A biceps tenodesis is a surgical correction specifically for the attachment of the biceps at the shoulder. This could involve the long or short head of the biceps, but more commonly involves the long head.
There are multiple surgical techniques that may be used to during this type of surgery. Essentially, the damaged portion of the biceps is surgically removed from its current attachment point, and is then re-attached to a more secure area. This more secure area usually involves attachment to the upper arm bone, or humerus, or it could be re-attached to a region of soft tissue, such as a nearby shoulder ligament.
A biceps tenodesis can be done as a solo procedure, but it’s also not uncommon for it to be performed in conjunction with another surgical procedure, such as a rotator cuff repair.
On a different note, a biceps tenodesis has even be used to correct a labral tear, specifically a SLAP (Superior Labrum Anterior Posterior) tear. While a SLAP repair is still commonly used, a biceps tenodesis has been used in certain patient populations.
Similar to other surgeries we’ve discussed, the recovery for a biceps tenodesis can vary among each individual. An average recovery time can range from 4-6 months. If you’re aiming to return to a specific sport or recreational activity, then recovery may go a bit longer than this, such as a 6-9-month time frame.
In this article, we’re going to take a closer look at the recovery time and rehab process after a biceps tenodesis.
Here we go!
Phase I: Weeks 0-6
The following are the primary goals during this phase of recovery:
- Protect the shoulder! (This is probably a given)
- Reduce pain and inflammation
- Avoid negative side effects from immobilization
It’s pretty typical to wear a sling after this type of surgery for about the first 3-4 weeks, including while sleeping. You will be allowed to practice elbow and hand range of motion, but must avoid active use of the shoulder.
You will be allowed to initiate gentle passive range of motion and active assisted range of motion in certain directions, such as with flexion, scaption, internal and external rotation in about 45-degrees of abduction (these specific directions will be reviewed by your physical or occupational therapist during rehab).
While light movement is able to begin, it’s important not to force the range of motion. Typically, you’ll be moving in these directions within somewhat of a restricted range.
As mentioned above, full active range of motion is not performed yet at this point; however, you will be able to begin practicing light shoulder isometrics. Shoulder isometrics involve a submaximal contraction of the shoulder musculature.
The one direction you will avoid with the isometrics though is shoulder flexion, so that you don’t actively contract the biceps. Generally speaking, you want to avoid any isolated biceps contraction.
Another important thing to remember… Ice, ice, ice! Inflammation is a natural part of healing, but we still want to keep it under control. Ice is very helpful for this, as well as pain management. You can ice for approximately a 20-30-minute time frame, but no longer than 30-minutes max to avoid hurting the skin. Always give at least a half hour break in between icing sessions.
As you reach the 3-4-week mark post-operatively, your surgeon will usually allow you to stop using your sling, but should still sleep in it for up to the 4-week mark.
As you continue to progress through your first 6 weeks, your movement and exercise allowance will also continue to improve and expand.
Some exercises and movements that will gradually be added throughout this phase include the following:
- Passive and active assisted range of motion progression
- Rhythmic stabilization exercises
- Proprioception training
- Scapular strengthening
- Resistance band exercises in certain directions
- Prone rowing and horizontal abduction
Throughout this first phase of recovery though, you will still hold on biceps strengthening. NO direct strengthening or activation of the biceps until cleared to do so by your surgeon and therapist.
In the later part of this phase (usually weeks 5-6), you will be able to start active range of motion in select directions, including shoulder abduction and scaption.
Phase II: Weeks 7-14
The following are the primary goals in this phase of recovery:
- Restore full range of motion gradually
- Continue to protect and preserve the surgical site
- Regain muscular strength and balance in the shoulder complex
During these weeks, your range of motion should gradually be restored to full capacity. Keep in mind that how much range of motion you regain will also be determined by the status of the shoulder pre-operatively, how much damage was done that needing repairing, and how diligent you are with your rehab post-operatively.
Your therapist will likely include hands-on manual techniques, such as massage, myofascial release, trigger point release, and joint mobilizations. These techniques will help with pain management and restoring your range of motion.
You will gradually progress resistance training during this time frame to regain strength and stability in the shoulder complex. This will include use of resistance bands and light free weights.
Towards the end of this phase, the exercise and activity progression in rehab should include focus especially on functional demands, such as that of a baseball player that must return to overhead throwing.
Along the way, of course, day-to-day functional tasks will be included in the recovery process.
Phase III: Weeks 14-20
The following are the main goals looking to be achieved during this phase of recovery:
- Achieve and maintain full range of motion
- Gradually initiate functional activities, such as return to sport
- Continue to progress strength, stability, power and endurance
If any range of motion is lacking, it will continue to be addressed in this phase of recovery.
As previously mentioned, we’re looking at adding components of early return to sport. This may include practice of a thrower’s motion, endurance training, light plyometrics, and restricted sports activities. Make sure to tell your therapist which specific sports and recreational activities you’re trying to get back to, so that they can include this in your program.
Phase IV: Weeks: 20-26
During this phase of healing, the following are goals to keep in mind:
- Achieve full, pain-free range of motion
- Achieve nearly full strength and stability as opposite shoulder
- Have no pain or tenderness present
As each phase of recovery continues, you’re trying to continue pushing yourself, so that you can get back to your prior level of function.
This includes continuing to practice exercises to maintain range of motion and flexibility, progress your strengthening program, as tolerated, progress plyometric strengthening, if applicable, and continue your return to sports program.
Phase V: 6-9 Months Post-Surgery
At this point, you should really feel more like yourself again (yay!). If you’re participating in a return to sports program, you’ll gradually get back to your actual sporting and recreational activities versus solely training for them.
That’s essentially it!
A biceps tenodesis can be more of a challenging surgery to recover from, especially early on. If you allow yourself the proper healing time and follow the instructions of your surgeon and rehab specialist, you will recover beautifully.