Biceps tenodesis recovery usually follows a steady path. Most people wear a sling for about 2 to 6 weeks, avoid lifting or resisted bending of the elbow for about 6 to 8 weeks, and start building strength after that. Everyday use of the arm often returns by about 3 months. Heavy lifting, manual work and sport often take 4 to 6 months.
Your surgeon’s protocol comes first. If the tenodesis was done alongside another repair, such as a rotator cuff repair, the slower of the two protocols usually sets the pace.
In a biceps tenodesis, the surgeon detaches the long head of the biceps tendon from where it starts inside the shoulder joint, and fixes it lower down, to the upper arm bone (humerus). This removes a painful or damaged section of tendon from the joint. The fixing point needs about 6 to 8 weeks to heal before the biceps can pull hard on it, which is why early limits focus on the elbow as much as the shoulder.
Key takeaways
- Sling: usually about 2 to 6 weeks, depending on your surgeon and any other repair.
- Elbow limits: lifting with the elbow bent, and turning the palm up against resistance, are usually avoided for about 6 to 8 weeks.
- Everyday use: often returns by about 3 months.
- Heavy lifting and sport: often 4 to 6 months.
- Combined surgery: if a rotator cuff repair was done too, recovery usually follows the longer cuff timeline.
Where are you right now?
- The first 2 weeks: read weeks 0 to 2 and “Is this normal?”. Rest the elbow, keep the hand moving.
- Weeks 2 to 6: read weeks 2 to 6. Movement without load.
- 6 to 12 weeks: read weeks 6 to 12 and “If it isn’t going to plan”. Strength starts here.
- 3 months on: read months 3 to 6 and the “When can I” table.
Week by week, then month by month
- Weeks 0 to 2: the arm rests in a sling most of the time. Gentle hand and wrist movement, and often gentle shoulder movement with help, as your surgeon allows. The elbow is usually bent and straightened only with help from the other hand, with no lifting.
- Weeks 2 to 6: shoulder and elbow movement build toward full, without load. Many people come out of the sling during this window if no other repair was done. Avoid carrying bags, opening heavy doors, or twisting a stiff jar lid with that arm.
- Weeks 6 to 12: light strengthening usually starts, beginning with very light weights for the elbow and shoulder and building gradually. Desk work and driving have usually returned by now.
- Months 3 to 4: strengthening progresses. Moderate lifting and gym work with the upper body often return, with heavier loads still building.
- Months 4 to 6: heavy lifting, manual work and sport often return, once strength is close to the other side.
Is this normal?
- Night pain: common for the first few weeks. Sleeping propped up with a pillow under the forearm helps many people.
- Swelling and bruising: bruising down the upper arm and toward the elbow is common in the first two weeks and usually fades.
- Ache at the front of the upper arm: common around the fixing point, especially when you first start strengthening. It usually settles over weeks.
- Stiffness: the shoulder and elbow can both feel stiff while movement is limited. It usually eases as the limits lift.
- Clicking: painless clicking in the shoulder is common and not usually a concern.
- Numbness near the scars: small numb patches around the incisions are common and often shrink over months.
- Low mood: weeks of limited use can wear you down. It is common, and worth telling your doctor about if it lasts.
After a tenodesis, the shoulder may feel ready weeks before the tendon’s new anchor point is.
If it isn’t going to plan
It is week five. The shoulder feels better than it has in a year, and the shopping bag on the kitchen floor looks light. The thought in your head is that the pain has gone, so the tendon must have healed.
The old pain often goes early because the damaged section of tendon has been taken out of the joint. The new fixing point is a different matter. It is usually still healing until about 6 to 8 weeks, and a sudden load through the biceps, such as lifting a bag with the elbow bent, is the strain it is least ready for.
Later on, the opposite can happen: stiffness that stops improving, pain that rises after week 6, or weakness that is not getting better as strengthening goes on. Get assessed by your surgeon or physical therapist if any of these happen. Useful questions to ask:
- Limits: exactly what weight can I lift with this arm, and from when?
- Other repairs: was anything else repaired, and does that change my timeline?
- Strength: how will we progress strengthening, and what is the target before heavy lifting?
- Warning signs: what would tell me the fixing point has been strained?
When can I…
| Activity | Typical range |
|---|---|
| Shower | Usually within a few days, keeping the dressings as your surgeon advises |
| Sleep in bed | Often within 1 to 2 weeks, propped on pillows at first |
| Drive | Often 2 to 6 weeks, once out of the sling and able to control the car safely |
| Desk work | Often 1 to 2 weeks, with the forearm supported |
| Lift | No lifting with the elbow bent for about 6 to 8 weeks; light loads after that, heavier loads often 3 to 4 months |
| Reach overhead | Often from about 4 to 6 weeks without load, later with weight |
| Manual work or sport | Often 4 to 6 months; longer if a rotator cuff repair was also done |
Your surgeon’s protocol comes first.
Call your local emergency number or go to the emergency department if
- Breathing or chest: you have sudden breathlessness or chest pain.
- Tight, swollen arm: the upper arm or forearm becomes very swollen, tight and increasingly painful.
- Hand circulation: the hand turns cold, pale or blue.
See a doctor today if
- Wound changes: a wound is red, hot, leaking or opening.
- Fever: you have a temperature of 100.4°F (38°C) or higher, or chills, or feel unwell.
- Calf swelling: one calf is swollen, warm or painful.
- Spreading numbness or weakness: numbness or weakness in the forearm or hand that is spreading or getting worse.
- Uncontrolled pain: pain is not controlled by the medicine you were given.
- A pop and a bulge: you feel a pop at the front of the arm, followed by a new bulge low in the upper arm or bruising near the elbow. Contact your surgeon today.
Get it checked soon if
- Rising pain: pain at the front of the arm is getting worse after week 6 rather than easing.
- Stalled movement: shoulder or elbow movement has not improved for 3 to 4 weeks.
- Weakness not improving: bending the elbow or turning the palm up stays weak despite strengthening.
More on this area: surgery recovery guides.
After biceps tenodesis, let the calendar set the load, even when the shoulder says it is ready.
Written by Louise Yow, Neck & Shoulder Physio.