Biceps Tenotomy

The most common cause of long head biceps tendon problems is degeneration from aging and repetitive use. Over time, the tendon becomes worn and may fray or tear. Other causes include:

• Overuse from repetitive overhead motions, common in athletes and workers who use their arms frequently
• Rotator cuff injuries, which often occur in combination with biceps tendon problems
• Shoulder impingement syndrome, where the tendon becomes pinched and irritated
• Trauma, such as a fall or sudden heavy lifting, which can cause acute tearing of the tendon

Many patients develop symptoms gradually, but others may notice sudden pain and weakness if the tendon ruptures.

Problems with the long head of the biceps tendon can place added strain on the shoulder and lead to other complications if left untreated. Risks of untreated tendon problems include:

• Chronic shoulder pain that limits mobility
• Progressive weakness in lifting and overhead function
• Increased stress on the rotator cuff tendons, potentially leading to additional injury
• Tendon rupture, which may result in sudden pain, bruising, and the characteristic “Popeye” bulge

Not every patient with biceps tendon problems requires surgery. Many people improve with nonsurgical treatments such as rest, physical therapy, activity modification, anti-inflammatory medications, or corticosteroid injections.

When symptoms persist despite these measures, surgical intervention may be recommended. Biceps tenotomy is one of the options, often chosen for older or less physically active individuals who want pain relief with a simpler procedure.

A biceps tenotomy is a straightforward procedure designed to relieve discomfort and restore mobility when other treatments are not enough.

Biceps tenotomy is a surgical procedure in which the long head of the biceps tendon is cut to relieve pain and dysfunction in the shoulder. When this tendon is damaged or causing persistent pain, releasing it from its attachment can reduce symptoms and restore function. After the procedure, the biceps muscle still functions, but the appearance of the arm may change slightly, and some patients notice a small bulge in the upper arm, commonly referred to as a “Popeye deformity.”

Individuals who may be candidates for biceps tenotomy usually experience shoulder-related symptoms that affect daily activities. Common symptoms include:

• Pain at the front of the shoulder, especially when lifting, reaching overhead, or performing repetitive motions
• Weakness in the arm, particularly with lifting or twisting movements
• A catching or popping sensation within the shoulder joint
• Difficulty performing tasks that require rotation of the forearm, such as turning a key or using a screwdriver
• In some cases, a visible bulge in the upper arm if the tendon has already ruptured on its own

These symptoms can interfere with work, exercise, and simple daily movements, making medical evaluation important.

Recovery after a biceps tenotomy is usually quicker and easier compared to many other shoulder surgeries. Because the procedure simply involves releasing the long head of the biceps tendon, it does not require reattaching the tendon or using anchors, which means healing time is shorter, and patients are usually able to move the arm shortly after surgery.

Physical therapy may be recommended to restore range of motion and gradually rebuild strength, but the overall rehabilitation process is less demanding than with procedures like rotator cuff repair or biceps tenodesis.

Most patients return to normal daily activities within a few weeks. Athletes and individuals with physically demanding jobs may take a bit longer, but in general, recovery is faster because the tendon does not need to heal back into bone. The main trade-off is that the muscle may look slightly different (the “Popeye” appearance), and some people notice mild fatigue or cramping in the biceps with very heavy use.