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ShouldersBicep Tenodesis

ShouldersBicep Tenodesis

Bicep Tenodesis

Shoulder joint repair is a medical procedure adopted worldwide to correct shoulder problems. One of the surgical procedures used by Christopher Sforzo, M.D for shoulder repair is The Biceps Tenodesis.

This article will focus on Biceps Tenodesis, symptoms and risk factors, and our Biceps Tenodesis protocol. We will also help you understand what to expect during and after your surgery at Sforzo l Dillingham l Stewart|Orthopedics + Sports Medicine.

What Is Biceps Tenodesis?

This is a surgical procedure carried out to treat and repair a biceps tendon tear or severe tendonitis.   The biceps tendons are the muscles that connect your shoulder and the biceps muscles. These muscles enable you to bend your elbows and turn your forearm upwards.

A biceps tendon tear reduces the strength of your muscle movements and may deform the muscles. This surgical procedure is necessary when your biceps tendons cause pain in your shoulders.

Biceps Tenodesis involves the removal of the damaged biceps tendon and reattachment to the top of the shoulder to a new place. As a result, you will experience pain relief, and retain strength, and mobility of your shoulder joints.

Symptoms of Biceps Tenodesis

A biceps tendon tear may occur as a result of a traumatic injury to your shoulder muscles or repeated shoulder movement. Despite the cause, you should watch for worrying symptoms of abnormalities around your shoulder muscles.

Below are common symptoms of Biceps Tenodesis:

  • Bruises on your biceps from the middle portion toward the elbow
  • Cramping of your biceps during a tedious shoulder exercise or after carrying a heavy load
  • Difficulty rotating your arm upward or downward
  • Sudden pain in the upper arm, characterized by a snapping sound
  • Pain and weakness on both the shoulder and elbows
  • Swelling on your upper arm

Risk Factors of Biceps Tendon Tear

Biceps tendon tear is caused by several factors such as shoulder injury and advanced age. However, there are risk factors that may contribute to the tearing of your biceps tendon muscles.

Below are the risk factors that may increase the tear of tendon muscles:

Overuse of the Shoulder

Shoulder overuse occurs from a repeated shoulder motion while doing daily activities. This may be due to sporting activities like tennis, swimming, baseball, and physical labor. A continuous overhead motion of your shoulder muscles increases your chances of tendon tear because it wears out the biceps tendons.

Shoulder Overuse Injury Showing an Inflamed Bursa

Image Source: The University of Pennsylvania


These are anti-inflammatory medications prescribed for various conditions. They are effective in the treatment of swelling, bowel disease, asthma, and rashes. Corticosteroid injections can also treat joint and muscle conditions, including inflammation of tendinitis.

However, according to Mayo Clinic, Corticosteroids also carry serious health risks and side effects. Long-term use of oral Corticosteroids, for instance, leads to bone thinning and fracture. Thus, if you are on long-term corticosteroid therapy, be sure to talk to Dr. Christopher Sforzo about the side effects to reduce your chances of developing biceps tenodesis.


According to studies, cigarette smoking has serious effects on the body’s muscle-skeletal system. This comes from the toxic effect of nicotine, a compound present in cigarettes. Increased nicotine intake through smoking reduces your bones’ mineral content and increases your chances of fracture. In the study published by The US National Library of Medicine, smoking increased the risk of having a bone fracture by 32% and 13% in men and women, respectively.


Age advancement increases the risk of fracture or tears on the biceps tendons. The condition is most common among patients aged 40-60 years. This occurs due to rapid wear out of the tendons due to old age.

How is the Surgery Performed?

The aim of the surgery is to remove the damaged tendon from its normal point of attachment to the shoulder to a new position at the top of the arm bone. This prevents the damaged tendons from affecting your shoulder movement. A biceps surgery may involve a simple, soft tissue technique or a hardware fixation procedure.

Subpectoral Biceps Tenodesis

Image: Science Direct

Below are the steps you should expect during your surgery:

Health Evaluation

Dr. Christopher Sforzo at Sforzo | Dillingham | Stewart Orthopedics + Sports Medicine will first evaluate your medical condition before surgical operation. This will help identify if you are medically fit and able to recover from the surgical procedure without major complications. The medical examination may involve an overall review of general, mental, and physical health.

Medication Review

Are you on any medication? Be sure to share that information with Dr. Christopher Sforzo before the actual surgery. The purpose is to ensure you do not experience excessive bleeding during the operation. Such medication includes blood thinners, aspirin, and anti-inflammatory medications. Three days before the procedure, you should not take any of the medications unless guided by the doctor.


Before the operation, you will receive a dose of anesthetic medicine to help control the pain arising from the incision within 12-18 hours after surgery. For all forms of shoulder tendon surgery, general anesthesia is used. Thus, you will likely fall asleep during the entire procedure.

Actual Surgery

During the procedure, Dr. Christopher Sforzo at Sforzo | Dillingham | Stewart Orthopedics + Sports Medicine will use a special camera aid (arthroscope) to view the interior part of the shoulder joint. The doctor will use a suture to mark the exact position of the affected tendon. 

For a clear view of the biceps tendon, Dr. Christopher Sforzo will make a small incision on the front part of your shoulder. The doctor will then open the biceps sheath to remove the tendon from the wound. He will create a hole in the shoulder bone and fix the tendon onto the humerus bone using a special screw or anchor device. 

How to Tell If You Need Surgery

Besides surgery, a mild form of biceps tendons tear is manageable using simple treatment options. These include:

  • Icing
  • Anti-inflammatory medication such as ibuprofen
  • Cortisone injections
  • Physical therapy and training exercises
  • Body rest

Mild forms of biceps tendonitis will allow your arm to function well. However, if you fail to find pain relief or recovery of muscle strength after these simple treatment techniques, then you may consider surgery. Dr. Christopher Sforzo at Sforzo | Dillingham | Stewart Orthopedics + Sports Medicine will help you perform shoulder and arm movements to determine the severity of your condition.

Possible Complications

Unlike other forms of surgery, complications arising from biceps tenodesis are uncommon. According to research gate, in orthopedic sports medicine, only 2% of post tendonitis complications occurred among 353 patients sampled between January 2005-December 2007.

One of the most common complications of biceps tenodesis is a bulge on the upper part of the arm. This condition is sometimes referred to as Popeye’s deformity. It occurs from an injured tendon that is detached from the shoulder joint, creating a bunch of muscle mass on the upper shoulder.

Other complications:

  • Re-rapture of the biceps tendon
  • Infections
  • Hematoma
  • Nerve injuries
  • Fracture of the humerus bone
  • Persistent pain


What is a Bicep Tenodesis?

It is a surgical operation carried out on the biceps tendons to help reduce pain on the shoulders. The major causes of biceps tenodesis are injury on the shoulders, overuse of the shoulder muscle movement, aging, and rotator cuffs complications among athletes.

How long does Bicep Tenodesis surgery take to heal?

Recovery from a bicep operation procedure is a gradual process that takes occurs in stages. In addition, recovery depends on a number of factors: age, the severity of your injury, your health condition before the injury, and the rehabilitation techniques you use.

During the first 4 – 6 weeks after your operation, you will wear a sling to restrict your arm movement and facilitate healing. 

After six weeks, you may increase your range of motion under the guidance of a physical therapist. Gradually, you may increase the amount of effort on your shoulders, hands, and arm. 

Within 12 weeks, you should expect a return to normalcy, where you may take part in sporting activities such as throwing sports and swimming.

What can you not do after Bicep Tenodesis?

Shoulder surgery requires post-operative care and management to help in the recovery process. Thus, after your surgery, you should observe a number of precautions.

First, you will wear a sling during the first month after your surgery. During this period, you should wear the sling at all times and sleep with the sling on. You may, however, remove it to facilitate elbow movement when dressing or washing.

In addition, you shouldn’t lift any weight or object using your operated arm until allowed by the doctor. Before you heal completely, avoid activities that may put pressure on the affected arm. These may include chopping wood, sports with a high risk of falling or contact, and overhead tasks such as painting the ceiling.

As long as you are on pain medication, you should not drive a car. You may only resume driving your car when you no longer take medication and are cleared by Dr. Christopher Sforzo. This may take about 4-5 weeks.

If you had an open bicep tendon surgery, you should not take a shower until Dr. Christopher Sforzo at Sforzo | Dillingham | Stewart Orthopedics + Sports Medicine confirms it is okay. However, for arthroscopic bicep surgery, you may take a shower between 48-2 hours after the surgical procedure. While bathing, do not raise your affected arm.

If you had open surgery, do not remove the dressing unless instructed by Christopher Sforzo, M.D., and verified to be okay.

Is Bicep Tenodesis a Major Surgery?

The procedure is a minor surgery that lasts for about 60-90 minutes. It may be carried out alone or as part of a major procedure on your shoulder. 

Shoulder surgery is still a safe and effective treatment option for shoulder fractures and related complications. However, after surgery, follow-up care is the key to a quick recovery. At Sforzo Dillingham|Stewart Orthopedics + Sports Medicine, we offer emergency help for post-surgical complications. In addition, if you’re unsure whether your condition requires surgery, do not hesitate to contact us.

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