What does recovery look like after a biceps tenodesis?
A biceps tenodesis moves the long head of the biceps tendon out of the shoulder joint and reattaches it to the arm bone just below, where it heals into the bone. Done on its own, without a rotator cuff repair, the recovery is much lighter than a cuff repair: a sling for comfort for a week or two, full motion of the shoulder right away, physical therapy starting at 1 to 2 weeks, no curls or carrying with the elbow bent for about 12 weeks, and no heavy lifting for 3 to 4 months. Carrying things with the arm straight at your side waits the same 12 weeks. Strengthening starts at 3 months, when you can also get back to the gym; golf comes back at 4 months, contact sports at about 4 months, and overhead sports at 4 to 6 months. The roadmap below walks through each stage. If you have already had surgery, enter your surgery date and it will show you which stage you are in and what comes next.
This roadmap is for a biceps tenodesis done on its own, for example for biceps tendinitis or a SLAP tear. If your biceps tenodesis was done as part of a rotator cuff repair, follow the rotator cuff repair recovery roadmap instead; the cuff sets the pace. If your SLAP tear was repaired together with the back of the labrum, follow the shoulder stabilization recovery roadmap. For the condition and the surgery, see biceps tenodesis and SLAP tears.
The roadmap as text
The same roadmap you can scroll through above, written out stage by stage so you can read it, print it or search it. Tap a stage to open it.
| Stage | When | What it is about |
|---|---|---|
| Stage 1: Comfort and Motion | Surgery to week 2 | Home the same day; nerve block for 1 to 3 days; sling for comfort; move the shoulder right away |
| Stage 2: Out of the Sling | Weeks 2 to 6 | Out of the sling; physical therapy under way; still no curls or carrying with a bent elbow; careful with driving |
| Stage 3: Let It Heal | Weeks 6 to 12 | Daily life mostly normal; still no curls or bent-elbow carrying until about 12 weeks; strengthening and the gym at 3 months |
| Stage 4: Back to the Gym | Months 3 to 4 | Elbow rule over at about 12 weeks; strengthening and the gym at 3 months; heavy lifting and physical labor after 3 to 4 months |
| Stage 5: Back to Sport | Months 4 to 6 | Golf at 4 months; contact sports at about 4 months; overhead sports at 4 to 6 months; no real restrictions |
Stage 1: Comfort and Motion Surgery to week 2
Surgery day. A biceps tenodesis is usually done arthroscopically, through small poke holes; sometimes it is done through a small incision near the armpit instead. Either way, you go home the same day. In the operating room, just before you go to sleep, an anesthesiologist places a nerve block that numbs the shoulder and arm, and then you have general anesthesia. The block lasts about 1 to 3 days. Plan for someone to drive you home and stay with you the first night. Before surgery, set up a recliner or a stack of pillows, because most patients sleep propped up for the first few weeks.
The sling
- The sling is for comfort. Wear it when you are up and around and while you sleep, for the first week or two.
- It is not there to protect the tendon. Once the nerve block wears off and you have control of the arm, you can take it off whenever you are comfortable without it.
Motion
- Full range of motion of the shoulder is allowed right away.
- Moving the elbow, wrist and hand is fine, as long as nothing resists the elbow as it bends. No curls, no lifting or carrying with the elbow bent. (This rule lasts about 12 weeks.)
- No carrying things with the arm straight at your side, either. (This rule also lasts about 12 weeks.)
Pain and swelling
- Pain varies a lot from person to person. The nerve block covers the first part. After that, a biceps tenodesis is not an operation where you feel good right away; the tendon needs time to heal into the bone.
- Ice the shoulder several times a day. Bruising often tracks down the arm toward the elbow; that is normal.
- You will go home with prescription pain medication. Ibuprofen and acetaminophen help too; your folder explains how to combine them.
- Nights are the hardest part early on. A recliner, or pillows behind your back with one under the elbow, usually works best.
Preventing blood clots
- Take one baby aspirin daily for about 3 weeks, unless we tell you otherwise. Ankle pumps and walking help too.
Incision care
- You can shower right away. Cover the incisions for the first 3 to 5 days, then let water run over them. Do not scrub or soak them.
- If your tenodesis was done through a small incision near the armpit, it has a waterproof dressing that can come off around day 3 to 5.
- Stitches come out at your first post-op visit, about 7 to 14 days after surgery.
Watch: changing your dressing at home. How to change your dressing after shoulder surgery.
Physical therapy
- Physical therapy starts 1 to 2 weeks after surgery. Schedule it now; your discharge paperwork includes the prescription and your protocol.
Work
- Desk work can start as soon as you are off prescription pain medication and the nerve block has worn off.
- Physical labor waits at least 3 to 4 months, because the tendon has to heal into the bone and be protected.
Driving
- Not while you are still in the sling. Use caution driving for the first 6 weeks.
What's normal
- Numbness from the nerve block for 1 to 3 days, then a sore shoulder.
Call 911 or go to the nearest emergency room if you have
- Chest pain, trouble breathing, or coughing up blood. These can be signs of a blood clot in the lung and should not wait for a call back.
Call us at (214) 265-3211 if you have
- Fever over 101.4, or increasing redness or pus at an incision (some clear drainage in the first few days is normal).
- Calf swelling or calf pain.
- Pain that is getting worse instead of better after the first few days.
- Numbness or tingling that is new or getting worse.
Ready for the next stage when: you are comfortable out of the sling and your first post-op visit shows the incisions healing well.
Stage 2: Out of the Sling Weeks 2 to 6
By about 2 weeks most people are out of the sling and using the arm for light, everyday things. The tendon is healing into the bone, and it is not ready for load, so the elbow rule still applies.
What you can do
- Use the arm for light daily activities: dressing, eating, typing, light chores.
- Keep moving the shoulder through its full range.
- Desk work, if you have not already gone back.
What you can't do yet
- No resisted elbow bending: no curls, no lifting or carrying things with the elbow bent.
- No carrying things with the arm straight at your side, either.
- No heavy lifting.
- No physical labor.
Driving
- Some people can drive after about 2 weeks, since they are out of the sling. Use caution driving through the first 6 weeks.
Physical therapy
- Keep going to physical therapy. Strengthening starts at 3 months.
What's normal
- The shoulder feels good enough that you will be tempted to lift or carry more. Don't let it fool you; the tendon is still healing into the bone.
Ready for the next stage when: you reach 6 weeks with the shoulder moving well.
Stage 3: Let It Heal Weeks 6 to 12
By 6 weeks daily life is mostly back to normal. The tendon is still healing into the bone, so the elbow rule stays in place through about 12 weeks. Strengthening and the gym start at 3 months, and heavy lifting at 3 to 4 months.
What you can do
- Normal daily activities with the arm.
- Driving, once you are comfortable.
What you can't do yet
- No resisted elbow bending, curls or carrying with a bent elbow until about 12 weeks.
- No carrying with a straight arm until about 12 weeks, either.
- The gym waits until 3 months, and heavy lifting until 3 to 4 months.
- No physical labor.
Physical therapy
- Strengthening starts at 3 months.
Ready for the next stage when: you reach about 12 weeks. The elbow rule ends then.
Stage 4: Back to the Gym Months 3 to 4
At about 12 weeks the elbow rule ends, and at 3 months strengthening starts and you can get back to the gym. Heavy lifting and physical labor come back after 3 to 4 months, once the tendon has healed into the bone.
What you can do
- Strengthening, from 3 months.
- Back to the gym at 3 months.
- Curls and carrying with the elbow bent, from about 12 weeks.
- Carrying with the arm straight, from about 12 weeks.
- Heavy lifting, after 3 to 4 months.
- Physical labor, after at least 3 to 4 months.
What you can't do yet
- Golf waits until 4 months.
- Contact sports wait until about 4 months.
- Overhead sports wait until 4 to 6 months.
Ready for the next stage when: you reach 4 months.
Stage 5: Back to Sport Months 4 to 6
Golf comes back at 4 months, contact sports at about 4 months, and overhead sports at 4 to 6 months. Apart from that sport timing, there are no real restrictions after 3 to 4 months.
What you can do
- Golf, from 4 months.
- Contact sports, from about 4 months.
- Overhead sports, such as tennis, volleyball and throwing sports, from 4 to 6 months.
Ready when: you reach 4 to 6 months. Then you are back to overhead sports, with no real restrictions.
If your tenodesis was part of a rotator cuff repair
- This is not your roadmap. Follow the rotator cuff repair roadmap: the cuff repair sets the pace, with 6 weeks in a sling.
- The cuff rules already keep you from curls and carrying with the elbow bent while the biceps heals.
If your tenodesis was done through a small incision near the armpit
- Same roadmap. The incision near the armpit has a waterproof dressing that can come off around day 3 to 5.
If you had a SLAP tear
- When a SLAP tear is treated with a biceps tenodesis, this is your roadmap.
- If your SLAP tear was repaired together with the back (posterior) labrum, follow the shoulder stabilization roadmap instead.
When to get help
Call 911 or go to the nearest emergency room for chest pain, trouble breathing, or coughing up blood. These can be signs of a blood clot in the lung and should not wait for a call back.
Call the office at (214) 265-3211 if you have:
- Pain that isn't controlled with your medication
- Significant new swelling, or drainage from an incision
- Fever over 101.4
- Calf pain or swelling
- Numbness or tingling that is new or getting worse
- Anything else that worries you. That's what we're here for.