Biceps Tenodesis

Biceps tenodesis is a surgical procedure performed to treat issues involving the long head of the biceps (LHB) tendon, a common source of shoulder pain and dysfunction.

How Common It Is and Who Gets It? (Epidemiology)

Biceps tendon issues are common in individuals who engage in repetitive overhead activities or sports, especially in athletes involved in throwing, swimming, or weightlifting. The condition can also occur as a result of aging, wear and tear, or traumatic injury. Biceps tenodesis is often performed in patients experiencing chronic pain that hasn’t responded to conservative treatments like physical therapy or injections.

Why It Happens – Causes (Etiology and Pathophysiology)

The long head of the biceps tendon runs through the shoulder joint and plays a significant role in stabilizing the shoulder and enabling elbow flexion and forearm supination. Over time or due to injury, the tendon can become inflamed, partially torn, unstable, or degenerated, leading to pain and dysfunction. These conditions can result from repetitive strain, trauma, or age-related wear and tear.

How the Body Part Normally Works? (Relevant Anatomy)

The biceps brachii muscle consists of two heads: the long head and the short head. The long head originates from the top of the shoulder socket (glenoid) and travels through the shoulder joint, passing into a groove in the upper arm bone (humerus). The tendon helps stabilize the shoulder joint and allows for forearm movement, such as supination and elbow flexion. When the tendon becomes damaged or irritated, it can cause pain and instability in the shoulder.

What You Might Feel – Symptoms (Clinical Presentation)

Common symptoms of biceps tendon issues include pain in the front of the shoulder, especially when lifting or rotating the arm. Patients may experience weakness in the shoulder or elbow, as well as visible deformity, such as the “Popeye” sign (where the biceps muscle bulges). Activities involving overhead motions or lifting objects can exacerbate the pain. In some cases, the pain may be associated with a tear of the rotator cuff or instability in the shoulder.

How Doctors Find the Problem? (Diagnosis and Imaging)

A thorough clinical examination is crucial for diagnosing biceps tendon issues. Tests such as the Speeds test or Yergason’s test can help localize pain to the biceps tendon. Imaging studies, including X-rays, MRI, or ultrasound, are often used to confirm the diagnosis and assess the extent of tendon damage, including tears, inflammation, or instability.

Classification

Biceps tendon injuries are typically classified based on the degree of damage. Partial tears involve only a portion of the tendon, while complete tears involve the tendon fully separating from its attachment point. Tenosynovitis refers to inflammation of the tendon sheath, while instability or subluxation involves the tendon becoming displaced from its normal position.

Other Problems That Can Feel Similar (Differential Diagnosis)

The symptoms of biceps tendonitis or tears can mimic other shoulder conditions, such as rotator cuff injuries, SLAP tears (superior labrum anterior to posterior lesions), or impingement syndrome. Accurate diagnosis requires detailed clinical evaluation and imaging to distinguish between these conditions.

Treatment Options

Non-Surgical Care

• Rest and activity modification to reduce strain on the biceps tendon
• Anti-inflammatory medications or corticosteroid injections for pain relief
• Physical therapy to strengthen the shoulder and improve mobility

Surgical Care

• Biceps tenodesis, which involves the removal of the long head of the biceps tendon from its original attachment point and reattachment to a different site on the upper arm
• Other procedures may include rotator cuff repair or labral stabilization if necessary

Recovery and What to Expect After Treatment

Following surgery, the patient will be immobilized in a sling to protect the shoulder and allow for healing. Rehabilitation will begin after several weeks, focusing on regaining range of motion and strength. Recovery typically takes 4 to 6 months, with a gradual return to normal activities. Athletes and those involved in labor-intensive work may require longer rehabilitation before returning to full activity.

Possible Risks or Side Effects (Complications)

Like any surgery, biceps tenodesis carries risks such as infection, nerve injury (though rare), re-tear or failure of the tendon reattachment, residual pain or stiffness, and potential cosmetic deformities if the tendon is not securely fixed.

Long-Term Outlook (Prognosis)

The prognosis for biceps tenodesis is generally very positive, with most patients experiencing significant pain relief and a return to function. The procedure is highly effective in alleviating pain and preserving muscle strength. The long-term outcomes are generally excellent, particularly for patients who follow a structured rehabilitation program. In rare cases, patients may experience some residual pain or limited mobility, but overall, most recover fully.

Out-of-Pocket Cost

Medicare

CPT Code 29828 – Biceps Tenodesis (Arthroscopic Biceps Tendon Repair): $216.87

Medicare Part B typically covers 80% of the approved cost for this procedure once your annual deductible has been met, leaving you responsible for the remaining 20%. Supplemental Insurance plans such as Medigap, AARP, or Blue Cross Blue Shield generally cover that 20%, minimizing or eliminating out-of-pocket expenses for Medicare-approved surgeries. These plans coordinate with Medicare to fill the coverage gap and reduce patient financial responsibility.

If you have Secondary Insurance, such as TRICARE, an Employer-Based Plan, or Veterans Health Administration coverage, it acts as a secondary payer. These plans typically cover any remaining balance, including coinsurance or small deductibles, which generally range between $100 and $300, depending on your plan and provider network.

Workers’ Compensation

If your biceps tenodesis is required due to a work-related injury, Workers’ Compensation will cover all associated medical expenses, including surgery, rehabilitation, and follow-up care. You will not have any out-of-pocket expenses, as the employer’s insurance carrier directly covers all approved treatments.

No-Fault Insurance

If your biceps tenodesis is needed due to an automobile accident, No-Fault Insurance will typically cover the total cost of your treatment, including surgery and postoperative care. The only potential out-of-pocket cost may be a small deductible or co-payment, depending on your insurance policy.

Example

Matthew Clark required biceps tenodesis (CPT 29828) after a rotator cuff tear and labral damage. His estimated Medicare out-of-pocket cost was $216.87. Since Matthew had supplemental insurance through Blue Cross Blue Shield, his remaining balance was fully covered, leaving him with no out-of-pocket expenses for the surgery.

Frequently Asked Questions (FAQ)

Q. What is a biceps tenodesis?
A. Biceps tenodesis is a surgical procedure that involves detaching the long head of the biceps tendon from its original attachment and reattaching it to the humerus bone.

Q. Why is biceps tenodesis performed?
A. It is performed to relieve pain caused by biceps tendonitis, partial tears, or instability of the tendon.

Q. What symptoms may indicate the need for a biceps tenodesis?
A. Symptoms include pain in the front of the shoulder, weakness, and a popping or snapping sensation.

Q. How is the diagnosis of biceps tendon problems made?
A. Diagnosis is made through physical examination, patient history, and imaging studies such as MRI.

Q. What nonsurgical treatments are considered before surgery?
A. Nonsurgical treatments include rest, physical therapy, anti-inflammatory medications, and corticosteroid injections.

Q. When is surgery recommended for biceps tendon issues?
A. Surgery is recommended when conservative treatments fail to relieve symptoms or when there is a significant tear or instability.

Q. What is involved in the biceps tenodesis procedure?
A. The procedure involves detaching the biceps tendon from the shoulder and reattaching it to the upper part of the humerus using anchors or screws.

Q. Is biceps tenodesis done arthroscopically or through open surgery?
A. It can be performed arthroscopically, through a small incision, or as an open procedure depending on the specific case.

Q. How long does a biceps tenodesis surgery take?
A. The procedure typically takes about one hour.

Q. What is the recovery time after biceps tenodesis?
A. Recovery can take several months, with physical therapy starting soon after surgery to restore motion and strength.

Q. Will I need to wear a sling after biceps tenodesis?
A. Yes, patients are usually required to wear a sling for a few weeks to protect the repair.

Q. When can I return to regular activities after biceps tenodesis?
A. Return to normal activities can take several months, with heavy lifting or strenuous activities often restricted for three to six months.

Q. What are the potential risks of biceps tenodesis?
A. Risks include infection, stiffness, nerve injury, failure of the tendon to heal, and persistent pain.

Q. How successful is biceps tenodesis surgery?
A. The surgery is generally successful in relieving pain and restoring function in the shoulder.

Summary and Takeaway

Biceps tenodesis is an effective surgical solution for patients suffering from chronic pain due to biceps tendon instability, degeneration, or tearing. By reattaching the tendon to a different location, the procedure relieves pain, restores function, and preserves muscle strength. While recovery can take several months, the long-term prognosis is generally excellent, particularly for active individuals and athletes.

Clinical Insight & Recent Findings

A recent study compared the biomechanical strength of two biceps tenodesis techniques: the metal button (MB) and all-suture Caspari-Weber (CW) methods. The results indicated that the CW technique had a significantly greater maximal load to failure than the MB technique, making it a more robust option under high-stress conditions. Both techniques showed similar performance in terms of displacement and stiffness, but CW demonstrated superior strength, offering a lower-cost alternative without relying on implants. This study suggests that the CW technique could be more beneficial for patients requiring a more cost-effective and mechanically stable option, especially in athletes or those who engage in activities demanding early load on the repair. (“Study on biceps tenodesis techniques – see PubMed.“)

Who Performs This Treatment? (Specialists and Team Involved)

Orthopedic surgeons specializing in shoulder and sports medicine typically perform biceps tenodesis. A rehabilitation team, including physical therapists, is integral to the recovery process.

When to See a Specialist?

If you are experiencing persistent shoulder pain related to the biceps tendon that does not improve with conservative treatments like rest or physical therapy, you should consult a specialist to explore surgical options.

When to Go to the Emergency Room?

Seek emergency care if you experience severe shoulder pain following a traumatic injury or if you notice signs of nerve damage, such as numbness or tingling in the arm.

What Recovery Really Looks Like?

After surgery, patients typically wear a sling for the first few weeks to protect the shoulder. Rehabilitation focuses on restoring motion and strength, with full recovery expected within 4 to 6 months, depending on the severity of the condition and the individual’s progress.

What Happens If You Ignore It?

If left untreated, biceps tendon issues can lead to chronic pain, decreased strength, and further damage to the shoulder, which may complicate recovery and require more extensive surgery.

How to Prevent It?

To prevent biceps tendon injuries, it’s important to perform strengthening exercises for the shoulder and forearm muscles, maintain proper lifting techniques, and avoid repetitive overhead movements that strain the tendon.

Nutrition and Bone or Joint Health

A diet rich in calcium, vitamin D, and omega-3 fatty acids can support joint and tendon health, reduce inflammation, and promote healing following surgery.

Activity and Lifestyle Modifications

Avoid activities that put strain on the shoulder joint, particularly overhead lifting or repetitive motions, during the recovery process. Strengthening exercises and proper posture can help prevent future injuries.