Biceps tenotomy is a surgical procedure that involves cutting the tendon of the biceps muscle, often performed to treat conditions such as long-standing shoulder pain, biceps tendonitis, or rotator cuff tears. This procedure is typically recommended when conservative treatments, including physical therapy, medications, or injections, have failed to alleviate symptoms. Biceps tenotomy is particularly effective in cases where the biceps tendon causes shoulder pain or dysfunction and is often used in conjunction with other shoulder surgeries such as rotator cuff repair or shoulder replacement.

In this guide, we will explore the details of biceps tenotomy, from the procedure itself to the recovery and rehabilitation process. We will also explain how Palms Physiotherapy & Allied Health can assist in preparing for surgery (pre-habilitation) and supporting rehabilitation after the surgery (post-operative rehabilitation).

Biceps Tenotomy Surgery: Procedure, Recovery, and Rehabilitation

What is Biceps Tenotomy Surgery?

Biceps tenotomy involves the release or cutting of the long head of the biceps tendon, which is located in the shoulder. The tendon connects the biceps muscle to the labrum of the shoulder joint. Over time, the tendon may become inflamed or damaged due to repetitive use, trauma, or degeneration, leading to pain and reduced shoulder function. In biceps tenotomy, the surgeon cuts this tendon to relieve the pain and restore functionality in the shoulder.

Indications for Biceps Tenotomy

• Biceps Tendonitis: Chronic inflammation of the tendon.

• Rotator Cuff Tears: When the rotator cuff is torn, the biceps tendon may also become involved.

• Shoulder Impingement: Pain from the biceps tendon impinging on the surrounding structures of the shoulder.

• Overuse Injuries: Repetitive motions or lifting can strain the biceps tendon.

The Biceps Tenotomy Surgery Procedure

1. Pre-Surgical Preparation

• Diagnostic Evaluation: The surgeon will evaluate the shoulder joint using physical examination and imaging studies, such as X-rays or MRI, to assess the condition of the biceps tendon and surrounding structures.

• Pre-Surgical Physiotherapy (Pre-Hab): Physiotherapy before surgery focuses on strengthening the shoulder and improving its range of motion to enhance recovery post-surgery and prepare the muscles for rehabilitation.

2. Surgical Procedure

• Anesthesia: Biceps tenotomy is typically performed under general anesthesia, although regional anesthesia (nerve block) may also be used in some cases.

• Incision: The surgeon makes small incisions around the shoulder to access the biceps tendon. The procedure is often done arthroscopically, meaning it is minimally invasive and guided by a small camera called an arthroscope.

• Tendon Release: The surgeon cuts the long head of the biceps tendon to release it from its attachment to the shoulder joint. In some cases, the tendon may be repositioned or reattached, depending on the patient’s specific needs and the surgeon’s assessment.

• Duration: The surgery usually takes around 30 minutes to an hour, depending on whether other procedures, such as rotator cuff repairs, are also performed.

3. Post-Surgical Care

• Pain Management: After surgery, patients may experience discomfort, which can be managed through pain relief medications and ice therapy.

• Hospital Stay: Most patients can go home the same day after surgery, but some may need to stay overnight if the procedure was more complex.

Recovery Timeline After Biceps Tenotomy Surgery

Immediate Post-Operative Phase (Days 1–7)

• Sling Use: Patients are typically advised to wear a sling for the first 1–2 weeks to protect the shoulder joint and reduce strain on the tendon.

• Pain and Swelling Control: Ice therapy and prescribed medications will help manage pain and reduce swelling.

• Initial Range of Motion (ROM) Exercises: Gentle range of motion exercises may begin during this phase, as prescribed by the physiotherapist, to prevent stiffness and improve mobility.

Short-Term Recovery (Weeks 1–6)

• Sling Usage: The sling may be worn for 2–4 weeks, depending on the surgeon's instructions, to keep the shoulder secure during the healing process.

• Follow-Up Appointments: The surgeon will check for any complications during follow-up appointments and ensure that the healing process is progressing as expected.

• Physical Therapy Begins: Physiotherapy typically begins 1–2 weeks post-surgery with gentle range of motion exercises. Strengthening exercises may start after 4–6 weeks.

Long-Term Recovery (Months 2–6)

• Gradual Return to Function: Full shoulder rehabilitation progresses with increasing strength training and functional exercises to help the patient return to daily activities and sports.

• Return to Work and Activities: Depending on the physical demands of the individual’s work, they may return to office-based work in 2–6 weeks. More physically demanding activities (such as lifting, sports, or manual labor) may take up to 3–6 months.

Rehabilitation After Biceps Tenotomy Surgery

Phase 1: Early Rehabilitation (Weeks 1–6)

• Focus: Pain management, restoring basic range of motion, and preventing stiffness.

• Exercises:

  • Pendulum exercises: Gentle movement to help with shoulder mobility and flexibility.

  • Passive range of motion (PROM): These exercises help the shoulder joint regain mobility without requiring muscle activation.

  • Ice therapy: To reduce swelling and manage discomfort.

Phase 2: Active Rehabilitation (Weeks 6–12)

• Focus: Strengthening muscles around the shoulder and increasing shoulder mobility.

• Exercises:

  • Active range of motion (AROM): Movements performed independently to increase shoulder flexibility.

  • Isometric strengthening: Exercises aimed at activating shoulder muscles without overloading the tendon.

  • Stretching: To prevent shoulder tightness and improve flexibility.

Phase 3: Advanced Rehabilitation (Months 3–6)

• Focus: Restoring full strength and returning to functional tasks.

• Exercises:

  • Progressive strengthening: Gradually adding resistance to rebuild shoulder strength and stability.

  • Functional training: Exercises that mimic daily activities, such as lifting, reaching, and overhead movements.

  • Sport/Activity-Specific Rehab: If applicable, training specific to returning to sports or more demanding activities.

How Palms Physiotherapy & Allied Health Can Help

Pre-Habilitation Services

• Shoulder Strengthening: Before surgery, we focus on strengthening the muscles surrounding the shoulder joint to ensure a faster recovery and reduce post-operative complications.

• Range of Motion Improvement: Improving flexibility and range of motion before surgery helps patients avoid stiffness after surgery and accelerates recovery.

• Education and Preparation: We provide education about the surgery, post-surgical expectations, and recovery to help prepare you mentally and physically for the procedure.

Post-Operative Rehabilitation

• Individualized Rehab Plans: After surgery, we create a personalized rehabilitation program to help you regain strength, mobility, and function in your shoulder.

• Pain and Swelling Management: Our physiotherapists use modalities like manual therapy, ice therapy, and ultrasound therapy to reduce pain and swelling.

• Strength and Functional Training: We work with you to restore shoulder strength and improve your ability to perform daily tasks, return to work, and resume sports or physical activities.

• Sports-Specific Rehab: For those who are athletes or return to heavy physical work, we offer tailored rehabilitation to ensure a safe return to activity.

Frequently Asked Questions

1. How long will it take to recover from biceps tenotomy surgery?

Recovery time varies, but most patients experience significant recovery within 3–6 months. Full recovery and return to activity can take up to a year.

2. Will my shoulder function return to normal after the surgery?

In most cases, biceps tenotomy significantly improves shoulder function, though patients may experience a decrease in strength in the biceps muscle, especially in overhead motions. The surgery is often well tolerated with good functional outcomes.

3. Can I return to work after biceps tenotomy surgery?

For desk jobs, patients may return to work within 2–4 weeks. However, for jobs involving heavy lifting or overhead activities, a return to full duties may take 3–6 months.

4. Do I need to wear a sling after surgery?

Yes, a sling is typically recommended for 2–4 weeks after surgery to help protect the shoulder during healing.

5. What are the risks associated with biceps tenotomy surgery?

Risks include infection, nerve injury, shoulder weakness, or recurrence of pain. Your surgeon will discuss these risks with you prior to the procedure.

Reputable Australian Resources

• Health Direct – Shoulder Surgery: https://www.healthdirect.gov.au/shoulder-surgery

• Better Health Channel – Shoulder Surgery: https://www.betterhealth.vic.gov.au/shoulder-surgery

• Australian Physiotherapy Association: https://australian.physio

This guide to biceps tenotomy surgery provides an in-depth understanding of the procedure, its recovery process, and how Palms Physiotherapy & Allied Health can assist in optimizing your recovery. Whether you're preparing for surgery or need post-operative rehabilitation, we are here to support you in achieving the best possible outcome.