Sports MedicineShoulderSurgery Center

Biceps Tenodesis

Performed by Drs. Gardiner, Raffo, and Christoforetti, fellowship-trained shoulder surgeons who perform biceps tenodesis as a standalone procedure or combined with rotator cuff repair.

Duration: 30–60 minutesAnesthesia: General with nerve block

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What is biceps tenodesis?

Biceps tenodesis cuts the long head of the biceps tendon from its torn or painful attachment at the top of the shoulder socket and reattaches it lower on the upper arm bone. This eliminates pain from the damaged proximal biceps while preserving full biceps muscle function. It is performed arthroscopically or through a small open incision.

Why this approach — at MOS

We prefer subpectoral biceps tenodesis (fixing the tendon below the pectoralis major tendon on the humerus) for most patients. This position places the fixation in a biomechanically favorable zone, avoids the bicipital groove area which can be inflamed and scarred, and ensures the tendon is completely removed from the region of pathology. An interference screw provides rigid fixation with low rates of pullout.

For patients undergoing rotator cuff repair, we consider suprapectoral tenodesis in the bicipital groove if the operative plan allows — this can be done entirely arthroscopically without an additional incision. The choice between approaches is based on the patient's anatomy and the other procedures planned.

Who is a candidate?

Indications

Biceps tendinopathy or partial tendon tear unresponsive to conservative management
Type II SLAP tear in patients over 35, or in non-overhead athletes of any age
Biceps tendon instability (medial subluxation out of the bicipital groove) with pain
Long head biceps rupture with persistent pain, weakness, or fatigue ("Popeye" deformity with symptoms)
Performed concomitantly with rotator cuff repair when the biceps tendon is frayed or unstable

Contraindications

Young competitive overhead throwers with Type II SLAP tears (SLAP repair preferred)
Isolated low-grade biceps tendinopathy without structural pathology (conservative management)
Active infection
Patients in whom biceps weakness would be professionally significant (heavy manual laborers should understand elbow flexion strength may very mildly decrease, though this is clinically minimal for most)

Conservative Treatment First

Biceps tendinopathy is first treated with physical therapy — a program targeting bicipital groove load reduction, rotator cuff strengthening to stabilize the humeral head, and posterior capsular stretching. Ultrasound-guided corticosteroid injection into the biceps tendon sheath can reduce acute inflammation. Platelet-rich plasma (PRP) injections into the tendon are used by some practitioners, though evidence is mixed.

Many patients with mild to moderate biceps tendinopathy achieve lasting improvement with 6–12 weeks of structured conservative care. Surgery is recommended when symptoms remain severe or functionally limiting after this trial, or when structural pathology — partial or complete tear, medial subluxation, or significant fraying — is identified and the decision to operate on the shoulder for another reason (rotator cuff repair) has already been made. The Bethesda-area patient who is already undergoing rotator cuff repair with an incidentally frayed biceps tendon benefits from addressing both pathologies in the same operative setting.

The procedure

What Is Biceps Tenodesis?

The biceps muscle has two heads at the shoulder — hence "bi" (two) "ceps" (heads). The short head of the biceps attaches to the coracoid and is almost never a source of problems. The long head of the biceps tendon travels through the glenohumeral joint, attaches to the superior glenoid (the biceps anchor or SLAP complex), and then exits the shoulder through the bicipital groove — a channel between the two muscle heads of the rotator cuff. This long intra-articular course makes the long head tendon uniquely vulnerable to wear, fraying, tearing, and instability.

Biceps tendon pathology is a major source of anterior shoulder pain. A torn or inflamed tendon produces aching along the front of the shoulder, pain with overhead lifting, and tenderness directly over the bicipital groove. When the tendon ruptures spontaneously (the "Popeye deformity"), the muscle belly bunches toward the elbow, and while function is mostly preserved, pain and fatigue in the biceps with use can persist.

Biceps tenodesis resolves the problem by taking the tendon out of the equation at the shoulder entirely. The tendon is released from its painful attachment, the problematic intra-articular and bicipital groove portion is removed, and the distal end is reattached to a stable new anchor point on the humerus. The biceps muscle then functions normally from this new, pain-free origin.

Biceps tenodesis is a more reliable procedure than SLAP repair in patients over 35 and in non-throwing athletes, making it the preferred treatment in these populations when there is concurrent biceps and labral pathology.

What Happens During Biceps Tenodesis?

You arrive at the ambulatory surgery center approximately 90 minutes before surgery. An interscalene nerve block is placed and general anesthesia administered. You are positioned in the beach chair or lateral decubitus position.

Diagnostic arthroscopy is performed first. The biceps tendon is directly visualized from inside the joint — the quality, stability, and degree of tearing are assessed. The tendon is released from its superior glenoid attachment (the SLAP anchor) with an arthroscopic cutter or radiofrequency device. This immediately eliminates the intra-articular source of pain.

The tendon is then reattached either arthroscopically (subpectoral or suprapectoral) or through a small auxiliary incision at the bicipital groove. A suture anchor or interference screw is used to fix the tendon to the humerus at a point that maintains appropriate muscle length and tension. Excess tendon above the fixation site is excised.

For combined cases (rotator cuff repair + biceps tenodesis), the biceps is typically released at the beginning of arthroscopy and fixated after the rotator cuff repair is complete.

Recovery timeline

Days 0–14

Arm in sling. No active biceps curling or lifting with the operated arm. Elbow, wrist, and hand passive motion only.

Weeks 2–6

Physical therapy begins gentle shoulder passive motion. The tenodesis fixation site requires protection during this period — no resisted elbow flexion.

Weeks 6–10

Active shoulder motion. Light elbow flexion against gravity begins at week 6. Gradual strengthening.

Months 3–4

Return to gym, overhead activity, and sport. Heavy lifting (greater than 20–30 lbs with elbow flexion) deferred to month 3 to protect the fixation site.

Biceps tenodesis is generally well tolerated with rapid return of function. The most critical precaution is avoiding heavy elbow flexion loading (biceps curls, carrying heavy loads) for the first 6 weeks while the tendon-to-bone fixation heals. Cramping or fatigue in the biceps during the first 4–8 weeks is normal as the tendon adapts to its new length and position. The vast majority of patients report resolution of their anterior shoulder pain within 4–8 weeks.

Frequently Asked Questions

Will I lose biceps strength after biceps tenodesis?

Clinical studies consistently show no significant loss of elbow flexion strength or supination strength after biceps tenodesis. The short head of the biceps and the brachialis muscle compensate for any mechanical change from the reattachment. Most patients report no functional difference in arm strength after full recovery.

Is there a "Popeye" deformity after tenodesis?

No. A "Popeye" deformity — where the muscle belly bunches toward the elbow — occurs when the long head of the biceps ruptures spontaneously and the tendon is not repaired. Biceps tenodesis reattaches the tendon to a new point on the humerus, maintaining normal resting muscle length and preventing any cosmetic deformity.

What is the difference between biceps tenodesis and SLAP repair?

Both procedures address pathology at the biceps anchor area. SLAP repair reattaches the torn labrum back to the glenoid, preserving the biceps' original attachment point — it is preferred in young overhead athletes. Biceps tenodesis releases the tendon from the glenoid and fixes it lower on the arm — preferred in older patients and non-throwers because it is more reliable and less likely to cause stiffness.

Can this procedure be done at the same time as rotator cuff repair?

Yes. In fact, when a surgeon finds a frayed or unstable biceps tendon during rotator cuff repair, performing biceps tenodesis at the same sitting is standard practice. This avoids a second surgery and adds minimal operative time.

How soon can I return to weightlifting after biceps tenodesis?

Light upper body training (avoiding loaded elbow flexion) can typically begin at 6–8 weeks. Full return to heavy lifting — including biceps curls and bench press — is generally permitted at 3 months, when the tendon fixation site has sufficiently healed.