cartilage rim). It then runs through the shoulder joint before exiting a bony channel on the humerus called the bicipital groove.
Because of this path, the LHB is highly susceptible to wear and tear, making it a frequent source of anterior shoulder pain. Chronic tendinitis (inflammation and degeneration) or partial/full-thickness tears often lead to the need for surgery. These injuries typically result from repetitive overhead activities or sudden trauma.
Instability is also common, where the tendon repeatedly slips out of its groove (subluxation), often associated with rotator cuff tears. Severe injuries to the labrum, known as SLAP tears, can also involve the LHB attachment. When non-surgical treatments like rest, medication, and physical therapy fail, tenodesis is recommended.
Details of the Tenodesis Procedure
Biceps tenodesis involves surgically detaching the damaged LHB from its anchor point on the superior labrum. The surgeon prepares the remaining, healthy tendon for reattachment to the humerus bone. This new attachment site is typically located lower down the arm, either above or below the major pectoral muscle tendon (suprapectoral or subpectoral area).
The procedure can be performed using two main approaches: arthroscopic or open surgery. The arthroscopic method is minimally invasive, utilizing a small camera and instruments inserted through tiny incisions. Conversely, an open procedure requires a slightly larger incision to directly access the tendon and perform the reattachment.
The reattachment relies on specialized fixation methods to secure the tendon firmly to the bone. Common techniques include using a biocompatible interference screw, suture anchors, or cortical buttons. Fixing the tendon lower on the humerus removes the source of irritation from the shoulder joint. This preserves arm function and prevents the cosmetic deformity known as the “Popeye” sign.
What to Expect During Recovery
Recovery following a biceps tenodesis emphasizes protection of the repair and gradual restoration of movement. Immediately after the operation, the arm is immobilized in a sling, often for four to six weeks, allowing the tendon to heal to the bone. Pain management, including medication and cold therapy, controls discomfort and swelling during this initial period.
The first phase of physical therapy typically begins within one to two weeks, focusing on passive range of motion. During this phase, a therapist moves the arm without the patient activating the biceps muscle. This is essential to prevent stiffness while protecting the repair site. Active motion, where the patient moves the arm independently, usually starts around six weeks post-surgery.
Strengthening exercises are introduced only after the tendon has demonstrated sufficient healing, generally beginning around eight to twelve weeks. Patients must avoid active elbow flexion and forearm supination, which stress the biceps, for the first six weeks. A full return to strenuous activity, including heavy lifting or sports, is typically permitted between four to six months, based on the surgeon’s clearance and adherence to rehabilitation.