💡 What is Long Head of Biceps Tenodesis?

Long Head of Biceps (LHB) Tenodesis is a surgical procedure designed to address chronic pain, inflammation, instability, or tearing of the biceps tendon at the shoulder. During surgery, the damaged portion of your long head of biceps tendon is removed from its original attachment at the shoulder socket. The surgeon then reattaches it to the upper humerus (upper arm bone) using a small anchor or screw, depending on the technique chosen. from its original attachment at the shoulder socket and reattaches it to the upper humerus (upper arm bone).

The primary goal is to relieve pain, improve shoulder stability, and allow a full return to activity.

🤔 Is Biceps Tenodesis Ever Done on Its Own?

Standalone biceps tenodesis is relatively uncommon. In most cases, it is performed alongside other procedures, such as:

• Rotator cuff repairs
• Subacromial decompression
• SLAP or labral repairs
• Shoulder stabilization procedures

This is because long head of biceps pathology rarely occurs in isolation—it’s often part of a broader spectrum of shoulder pathology. However, standalone tenodesis may be appropriate when:

• Imaging and clinical tests confirm isolated biceps tendinopathy
• The patient is young, active, or has cosmetic or functional issues after a previous tenotomy
• There’s persistent biceps-related pain without other significant structural damage

Your surgeon will determine whether tenodesis is part of a broader shoulder reconstruction or a standalone intervention.

🔄 Alternatives to Tenodesis

Before committing to surgery, your specialist will usually suggest conservative management, including:

• Physiotherapy and rehabilitation exercises
• Anti-inflammatory medications
• Corticosteroid injections

If conservative measures fail, surgical options like tenotomy (simply cutting the tendon) may also be considered, particularly for less active individuals.

🛠️ How to Prepare for Your Surgery

To set yourself up for the best outcome, it’s important to understand the process and prepare thoughtfully:

• Pre-operative Imaging: Your surgeon may use MRI or ultrasound scans to evaluate tendon quality and confirm the diagnosis.
• Optimise Your Health: Maintain good overall fitness, as better general health promotes quicker recovery.
• Plan Your Support: Arrange assistance for daily tasks post-surgery, as you’ll initially have limited shoulder function.

🧬 Step-by-Step: What Happens During the Surgery?

Biceps tenodesis can be performed arthroscopically (keyhole surgery) or via an open approach:

• Arthroscopic Tenodesis: Minimally invasive, shorter recovery period, smaller incisions.
• Open Tenodesis: Offers direct visualization and might be used in more complex cases.

The damaged tendon is detached and anchored into the humerus using bioabsorbable screws or anchors. Your surgeon will select the technique based on your tendon quality, age, and activity goals.

⚠️ Potential Risks and Complications

Though uncommon, it’s important to know potential complications such as:

• Infection or wound issues (very rare)
• Temporary nerve irritation or numbness
• Stiffness or reduced range of motion
• Rarely, failure of the tenodesis requiring revision surgery

By being aware of these risks, you can spot potential problems early and take proactive steps to address them.

Recovery Timeline: Week-by-Week

👉 For Standalone Biceps Tenodesis

Weeks 1–2: Immediate Post-Op

• Sling protection, gentle hand/wrist exercises
• Pain and swelling management

Weeks 3–6: Initial Healing

• Sling gradually discontinued
• Physiotherapy begins with passive and gentle active-assisted exercises

Weeks 6–12: Building Strength and Mobility

• Active strengthening exercises begin
• Gradually resume non-overhead functional tasks

Weeks 12–16: Return to Activity

• Advanced strengthening
• Gradual reintroduction to sports and overhead tasks under guidance

16+ Weeks: Full Recovery

• Return to unrestricted activity, including competitive sports, typically around 4–6 months post-surgery.

⚠️ If Combined With Rotator Cuff Repair or Labral Surgery

• Recovery may be slower and more cautious, especially in the early stages
• Sling use may be required for longer (4–6 weeks)
• Strengthening phases may be delayed to protect repaired tissues
• Return to full sport or overhead work may take 6+ months, depending on the complexity

Your physiotherapist will tailor your rehab to the specifics of your surgery and tissue healing timelines.

🧘 Why Physiotherapy Is Essential

Physiotherapy isn’t just beneficial—it’s essential to your successful recovery from tenodesis surgery:

• Individualised Rehab Programs: Tailored exercises help restore shoulder strength, stability, and function safely.
• Minimise Complications: Early guided movement reduces the risk of stiffness or scarring.
• Optimise Return to Activity: Progressive rehabilitation ensures you return to sport or work confidently, reducing re-injury risk.

🏃 Returning to Work and Sport

• Office or light work: 2–4 weeks (standalone) or 4–6 weeks (if combined procedure)
• Physical/manual labour: Typically 3–4 months (standalone) or longer with combined surgery
• Overhead sports: Approximately 4–6 months (standalone) or 6–9 months (if concurrent rotator cuff repair)

Your exact timeline depends on healing, strength, and specific occupational or athletic demands.

📈 Signs Your Rehab Is On Track (or Not)

• Positive Signs: Gradual reduction in pain, steady improvement in strength and range of motion.
• Warning Signs: Persistent or worsening pain, swelling, or significant stiffness beyond expected timelines. Consult your physiotherapist or surgeon immediately if these arise.

❓ Frequently Asked Questions

Is weakness only limited to elbow flexion?

Not necessarily. While many people associate biceps function primarily with elbow flexion, the long head of the biceps also contributes to forearm supination and assists in shoulder flexion.

From clinical experience, some patients report lingering weakness not only in bending the elbow, but also when rotating the forearm (e.g., turning a doorknob or using a screwdriver) and lifting the arm forward. These deficits can sometimes be subtle or overlooked, which is why thorough assessment and targeted rehab are critical.

Will I regain full strength?

Most patients return to near-normal strength and function, particularly with a structured physiotherapy program.

Does tenodesis affect appearance?

Cosmetic changes (such as “Popeye” deformity) are rare and far less likely than with tenotomy.

Can tenodesis fail?

Rarely, but revision surgery is possible if necessary.

🔑 Key Takeaways for a Successful Recovery

Long head of biceps tenodesis can provide lasting relief and restore functional use of your shoulder and arm—especially when the right surgical approach is matched with a well-structured rehab plan 💪. Understanding the timeline, recognising potential pitfalls, and actively participating in physiotherapy can make a significant difference in your outcome ✅.

Don’t leave your recovery to chance—team up with clinicians who understand how to guide you through both the surgical and rehab process with clarity and confidence 🧠.

📅 Ready to Get Started with Expert Physiotherapy Support?

If you’re considering biceps tenodesis or already recovering, our specialised shoulder physiotherapy team at Melbourne Shoulder Rehab can help you achieve optimal results through evidence-based rehabilitation.

Book your expert consultation now, and let us guide you safely through every stage of your recovery.

References

• Frank, R. M., et al. (2018). Biceps Tenodesis Versus Tenotomy: An Evidence-Based Perspective. The Journal of Bone and Joint Surgery, 100(20), 1712-1720.
• Werner, B. C., & Brockmeier, S. F. (2017). Outcomes of Biceps Tenodesis in Athletes. Clinics in Sports Medicine, 36(4), 679-688.
• Creech, M. J., & Yeung, M. (2020). Biceps Tendon Pathology: Diagnosis and Management. Journal of the American Academy of Orthopaedic Surgeons, 28(5), e207-e217.