Biceps Tenotomy

Biceps tenotomy is a surgical procedure used to treat problems with the long head of the biceps tendon—one of the two tendons that connect the biceps muscle to the shoulder. In this technique, the tendon is simply released from its attachment in the shoulder joint. It is typically performed arthroscopically, meaning through small incisions using a camera and specialized instruments.

This procedure is often used in patients with chronic shoulder pain due to biceps tendinopathy, tendon tears, instability, or tenosynovitis that has not responded to non-surgical treatments such as physical therapy, anti-inflammatory medications, or steroid injections.

Why Is Biceps Tenotomy Done?

Biceps tendon pathology is a significant source of shoulder pain and dysfunction, particularly in older individuals or those with associated rotator cuff tears. When conservative treatments fail, surgery may be considered. Traditionally, biceps tenodesis (re-anchoring the tendon) was preferred, but tenotomy has emerged as a simpler alternative with strong results.

How Is the Procedure Performed?

Biceps tenotomy is usually done arthroscopically:

1. The surgeon inserts a small camera (arthroscope) into the shoulder joint through a tiny incision.
2. Special instruments are used to locate and cut the long head of the biceps tendon at its attachment in the joint.
3. The free end of the tendon is allowed to retract and scar down naturally, relieving the tension and inflammation responsible for pain.

Because there is no reattachment, healing is generally quicker than with tenodesis, and postoperative restrictions are minimal.

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Patient Outcomes: What the Research Shows

• ASES Shoulder Score (Function/Pain): Average of 81.8 out of 100
• Pain Relief: 97% required no pain meds at follow-up
• Return to Work: 96.7% returned to work within 1.9 weeks
• Return to Sports: 90% resumed their previous level of sports
• Complications: 13.3%, including cosmetic deformity and persistent pain
• Satisfaction: 91% were satisfied or very satisfied
• Willingness to Repeat Surgery: 95% would undergo tenotomy again
• Complications:
  • Biceps cramping/spasms: 20%
  • Biceps pain: 19%
  • Shoulder pain: 36%
  • Weakness: 17%
  • Cosmetic deformity (Popeye sign): 13% (only 2% were cosmetically bothered)

Tenotomy vs. Tenodesis: How Does It Compare?

Both tenotomy and tenodesis are viable options, and the choice depends on patient age, lifestyle, and cosmetic concerns.

Feature	Tenotomy	Tenodesis
Simplicity	Very simple, fast procedure	Technically more complex
Recovery Time	Shorter	Slightly longer
Hardware Used	None	Requires implants or screws
Cosmetic Issues	Higher chance of “Popeye” sign	Lower chance of cosmetic deformity
Spasms/Cramping	More common	Less common
Ideal Patient	Older, less active	Younger, active individuals

 

Risks and Complications

While most patients experience relief, potential risks include:

• Popeye Deformity: Bulging of the biceps muscle due to tendon retraction.
• Persistent Shoulder Pain
• Loss of Strength in Overhead or Repetitive Elbow Movements
• Cramping or Muscle Spasms

However, these complications are usually minor, and very few patients require revision surgery.

Who Is a Good Candidate?

Biceps tenotomy is especially appropriate for:

• Older patients with low cosmetic concerns
• Those with persistent pain unresponsive to conservative therapy
• Patients with associated rotator cuff disease
• Individuals who need a quick return to daily function

Conclusion

Biceps tenotomy offers a reliable, minimally invasive solution for patients suffering from long head of biceps tendon problems. It provides high satisfaction, excellent pain relief, and a fast return to normal activities with minimal recovery time. While tenodesis may offer better cosmetic outcomes for younger, more active individuals, tenotomy remains an excellent and widely accepted treatment option.

 

Do you have more questions?

Q. What is a biceps tenotomy?
A. A biceps tenotomy is a surgical procedure that involves cutting the long head of the biceps tendon from its attachment in the shoulder joint.

Q. When is a biceps tenotomy recommended?
A. It is typically recommended when the long head of the biceps tendon is torn, inflamed, or causing shoulder pain that has not improved with conservative treatments.

Q. What are common symptoms that may lead to a biceps tenotomy?
A. Symptoms may include persistent shoulder pain, especially in the front of the shoulder, pain with overhead activities, and a popping or catching sensation.

Q. What happens to the tendon after a biceps tenotomy?
A. After the tendon is released, it retracts down the arm and may form a bulge known as a “Popeye” muscle.

Q. What are the potential benefits of a biceps tenotomy?
A. The procedure can relieve pain, improve function, and eliminate mechanical symptoms such as catching or snapping.

Q. What are the potential risks of a biceps tenotomy?
A. Risks include muscle cramping, cosmetic deformity, weakness in elbow flexion and forearm supination, and persistent pain.

Q. What type of anesthesia is used for a biceps tenotomy?
A. The procedure is typically performed under general anesthesia, sometimes with a nerve block.

Q. How long does a biceps tenotomy procedure take?
A. The procedure usually takes less than 30 minutes.

Q. Is biceps tenotomy done alone or with other procedures?
A. It is often performed along with other shoulder procedures such as rotator cuff repair or shoulder debridement.

Q. What is the typical recovery time after a biceps tenotomy?
A. Most patients recover in a few weeks, with gradual improvement in pain and function.

Q. Will I need physical therapy after a biceps tenotomy?
A. Yes, physical therapy may be recommended to help regain range of motion and strength.

Q. Can the muscle deformity after a tenotomy be avoided?
A. A tenodesis, which involves reattaching the tendon to the bone, may be done instead to avoid cosmetic deformity in select patients.

Q. What is the difference between a biceps tenotomy and a tenodesis?
A. A tenotomy cuts and releases the tendon, while a tenodesis cuts and reattaches the tendon to the bone to preserve muscle contour and strength.

Q. Who is a good candidate for biceps tenotomy?
A. Older, less active individuals who are not concerned with cosmetic appearance or slight strength loss are typically good candidates.

Q. What is the recovery like compared to a biceps tenodesis?
A. Recovery from a tenotomy is generally quicker and easier compared to tenodesis, which has a longer healing period due to tendon reattachment.