Biceps Tenodesis surgeon in Ahmedabad, Gujarat

What is biceps tenodesis?

The biceps muscle has two tendons at its upper end. The long head runs up into the shoulder joint and over the top of the ball, through a narrow groove in the arm bone - an awkward course that makes it a common source of pain. When that tendon becomes inflamed, frayed or unstable in its groove, it hurts at the front of the shoulder and often refers to pain down the arm.

Biceps tenodesis divides the tendon where it enters the joint and reattaches it lower down, to the arm bone outside the joint. The painful portion inside the joint is taken out of the equation while the muscle keeps its attachment, so elbow bending and forearm rotation stay strong.

Who needs biceps tenodesis

It is considered when front-of-shoulder pain is clearly coming from the biceps tendon and has not settled with physiotherapy, activity modification and sometimes an injection. The common situations are:

• Long head of biceps tendinitis that persists despite non-surgical treatment
• A partially torn or frayed biceps tendon
• An unstable tendon that slips out of its groove
• A SLAP tear where the tendon anchor has pulled off the socket rim
• As part of a rotator cuff repair, where the biceps is a further source of pain

Tenodesis or tenotomy?

There are two ways to take a painful biceps tendon out of the joint. A tenotomy simply releases it and lets it retract - quicker, and reliably effective at relieving pain - but it can leave a visible bulge in the upper arm (the so-called "Popeye" sign) and occasionally some cramping or loss of forearm-rotation strength. A tenodesis re-anchors the tendon and avoids both, at the cost of a slightly longer operation and a period of protected recovery.

Tenodesis is generally preferred for younger, active or slimmer patients, where appearance and strength matter more, while a tenotomy remains a reasonable choice for older or lower-demand patients. The decision is made with you before surgery.

How biceps tenodesis is performed

Under general anaesthesia with a nerve block, the shoulder is inspected arthroscopically and the biceps tendon assessed along its course. The tendon is released at its origin on the socket rim, then fixed to the upper arm bone either arthroscopically or through a small incision at the front of the arm using a screw or an anchor, at a point that sits below the painful groove.

Because the biceps is so often one problem among several, the same anaesthetic usually addresses whatever else is found: a bursa cleared, a bone spur trimmed, or a labral or rotator cuff tear repaired. Most patients go home the same day.

Recovery after biceps tenodesis

A sling is worn for about two to four weeks to protect the fixation while it takes hold. Gentle shoulder and elbow movement starts early, but active bending of the elbow against resistance and lifting are avoided for around six weeks, since those load the repair directly. Strengthening follows from about six to eight weeks.

Front-of-shoulder pain usually settles within the first weeks. Most patients return to daily activities by two to three months, with full strength for lifting and sport at around four to six months. Where the tenodesis was done alongside a rotator cuff repair, the cuff rehabilitation sets the pace and recovery is longer.

Frequently asked questions