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Biceps tenotomy or tenodesis

Upper Biceps Surgery

This is performed if your long head of biceps tendon is painful and injured, or if it is pulling on an injured superior labrum. The tendon is divided by keyhole surgery often as part of another procedure (e.g. subacromial decompression or rotator cuff repair).  If your tendon is to be re-fixed, this normally involves a 3cm scar near the armpit crease.  It is performed under General anaesthetic +/- regional nerve block

In surgery, your biceps and superior labrum are assessed by arthroscopy before the biceps tendon is divided


If you are having a tenotomy, your biceps tendon is cut at its base


If you are having your biceps tendon re-fixed, the biceps can be re-fixed into the humerus either above or below your Pectoralis major muscle. If you are having a rotator cuff repair at the same time the tendon is often re-fixed to your arm bone arthroscopically within your joint.  However, if the biceps surgery is done as a sole procedure, your tendon is normally fixed below your pectoralis major muscle: this is called a sub-pectoral tenodesis and it involves a small cut just at the front outside edge of your armpit fold. 


What is my recovery after tenodesis surgery?

You will go home a few hours after your operation. Please take your prescribed painkillers regularly for the first few days. Take down any bulky padded dressings on day 2 after surgery. Keep your wound dry and covered with a dressing for 12 days. You can shower after 4 days if your waterproof dressings are on.

You will need to wear a sling for the first four weeks to protect the fixation of the tendon.  You will come out of your sling between after four weeks and increase your range of movement.  Strengthening will begin at about three months. All restrictions will be removed by six months.

Patients vary in their symptoms after surgery, but in general you can expect to return to:

Office work after two weeks (in a sling)

Light physical work after eight to twelve weeks

Heavier labour may take 16-24 weeks

Contact sport usually takes six months

Driving is allowed once you are competent and confident to control a car both for routine and emergency manoeuvres.  It will probably take six to eight weeks for you to be ready. 

When will I be followed up?

You will be seen at two weeks after your operation.  Depending on your progress, your on-going follow up will vary, but many patients can be discharged between three months and nine months after surgery

What can go wrong?

Keyhole Shoulder surgery is generally very safe, but specific risks of upper biceps surgery include:

Stiffness (5%), rarely needs surgery

Popeye sign (50% risk with tenotomy, rare with tenodesis)

This happens when the cut tendon sinks down the arm and causes part of the biceps muscle to bunch up - the contour change is called the 'Popeye' sign

Occasionally patients complain of cramping and fatigue in their arm.  This is usually in younger, higher demand patients and tenodesis reduces, but does not eradicate the likelihood of this

Humeral fracture is a very rare risk following tenodesis, where the fixation slightly weakens the bone.  If the humerus does break, it may require surgery to fix it

Nerve injury is very rare