Proximal biceps tenodesis is an operation to detach the long head of the biceps tendon from inside the shoulder joint and reattach it to the upper arm bone (humerus). It is performed for painful biceps tendon conditions and as an alternative to SLAP repair in some patients.
The procedure can be performed arthroscopically, through a small open incision, or as a combination. The long head of the biceps tendon is released from its attachment inside the shoulder joint and fixed to the humerus using a screw, button, or suture anchor in the bicipital groove. The operation takes 30–60 minutes and is often combined with other shoulder procedures.
Biceps tenodesis is recommended for painful SLAP tears (particularly in patients over 35), biceps tendinitis or tendinopathy that has not responded to non-operative treatment, partial biceps tendon tears, and as part of rotator cuff repair when the biceps is damaged.
Physiotherapy, corticosteroid injection, activity modification, and anti-inflammatory medication. SLAP repair is an alternative for younger patients with SLAP tears.
MRI or MR arthrogram for assessment. Standard pre-assessment.
Good pain relief and preservation of biceps muscle strength and appearance. Recovery is generally faster and more predictable than SLAP repair, particularly in patients over 35.
Tenderness at the tenodesis site may persist for several weeks.
Temporary shoulder stiffness.
The tenodesis may pull out, causing a 'Popeye' deformity of the biceps muscle. Functionally this is rarely significant.
Very rare fracture of the humerus at the fixation site.
Musculocutaneous nerve injury is very rare.
Shoulder infection.
General anaesthesia with a nerve block.
Sling for two to four weeks. Gentle exercises begin immediately. Active biceps loading restricted for six weeks. Return to sport at three to four months. Full recovery at four to six months.
Reviews at two weeks and six weeks. Physiotherapy as needed.
In most cases, the biceps muscle appearance is preserved. Occasionally, if the tenodesis fails, the muscle may bunch slightly ('Popeye sign'), but this is usually cosmetic only.
In patients over 35, tenodesis provides more reliable pain relief with faster recovery. The labrum in older patients heals less predictably, making tenodesis a better option.