What to Know About Biceps Tenodesis

Medically Reviewed by Tyler Wheeler, MD on February 27, 2024
3 min read

Biceps tenodesis is a treatment for chronic long head of the bicep tendon pain due to a variety of causes. This type of surgical repair can either be a stand-alone procedure or part of a larger shoulder surgery.

There are two primary joints in the shoulder: the glenohumeral joint and the acromioclavicular joint. 

Within and around the joints is a group of muscles known as the rotator cuff tendons. A tendon attaches muscle to bone. The long head of the biceps, which is a stabilizer of the shoulder joint, is found within these muscles.

The most common type of biceps injury happens at the long head of the biceps tendon. Lesions at the long head of the bicep tendons may lead to fractures of the humerus bone. 

These tendons can easily become unstable and torn, causing pain in the shoulder. A biceps tenodesis can help repair the tendon.

Middle-aged people experience a higher rate of tendonitis and rotator cuff injuries, which often lead to a rupture of the biceps tendon. However, rotator cuff injuries are common in younger people as well, especially athletes.  

Risk factors for a bicep tendon rupture include:

  • Overuse of the shoulder muscles/joint
  • Age and gradual arthritic changes
  • Smoking and use of nicotine products
  • Corticosteroids, which can delay healing and cover up symptoms

Biceps tenodesis is used for both partial and full tendon tears, an unstable joint, or pain caused by overuse of the biceps. A biceps tenodesis is more complicated than a tenotomy procedure, which uses needles to break up scar tissue.

Bicep tendon tears may come with the following symptoms:

  • Cramps in the bicep after repetitive use
  • Pain in the affected shoulder and elbow
  • Quick, sharp pain in the arm, with or without a popping sound
  • Difficulty rotating the arm
  • Bruising in the bicep area

One specific symptom is known as the “Popeye muscle,” because it involves a prominent bulging in the upper arm area.

Your doctor may suggest other methods to treat the bicep tendon injury, including:

  • Icing the area
  • Massage
  • Using non-steroidal anti-inflammatory drugs (NSAIDs), like ibuprofen and acetaminophen
  • Steroid injections
  • Physical therapy

If these methods fail to show improvements, your doctor may recommend you get biceps tenodesis surgery.

Biceps tenodesis surgery is divided into two categories: soft tissue procedures and bone procedures with hardware fixation. Both forms are performed under general anesthesia, and the procedure involves cutting the biceps tendon off its attachment to the superior labrum and then anchoring it to the humerus. 

Soft tissue procedures. With an open-hole procedure, the surgeon moves the biceps tendon. The end of the tendon is rolled into a ball, then stitched together. A keyhole is made in the humerus bone, then the stitched end is placed in the keyhole and “locked” into place.

Meanwhile, the Pitt technique uses two needles to punch through the bicep tendon in opposing directions. Stitching is then threaded through the needles and repeated to create a locking pattern. A knot is used to lock the stitching to the transverse shoulder ligament. 

Hardwire fixation. This technique uses a screw to attach the removed tendon from its place of origin to a hole in the area of the bone.  A screen is placed over the tendon into the bone to hold it in place. 

It typically takes at least 4 to 6 weeks to recover from biceps tenodesis surgery. However, depending on the extent of damage — or complications during surgery — full recovery could take up to a year.

After surgery, the shoulder is typically kept numb via pain medications. Recovery includes resting, pain control, and physical therapy. The patient must wear a sling for about 4 to 6 weeks.

Physical therapy is crucial for a full recovery of the shoulder joint. Passive range of motion is important during the first two weeks after surgery. 

If you experience progress, you can start with active range of motion exercises around the fourth week. You should experience strengthening of the area within 6 to 8 weeks post-surgery. By week 10, you can begin with advanced strength exercises and heavy lifting.