Tenodesis is a surgical procedure that reattaches a tendon to bone. While the term can apply to tendons anywhere in the body, it most commonly refers to biceps tenodesis, a shoulder surgery that anchors the long head of the biceps tendon to the upper arm bone (humerus). The procedure is performed when the tendon is damaged, inflamed, or partially torn, and conservative treatments like physical therapy and anti-inflammatory medications haven’t resolved the pain.
Why Biceps Tenodesis Is Performed
The long head of the biceps tendon runs from the top of the shoulder socket, through the shoulder joint, and down a groove in the upper arm bone. It’s vulnerable to wear and tear, especially in people who repeatedly use overhead motions, whether from sports like baseball and swimming or from manual labor. Over time, the tendon can fray, partially tear, or become chronically inflamed. It can also slip out of the bony groove that normally holds it in place.
Tenodesis is also used to treat a specific type of cartilage tear in the shoulder called a SLAP tear, which affects the ring of tissue where the biceps tendon attaches at the top of the shoulder socket. In many cases, repairing the cartilage alone doesn’t fully resolve pain, so surgeons detach the biceps tendon from that damaged anchor point and reattach it lower on the arm bone instead. This effectively removes the tendon from the shoulder joint, eliminating it as a source of pain while preserving muscle function and arm strength.
How Surgeons Diagnose the Problem
Before recommending tenodesis, your surgeon will typically combine a physical exam with imaging. Four clinical tests are commonly used to evaluate biceps tendon problems: the Speed test and Yergason test (which provoke pain by stressing the tendon in specific positions), the Kibler test, and direct tenderness when pressing on the bicipital groove at the front of your shoulder. On MRI, doctors look for three key signs: thickening of the tendon, the tendon slipping out of its groove, and bright signal on certain MRI sequences that indicates inflammation or tearing.
Accurate diagnosis matters because if the biceps tendon is left untreated during other shoulder repairs like rotator cuff surgery, residual biceps pain can persist and sometimes require a second operation.
How the Surgery Works
The core idea is straightforward: the surgeon detaches the damaged portion of the biceps tendon from its original attachment inside the shoulder joint, then secures it to the humerus using hardware. There are several ways to do this.
In the most common technique, the surgeon drills a small tunnel into the front of the humerus and seats the tendon inside it, then locks it in place with an interference screw, a small device (often made from a durable plastic called PEEK) that wedges the tendon against the walls of the tunnel. Sutures are typically tied over the top as backup fixation. Another approach uses a cortical button, a small metal plate threaded through the bone and flipped against the far side, with surgical tape cinched tight to hold the tendon at the correct tension. Suture anchors, which screw into the bone surface and hold the tendon down with stitches, are another option.
The fixation point also varies. Some surgeons attach the tendon higher on the arm bone near the top of the bicipital groove (suprapectoral), while others prefer a lower attachment point below the chest muscle (subpectoral). The suprapectoral approach is often done arthroscopically through small incisions using a camera, while the subpectoral technique typically requires a small open incision of a few centimeters.
Tenodesis vs. Tenotomy
The main alternative to tenodesis is tenotomy, where the surgeon simply cuts the damaged tendon and lets it retract without reattaching it. Both procedures effectively relieve shoulder pain, but there are trade-offs.
Tenotomy is faster and simpler, with no hardware and no bone tunnel to heal. The downside is cosmetic: without an anchor point, the biceps muscle can bunch up in the middle of the arm, creating a visible bulge sometimes called a “Popeye deformity.” There can also be some loss of forearm rotation strength and elbow flexion power, though many patients don’t notice it in daily life.
Tenodesis preserves the normal contour of the arm and maintains more of the muscle’s original tension, which is why it tends to be favored for younger, more active patients and anyone concerned about appearance or arm strength. The trade-off is a slightly longer recovery because the tendon needs time to heal into the bone.
What Recovery Looks Like
Recovery follows a structured timeline. For the first three to four weeks, you’ll wear a sling, including while sleeping for at least the first three weeks. During the first two weeks, only passive range of motion is allowed, meaning a therapist or your other hand moves the arm while the surgical shoulder stays relaxed. No active lifting, reaching out to the side, or rotating the arm outward is permitted for four to six weeks, because these motions stress the healing tendon.
Between weeks three and six, you’ll gradually transition from passive to active motion. Full range of motion is typically achieved by eight to ten weeks. After week eight, low-impact activities like biking, running, and golf are usually cleared. Return to sport and full activity begins around twelve weeks post-op, provided you can perform sport-specific movements without pain and with normal stability and control.
Protecting the tendon-to-bone healing is the most important factor in early recovery. Lifting anything heavy too soon, or doing active biceps curls before you’re cleared, risks pulling the tendon out of its fixation before the bone has incorporated it.
Outcomes and Success Rates
Biceps tenodesis has strong outcomes across a wide range of patients. Postoperative shoulder function scores (measured on a standardized 100-point scale) typically range from about 82 to 96, and pain scores drop to between 0 and 2 out of 10. For patients 35 and younger, return-to-sport rates range from 46% to 100% for non-overhead athletes and 35% to 86% for overhead athletes. Overhead sports, particularly baseball pitching, are the hardest to return to, with rates as variable as 17% to 100% depending on the competitive level.
Risks and Complications
Overall complication rates run about 9% for arthroscopic approaches and 13.5% for open techniques. Most of these are minor. Residual pain at the tenodesis site is the most common issue, occurring in roughly 5% to 6% of patients. Postoperative stiffness affects about 2% to 3%. A Popeye deformity, the cosmetic issue tenodesis is designed to prevent, still occurs in about 1% to 2% of cases, typically when the fixation loosens.
Serious complications are rare. Nerve injury occurs in fewer than 1% of open procedures and is essentially unreported with arthroscopic techniques. Infection rates are around 1% for open surgery. Traumatic re-rupture of the tenodesis, where the repaired tendon pulls free, has been reported in under 0.5% of cases. Revision surgery is needed in 0% to 3% of patients depending on the approach, with arthroscopic techniques showing lower reoperation rates.