Biceps tenodesis is a surgery to repair the biceps tendon. This procedure can help if pain or an injury affects the biceps tendon in and around the shoulder.

In biceps tenodesis, a surgeon removes a damaged section of the biceps and reattaches the rest of the tendon to the bone of the upper arm. By removing the part that causes pain, this procedure can help restore function and relieve symptoms.

In this article, learn more about biceps tenodesis and its possible risks and complications.

Person with an injury who may need biceps tendonesis.Share on Pinterest
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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
  • damage to the rotator cuff

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 known as superior labrum anterior and posterior (SLAP) tears and involve the cartilage around the shoulder joint. They can also involve the biceps tendon. Overuse, powerful pulling on the arm, falling on an outstretched arm, and other accidents can all cause SLAP tears.

There are different ways of carrying out biceps tenodesis. After removing the damaged part of the tendon, a surgeon may attach the remaining tendon to 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. In this approach, the surgeon attaches the tendon to a button that slides into a hole at the top of the arm bone.

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 3–10 days. If the surgeon uses hardware techniques, a person will need to avoid biceps tension for 4–6 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 20 weeks.

In the later phases of recovery, the therapist may tailor treatment to help a person return to their individual sport.

In the first 4 weeks, the person will start to do cardiovascular exercise, such as walking or riding a stationary bike. Swimming, weight lifting, and throwing sports are the last activities to be reintroduced.

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
  • 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 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:

Biceps tenodesis has a high success rate, and most people report less pain, better use of their shoulders, and a return to sports and activities after surgery.

A 2017 study found that 91% of people who underwent biceps tenotomy were either satisfied or very satisfied with the result, and 95% said they would have the surgery again. Results are reportedly similar for biceps tenodesis, according to a study that compared the two procedures in people ages 55 years and younger.

Experts say biceps tenodesis is most likely to be effective if surgery happens within 3 months of the initial injury. However, some people report a positive outcome even if they wait longer than 3 months.

Complications after biceps tenodesis are uncommon. A 2020 review found that around 13.5% of people experienced complications after surgery.

These included:

  • ongoing pain
  • a need for further surgery
  • wound complications
  • nerve injury
  • Popeye deformity, which changes the appearance of the arm

Popeye deformity is named after the muscled cartoon character. A tendon that is injured, torn, or otherwise unattached from the shoulder joint can bunch up, creating a bulge along the arm that looks similar to one of Popeye’s muscles.

Before recommending surgery, a doctor will usually recommend treating biceps pain with conservative methods, such as:

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 cuts and releases the tendon as close as possible to the shoulder joint.

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 pain after surgery, but strength and endurance appear similar after both procedures.

Younger people, athletes, laborers, and those concerned with how their arm will appear after surgery are more likely to choose biceps tenodesis over a tenotomy.

Another option for biceps repair is SLAP repair. This is a less invasive option. It may be suitable for people with an injury called superior labral anterior-posterior (SLAP) tears. This injury affects the cartilage around the socket of the shoulder joint.

A 2019 review found that both SLAP repair and biceps tenodesis can help relieve pain and recover shoulder function. However, people who underwent tenodesis were more likely to say they were satisfied with the result and return to their original sport participation.

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 they need, if any.