Biceps tenodesis is a common orthopedic procedure focusing on the long head of the biceps tendon, which connects the biceps muscle to the shoulder joint. The procedure is typically recommended when this tendon, near the shoulder, causes persistent pain or mechanical issues. The surgery’s core purpose is to relocate the damaged or unstable tendon, eliminating pain originating from the shoulder joint while preserving the biceps muscle’s function. Evaluating the worth of this surgery requires understanding the conditions it treats, the recovery effort, and the expected long-term outcomes.
Identifying the Conditions Requiring Tenodesis
Biceps tenodesis is generally considered only after non-surgical treatments, such as physical therapy, rest, and corticosteroid injections, have failed to relieve symptoms. This procedure is primarily indicated for chronic conditions affecting the long head of the biceps tendon at the shoulder joint. A frequent indication is chronic biceps tendonitis, which involves long-term inflammation and degeneration of the tendon tissue.
The surgery also addresses superior labrum anterior-posterior (SLAP) tears, especially those extending into the biceps tendon attachment point. These tears compromise the tendon’s anchor to the shoulder socket’s rim, causing pain and instability. Another indication is biceps tendon instability (subluxation), where the tendon repeatedly slips out of its groove in the upper arm bone. The procedure is often performed alongside other shoulder surgeries, such as rotator cuff repair, to treat the biceps tendon as a coexisting source of pathology.
Understanding the Surgical Technique
The fundamental goal of biceps tenodesis is to surgically detach the problematic long head of the biceps tendon from its connection inside the shoulder joint. The tendon is then secured to a new, more stable position lower down on the humerus (upper arm bone). This relocation removes the source of pain from the shoulder joint while maintaining the muscle’s strength.
Surgeons typically choose between two main approaches: arthroscopic (keyhole) or mini-open. The arthroscopic method uses small incisions and a camera to release the tendon, often combined with other shoulder repairs. The mini-open technique involves a slightly larger incision, usually performed lower on the arm, offering more direct access for securing the tendon.
The reattachment of the tendon to the humerus is achieved through various fixation methods. Common techniques include bioabsorbable screws, metal anchors, or sutures, all aiming to provide a stable construct for the tendon to heal to the bone. Both arthroscopic and open techniques generally result in comparable functional outcomes, although the choice depends on the patient’s specific anatomy and the surgeon’s preference.
The Post-Operative Recovery and Rehabilitation Timeline
Recovery from biceps tenodesis is a structured, multi-phase process requiring significant commitment to physical therapy. Immediately following surgery, the arm is immobilized in a sling for two to six weeks to protect the repaired tendon. During this initial phase, the focus is on controlling pain and swelling, allowing only passive range of motion exercises to prevent stiffness without activating the biceps muscle.
The next phase, typically beginning around four to six weeks post-operation, transitions the patient to active range of motion (AROM) exercises. The patient begins moving the arm using their own muscles, working to restore full, pain-free mobility to the shoulder and elbow. This slow progression allows the tendon to fully heal into its new position on the humerus.
The final phases, generally starting between six to twelve weeks, introduce strengthening exercises to rebuild muscle and tendon capacity. This includes light resistance work for the rotator cuff and eventually the biceps itself. Returning to full, unrestricted activity, such as overhead sports or heavy labor, typically takes four to six months.
Evaluating Success Rates and Potential Risks
Biceps tenodesis has a high reported success rate in achieving pain relief and restoring shoulder function. Most patients report being symptom-free or experiencing dramatic improvement. Studies indicate high patient satisfaction, with reports showing over 90% of patients are satisfied with the outcome and would elect to have the surgery again.
Potential risks and complications must be weighed against these benefits. A specific cosmetic concern is the “Popeye” deformity, a visible bulge in the lower arm muscle. Tenodesis is chosen over a simpler procedure called tenotomy to avoid this deformity by maintaining tendon length, but it remains a risk if fixation fails.
Other potential complications include persistent stiffness, which can occur if physical therapy is not diligently followed, or residual pain in the bicipital groove. Although rare, fixation failure, where the tendon pulls out from its attachment point on the bone, can happen, sometimes requiring a revision surgery. Nerve damage around the shoulder and persistent biceps cramping are also reported, though the overall risk of revision surgery remains low.