Biceps Tenodesis

Overview

What is biceps tenodesis surgery?

Biceps tenodesis surgery treats injuries that happen when you tear or damage the tendon that connects your biceps muscle to your shoulder. This type of tendon damage may be called biceps tendonitis.

What are symptoms or signs I might need biceps tenodesis surgery?

You might need biceps tenodesis if:

  • You have shoulder pain that hasn’t been helped by rest, physical therapy or pain medication.
  • You feel a sudden sharp pain in your upper arm. You also hear a snapping and popping noise.
  • You feel cramps in your upper arm, especially when you’ve been carrying or lifting heavy objects.
  • You notice an unusually large bulge in your upper arm. This bulge is sometimes called a Popeye bulge.
  • There are bruises or swelling from your upper arm to your elbow.
  • You can’t rotate your arm so that your palm is up.

What factors can cause your biceps tendon to tear?

  • Your age. Your biceps tendon wears out over time and so tears more easily.
  • You play sports like baseball, swimming or tennis where your arms move and reach overhead.
  • Your labrum tears and your biceps tendon is either torn in the process or is disconnected from your shoulder. This injury is called a SLAP tear.

What is the recovery timeline for biceps tenodesis surgery?

Full recovery typically takes four to six months.

Are biceps tenodesis surgeries successful?

Biceps tenodesis is successful more than 70% of the time.

Procedure Details

What is the biceps tenodesis procedure?

The biceps tenodesis procedure treats shoulder and biceps muscle pain and weakness that happens when you tear your long head biceps tendon. This tendon is located at the top of your bicep muscle. It’s connected to your labrum, which is cartilage that lines your shoulder socket.

In the biceps tenodesis procedure, your surgeon releases your torn biceps tendon from your labrum.

In some instances, your surgeon relocates your biceps tendon to your upper arm bone (humerus).

Your surgeon can fix your biceps tendon with open surgery or arthroscopic surgery.

What happens before open biceps tenodesis?

You’ll receive general anesthesia (you’re asleep) or regional anesthesia (you’re awake but can’t feel or move your arm) before the procedure. Your healthcare provider will give you specific instructions, but here’s some general guidance:

  • Avoid food or drink for eight hours before you go to the hospital. (Use a sip of water to take your regular medication, such as blood pressure medication.)
  • Don’t take Viagara® or other medication for erectile dysfunction for at least 24 hours before surgery.
  • If you smoke, stop smoking for two weeks before your surgery. Not smoking can help your heart and lung function better during surgery.
  • Stop taking herbal supplements for one or two weeks before surgery.

What happens during open biceps tenodesis?

  • Your surgeon cuts into the area where the top of your biceps tendon connects to your labrum.
  • They pull your biceps tendon through the incision and release it from your labrum.
  • They drill a small hole in your upper arm bone.
  • Your surgeon uses a suture anchor to push your bicep tendon into the hole in your upper arm bone. This technique is the screw fixation technique.
  • Your surgeon closes your incision.

Does biceps tenodesis leave scars?

Scars from open biceps tenodesis are small. Typically, they’re around 3-4 centimeters.

Do you feel pain after biceps tenodesis?

You might have some pain and discomfort after the surgery. Ice packs, pain medication and wearing a sling should help relieve both.

What’s involved in biceps tenodesis rehabilitation?

  • You’ll wear an arm sling or arm immobilizer for two to four weeks after your surgery. As a result, you might need to take off work or ask for help with everyday activities.
  • Most people who have biceps tenodesis surgery have physical therapy to increase shoulder range of motion and strength.

How long does it take to recover from open biceps tenodesis?

It can take up to four to six months to recover from biceps tenodesis surgery.

When can I start exercising, playing sports or lifting weights after open biceps tenodesis?

Whether your game is exercise, sports or lifting weights, getting back into the game too soon can derail your recovery from biceps tenodesis. Talk to your healthcare provider about adding activities to your physical therapy routine.

What happens before arthroscopic biceps tenodesis?

You will receive local or general anesthesia.

What happens during arthroscopic biceps tenodesis?

  • Your surgeons make several tiny cuts in your shoulder to insert a tiny camera called an arthroscope.
  • They use the arthroscope to view your biceps tendon and labrum.
  • They use small surgical tools to cut your biceps tendon from your labrum.
  • They drill a small hole in your upper arm.
  • Your surgeons close the tiny cuts in your shoulder.

What happens after arthroscopic biceps tenodesis?

  • You might receive a pain block that will keep your shoulder numb for several hours after your surgery.
  • You’ll need to wear an arm sling for four to six weeks after your surgery. As a result, you might need to take off work or ask for help with everyday activities including driving.
  • You will have physical therapy that begins about two weeks after your surgery and continues for several months.

Are there alternatives to biceps tenodesis?

Biceps tenotomy is an alternative procedure. In this procedure, surgeons cut your bicep tendon away from your labrum but don’t reconnect it to your upper arm bone.

Is biceps tenotomy as effective as biceps tenodesis?

While both procedures treat the symptoms your torn biceps causes, people who have biceps tenotomy are more likely to develop unusually large bulges in their biceps. The bulges are sometimes called Popeye syndrome.

Risks / Benefits

What are complications after open biceps tenodesis?

Complications can include:

  • Blood clots.
  • Pain.
  • Stiffness.
  • Infection.
  • Recurring shoulder instability.
  • Nerve injury.

What are the benefits of open biceps tenodesis?

Studies show that people who have open biceps tenodesis may return to sports more quickly than people who have arthroscopic biceps tenodesis.

What are the complications after arthroscopic biceps tenodesis?

Complications can include:

  • Blood clots.
  • Pain.
  • Stiffness.
  • Infection.
  • Recurring shoulder instability.

What are the benefits of arthroscopic biceps tenodesis?

You might have less pain and shorter recovery time if you have arthroscopic surgery instead of open surgery.

Recovery and Outlook

How long does it take to recover from biceps tenodesis?

It usually takes four to six months to recover from biceps tenodesis.

When can I drive after biceps tenodesis?

You can drive if you aren’t taking medication that affects your ability to drive and once your shoulder doesn’t hurt when you control the wheel.

When can I start exercising, playing sports or lifting weights after open biceps tenodesis?

Whether your game is exercise, sports or lifting weights, getting back into the game too soon can derail your recovery from biceps tenodesis. Talk to your healthcare provider about adding activities to your physical therapy routine.

Can I re-injure my biceps tendon and need another biceps tenodesis?

You can re-injure your biceps tendon by resuming sports and other activities before your tendon heals.

When to Call the Doctor

When should I call my healthcare provider?

You should call your healthcare provider if you have:

  • Bleeding that soaks through your dressing and doesn't stop when you place pressure over the area.
  • Pain that doesn't go away when you take your pain medicine.
  • Swelling in your arm.
  • Numbness or tingling in your fingers or hand.
  • Darkened color or coolness in your hand or fingers.
  • Redness, pain, swelling or a yellowish discharge from the surgery site.
  • A temperature that is higher than 101 F (38.3 C).

A note from Cleveland Clinic

Biceps tenodesis is the first step toward healing your biceps tendon so you can resume favorite activities like sports. Before you can do that, however, you’ll need physical therapy and a healthy dose of patience so your biceps tendon can heal. Try not to get frustrated and give in to the temptation to do more because you might end up doing too much too soon. Talk to your healthcare provider about your concerns. They might have recommendations such as occupational therapy or sports therapy to help you ease back into your usual routines.

Last reviewed by a Cleveland Clinic medical professional on 09/24/2021.

References

  • AlQahtani SM, Bicknell RT. Outcomes following long head of biceps tendon tenodesis. (https://pubmed.ncbi.nlm.nih.gov/27599831/) Curr Rev Musculoskelet Med. 2016 Dec;9(4):378-387. Accessed 10/18/2021.
  • Khazai RS, Lee CS, Boyajian HH, Shi LL, Athiviraham A. Rates of subsequent shoulder surgery within three years for patients undergoing SLAP repair versus biceps tenodesis. (https://pubmed.ncbi.nlm.nih.gov/32368749/) Am J. SportsMed. 2020 Apr 8;2(2):2129-e135. Accessed 10/18/2021.
  • Li M, Shaikh AB, Sun J, Shang P, Shang X. Effectiveness of biceps tenodesis versus SLAP repair for surgical treatment of isolated SLAP lesions: A systemic review and meta-analysis. (https://pubmed.ncbi.nlm.nih.gov/30723678/) J Orthop Translat. 2018 Oct 4;16:23-32. Accessed 10/18/2021.

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