Biceps Tenodesis

Biceps tenodesis is a surgical procedure performed to treat issues involving the long head of the biceps (LHB) tendon, a common source of shoulder pain and dysfunction.

Understanding the Long Head of the Biceps

The biceps brachii is a two-headed muscle that spans the shoulder and elbow. The long head of the biceps tendon originates at the top of the shoulder socket (glenoid) and travels through the shoulder joint, passing into a groove in the upper arm bone (humerus). This tendon is involved in shoulder stabilization and helps with forearm supination and elbow flexion.

Over time or due to injury, this tendon can become inflamed, partially torn, unstable, or degenerated—leading to significant discomfort, especially with overhead activity.

What Is Biceps Tenodesis?

Biceps tenodesis is the surgical removal of the long head of the biceps tendon from its original position at the shoulder joint and its reattachment to a different location on the upper arm. This reattachment eliminates the diseased portion of the tendon from the joint space, helping alleviate pain while maintaining muscle function and appearance.

Common Indications for Surgery

Biceps tenodesis is not performed for every case of shoulder pain. According to a large systematic review, the most common clinical scenarios for considering this surgery include:

• Partial tearing of the long head of the biceps tendon (reported in 51% of reviewed studies)
• Instability or subluxation of the tendon (49%)
• Tenosynovitis—inflammation of the tendon sheath (44%)
• SLAP tears (superior labrum anterior to posterior lesions) (28%)
• Unrelenting shoulder pain without improvement from conservative treatment
• Positive findings on clinical examination specifically localizing pain to the biceps tendon (26%)
• Cosmetic concerns (such as the “Popeye” deformity)
• Younger patients who are active or involved in sports

Despite these common patterns, it’s important to note that the medical literature often lacks consistency in how these indications are described. Many studies do not specify how tendon tears were diagnosed or whether conservative therapy was tried and failed before surgery.

Surgical Techniques

There are two primary variables in performing a biceps tenodesis: where the tendon is reattached and how it is fixed to the bone.

Fixation Techniques

1. Interference Screw – The tendon is anchored into a bone tunnel using a screw. This is the most widely used and provides high stiffness.
2. Suture Anchor – The tendon is sewn into the bone using strong stitches and anchor systems.
3. Cortical Button – A small button placed behind the bone holds the tendon in place.
4. Soft Tissue Techniques – The tendon is sewn into surrounding muscles or soft tissue, avoiding hardware entirely.

Fixation Locations

• Suprapectoral (proximal) – Just below the shoulder joint, but above the chest muscle.
• Subpectoral (distal) – Lower on the arm, beneath the pectoralis major muscle.

Both locations have shown excellent biomechanical integrity in lab studies, and there is no significant difference in fixation strength or durability between them.

Biomechanical Evidence: What the Studies Say

A major meta-analysis compared the strength and durability of various fixation techniques and locations. Here’s what was found:

• Fixation Type: Interference screw fixation showed slightly higher construct stiffness than other techniques, which may reduce tendon movement after surgery. However, load to failure and cyclic displacement (measures of strength and durability) were equivalent across all techniques.
• Fixation Location: Whether the tendon was fixed in a suprapectoral or subpectoral location made no significant difference in biomechanical strength, stiffness, or displacement. This suggests that surgeon preference and patient-specific factors should guide the choice of location.

Benefits of Biceps Tenodesis

• Relieves shoulder pain caused by tendon inflammation, tearing, or instability
• Preserves normal biceps appearance (avoiding the “Popeye” deformity)
• Maintains arm strength, especially in elbow flexion and forearm rotation
• Suitable for active patients and athletes

What to Expect After Surgery

Recovery Timeline

• 0–6 weeks: Immobilization in a sling; passive motion only.
• 6–12 weeks: Begin active range of motion; light strengthening.
• 3–6 months: Gradual return to sports or labor-intensive activities.

Rehabilitation

Physical therapy is critical to success. The rehab process focuses on regaining motion, building strength, and protecting the surgical repair as it heals.

Risks and Considerations

As with any surgery, there are potential risks:

• Infection
• Nerve injury (rare)
• Re-tear or failure of the tenodesis
• Residual pain or stiffness
• Cosmetic deformity if tendon is not securely fixed

Final Thoughts

Biceps tenodesis is a well-established and reliable solution for patients with biceps-related shoulder pain. With numerous studies supporting its effectiveness and flexibility in surgical technique, this procedure offers lasting relief and functional restoration.

 

Do you have more questions?

Q. What is a biceps tenodesis?
A. Biceps tenodesis is a surgical procedure that involves detaching the long head of the biceps tendon from its original attachment and reattaching it to the humerus bone.

Q. Why is biceps tenodesis performed?
A. It is performed to relieve pain caused by biceps tendonitis, partial tears, or instability of the tendon.

Q. What symptoms may indicate the need for a biceps tenodesis?
A. Symptoms include pain in the front of the shoulder, weakness, and a popping or snapping sensation.

Q. How is the diagnosis of biceps tendon problems made?
A. Diagnosis is made through physical examination, patient history, and imaging studies such as MRI.

Q. What nonsurgical treatments are considered before surgery?
A. Nonsurgical treatments include rest, physical therapy, anti-inflammatory medications, and corticosteroid injections.

Q. When is surgery recommended for biceps tendon issues?
A. Surgery is recommended when conservative treatments fail to relieve symptoms or when there is a significant tear or instability.

Q. What is involved in the biceps tenodesis procedure?
A. The procedure involves detaching the biceps tendon from the shoulder and reattaching it to the upper part of the humerus using anchors or screws.

Q. Is biceps tenodesis done arthroscopically or through open surgery?
A. It can be performed arthroscopically, through a small incision, or as an open procedure depending on the specific case.

Q. How long does a biceps tenodesis surgery take?
A. The procedure typically takes about one hour.

Q. What is the recovery time after biceps tenodesis?
A. Recovery can take several months, with physical therapy starting soon after surgery to restore motion and strength.

Q. Will I need to wear a sling after biceps tenodesis?
A. Yes, patients are usually required to wear a sling for a few weeks to protect the repair.

Q. When can I return to regular activities after biceps tenodesis?
A. Return to normal activities can take several months, with heavy lifting or strenuous activities often restricted for three to six months.

Q. What are the potential risks of biceps tenodesis?
A. Risks include infection, stiffness, nerve injury, failure of the tendon to heal, and persistent pain.

Q. How successful is biceps tenodesis surgery?
A. The surgery is generally successful in relieving pain and restoring function in the shoulder.