Why Is a Biceps Tenodesis Procedure Performed?

Tears in your biceps can occur in several ways. Some people develop biceps tears suddenly, while others experience gradual wear from repetitive shoulder movement.

The most common type of biceps tear occurs when the tendon loosens from the shoulder joint. The biceps tendon attachment can separate from the front or within the shoulder joint. Biceps tenodesis is performed to treat these injuries by reattaching the tendon to a new location on the arm bone. After the tendon is moved, it no longer connects to the shoulder joint, which helps relieve pain.

Common symptoms of biceps tears include:

• Sharp upper arm pain, sometimes with a popping or snapping sound

• Cramping after or during heavy use

• Pain, tenderness, or weakness at the elbow and shoulder

• Difficulty moving and rotating the arm

• A bulge in the upper arm, sometimes called a “Popeye” muscle

In some cases, severe tears or complications may require surgery to properly restore function or relieve persistent symptoms.

Biceps tenodesis can treat many conditions related to the biceps tendon, including biceps tendon rupture, biceps tendinitis, and SLAP tears. The procedure is often performed as part of a more extensive shoulder surgery, such as a rotator cuff repair.

Understanding Biceps Tenodesis vs. Biceps Tenotomy

When treating injuries of the biceps tendon—especially those involving the long head (LHB) tendon—two main surgical options are available: biceps tenodesis and biceps tenotomy. The key difference lies in how the damaged tendon is managed.

In biceps tenodesis, the surgeon detaches the injured tendon from its original attachment and reattaches it to the upper arm bone (humerus). This helps maintain the normal contour and strength of the biceps muscle, making it a preferred choice for younger or more active individuals who want to preserve function and avoid cosmetic changes.

Biceps tenotomy involves cutting the long head of the biceps tendon and allowing it to retract. While less complex and providing quick pain relief, it may result in a noticeable bulge in the upper arm—often called a “Popeye” deformity—due to the muscle bunching up. Tenotomy is often chosen for older or less active patients, or when a simpler approach is appropriate.

Both procedures aim to reduce pain and restore function, but the decision depends on age, activity level, cosmetic concerns, and the specific nature of the injury. Your surgeon will help determine which option is best for your needs.

How To Prepare for a Biceps Tenodesis Surgery

Before surgery, you may need to make some lifestyle adjustments. Tell your physician about all medications you are taking and any long-term medical conditions, such as diabetes.

In the days leading up to surgery, stop taking anti-inflammatory medications like Aleve or Advil. Do not eat or drink for at least eight hours before surgery. Wear loose, comfortable clothing.

Plan to have someone drive you home after surgery and assist you for at least 24 hours. Your doctor will give you specific preoperative instructions. Book an appointment now to learn more about biceps tenodesis.

Diagnostic Arthroscopy: Assessing the Shoulder Before Surgery

Before performing a biceps tenodesis or tenotomy, your surgeon may recommend a diagnostic arthroscopy to evaluate the shoulder joint. This minimally invasive procedure uses a small camera, called an arthroscope, inserted through tiny incisions. The arthroscope provides a clear view of the biceps tendon, rotator cuff, labrum, and other important structures.

This allows the surgeon to assess the extent of tendon damage and identify additional injuries, such as rotator cuff or labral tears, that may also need treatment. Diagnostic arthroscopy is typically performed under general anesthesia or a regional nerve block. The detailed view helps the surgeon plan the most effective approach, ensuring the best outcome for your surgery.

What Happens During Biceps Tenodesis Surgery?

Biceps tenodesis can be performed in several ways, ranging from soft tissue to hardware fixation techniques, and from minimally invasive to open surgery. Your doctor will determine the best approach for your condition.

For a right shoulder procedure, the surgeon typically makes an incision near the affected shoulder, identifying the pectoralis major tendon as a landmark. The biceps tendon is detached from the labrum and reattached to the arm bone using an interference screw or suture anchor. This secure fixation provides stability while allowing the tendon to heal in its new position.

Subpectoral biceps tenodesis is an alternative technique. Humeral fracture is a rare but possible complication.

Arthroscopic Biceps Tenodesis: A Minimally Invasive Approach

Arthroscopic biceps tenodesis uses an arthroscope and specialized tools to perform the procedure through small incisions around the shoulder. The tendon is detached and reattached to the humerus with an interference screw or suture anchor. This approach minimizes scarring and post-operative pain while promoting faster recovery. Most patients go home the same day.

Fixation Methods: The Interference Screw Technique

The interference screw technique is one of the most reliable ways to secure the tendon during surgery. The surgeon drills a small hole in the humerus, places the tendon inside, and inserts a screw to press it firmly against the bone. This strong fixation supports early rehabilitation and reduces the risk of displacement.

While suture anchors are sometimes used, interference screws are often preferred for their simplicity and effectiveness in restoring shoulder function.

Are There Risks Associated with Biceps Tenodesis Surgery?

All surgeries carry some risk. Potential complications include infection, healing problems, nerve damage, discomfort, and stiffness. Biceps tenodesis is generally safe and effective, with a high success rate.

Possible complications include:

• Nerve injury around the shoulder

• Stiffness or frozen shoulder

• Chondrolysis (cartilage damage)

• Humeral fracture (rare)

• Stroke, heart attack, or anesthesia reaction

Your doctor will discuss these risks before your procedure.

Clinical Outcomes: What the Research Shows

Research shows that both biceps tenodesis and tenotomy provide significant pain relief and improved shoulder function. Tenodesis helps maintain muscle strength and avoids cosmetic changes sometimes seen with tenotomy.

Complications such as nerve injury, humeral fracture, or residual pain are rare but possible. Recovery, including physical therapy, is essential for optimal results. Most patients regain strength and mobility and can return to their usual activities.

Post Biceps Tenodesis Surgery and Recovery

Plan to recover for at least four to six weeks. During this period, you will wear a sling and avoid heavy lifting or strenuous activity. Most patients begin physical therapy around six weeks after surgery to restore range of motion. Light exercise, such as walking or using a stationary bike, can aid recovery.

If you had an isolated subpectoral tenodesis, your rehabilitation plan may include guidelines for sling use, movement limits, and timelines for returning to overhead activities.

After approximately 20 weeks, you may return to normal activities, depending on your progress. Recovery time varies based on the injury’s severity, your health, and your adherence to post-operative care.

Schedule an appointment with a Resurgens Orthopaedics shoulder specialist today to learn more about shoulder treatment options and start your recovery journey.