Biceps tenodesis

Overview

Shoulder joint anatomy showing the humeral head, glenoid socket, and rotator cuff muscles (supraspinatus and infraspinatus). — **Shoulder anatomy.** The shoulder is a shallow ball-and-socket joint. The top of the upper-arm bone (humerus) sits against a small dish on the shoulder blade (glenoid), and four rotator-cuff tendons wrap around the ball to hold it centered during every arm motion.

The long head of the biceps tendon travels through the shoulder joint and anchors onto the top of the glenoid — the same region affected by SLAP tears. When that intra-articular portion of the biceps is damaged or diseased, it becomes a persistent pain generator. Biceps tenodesis moves the anchor out of the joint.

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.