Common Biceps Tenodesis Symptoms & Causes
Candidates for biceps tenodesis experience persistent anterior (front) shoulder pain that worsens with overhead activities or lifting, deep aching pain in the front of the shoulder, pain radiating down the biceps muscle, clicking or popping sensation with shoulder movement, weakness with lifting or reaching, and night pain disrupting sleep. Symptoms typically persist despite conservative treatment including rest, physical therapy, anti-inflammatory medications, and corticosteroid injections over 6-12 months. The procedure addresses biceps tendinitis, partial biceps tears, SLAP lesions, biceps instability, and degenerative biceps tendinopathy common in overhead athletes and manual laborers.
Schedule Your ConsultationWho's a Candidate for Biceps Tenodesis?
Not everyone with biceps pain requires surgery. Understanding candidacy criteria helps determine if biceps tenodesis is appropriate for your condition:
Failed Conservative Treatment
+Surgery is typically considered after 6-12 months of unsuccessful conservative management including activity modification, physical therapy, NSAIDs, and at least one corticosteroid injection. If symptoms persist and significantly impact daily activities or sleep despite compliance with treatment, surgical intervention provides definitive relief.
Specific Biceps Pathology
+Ideal candidates have confirmed biceps tendon tears (partial or complete), SLAP lesions, biceps subluxation or instability, or chronic degenerative biceps tendinopathy. MRI or diagnostic arthroscopy confirms the pathology. Overhead athletes, manual laborers, and those with repetitive lifting demands commonly develop these conditions.
Age and Activity Level
+Biceps tenodesis is preferred over simple tenotomy (cutting the tendon without reattachment) for younger, active patients who want to maintain biceps strength and avoid cosmetic deformity. Patients over 60 with lower activity demands may be candidates for simpler tenotomy procedures.
Associated Shoulder Problems
+Biceps pathology often occurs with rotator cuff tears, labral tears, or impingement syndrome. Candidates may require combined procedures addressing multiple issues. Overall shoulder health, realistic expectations, and commitment to rehabilitation are essential. Smokers, those with active infections, or uncontrolled medical conditions need optimization before surgery.
Preparing for Biceps Tenodesis Surgery
Proper preparation optimizes surgical outcomes and recovery. Complete pre-operative medical clearance if you have chronic health conditions. Stop smoking at least 4 weeks before surgery to improve healing and reduce complications. Discontinue anti-inflammatory medications as directed. Arrange transportation home and assistance for 24-48 hours post-surgery. Prepare your home with frequently used items at waist level to avoid overhead reaching initially. Complete prescribed pre-operative physical therapy to maximize shoulder motion and rotator cuff strength. Fill prescriptions beforehand and plan time off work—most need 1-2 weeks for desk jobs, 6-12 weeks for physical labor. Purchase a comfortable sling for post-operative immobilization. Mental preparation and understanding recovery expectations contribute to satisfaction and compliance with rehabilitation protocols.
How is Biceps Tenodesis Performed?
The procedure begins with general anesthesia and nerve block for post-operative pain control. You're positioned in beach chair position. The surgeon creates 2-3 small arthroscopic incisions (5-10mm) around the shoulder. An arthroscope (camera) is inserted, displaying magnified images on monitors. Sterile fluid inflates the joint for optimal visualization.
The surgeon performs comprehensive shoulder examination, documenting all findings with photographs. The biceps tendon is evaluated for tears, inflammation, or instability. The damaged portion attached to the labrum is identified and cut. A small incision may be made over the upper arm. The biceps tendon is then reattached to the humerus below the bicipital groove using specialized fixation—either an interference screw, suture anchors, or bone tunnel technique depending on surgeon preference and your anatomy. This removes the painful segment while maintaining tendon tension and function. Any associated pathology like rotator cuff tears or labral damage is addressed simultaneously. Incisions are closed with absorbable sutures. The entire procedure takes 60-90 minutes with same-day discharge.
What to Expect After Biceps Tenodesis?
Recovery follows a structured protocol protecting the tendon repair while gradually restoring motion and strength. Tendon healing to bone takes 6-8 weeks. Success depends on rehabilitation compliance. Most patients achieve significant improvement within 3-4 months with full recovery by 6 months.
Immediate Post-Operative Period (Weeks 0-2)
+Nerve block provides 12-24 hours of numbness. Arm remains in sling continuously except for gentle elbow and hand exercises. Ice application reduces swelling. Pain medication manages discomfort. No shoulder motion or biceps activation during this critical healing phase. Sleep semi-reclined for comfort. Incisions remain covered and dry for 48 hours.
Early Motion Phase (Weeks 2-6)
+Sling continues for 4-6 weeks total. Physical therapy begins with gentle passive range of motion exercises—therapist moves your arm without muscle activation. Gradually progress to active-assisted motion. No lifting, pushing, or pulling. No biceps muscle activation. Driving resumes at 2-3 weeks once off narcotics and with surgeon clearance.
Strengthening Phase (Weeks 6-12)
+Sling discontinued once tendon healing confirmed. Active range of motion exercises progress to strengthening with resistance bands and light weights. Gradual biceps strengthening begins around 8 weeks. Rotator cuff and scapular stabilization emphasized. Most daily activities resume. Return to light work duties with restrictions.
Return to Full Activity (Months 3-6)
+Progressive strengthening continues with heavier weights and functional exercises. Return to unrestricted work typically 3-4 months. Athletes return to sport-specific training around 4 months with full clearance at 5-6 months. Continued home exercises maintain strength and flexibility. Full recovery with maximum strength achieved by 6-12 months.
Biceps Tenodesis Surgery in Cleveland, Ohio
Cleveland Shoulder Institute specializes in advanced arthroscopic biceps tenodesis procedures. Our surgeons perform hundreds of biceps procedures annually using refined techniques that optimize tendon healing and functional outcomes. We utilize multiple fixation methods—interference screws, suture anchors, and bone tunnels—selecting the optimal technique for each patient's anatomy and activity demands.
Our comprehensive approach includes thorough diagnostic evaluation with advanced imaging, expert arthroscopic technique addressing all shoulder pathology, and structured rehabilitation protocols. We coordinate with specialized shoulder physical therapists who understand the critical phases of biceps tendon healing. Surgery is performed at accredited ambulatory surgery centers with experienced surgical teams. We've published research on surgical outcomes for this procedure demonstrating excellent pain relief and functional recovery. Located in Cleveland with convenient scheduling and same-day appointments available for urgent evaluations.
Schedule Your ConsultationMeet our Biceps Surgery Specialist Team
Dr. Gobezie is a fellowship-trained orthopedic surgeon specializing in shoulder and elbow conditions. He completed additional advanced training beyond residency, focusing on arthroscopic techniques, rotator cuff repairs, and complex shoulder reconstruction. Dr. Gobezie performs hundreds of arthroscopic procedures annually, maintaining expertise through active research participation, teaching commitments, and regular attendance at specialized shoulder conferences.
Supporting Dr. Gobezie are board-certified anesthesiologists experienced in regional nerve blocks for shoulder surgery, certified surgical technologists trained in shoulder-specific arthroscopic instrumentation, and specialized physical therapists with expertise in biceps tenodesis rehabilitation protocols. Our medical staff understands the unique healing timeline for tendon-to-bone repairs. This collaborative approach ensures optimal surgical technique, complication prevention, and structured recovery. We provide thorough pre-operative education, realistic expectation setting, and accessible post-operative communication throughout your recovery journey.
What Our Patients Say About Biceps Tenodesis Surgery
Real results from patients who eliminated chronic biceps pain through surgery:
"I dealt with shoulder pain for over a year trying physical therapy and injections. The biceps tenodesis finally gave me relief. Three months post-op I'm back to lifting weights with no pain. Wish I'd done it sooner."
— Kevin Foster
"Dr. Gobezie explained that my SLAP tear wasn't going to heal on its own. The surgery was straightforward and recovery went exactly as he described. My shoulder feels stable and strong again. Very pleased with the outcome."
— Rebecca Stone
"The arthroscopic approach meant small scars and quick recovery. Physical therapy was crucial but manageable. Six months later I have full range of motion and can do everything I couldn't before. The constant aching is completely gone."
— Marcus Williams
Biceps Tenodesis Frequently Asked Questions
What is the difference between biceps tenodesis and biceps tenotomy?
+Biceps tenodesis reattaches the cut biceps tendon to the humerus bone, maintaining strength and preventing cosmetic deformity. Biceps tenotomy simply cuts and releases the tendon without reattachment. Tenodesis is preferred for younger, active patients while tenotomy may be appropriate for older, less active individuals. Your surgeon recommends the best option based on your age and activity level.
How long does biceps tendon take to heal after tenodesis?
+Tendon-to-bone healing takes approximately 6-8 weeks. During this time, the arm remains protected in a sling and no biceps activation is allowed. Progressive strengthening begins after healing is confirmed. Full strength recovery typically takes 4-6 months, though continued improvement occurs up to 12 months post-surgery.
Will I lose strength after biceps tenodesis?
+Most patients regain normal or near-normal biceps strength with proper rehabilitation. Some studies show minimal strength loss (5-10%) in maximum biceps strength testing, but this rarely affects daily activities or sports performance. The benefit of pain elimination far outweighs minimal strength changes for most patients.
Can I avoid the "Popeye" deformity with tenodesis?
+Yes, biceps tenodesis specifically prevents the Popeye deformity (bunching of the biceps muscle in the lower arm) by reattaching the tendon to bone and maintaining normal tension. Simple tenotomy without reattachment causes this cosmetic deformity in many patients. This is why younger, active patients typically choose tenodesis over tenotomy.
When can I return to sports after biceps tenodesis?
+Light sports and activities typically resume at 3-4 months. Return to contact sports, overhead sports, or heavy lifting occurs at 5-6 months once full strength is restored and surgeon clearance is obtained. Athletes should complete sport-specific training and demonstrate adequate strength before full return to competition.