Biceps Tenodesis

Biceps Tenodesis in Houston

The long head of the biceps tendon runs through the shoulder joint and attaches to the top of the shoulder socket at the labrum. Although the biceps muscle is best known for bending the elbow, its long-head tendon is a common source of shoulder pain when it becomes inflamed, partially torn, or unstable. Biceps tenodesis is a surgical procedure that addresses these problems by detaching the tendon from inside the joint and reattaching it to the upper arm bone outside the joint, eliminating the painful intra-articular portion while preserving the muscle's function.

When Biceps Tenodesis Is Considered

Biceps tenodesis is most often considered for:

  • Biceps tendonitis that has not responded to several months of physical therapy, activity modification, anti-inflammatory medication, and selective corticosteroid injections.
  • Partial tears of the proximal biceps tendon that cause persistent pain.
  • SLAP tears in patients over approximately 35–40 years of age, where direct labral repair has historically had less reliable outcomes than tenodesis.
  • Biceps tendon instability or subluxation, where the tendon slips out of its groove on the humerus.
  • As part of a rotator cuff repair when the biceps tendon is also damaged, since untreated biceps pathology is a common reason for residual pain after cuff repair.

How the Procedure Works

Biceps tenodesis is performed under general anesthesia, often combined with a regional nerve block. It can be performed entirely arthroscopically, with a mini-open technique, or in combination with another arthroscopic shoulder procedure such as rotator cuff repair.

  1. Diagnostic arthroscopy. A small camera is placed into the shoulder joint to confirm the diagnosis and inspect for associated injuries.
  2. Tendon release. The long-head biceps tendon is detached from its attachment at the top of the socket.
  3. Tendon preparation. The damaged portion of the tendon is removed, and the healthy remaining tendon is prepared for fixation.
  4. Fixation to the humerus. The tendon is reattached to the upper arm bone—typically with an interference screw, suture anchor, or button—at a position just below the shoulder joint.
  5. Closure. Small incisions are closed with sutures or surgical strips, and the arm is placed in a sling.

The procedure is performed as an outpatient surgery.

Recovery Timeline

Weeks 0–4

  • Sling for protection
  • Gentle pendulum and passive motion exercises
  • Avoid active biceps loading

Weeks 4–8

  • Progressive active motion
  • Light strengthening of the surrounding shoulder muscles
  • Most daily activities resume

Months 2–4

  • Progressive biceps strengthening
  • Return to most non-strenuous activities
  • Driving and most desk work typically resumed earlier

Months 4–6

  • Return to heavy lifting and overhead athletic activities

Outcomes

Biceps tenodesis is highly effective at relieving biceps-related shoulder pain. Most patients maintain normal cosmetic appearance and near-normal strength. The procedure is one of the more predictable shoulder surgeries when patient selection and technique are appropriate.

Houston Locations and Scheduling

Biceps tenodesis is performed at outpatient surgery centers in Houston affiliated with UTHealth Houston and Memorial Hermann. Office consultations are available at Memorial Villages and Texas Medical Center locations.

Appointments are scheduled through UTHealth Houston at 713-486-1700.

Frequently asked questions

What is biceps tenodesis?

Biceps tenodesis is a surgical procedure in which the long head of the biceps tendon is released from its attachment inside the shoulder joint and reattached to the upper arm bone (humerus) outside the joint. It treats pain from a damaged or unstable biceps tendon while preserving the muscle's strength and contour.

Who is a candidate for biceps tenodesis?

Common indications include painful biceps tendonitis that has not responded to conservative treatment, partial tears of the proximal biceps tendon, certain SLAP tears (particularly in patients over 35–40 years old), and biceps tendon instability. It is also often combined with rotator cuff repair.

How is biceps tenodesis different from biceps tenotomy?

Both procedures release the tendon from inside the joint. Tenotomy simply releases the tendon and lets it retract, which is faster and simpler but can cause a "Popeye" deformity and mild fatigue cramping in active patients. Tenodesis reattaches the tendon to the bone, preserving cosmetic appearance and strength—generally preferred in younger or more active patients.

How long is recovery after biceps tenodesis?

A sling is typically worn for several weeks. Light activity resumes around four to six weeks, with strengthening progressing from six weeks through three months. Most patients return to most recreational activities within three to four months and to heavy lifting by four to six months.

Will I lose strength after biceps tenodesis?

Most patients regain normal or near-normal strength in elbow flexion and forearm rotation. Tenodesis preserves the biceps muscle's function by maintaining its attachment to bone.

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