🔎 What Is a Long Head of Biceps Tenotomy?

The long head of the biceps tendon runs from the top of your shoulder socket (glenoid) through a groove in the upper arm. In some cases, this tendon becomes irritated, inflamed, frayed, or contributes to pain. A tenotomy involves simply releasing or cutting this tendon from its attachment in the shoulder.

It’s often done arthroscopically (keyhole surgery) and may be performed as a standalone procedure or in combination with other surgeries like rotator cuff repair or subacromial decompression.

⚖️ Tenotomy vs Tenodesis: What’s the Difference?

Both tenotomy and tenodesis aim to relieve pain caused by the biceps tendon. But there’s an important distinction:

• Tenotomy: The tendon is cut and allowed to retract.
• Tenodesis: The tendon is cut but then re-anchored to the humerus.

Tenotomy is quicker, simpler, and often preferred for older or less active patients, while tenodesis is typically offered to younger, active individuals concerned about arm aesthetics or strength loss.

🏋️️ What to Expect After Biceps Tenotomy

Most people experience rapid pain relief, especially if the tendon was the main pain generator. Recovery is usually quicker than for procedures like rotator cuff repair.

That said, there can be:

• Popeye deformity: A bulge in the biceps muscle due to tendon retraction. It’s cosmetic and doesn’t affect function.
• Cramping or fatigue in the upper arm during sustained elbow flexion.
• Weakness, especially in elbow flexion, forearm supination, and sometimes shoulder flexion.

These effects tend to be more pronounced in active individuals or those who perform heavy manual work.

⏱️ Recovery Timeline (Standalone vs Combined Procedures)

Standalone Tenotomy:

• Sling use: 1-2 days (if any)
• Return to driving: Within a week
• Gym/light resistance: 2-3 weeks
• Full recovery: ~6 weeks

Tenotomy + Rotator Cuff Repair/Subacromial Decompression:

• Sling: Up to 4-6 weeks (for cuff protection)
• Rehab is dictated by the other procedure
• Recovery may extend to 3-6 months depending on cuff involvement

💪 Can I Still Lift Weights or Climb After Tenotomy?

Yes—many people return to the gym, rock climbing, or manual work. However, some may notice a loss of peak strength, especially in pulling or twisting movements. Progressive loading through a structured rehab program makes a big difference here.

🎯 Why Physiotherapy Still Matters

Even though tenotomy is a relatively low-maintenance procedure, physiotherapy plays a key role in:

• Restoring strength and control in the shoulder and elbow
• Addressing associated issues (e.g., scapular mechanics, rotator cuff deficits)
• Preventing overuse of the remaining short head of biceps
• Reducing the risk of persistent pain or functional limitations

In some cases, post-op pain isn’t from the biceps but from co-existing shoulder pathologies that weren’t addressed.

🤔 Still In Pain After Tenotomy?

Ongoing pain can happen, especially if:

• You had other pathologies (like rotator cuff tears, bursitis)
• There’s nerve irritation or frozen shoulder
• You haven’t rebuilt your strength or mobility adequately

A physiotherapy review can help identify the cause and guide the next step.

📝 Summary

A long head of biceps tenotomy is often a simple, effective solution for certain types of shoulder pain. Recovery is generally quick, but it depends on your activity level, the presence of other injuries, and how well you follow through with rehab.

✅ Need Support After Surgery?

At Melbourne Shoulder Rehab, we specialise in guiding people through shoulder surgery recovery, including biceps tenotomy. Whether you’re just starting your rehab or something doesn’t feel right, we’re here to help.

Book an appointment today and get expert guidance tailored to your goals.