Dr Puah Ken Lee 潘健理
Orthopaedic Surgeon
Shoulder, Elbow & Sports Injuries
Practising at Mount Elizabeth Novena Hospital, Singapore
Appointments by prior arrangement
Dr Puah Ken Lee 潘健理
Orthopaedic Surgeon
Shoulder, Elbow & Sports Injuries
Mount Elizabeth Novena Hospital, Singapore
✔ Subspecialty Focus in Shoulder & Elbow, Sports Injuries
✔ Practising at Mount Elizabeth Novena Hospital
✔ Evidence-based treatment, Individualised Care
Biceps Tenodesis
Biceps tenodesis is a surgical procedure used to treat painful conditions affecting the long head of the biceps tendon.
Instead of leaving the damaged tendon inside the shoulder joint, it is detached from its original attachment and reattached to the upper arm bone (humerus). This removes the painful portion of the tendon while preserving the function of the biceps muscle.
Biceps tenodesis is commonly performed together with other shoulder procedures, such as rotator cuff repair or subscapularis repair, when the long head of the biceps tendon is contributing to shoulder pain.
What is the Long Head of the Biceps Tendon?
The biceps muscle has two tendons that attach it to the shoulder:
- Long head of the biceps tendon
- Short head of the biceps tendon
The long head travels through the shoulder joint before running within the bicipital groove at the front of the upper arm.
Because of its location, it is susceptible to:
- Tendinopathy
- Partial tears
- Instability
- Degenerative changes
- SLAP tears
These conditions may cause persistent pain at the front of the shoulder.
The damaged portion of the tendon is removed from the shoulder joint and reattached outside the joint.
When is Biceps Tenodesis Recommended?
Biceps tenodesis may be recommended when the long head of the biceps tendon is a significant source of pain or dysfunction.
Common indications include:
- Persistent biceps tendinopathy
- Partial biceps tendon tears
- Biceps tendon instability
- SLAP tears (selected patients)
- Rotator cuff tears with biceps pathology
- Failed non-surgical treatment
The decision depends on the patient’s symptoms, examination findings and associated shoulder conditions.
Conditions Commonly Treated with Biceps Tenodesis
Biceps tenodesis is frequently performed alongside treatment for:
- Proximal biceps tendon tear
- Biceps tendon instability
- Rotator cuff tear
- Rotator cuff tendinopathy
- SLAP tear
- Shoulder impingement syndrome
Treating the underlying shoulder condition is just as important as addressing the biceps tendon itself.
How is the Procedure Performed?
Biceps tenodesis may be performed arthroscopically, through a small incision, or using a combination of both techniques.
The general steps include:
- Assess the shoulder arthroscopically.
- Detach the damaged long head of the biceps tendon from its attachment.
- Prepare the tendon and upper arm bone.
- Secure the tendon to the humerus using an appropriate fixation technique.
- Address any associated shoulder pathology, such as a rotator cuff tear.
The exact technique depends on the patient’s anatomy and the associated procedures being performed.
Why Choose Tenodesis Instead of Tenotomy?
Both procedures aim to relieve pain from the long head of the biceps tendon, but they differ in how the tendon is managed.
Visual
| Biceps Tenodesis | Biceps Tenotomy |
|---|---|
| Tendon is reattached | Tendon is released without reattachment |
| Preserves muscle contour | Higher chance of Popeye deformity |
| Less risk of cramping | Slightly higher risk of cramping |
| Often preferred for younger or active patients | Often suitable for older or lower-demand patients |
| Longer rehabilitation | Simpler procedure |
The most appropriate option depends on your age, activity level, cosmetic concerns and associated shoulder pathology.
Advantages of Biceps Tenodesis
Potential benefits include:
- Relief of anterior shoulder pain
- Preservation of biceps muscle contour
- Reduced risk of Popeye deformity
- Lower risk of muscle cramping compared with tenotomy
- Can be combined with other shoulder procedures
Risks
As with any operation, potential risks include:
- Infection
- Bleeding
- Shoulder stiffness
- Failure of tendon healing
- Persistent pain
- Re-rupture (uncommon)
- Nerve injury (rare)
Your surgeon will discuss these risks in relation to your individual circumstances.
Recovery After Biceps Tenodesis
Recovery depends on whether additional shoulder procedures are performed at the same time.
Typical recovery includes:
First 4 Weeks
- Sling
- Gentle movement exercises
- Protection of the repair
Weeks 4–8
- Gradual increase in shoulder movement
- Physiotherapy
Weeks 8–12
- Progressive strengthening
- Functional rehabilitation
3–6 Months
- Return to heavier lifting
- Return to sport
- Full functional recovery
Recovery Timeline
| Activity | Approximate Time |
|---|---|
| Sling | 4-6 weeks* |
| Desk work | 1–2 weeks |
| Driving | 2–6 weeks |
| Strengthening | 8–12 weeks |
| Return to sport | 3–6 months |
*The duration of sling use may be longer if biceps tenodesis is performed together with procedures such as rotator cuff repair.
Frequently Asked Questions
Will my biceps still work normally?
Yes. The aim of biceps tenodesis is to preserve the function of the biceps muscle while removing the painful portion of the tendon from inside the shoulder joint.
Is biceps tenodesis better than tenotomy?
Neither procedure is universally better. Biceps tenodesis is often preferred for younger or more active patients and for those who wish to minimise the risk of a Popeye deformity. Biceps tenotomy may be appropriate for selected older or lower-demand patients.
Will I have a Popeye deformity?
Biceps tenodesis reduces the likelihood of a Popeye deformity because the tendon is reattached to the upper arm bone. Although no procedure can guarantee a specific cosmetic result, preserving the contour of the biceps is one of the advantages of tenodesis.
Can biceps tenodesis be performed together with rotator cuff repair?
Yes. Biceps tenodesis is commonly performed at the same operation when there is significant disease of the long head of the biceps tendon in addition to a rotator cuff tear.
Why Choose Dr Puah Ken Lee?
Dr Puah Ken Lee is an orthopaedic surgeon in Singapore whose practice focuses on shoulder, elbow and sports injuries. He has extensive experience treating disorders of the long head of the biceps tendon and frequently performs biceps tenodesis as part of a comprehensive approach to shoulder surgery. Every treatment plan is tailored to the patient’s symptoms, examination findings, imaging and activity level.
Related Pages
Conditions
- Proximal Biceps Tendon Tear
- Biceps Tendon Instability
- Rotator Cuff Tendinopathy
- Rotator Cuff Tear
- SLAP Tear
- Shoulder Impingement Syndrome
Procedures
For a full overview of shoulder conditions, visit Shoulder Specialist Singapore
Dr Puah is regularly invited to teach shoulder surgery internationally
Specialist Care for Shoulder Injuries in Singapore
Dr Puah is an orthopaedic surgeon specialising in shoulder, elbow and sports injuries. He provides personalised care tailored to each patient’s condition and activity level.
Consultations are available at Mount Elizabeth Novena.
If you are experiencing shoulder pain that is affecting your daily life or sports, early assessment can help guide appropriate treatment.
Book a consultation or contact the clinic to discuss your condition.
Book a Consultation
Book a consultation or contact the clinic via WhatsApp to get started
Book a consultation at 360 Orthopaedics, Mount Elizabeth Novena
Conditions involving the biceps are common but treatable. Early diagnosis and appropriate management can improve outcomes and prevent long-term problems.
Dr Puah Ken Lee is an orthopaedic surgeon in Singapore specialising in shoulder, elbow and sports injuries at 360 Orthopaedics, Mount Elizabeth Novena. Patients with persistent shoulder pain or instability after injury are encouraged to seek specialist evaluation.