The long-head biceps tendon can cause pain at the front of the shoulder, often with lifting or overhead activity. Tendon problems may coexist with rotator cuff or labral injuries.
Symptoms and related conditions
Patients may experience pain in the groove at the front of the shoulder, tenderness, pain with resisted lifting, or mechanical catching. Biceps disorders often coexist with rotator cuff tears, subscapularis injury, or SLAP lesions. The physical examination helps distinguish these conditions; ultrasound or MRI may be useful when diagnosis is uncertain.
Nonoperative treatment first
Depending on the cause, initial care may include temporary modification of aggravating activities, physical therapy focused on shoulder mechanics, targeted strengthening and appropriately selected anti-inflammatory strategies. An injection may sometimes help clarify the source of pain or provide symptom relief, but its benefits and potential risks should be discussed carefully.
When is biceps tenodesis considered?
For persistent symptoms, significant tendon tearing, certain biceps pulley injuries, or associated pathology requiring surgery, biceps tenodesis may be considered. In this procedure, the diseased long-head tendon is released from its intra-articular attachment and secured elsewhere on the upper arm bone. This can address a symptomatic tendon while maintaining a functional attachment for the muscle. It is not necessary for every case of biceps pain.
Tenodesis, tenotomy or labral repair?
Technique selection depends on age, athletic demands, tendon and labral integrity, concurrent procedures and personal goals. Certain younger overhead athletes with a repairable superior labral injury may be considered for labral repair, while others may be better served by a biceps-focused procedure. There is no universally best operation for all patients.
Recovery after biceps tenodesis
Passive range of motion (PROM) means your shoulder is moved with help, without the shoulder muscles lifting the arm. Active range of motion (AROM) means you move the arm using your own muscles. Both follow the limits in your physical therapy protocol.
- First 2 weeks: use a sling to protect the shoulder after an isolated biceps tenodesis.
- Until 6 weeks: protect the biceps attachment. Do not progress to full biceps effort or put weight through the arm before the 6-week point and clearance from your care team. Your protocol specifies which elbow movements and exercises are allowed.
- If another repair is performed: these timings apply only to biceps tenodesis without a rotator cuff repair. A combined cuff or labral repair follows the restrictions for the full operation.
Preventing stiffness is a priority
Stiffness is a major concern after shoulder surgery. Physical therapy is essential to restoring motion and function while protecting healing tissue. Dr. Haber works with trusted therapists across the Front Range and recommends a therapist based on where you live.
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