Orthopedics Shoulder & Elbow Treatment & Surgery Do You Need Biceps Tenodesis Surgery? By Jonathan Cluett, MD Jonathan Cluett, MD LinkedIn Twitter Jonathan Cluett, MD, is a board-certified orthopedic surgeon with subspecialty training in sports medicine and arthroscopic surgery. Learn about our editorial process Updated on January 04, 2020 Medically reviewed Verywell Health articles are reviewed by board-certified physicians and healthcare professionals. These medical reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Stuart Hershman, MD Medically reviewed by Stuart Hershman, MD LinkedIn Stuart Hershman, MD, is a board-certified spine surgeon. He specializes in spinal deformity and complex spinal reconstruction. Learn about our Medical Expert Board Print Table of Contents View All Table of Contents Biceps Tendon Tears Biceps Tenodesis Who Needs a Biceps Tenodesis? Are There Alternatives? Tenotomy or Tenodesis? Recovery From Surgery Complications The biceps tendon is the attachment of the biceps muscle to the bone. The biceps muscle is named because there are two tendon attachments (therefore, "bi"-ceps) in the shoulder, and there is also a tendon attachment of the muscle below the elbow. The biceps muscle is important both in bending the elbow (flexion) as well as turning the forearm upwards (supination). Biceps tendon tears can diminish the strength of these movements and can also cause a deformity of the biceps muscle. Juanmonino / istock Find out How Problems With the Biceps Tendon Can Lead to Shoulder Pain Biceps Tendon Tears The most common type of biceps tendon tear is a detachment (partial or complete) of one of the biceps tendons within the shoulder joint. There are two attachments of the biceps tendon at the shoulder, one within the shoulder joint (the long head of the biceps), and the other is in front of the shoulder joint (the short head of the biceps). Injuries to the proximal biceps tendon almost always involve the long head of the biceps. When the long head of the biceps tendon is damaged, a treatment that may be considered is called a biceps tenodesis. Biceps tendon tears in the shoulder are a common source of shoulder pain. The biceps is often considered a major "pain generator" in the shoulder, and tears in the biceps are commonly associated with rotator cuff conditions. In order to fully relieve shoulder pain, the biceps tendon problem may need to be addressed. There are different ways to address biceps tendon problems, both surgical and nonsurgical treatments. A biceps tenodesis is one of the surgical methods to address biceps tendon tears. Learn the Symptoms and Treatments of a Proximal Biceps Tendon Tear Biceps Tenodesis A biceps tenodesis is a surgical procedure performed for the treatment of a damaged proximal long head of biceps tendon. A biceps tenodesis may be performed as an isolated procedure but more often is part of a larger shoulder surgery, such as a rotator cuff repair. During biceps tenodesis surgery, the normal attachment of the biceps tendon in the shoulder joint is detached (if not completely torn already), and the tendon is reinserted to the bone of the humerus (arm bone). When the biceps tendon has ruptured completely, it is obviously not necessary to detach the tendon from within the shoulder. The key to performing a biceps tenodesis is moving the tendon from its normal attachment within the shoulder joint to a new location further down the arm bone. By moving the attachment of the biceps tendon, it is no longer attached to the shoulder joint. This leads to fewer problems down the road, as the damaged biceps tendon can cause problems within the joint. Surgical Options for Rotator Cuff Repair Who Needs a Biceps Tenodesis? A biceps tenodesis can be performed for the treatment of a number of conditions that involve the biceps tendon, including: Rupture of the long head of the biceps SLAP tears Biceps tendonitis Biceps tendinosis Are There Alternatives? There is great controversy about the best way to treat biceps tendon problems in the shoulder. Often, the best treatment of a biceps tendon condition depends on the age of the patient, the activities the patient does, the type of tendon injury, as well as other factors. The other types of biceps tendon surgeries that may be recommended include: SLAP repair Biceps tenotomy Tenotomy or Tenodesis? The ongoing debate is centered on which of these surgical procedures is better, a biceps tenotomy or a tenodesis. Both procedures have advantages and disadvantages. Both are reasonable options, and one may be better for some patients, and the other for other patients. There is not a better or worse procedure. People generally opt for a biceps tenodesis when they are more active, such as athletes or manual laborers, or if they are concerned about the appearance of their biceps muscle. People might opt for the biceps tenotomy if they want faster healing and want to avoid complications of repairing a tendon and having a longer surgery. Recovery From Surgery Surgical recovery after a biceps tenodesis is usually about four to six weeks. However, as mentioned earlier, often a tenodesis is performed along with other surgical procedures that may require a more lengthy recovery. If having an isolated tenodesis procedure, the patient can expect to wear a sling for a few weeks. Mobility of the arm is started early, but full activities are restricted for a minimum of three months. Physical Therapy for Your Shoulder to Increase Mobility After Surgery Complications of Biceps Tenodesis A biceps tenodesis can lead to surgical complications. Usual complications that can occur with any shoulder surgery include infection, healing problems, nerve injury, and pain. A biceps tenodesis requires that a tendon is repaired to the bone. For healing to be complete, the tendon must reattach to the bone. Failures of the tendon to heal, or failures of devices that hold the tendon during healing, occur in a small percentage of patients. The Types and Recovery of Arthroscopic Shoulder Surgeries 4 Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Virk MS, Cole BJ. Proximal Biceps Tendon and Rotator Cuff Tears. Clin Sports Med. 2016;35(1):153-61. doi:10.1016/j.csm.2015.08.010 Alqahtani SM, Bicknell RT. Outcomes following long head of biceps tendon tenodesis. Curr Rev Musculoskelet Med. 2016;9(4):378-387. doi:10.1007/s12178-016-9362-7 Castricini R, Familiari F, De Gori M, et al. Tenodesis is not superior to tenotomy in the treatment of the long head of biceps tendon lesions. Knee Surg Sports Traumatol Arthrosc. 2018;26(1):169-175. doi:10.1007/s00167-017-4609-4 Dang KH, Dutta AK. Osteomyelitis: A Rare Complication After Subpectoral Biceps Tenodesis. Orthop J Sports Med. 2019;7(1):2325967118822732. doi:10.1177/2325967118822732 Additional Reading Nho SJ, et al. Long Head of the Biceps Tendinopathy: Diagnosis and Management. J Am Acad Orthop Surg. 2010 ; 18:645-656. By Jonathan Cluett, MD Jonathan Cluett, MD, is board-certified in orthopedic surgery. He served as assistant team physician to Chivas USA (Major League Soccer) and the United States men's and women's national soccer teams. 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