Most people wear a sling for 2 to 6 weeks after a biceps tenodesis, avoid lifting with the arm for about 6 weeks, and are back to full activity at 4 to 6 MONTHS.
A tenodesis is often done alongside a rotator cuff repair or a labral repair. If so, the slower operation sets the pace, and you follow that timeline. See rotator cuff surgery recovery.
The tendon has to heal into bone, and for the first 6 weeks the rule is simple: no lifting and no carrying with that arm. Your surgeon’s protocol comes first. Where their numbers differ from these, use theirs.
What the operation does
- The long head of the biceps is one of the two tendons at the top of the biceps. It runs over the ball of the shoulder and attaches to the rim of the socket. It can fray, slip out of its groove, or pull on a torn labrum
- A tenodesis cuts the tendon from its attachment inside the joint and fixes it lower down on the arm bone, with an anchor, a screw or stitches. The painful part of the tendon is taken out of the joint, and the muscle keeps its normal length
- A tenotomy is the simpler option: the tendon is cut and left to settle. The operation is quicker, but the Popeye bulge is more likely
- It’s often one part of a bigger operation, especially with SLAP tears in people past their mid-thirties. See shoulder labral tear
Week by week (tenodesis on its own)
- Weeks 0 to 2: sling on except for washing, dressing and your exercises. Gentle shoulder movement as your surgeon allows, plus shoulder blade squeezes. Bending the elbow against any weight is off limits for now
- Weeks 2 to 6: the sling comes off somewhere in this window, depending on your surgeon and how the tendon was fixed. Shoulder movement increases. Light use at waist height is fine, but nothing heavier than a cup
- Weeks 6 to 12: light lifting starts. Many protocols set a limit of about 2 kg (5 lb) in the operated arm. Shoulder strengthening begins
- Months 3 to 6: heavier strengthening, building up in steps each month. Full clearance for work and sport usually comes between 4 and 6 months
It looks like a small operation. The tendon still needs six weeks to grip the bone.
The Popeye question
- What it is: if the tendon lets go, the biceps muscle slides down the arm and bunches into a ball, like the cartoon sailor’s arm
- How often: in one large trial, about 1 in 14 people had it after a tenodesis, compared with nearly 1 in 4 after a tenotomy. Avoiding it is the main reason surgeons choose tenodesis
- Does it matter? Mostly for looks. When the two operations were compared, strength, movement and pain relief ended up about the same
- Cramping: some people get an ache or cramp in the biceps with hard use. It is a known side effect of both operations, and worth mentioning to your physio
- How you’d know: a sudden pop or tearing feeling in the upper arm, bruising, then a change in shape. Tell your surgeon within a few days. It’s rarely an emergency
The Cleveland Clinic guide to biceps tenodesis covers the operation itself in more detail.
When can I…
- Drive: once you’re out of the sling, off strong painkillers and can control the car in an emergency. With a tenodesis alone that can be within a few weeks. With a rotator cuff repair, expect the cuff’s timeline, usually 6 to 8 weeks
- Go back to a desk job: as soon as pain and your commute allow, often within the first few weeks
- Go back to manual work: light duties from about 3 months, full heavy work around 6 months
- Go back to the gym or sport: a gradual build-up from about 3 months, with full clearance usually between 4 and 6 months. Lifting heavy and throwing come last
What’s normal
- An ache at the front of the shoulder or upper arm, where the tendon was fixed. It can linger for a few months and usually fades as strength returns
- Bruising and swelling down the upper arm in the first couple of weeks. Fluid used during keyhole surgery drains down with gravity
- Rough nights for the first few weeks. Sleeping propped up helps. See how to sleep after shoulder surgery
- Stiffness. Some is expected, especially after combined surgery. See stiff shoulder after surgery
Call your surgeon today if
- The wound is red, hot, swollen or leaking
- You have a fever or feel unwell
- Pain keeps getting worse instead of better
- You have new numbness, tingling or weakness in the arm
Go to the emergency department if
- You have chest pain, sudden breathlessness or cough up blood
- The arm turns cold, pale or blue, or swells up suddenly
Mention it at your next appointment if
- You’re not back to your normal everyday tasks by about 3 months
- Cramping in the biceps keeps stopping you from using the arm
- Pain at the front of the shoulder isn’t easing after 3 months
The bulge is what people worry about. The six-week lifting rule is what you can control.