Long Head Biceps Tenodesis/Tenotomy
How is a long head Biceps Tenodesis/Tenotomy performed?
Long head biceps tenodesis or tenotomy is performed to treat inflammation or damage in the long head of the biceps tendon, which runs through the shoulder joint.
In a tenotomy, the tendon is released from its attachment inside the shoulder joint, allowing it to retract. This is a quick, minimally invasive procedure often used in older or lower-demand patients.
In a tenodesis, the tendon is detached from its original position and reattached (fixed) to the upper arm bone (humerus) using an anchor. This maintains the contour and function of the biceps and is preferred in younger or more active individuals.
Both procedures can be performed arthroscopically (keyhole) or through a small incision, depending on the patient’s anatomy and associated shoulder pathology.
What Is the Recovery in the Immediate Postoperative Period?
Hospital stay: Most patients go home on the same day of surgery.
Sling: You will wear a sling to support and protect the arm for 2 weeks.
Range of motion: Gentle passive motion of the shoulder is started immediately. Active elbow flexion and resisted elbow movements are restricted for 2 and 4 weeks, respectively.
Ice: Used frequently to control pain and swelling. You should ice for 20 minutes, 3–4 times per day immediately after surgery. An ice/compression machine can be hired from a third party.
Sleep: You may find it more comfortable to sleep in a reclined or semi-upright position with the sling on for the first few weeks.
How Is the Wound Managed?
Bulky dressings will be removed 1–2 days after surgery.
A waterproof underlay dressing should be left on for 2 weeks.
Incisions typically heal within 2 weeks.
Showers are permitted while wounds are covered with waterproof dressings during the first 2 weeks.
Do not submerge incisions in water (baths, pools, or ocean) for 4 weeks.
A wound check with your GP, allied health provider, or our clinic is recommended at 2 weeks.
Absorbable sutures are usually used and do not require removal, though small remnants may surface naturally during healing.
How Do I Manage My Pain After a Long Head Biceps Tenodesis/Tenotomy Procedure?
Your anaesthetist may use a regional nerve block to help control pain immediately after surgery.
Local anaesthetic will also be injected into the shoulder during the procedure.
Use ice regularly (20 minutes, 3–4 times per day). An ice machine may be hired from a third party.
Take prescribed pain medication as directed. Opioids may be used short-term but have known side effects (nausea, constipation, dependence). Non-opioid medications such as paracetamol or anti-inflammatories are preferred when tolerated.
Keep the arm supported in the sling to minimise strain on the repair site and improve comfort.
What Issues Should I Call the Clinic Regarding?
You should contact your surgeon or clinic immediately if you notice:
Increasing redness, swelling, or foul-smelling drainage from the wound.
Persistent or worsening pain not controlled by medication.
Fever, chills, or night sweats.
Numbness or tingling that does not resolve after the nerve block wears off.
Any sudden injury to the arm or shoulder.
Prompt review allows early management of potential complications.
When Can I Return to Normal Activities After a Long Head Biceps Tenodesis/Tenotomy?
Recovery varies depending on whether a tenotomy or tenodesis was performed. General guidelines include:
Light daily activities: Immediately, using your non-operated arm.
Gentle shoulder and elbow movement: Starts at 2–4 weeks.
Strengthening: Begins around 4–6 weeks.
Return to sport or heavy activity: Usually 3–6 months after tenodesis and earlier after tenotomy, depending on recovery and the demands of activity.
When Can I Drive?
You can usually drive once you can safely control the steering wheel and perform emergency manoeuvres comfortably. This is typically around 4–6 weeks after surgery. You must not drive while taking strong pain medication (e.g., opioids).
When Can I Return to Work?
Return to work depends on your occupation:
Office or sedentary work: 1–2 weeks, once you can safely commute and perform desk tasks.
Light manual work: 2–4 weeks.
Heavy manual labour or overhead work: 6–8 weeks, depending on recovery and surgeon clearance.
Should I See a Physiotherapist?
While not strictly necessary, formal physiotherapy is strongly recommended for optimal recovery after long head biceps tendon procedures. Your physiotherapist will:
Guide you through a rehabilitation program focusing on gentle mobility, then gradual strengthening.
Protect the repair early on (avoiding resisted biceps loading after tenodesis).
Progress exercises to restore shoulder and elbow function safely.
What Are the Complications After a Long Head Biceps Tenodesis/Tenotomy Procedure?
While uncommon, complications may include:
Persistent pain or stiffness around the shoulder.
Re-rupture or failure of the tenodesis fixation.
Cosmetic deformity (“Popeye” bulge) after tenotomy.
Nerve irritation, injury, or numbness around the incision.
Infection or wound healing issues.
Fracture.
Weakness with heavy lifting or repetitive overhead activities.
Complications related to the anaesthetic block (temporary nerve effects, shortness of breath, or rarely pneumothorax).
