Biceps Tendonitis Surgical Treatment

Surgery may be recommended for patients who have:

• Persistent pain despite a full nonoperative program: Symptoms continuing after three to four months of therapy, load management, and injection.
• Significant partial tearing or degeneration: A thickened, frayed, or partially torn tendon on imaging with symptoms that match.
• Instability of the tendon in its groove: Subluxation or dislocation of the tendon, which nearly always accompanies a subscapularis tear and requires both to be addressed.
• A biceps problem identified alongside another procedure: Patients undergoing rotator cuff repair or labral surgery in whom the tendon is also diseased.
• Rupture in a younger, high-demand patient: Laborers and athletes for whom supination strength and arm contour matter.

Surgery is performed arthroscopically or through a small open incision depending on the procedure chosen, and it is an outpatient operation in nearly all cases. The two principal options address the same problem in different ways, and Dr. Rynecki Baker discusses the all options with each patient before surgery to allow for shared-decision making.

Biceps Tenodesis

The tendon is released from its origin inside the joint and secured to the upper arm bone, either with a suture button or with suture anchors. This removes the painful segment of tendon from the joint and the groove while maintaining the muscle’s length-tension relationship, which preserves contour and supination strength. It is generally preferred in younger patients, athletes, manual laborers, and anyone for whom appearance matters.

The position of the fixation is a meaningful technical decision. Securing the tendon below the groove removes the entire diseased segment, which matters in patients whose pain is localized there, while fixation higher in or above the groove is quicker and avoids a separate incision. Dr. Rynecki Baker selects the technique based on where the tendon is diseased and on the patient’s demands.

Biceps Tenotomy

The tendon is simply released from its origin and allowed to retract. It is a shorter procedure with no fixation to protect, which means a faster and simpler recovery with no restrictions to observe. The trade-offs are a visible bulge in the arm in a proportion of patients, occasional cramping with sustained activity, and a modest loss of supination strength. It is a reasonable choice for older, lower-demand patients, and Dr. Rynecki Baker discusses it honestly as a legitimate option rather than a lesser one.

Treatment of an Associated Subscapularis Tear

When the tendon has become unstable in its groove, the sling holding it there has failed, which almost always means a tear of the subscapularis tendon. Repairing that tear is essential; addressing the biceps alone leaves the underlying problem in place. Recognizing this pattern before surgery changes both the operation and the recovery, which is why the examination and imaging review are aimed specifically at it.

Combined Procedures

Biceps tenodesis is frequently performed alongside a rotator cuff repair, a subacromial decompression, or a distal clavicle excision. When the biceps is addressed as part of a larger operation, the recovery follows the more protective protocol, generally that of the cuff repair.

After an isolated tenodesis:

• Sling use: A sling is worn for approximately two to four weeks to protect the fixation.
• Early motion: Passive and gentle active motion begin early, with the elbow protected from resisted flexion and forceful supination.
• Strengthening: Active biceps strengthening typically begins around six weeks, once the tendon has begun to heal to bone, with progressive loading thereafter.
• Return to activity: Desk work within days, lifting at around three months, and full return to sport or heavy labor generally between four and six months.

After a tenotomy:

• Recovery is faster and less restricted. Motion is unlimited from the start, a sling is used only briefly for comfort, and strengthening progresses as tolerated, with most patients returning to full activity within six to eight weeks.

When a subscapularis or rotator cuff repair is performed at the same time, the protocol follows the repair: a sling for four to six weeks, careful protection of outward rotation, active motion at around six weeks, strengthening at three months, and return to overhead sport between six and nine months.

Every patient receives a written protocol specific to the procedure performed, and Dr. Rynecki Baker works closely with each patient and their physical therapist throughout recovery. Because biceps pain so often develops alongside impingement and rotator cuff dysfunction, the scapular and rotator cuff program continues well after the shoulder feels better.