Biceps tenodesis surgery takes the top of the long head of the biceps tendon out of the shoulder joint and fixes it lower down, to the upper arm bone. It is used when that tendon is a source of ongoing pain or damage. To prepare, set up your home for one arm for about 2 to 6 weeks in a sling, plan for no lifting with that arm for about 6 to 8 weeks, and arrange help with driving and heavy jobs.
Your surgeon’s protocol comes first. The ranges here are typical, and your surgeon may give you different timings. Use theirs.
Key takeaways
- What it does: the long head of the biceps tendon is detached inside the shoulder and fixed to the upper arm bone.
- Sling: usually about 2 to 6 weeks.
- No lifting: lifting with the elbow bent is usually avoided for about 6 to 8 weeks while the fixing point heals.
- Often combined: it is often done with other shoulder surgery, such as a rotator cuff repair, which can lengthen recovery.
- Heavy work and sport: often 4 to 6 months.
What the operation does
The biceps muscle has two tendons at the shoulder. The long head runs through a groove at the front of the upper arm and into the shoulder joint, where it attaches to the top of the socket. This part can become inflamed, frayed, unstable in its groove, or torn where it joins the socket rim (a SLAP tear).
- The release: the tendon is cut free from its attachment inside the joint, taking the painful section out of the joint.
- The fixation: the tendon is fixed to the upper arm bone, usually with a small anchor or screw, either near the top of the groove or lower down near the armpit. This keeps the biceps at its working length.
The procedure can be done through keyhole incisions, a small open incision at the front of the upper arm, or a mix of both. Your surgeon will choose based on your shoulder and any other repair needed.
What to set up at home before
- Clothing: loose button-front tops, elastic-waist pants, slip-on shoes and front-fastening bras. Put the operated arm in the sleeve first.
- Sleeping position: extra pillows to sleep propped up, and a small pillow to support the forearm.
- Kitchen: move everyday items to between waist and chest height. Use a light kettle filled halfway, and pre-open jars or buy food in containers you can open with one hand.
- Carrying: plan for someone else to carry shopping, laundry baskets and children for about 6 to 8 weeks. A wheeled bag helps.
- Help with driving: arrange rides for about 2 to 6 weeks, longer if another repair was done.
- Work: tell your employer the likely timeline. Desk work often returns in 1 to 2 weeks; manual work often takes 4 to 6 months.
What to practice before
- Sling on and off: practice with one hand, keeping the operated elbow relaxed and supported.
- Helped elbow movement: bending and straightening the elbow using the other hand to do the work. This is often allowed early and keeps the elbow from stiffening.
- Hand and wrist movement: making a fist and opening it, and bending the wrist, several times a day.
- Catching the habit: notice how often you lift a bag, pull a door or carry a cup with the operated arm. Start switching to the other hand now.
The hardest rule after a tenodesis is the one about lifting, because the arm often feels ready before it is.
Questions to ask your surgeon
- Why tenodesis: why this procedure for me, and not a tenotomy (release without fixing) or a SLAP repair?
- Other repairs: will anything else be done at the same time, and how does that change my recovery?
- Sling: how long will I wear it, and when can I take it off?
- Lifting: what can I lift with this arm, and from which week?
- Physical therapy: when does it start, and will you send my protocol to my physical therapist?
- Pain: will I have a nerve block, and how should I take my pain medicine?
The first 48 hours
Most people go home the same day. A nerve block often numbs the arm for several hours, sometimes into the next day. Keep the arm in the sling and start pain medicine as your team advises, before the block wears off.
Expect soreness at the shoulder and at the front of the upper arm where the tendon was fixed. Bruising may spread toward the elbow over the next few days. Keep the hand and wrist moving, and do any helped elbow movements you have been shown. Ice packs wrapped in a cloth, used for short periods if your team allows, help many people.
Call your surgeon or emergency number if
- Breathing: sudden breathlessness or chest pain. Call your local emergency number.
- Tight, swollen arm: the upper arm or forearm becomes very swollen, tight and increasingly painful, or the hand turns cold, pale or blue. Call your local emergency number.
- Pop and bulge: a pop at the front of the arm followed by a new bulge low in the upper arm. Call your surgeon today.
- Wound or fever: redness spreading from a wound, discharge, a temperature of 100.4°F (38°C) or higher, or chills. Call your surgeon.
- Calf: one calf becomes swollen, warm or painful. Call your surgeon the same day.
- Numbness that stays: numbness or weakness in the forearm or hand that lasts well beyond the nerve block, or is spreading. Call your surgeon.
More on this area: surgery recovery guides.
Set your home up for one arm before biceps tenodesis, and the first weeks become about healing rather than coping.
Written by Louise Yow, Neck & Shoulder Physio.