Biceps tenodesis · Dr Joe Coory

Type: Arthroscopic / mini-open
Anaesthesia: General + regional block
Day surgery: Yes
Sling: 3 weeks
Return to driving: ~3 weeks
Return to sport: 4–6 months

What it is.

Biceps tenodesis is a small operation in which the long head of biceps tendon — the most common source of front-of-shoulder pain — is detached from its intra-articular anchor and re-attached to the upper humerus. The procedure addresses the symptomatic tendon at the source without compromising the cosmetic contour or the functional strength of the biceps muscle.

Why it is done.

The long head of biceps is uniquely vulnerable to symptomatic disease because of where it sits — passing through the shoulder joint before becoming the upper-arm muscle. When the tendon is degenerated, partially torn, or its anchor at the superior labrum is damaged (a SLAP lesion), it can become a persistent and disabling pain source.

Tenodesis removes the painful intra-articular segment of the tendon and re-attaches it outside the joint. In patients over 35, tenodesis has a higher satisfaction rate and lower revision rate than SLAP repair.

How it is performed.

Performed under general anaesthesia with a regional block, as day surgery. The long head of biceps is identified arthroscopically (or via a small open mini-incision), released from its intra-articular biceps anchor, and re-attached to the upper humerus using a small interference screw or suture anchor. The most common location for the tenodesis is just above or below the upper border of pectoralis major. The skin is closed with absorbable sutures.

Recovery.

Weeks 0–3

Sling worn for 3 weeks.
Active range of motion of the elbow from day 1.
No active biceps loading (no lifting with the arm flexed at the elbow).

Weeks 3–8

Sling discontinued at 3 weeks.
Active-assisted shoulder range of motion under your physiotherapist.
Driving resumed at approximately 3 weeks once off opioid analgesia.

Months 2–6

Progressive strengthening from 8 weeks.
Return to non-contact sport at 3 months; contact sport at 4–6 months.

Rehabilitation protocol.

A written copy of this protocol is provided to your physiotherapist on the day of surgery. The timeline below is a guide — progression is based on clinical milestones, not the calendar alone.

Phase 1 — weeks 0–4 (protection)

Sling for comfort; wean as tolerated.
Pendular exercises and passive shoulder range of motion as directed.
Active range of motion for elbow, wrist and hand.
Do not flex the elbow under load — 600 g maximum in the hand for 4 weeks.
No resisted biceps curls.
Ice for 20 minutes every 2–3 hours during the first week.

Phase 2 — weeks 4–8 (early mobilisation)

Wean sling fully.
Active-assisted shoulder range of motion progressing to active.
Isometric external and internal rotation from week 6.
Scapula control and posture correction.

Phase 3 — weeks 8–12 (strengthening)

Isotonic rotator cuff and scapula stabiliser strengthening.
Proprioceptive and functional rehabilitation.
Progressive biceps loading as tolerated.

Phase 4 — week 12 onwards (return to activity)

Swimming and non-contact sport from 3 months.
Full unrestricted activity as strength and comfort allow.

View the recovery roadmap for the full rehabilitation journey, or visit For Physiotherapists for protocol requests.

Frequently asked questions.

Will I lose biceps strength?

Most published studies show no detectable loss of elbow flexion or supination strength after biceps tenodesis.

Will I get a Popeye deformity?

No — the muscle is re-attached securely. Popeye deformity occurs if the fixation fails or if a biceps rupture is left untreated, not after a properly fixed tenodesis.

Is it a big operation?

It is a small operation — usually day surgery with a quick recovery. The shoulder rehabilitation is the limiting factor, not the biceps work itself.

How long until I can lift weights again?

Strengthening commences at approximately 8 weeks. Heavy lifting and overhead loading by 4–6 months.

Will my pain definitely go away?

If the biceps was the symptom source — confirmed by examination, imaging and (often) a diagnostic local anaesthetic injection — pain relief is reliable. The most important step is confirming the diagnosis before operating.

References.

Boileau P, et al. Arthroscopic biceps tenodesis or SLAP repair in patients over 50. J Shoulder Elbow Surg. 2009;18(2):247–253.
Werner BC, et al. Outcomes of biceps tenodesis: subpectoral versus suprapectoral. Am J Sports Med. 2014;42(12):2870–2876.

Biceps tenodesis.