Overview
The long head of the biceps tendon (the longer of the two heads of your biceps muscle) takes an unusual path — it threads through the shoulder joint itself before anchoring onto the top of the socket, the same region where SLAP tears happen. When that part of the biceps is damaged — torn, frayed, or chronically inflamed — it becomes a constant pain generator deep in the shoulder. Biceps tenodesis solves this by moving the tendon's anchor point out of the joint and securing it to the upper arm bone instead. The biceps still works the same way; it just attaches at a quieter spot.
How the Procedure Works
We release the long head of the biceps from its intra-articular origin arthroscopically, then choose the fixation level. A proximal (suprapectoral) tenodesis — secured in the bicipital groove just outside the joint — is technically straightforward and works well for most patients. A subpectoral tenodesis moves the fixation further down the humerus, completely outside the groove, which is preferred when the groove itself is a pain source or the tendon is significantly diseased through its extra-articular segment. In either case the tendon is secured with a suture anchor or interference screw so it cannot retract; we want the biceps belly sitting at its normal resting length so elbow flexion and supination strength are preserved. When this is done alongside rotator cuff repair, we sequence it first — releasing the biceps decompresses the shoulder and improves visualization for the cuff work.
When to Consider Biceps Tenodesis
Biceps tenodesis is generally offered when symptoms, imaging, and a trial of non-operative care together point to surgery as the next step. The typical picture includes:
Painful biceps tendinopathy
Chronic anterior shoulder pain localized to the biceps tendon, unresponsive to therapy and injection.
SLAP tear in an older patient
A labral tear that would not heal predictably with repair; tenodesis addresses the pain without relying on labral healing.
Concomitant rotator cuff surgery
Biceps pathology discovered during cuff repair that should be addressed at the same time.
Conditions This Treats
Physicians Who Perform Biceps Tenodesis
Providers Who Surgically Assist with Biceps Tenodesis
Risks & Why We Still Recommend It
Every operation carries risk. The reason we offer this procedure is that the condition, left untreated, causes anterior shoulder pain that doesn't settle and a long head of biceps that keeps irritating the rotator cuff and labrum. That is the trade we are managing — not eliminating risk, but choosing the smaller of two unfavorable trajectories.
The risks we discuss with you before biceps tenodesis include:
- bleeding and infection
- anesthesia risk
- stiffness
- residual groove pain or cramping
- humerus fracture through the tenodesis site (rare, from over-reaming or early heavy loading)
- cosmetic 'Popeye' deformity if fixation fails
The indication to proceed is symptomatic biceps tendinopathy, a partial biceps tear, or a SLAP tear pattern better managed by tenodesis than repair. Patients who don't need this operation don't get it.
Further Reading
External patient-education references and related OSI pages for additional background: