Biceps Tenodesis

The Goal

Dr. Kevin Wall provides specialized, fellowship-trained surgical treatment for Biceps Tenodesis to restore function and relieve pain for patients in Richmond, VA, and the surrounding Central Virginia communities. The goal of this procedure is to treat biceps tendonitis or SLAP tears and eliminate chronic, deep-seated shoulder pain caused by this tearing or severe inflammation of the long head of the biceps tendon. The biceps tendon often becomes a "canary in the coal mine" for other shoulder issues, such as rotator cuff tears and so this procedure is commonly performed alongside other ones. By performing a tenodesis, we relocate the tendon's attachment from the sensitive superior labrum inside the joint to a more stable, non-articular position on the humerus bone. The inflammed and painful segment of tendon between the old attachment at the superior labrum and the new attachment on the humerus is then removed. This removes the painful "tugging" sensation while preserving the natural contour and strength of the bicep muscle.

This page is designed to educate you specifically about this procedure. Additional information that generally applies to most of Dr. Wall’s surgeries can be found on these pages:

• Pre-Operative Instructions

• Post-Operative Instructions

• Physical Therapy Protocols

The Procedure

• The Approach: Typically performed arthroscopically (minimally invasive). Small portals are made around your shoulder and instruments are used to pass high-strength suture through the biceps tendon.

• Tendon Release: The tendon is carefully detached from its origin at the top of the shoulder socket.

• Anatomical Fixation: A small socket is prepared in the humerus bone, and the tendon is secured by inserting the suture previously passsed through it into a high-strength anchor. This provides the strong fixation necessary for an early rehabilitation program.

• Debridement: Any frayed or unhealthy tissue still at the superior labrum is trimmed.

Post-Op Protocol

• Immobilization (0–4 weeks): A sling is required at all times, including during sleep, for the first 4 weeks to protect the new tendon attachment. It may be removed for hygiene, elbow range of motion, and formal therapy sessions.

• Early Motion (Weeks 2–4): Formal physical therapy begins at post-operative Week 2. Initial exercises focus on passive range of motion (PROM), with strict limits on external rotation (40°) and extension (neutral) to protect the repair.

• Active Motion (Weeks 4–6): You will begin weaning from the sling. Exercises progress from passive to active-assisted (AAROM) and eventually active range of motion (AROM). Heavy lifting and running remain restricted during this phase.

• Strengthening (Week 8+): Progressive strengthening begins once full range of motion is achieved. Most patients can return to labor-intensive work or recreational sports after the 12-week mark.

When to Seek Care

You should schedule a consultation if:

• You have a painful 'snap' or 'pop' in the front of your shoulder followed by a new bulge in your lower arm.

• You have sharp, localized pain in the front of the shoulder that worsens when lifting or reaching.

• Your shoulder pain is most intense when performing "pulling" motions or carrying heavy objects.