What it is
Biceps tenodesis reattaches the long head of the biceps to the humerus. Tenotomy releases the tendon to reduce pain without reattachment. Both minimise traction on the superior labrum. Selection depends on goals, tissue quality, and the presence of coexisting pathology.
Rehabilitation protects the biceps early, then restores shoulder strength and control for performing daily tasks and engaging in sports.
What happens when it occurs
The tendon is released and either reattached lower on the humerus or left free to heal on its own. Early phases limit biceps loading and shoulder external rotation if combined with labral repair. Strength and function progress in planned steps.
Common causes and risk factors
- Persistent biceps-related pain despite rehabilitation
- SLAP lesions and biceps tendon degeneration
- Overhead lifting or throwing with high volumes
Who is most affected
Adults with front-of-shoulder pain are often linked to biceps load, often with coexisting cuff or labral problems.
Typical symptoms pre op
- Anterior shoulder pain with pulling, reaching, and pressing
- Tenderness in the bicipital groove
- Clicking or catching in some positions
When to seek care
If symptoms persist and limit function after a well-run programme.
How we diagnose
History, palpation of the groove, and provocative tests. Imaging is used to assess the tendon and labrum when needed.
Management
- Protected range and avoidance of resisted elbow flexion and supination early
- Scapular and cuff strength within tolerance
- Gradual reintroduction of pulling and pressing
- Work and sport integration with criteria-based testing
Rehabilitation milestones
Phase 1 weeks 0 to 2: pain control, gentle shoulder range, no resisted biceps.
Phase 2 weeks 2 to 6: active range, light cuff and scapular strength, avoid heavy biceps loads.
Phase 3 weeks 6 to 12: progressive biceps loading, pulling and pressing drills.
Phase 4 months 3 to 6: return to heavy work and sport after testing.
Readiness to progress
- Pain is low and stable during pulling
- Strength symmetry within 90 per cent
- Functional tasks completed without next-day flare
Long-term care
- Maintain balanced pulling and pressing strength
- Plan volume increases in small steps
- Manage technique for rows and presses
Australia snapshot
- Tenodesis is common in active adults. Tenotomy is used in lower-demand or combined procedures.
- Access to arthroscopic procedures is broad
- Most return to their previous activity with a staged programme
Latest insights
Protect the biceps early. The quality of pulling and pressing mechanics determines long-term comfort.
Tenodesis preserves strength for individuals who engage in heavy pulling and throwing activities. Tenotomy simplifies recovery for lower-demand goals.
