The biceps muscle in the upper arm has two heads, the short head and the long head (LHB), each connecting to the shoulder by a tendon. The LHB tendon travels through the shoulder joint and attaches to the top of the shoulder socket (glenoid), where it acts as a secondary stabilizer. Damage, inflammation, or instability of this tendon is often the source of chronic pain felt in the front of the shoulder.
A biceps tenodesis is an orthopedic surgical procedure designed to treat this pain by rerouting and securing the problematic LHB tendon. The procedure involves detaching the tendon from its anchor point inside the shoulder joint and reattaching it to a new, stable location lower down on the humerus (upper arm bone). This relocation removes the source of pain while preserving the function of the biceps muscle.
The Rationale for Biceps Tenodesis
The underlying goal of a biceps tenodesis is to eliminate pain caused by an irritated, unstable, or damaged long head of the biceps tendon. This pain can result from chronic inflammation (tendinopathy) or mechanical issues like fraying and subluxation. The procedure is indicated when non-surgical treatments, such as rest, anti-inflammatory medications, and physical therapy, fail to provide lasting relief.
Common indications for this surgery include partial or full-thickness tears of the LHB tendon that have not ruptured completely. Instability, where the tendon repeatedly slips out of its groove in the humerus (bicipital groove), is another frequent reason for intervention. The tendon’s location inside the joint means its pathology is often associated with other shoulder injuries, particularly tears of the rotator cuff.
The surgery is also frequently performed alongside repairs for a superior labrum anterior-posterior (SLAP) lesion, which is a tear in the cartilage where the LHB tendon anchors. By detaching and re-anchoring the tendon outside the joint, the tenodesis removes the damaged structure from the shoulder joint’s high-stress environment. Fixation to the humerus helps maintain the muscle’s normal length-tension relationship, preserving elbow flexion and forearm rotation strength.
How the Procedure is Performed
The biceps tenodesis procedure begins with the surgeon detaching the long head of the biceps tendon from its original attachment site on the superior labrum within the shoulder joint. The entire process is most often performed using a minimally invasive arthroscopic technique, though open surgery may be used if other, more extensive repairs are needed.
Once the tendon is released, the surgeon prepares a new site for its reattachment, typically on the humerus bone just below the shoulder joint. This new anchor point is often outside the main shoulder capsule. The end of the detached tendon is then secured into this prepared bone bed, which provides a solid surface for healing and integration.
Various fixation methods are used to secure the tendon to the humerus bone, ensuring a strong, stable repair. These methods include hardware like interference screws or cortical button fixation systems. Strong sutures are also used to anchor the tendon directly to the surrounding soft tissue or to the bone. The choice of technique depends on the surgeon’s preference, the patient’s anatomy, and whether the procedure is performed arthroscopically or through a small open incision.
Post-Surgical Recovery and Rehabilitation
Recovery from a biceps tenodesis is a structured, multi-phase process that requires protecting the reattached tendon to allow for biological healing. Immediately following the surgery, the arm is typically immobilized in a sling for the first two to four weeks to prevent premature strain on the repair site. Pain management during this phase involves prescribed medications and ice.
The first phase of physical therapy focuses on gentle, passive range of motion, where the therapist moves the patient’s arm without the patient using their biceps muscle. This phase typically lasts through the first month and is crucial for preventing stiffness while the tendon heals. The patient is strictly instructed to avoid lifting, pushing, or pulling, as active contraction of the biceps could compromise the surgical fixation.
Around four to six weeks post-surgery, rehabilitation progresses to the active range of motion phase, allowing the patient to begin moving their arm under their own muscle control. Strengthening exercises are introduced gradually, often starting around eight to twelve weeks. These focus on low-resistance movements before progressing to heavier weights. The goal is to systematically rebuild the strength and endurance of the biceps and the surrounding shoulder musculature.
Full recovery, including a return to unrestricted activities and sports, generally takes between four and six months, though high-demand athletes may require up to nine months. The overall prognosis is positive, with the procedure being successful in relieving anterior shoulder pain and restoring functional strength once the rehabilitation protocol is completed. Consistent adherence to the structured physical therapy plan is crucial for a successful long-term outcome.