Overview
Your biceps muscle has two heads. The tendon of the long head takes an unusual path: it threads through the shoulder joint itself before anchoring onto the top of the socket. That is the same region where shoulder labral tears (SLAP) happen. When that part of the biceps is damaged, torn, frayed, or always inflamed, it becomes a constant source of pain deep in the shoulder. Biceps tenodesis solves this by moving the tendon's anchor point out of the joint. The tendon is secured to the upper arm bone instead. The biceps still works the same way; it just attaches at a quieter spot.
How the Procedure Works
We release the long head of the biceps from inside the shoulder using a camera, then choose where to reattach it. The tendon normally runs through a channel in the upper arm bone called the groove. A higher attachment secures the tendon in that groove, just outside the joint. It is straightforward and works well for most people. A lower attachment moves the anchor further down the arm, completely past the groove. We prefer it when the groove itself is a pain source, or when the tendon is badly worn along that section.
In either case the tendon is locked in place with an anchor or screw so it cannot pull away. We set it at its normal resting length to preserve your elbow bending and forearm rotation strength. When this is done alongside a rotator cuff repair, we do the biceps first. Releasing it opens up space and improves the view for the cuff work.
When to Consider Biceps Tenodesis
We generally offer biceps tenodesis when symptoms, imaging, and a full course of non-surgical care all point to surgery as the next step. The typical picture includes:
Painful biceps tendinopathy
Long-standing pain at the front of the shoulder, traced to the biceps tendon, that has not responded to therapy and injection.
SLAP tear in an older patient
A labral tear that would not heal predictably if repaired. Tenodesis treats the pain without relying on the labrum to heal.
Biceps damage found during cuff surgery
Biceps damage found during cuff repair that should be treated at the same time.
Conditions This Treats
Risks & Why We Still Recommend It
Every operation carries risk. This procedure is offered because the condition, when left untreated, can cause pain at the front of the shoulder that does not settle, with the long head of the biceps continuing to irritate the rotator cuff and labrum. The decision to proceed weighs the risks of surgery against the limitations the condition places on daily function. Surgery does not remove risk; it addresses a problem that is otherwise progressive. Whether it is appropriate is determined for each patient in consultation with the surgeon.
The risks we discuss with you before biceps tenodesis include:
- bleeding and infection
- anesthesia risk
- stiffness
- groove pain or cramping that stays
- a break of the arm bone through the fixation site (rare, tied to the bone tunnel or early heavy loading)
- a 'Popeye' bulge (the biceps muscle bunches lower in the arm) if the fixation fails
Surgery makes sense when you have a painful biceps tendon, a partial biceps tear, or a SLAP tear pattern that is better treated by moving the attachment point than by repairing it. If that picture does not fit you, we do not offer this operation.
Frequently Asked
questions we hear in clinicWill my biceps still work afterward?
Yes. The biceps still works the same way; it just attaches at a quieter spot. The tendon is set at its normal resting length to preserve your elbow bending and forearm rotation strength.
Why move the tendon instead of repairing the tear?
In an older patient, a SLAP tear would not heal predictably if repaired. Tenodesis treats the pain without relying on the labrum to heal, by moving the tendon's anchor point out of the joint entirely.
What is the difference between the high and low attachment points?
A higher attachment secures the tendon in its normal groove just outside the joint; it is straightforward and works well for most people. A lower attachment moves the anchor further down the arm, completely past the groove. We prefer it when the groove itself is a pain source or the tendon is badly worn along that section.
What is a "Popeye" bulge?
If the fixation fails, the biceps muscle can bunch lower in the arm, creating a visible bulge. It is one of the risks we discuss before surgery, along with stiffness, lingering groove pain or cramping, and a rare break of the arm bone through the fixation site.
Can this be done at the same time as a rotator cuff repair?
Yes. When biceps damage is found during cuff repair, it is treated at the same time. We do the biceps first, because releasing it opens up space and improves the view for the cuff work.
Further Reading
External patient-education references and related OSI pages for additional background:
