Biceps tenodesis is a surgery to repair the biceps tendon. This procedure can help alleviate pain or address an injury affecting the biceps tendon in and around the shoulder.
Biceps tenodesis involves detaching the long head of the biceps tendon from its attachment to the labrum and reattaching it to the humerus or upper arm bone. By removing the part that causes pain, this procedure can help restore function and relieve symptoms.
Biceps tenodesis is an option for treating shoulder pain that results from inflammation or tissue damage.
People who might benefit from this type of surgery include those with:
- wear and tear to the tendon, for example, from aging
- overuse or injury due to high impact or contact sports and activities that involve repetitive motions
- torn tissues in the biceps tendon
Pain from the biceps tendon usually affects the front of the shoulder and the top of the humerus bone, which runs from the shoulder to the elbow.
The pain may radiate to other parts of the arm and back. There may also be cramping, tingling, swelling, and difficulty moving the shoulders or arm.
Pain can also stem from the top edge of the shoulder, where the upper arm bone fits into the joint. These injuries are superior labrum anterior and posterior (SLAP) tears and
There are various methods for performing biceps tenodesis. A surgeon may attach the tendon to the surrounding soft tissues. They may also secure it to the shoulder socket using sutures, a screw, or a surgical implant known as a cortical button.
The two main soft tissue techniques are:
- Open keyhole procedure: Surgeons create an opening or keyhole in the humerus. Using tiny instruments, they stitch a rolled-up end of the biceps into place.
- Percutaneous intra-articular transtendon (PITT) technique: Surgeons use two needles to develop an interlocking pattern of sutures and then tie the tendon to a shoulder ligament.
In hardware fixation techniques, the surgeon first detaches the biceps tendon and then reattaches it to the bone.
There are two main hardware fixation techniques:
- Screw fixation technique: A surgeon creates a hole at the top of the arm bone, places one end of the cut tendon into it, and secures the tendon by screwing it to the bone.
- Endobutton technique: An endobutton is a type of cortical button used in orthopedic surgery. In this approach, the surgeon attaches the tendon to a button that slides into a hole at the top of the arm bone.
Biceps tenodesis has a high success rate, and most people report reduced pain, improved shoulder function, and a return to sports and activities after surgery.
A 2023 study found that 88 to 100% of people who underwent biceps tenodesis experience satisfaction with the result.
An additional study found that 90% of patients return to typical activities after surgery.
Recovery from biceps tenodesis takes place in stages.
How long does recovery take?
Depending on the type of surgery a person has, they may need to use a sling and avoid using the joint for some time.
In the case of soft tissue surgery, the person will need to keep the joint immobilized and rested for up to 10 days. If the surgeon uses hardware techniques, a person will need to avoid biceps tension for four to six weeks.
Rehabilitation and physical therapy will begin 7–10 days after surgery and continue for several weeks. In these sessions, the person will gradually learn to:
- protect the shoulder
- activate the relevant muscles
- increase their range of motion
A trained physical therapist will guide the person on returning to full movement and activity. Full rehabilitation may take up to four to six months.
In the later phases of recovery, the therapist may tailor treatment to help a person return to their individual sport.
In the first four weeks, the person will begin to engage in cardiovascular exercise, such as walking or riding a stationary bike. Swimming, weightlifting, and throwing sports are the last activities a person can engage in again.
The exact recovery time will depend on:
- the severity of the original injury
- the presence of other injuries
- a person’s age
- a person’s health status before the injury
- whether they follow a rehabilitation program
A physical therapist will guide the exercises a person should do while recovering from this surgery. Here are some examples of activities they may suggest. However, a person should follow their physical therapist’s instructions, as doing certain exercises too soon or without guidance could result in injury.
In the days after surgery, a physical therapist may recommend:
- hand-squeezing exercises that strengthen the biceps and rotator cuff
- moving the elbow and wrist with the arm in a neutral position by the side
- shoulder shrugs
- supported pendulum exercises
Next, a person may work with a physical therapist on the following exercises:
- full pendulum exercises
- exercises for the elbow and wrist, such as wall walks and using pulleys
- finger isometrics, such as slowly forming a fist and then slowly uncurling the fingers
- using a stationary bicycle while wearing a sling for support
In time, the physical therapist may add new exercises to the existing ones, such as:
- rotator cuff strengthening exercises using a resistance band
- resistive wrist and elbow exercises using a light dumbbell
- wall pushups
- using an elliptical trainer
- walking or running in a pool
As recovery progresses, a person will continue the previous exercises with increased resistance, but they may also try:
- doing activities to gradually increase the range of motion
- progressing from wall pushups to table pushups
- tossing a light ball with the arm at their side
- using a seated rowing machine with light weights
- using a treadmill
- doing resistance exercises in a pool
Next, the physical therapist may recommend:
- tossing a ball overhead
- doing weight training with light weights
- progressing from table to chair pushups
As a person progresses toward full recovery, a physical therapist may suggest they try:
- doing regular pushups
- doing situps
- swimming
- running on a track
- working with progressively heavier weights
- transitioning to a program for home or gym use
The following slideshow illustrates some of the exercises listed above:
IE CE 10/25/2025: Again cannot find any sources (after 2022 only) that confirm any of these exercises. Any help here MR? Thanks!
Complications after biceps tenodesis are uncommon, but may include:
- cramping
- pain
- re-rupture
- inflammation
- deformity
A 2023 study found that despite high success rates, complication rates can be as high as 48%.
Some people may experience “Popyeye deformity”. The Popeye deformity label stems from the muscled cartoon character. An injured, torn, or otherwise detached tendon from the shoulder joint can bunch up, creating a bulge along the arm that resembles one of Popeye’s muscles.
Before recommending surgery, a doctor will usually recommend treating biceps pain with conservative methods, such as:
- resting the joint
- applying ice packs, wrapped in a towel to prevent skin damage
- undergoing physical therapy
- using nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, to manage pain
- receiving steroid injections to reduce inflammation, in some cases
If these treatments do not relieve pain and restore freedom of movement, a person may need surgery.
If a person needs surgery, their doctor will explain the options. They may need to choose between biceps tenodesis and a procedure called a tenotomy. In a tenotomy, a surgeon
Tenotomy is a more straightforward procedure with a shorter recovery time, but it may increase the risk of cramping and developing Popeye deformity, a change in the appearance of the arm.
People who undergo biceps tenodesis may have a higher risk of post-surgical pain, but their strength and endurance appear to be similar after both procedures.
Younger individuals, athletes, laborers, and those concerned about the appearance of their arms after surgery are more likely to choose biceps tenodesis over a tenotomy.
Biceps tenodesis is a minor surgery, and many patients can go home the same day.
A person should avoiding lifting objects with their arm for four to six weeks.
One recent study shows that patient satisfaction with the result of the surgery is 88 to 100%.
Biceps tenodesis is a procedure that can help reduce pain and restore shoulder function and range of motion in those with a biceps injury. Athletes and others who are active in sports can benefit from this surgery.
Various surgical options are available for people with shoulder injuries. A doctor can help the individual decide which treatment, if any, they need.