Biceps Tenodesis Exercises: Post-Surgery Recovery Guide

Biceps tenodesis involves cutting the long head of the biceps tendon from its attachment inside the shoulder and reattaching it to the upper arm bone (humerus). This procedure addresses biceps tendon pain, SLAP tears, and other biceps pathology while preserving arm strength and appearance.

Understanding Biceps Tenodesis

What Was Done

During biceps tenodesis:

• Long head of biceps detached from superior labrum
• Tendon reattached to humerus (upper arm bone)
• May use screw, anchor, or other fixation
• Often combined with rotator cuff repair or labral work

Types of Tenodesis

Suprapectoral: Attached above the pectoralis tendon Subpectoral: Attached below the pectoralis tendon (open incision on arm)

Location affects rehab slightly—subpectoral may have more early biceps restrictions.

Why Tenodesis vs. Tenotomy

Tenodesis (reattachment):

• Preserves biceps strength
• Maintains arm contour
• Preferred in younger/active patients
• Requires tendon healing

Tenotomy (release only):

• Simpler procedure
• No healing required
• May cause cosmetic "Popeye" deformity
• Slight strength loss possible
• Often used in older patients

Healing Timeline

Tendon-to-bone healing:

• Weeks 0-6: Initial attachment, very fragile
• Weeks 6-12: Strengthening bond
• Weeks 12-16: Maturing repair
• 4-6 months: Full healing

Key insight: Protect the biceps from resisted elbow flexion and forearm supination during early healing.

Phase 1: Protection Phase (Weeks 0-4)

Sling Use

• Typically 2-4 weeks
• Longer if combined with rotator cuff repair
• Remove for exercises and hygiene

Goals:

• Protect biceps tendon healing
• Maintain shoulder and elbow mobility
• Control pain and swelling

Critical Restrictions (Weeks 0-6):

• NO active elbow flexion against resistance
• NO active supination against resistance
• NO lifting anything with operated arm
• These motions stress the healing tendon

1. Pendulum Exercises

How to do it:

1. Lean forward, support with good arm
2. Let operated arm hang relaxed
3. Gently sway body for arm circles
4. 2-3 minutes, 4-5 times daily

2. Passive Elbow Range of Motion

How to do it:

1. Use good arm to bend and straighten elbow
2. Full range of motion allowed
3. No active biceps use
4. 15-20 repetitions
5. Several times daily

3. Passive Shoulder Motion

If shoulder surgery was also performed, follow shoulder protocol. If tenodesis only:

How to do it:

1. Passive forward flexion (assist with good arm)
2. Passive external rotation
3. Per surgeon guidelines
4. 15-20 repetitions each

4. Wrist and Hand Exercises

How to do it:

• Wrist circles and movements
• Grip exercises (ball squeezes)
• Finger movements
• Throughout the day

5. Isometric Shoulder (Not Biceps)

How to do it:

• Scapular squeezes: 15 reps
• Isometric shoulder: As directed
• NO isometric elbow flexion

Phase 2: Early Motion (Weeks 4-8)

Sling Use

• Usually discontinued by week 4
• Unless combined with other repairs

Goals:

• Begin gentle active elbow motion
• Progress shoulder motion
• Protect from resistance

6. Active-Assisted Elbow Flexion

How to do it:

1. Support operated forearm with good arm
2. Gently assist bending elbow
3. Let gravity straighten (passive extension)
4. 15-20 repetitions
5. Several times daily

7. Active Elbow Flexion (Gravity-Eliminated)

How to do it:

1. Lie on back, arm at side
2. Slide hand toward shoulder (elbow bends)
3. Gravity eliminated, biceps works minimally
4. 15-20 repetitions
5. Progress to upright when ready

8. Forearm Rotation (Gentle)

How to do it:

1. Elbow at side, bent 90°
2. Slowly rotate palm up, then palm down
3. No resistance
4. 15-20 repetitions

9. Shoulder Active-Assisted Motion

How to do it:

• Forward flexion with wand
• External rotation with wand
• Progress per shoulder protocol
• 15-20 repetitions each

10. Scapular Exercises

How to do it:

• Scapular squeezes: Hold 5 sec, 15 reps
• Shrugs: Gentle, no weight
• Prone scapular exercises when ready

Phase 3: Progressive Motion (Weeks 8-12)

Goals:

• Full active range of motion
• Begin light strengthening
• Progress shoulder as appropriate

11. Active Elbow Flexion (Upright)

How to do it:

1. Standing or sitting
2. Bend elbow fully using biceps
3. Control descent
4. 15-20 repetitions
5. No resistance yet

12. Active Supination

How to do it:

1. Elbow at side, bent 90°
2. Actively rotate palm up
3. No resistance
4. 15-20 repetitions

13. Light Grip Strengthening

How to do it:

• Therapy putty exercises
• Soft ball squeezes
• 2-3 minutes
• Avoid heavy gripping

14. Shoulder Active Motion

How to do it:

• Active forward flexion
• Active external rotation
• Active scaption
• 15-20 repetitions each
• Progress per shoulder protocol

15. Prone Row (Light)

How to do it:

1. Lie face down, arm hanging
2. Row elbow toward ceiling
3. Squeeze shoulder blade
4. 15 repetitions
5. No weight or very light only

Phase 4: Strengthening (Weeks 12-16)

Goals:

• Progressive biceps strengthening
• Full shoulder strengthening
• Return to light activities

16. Biceps Curls (Very Light)

How to do it:

1. Start with 1-2 lb weight
2. Standing biceps curl
3. Control both up and down
4. 3 sets x 15 repetitions
5. Progress weight 1-2 lbs per week

Progression: Don't rush this—tendon is still maturing.

17. Hammer Curls

Neutral grip, may be more comfortable.

How to do it:

1. Palms facing each other
2. Curl toward shoulders
3. Lower slowly
4. 3 sets x 15 repetitions
5. Start light

18. Supination with Light Resistance

How to do it:

1. Hold light dumbbell or hammer at end
2. Rotate forearm to palm up
3. Control rotation to palm down
4. 3 sets x 15 repetitions

19. Shoulder Strengthening

Progress as tolerated:

• External rotation with band
• Internal rotation with band
• Scaption with light weight
• Rows

20. Triceps Strengthening

Can progress normally:

• Triceps pushdowns
• Overhead triceps extension
• Push-ups

Phase 5: Advanced Strengthening (Weeks 16+)

Goals:

• Full strength restoration
• Return to activities
• Sport-specific training

21. Progressive Biceps Loading

How to do it:

• Continue biceps curls with progressive weight
• Progress ~10% per week
• Include various curl variations
• Incline curls, preacher curls (when ready)

22. Chin-Ups (When Ready)

Usually 4-6+ months post-op.

Progression:

1. Assisted chin-ups
2. Negative/eccentric chin-ups
3. Partial range chin-ups
4. Full chin-ups

23. Pulling Exercises

How to do it:

• Lat pulldowns: Progress to normal weights
• Rows: All variations
• Cable curls
• Progress gradually

24. Sport-Specific Training

Based on activity:

• Throwing: 4-6 months typically
• Weightlifting: 4-6 months for full loads
• Climbing: 6+ months
• Contact sports: 6+ months

Timeline Summary

| Phase | Timeframe | Biceps Activity | |-------|-----------|-----------------| | Protection | Weeks 0-4 | NO active use | | Early Motion | Weeks 4-8 | Assisted/gravity-eliminated | | Progressive Motion | Weeks 8-12 | Active without resistance | | Strengthening | Weeks 12-16 | Light resistance | | Advanced | Weeks 16+ | Progressive loading |

Common Mistakes

1. Lifting too early — Even light objects stress biceps
2. Active curling in sling — Reflexive but harmful
3. Carrying bags — Easy to forget restrictions
4. Rushing strength training — Tendon needs time
5. Ignoring shoulder rehab — Often needs attention too

If Combined with Other Procedures

With Rotator Cuff Repair:

• Follow rotator cuff protocol primarily
• Biceps restrictions still apply
• Longer overall recovery

With SLAP Repair:

• Follow labral protocol
• Additional restrictions may apply
• Often 6+ month recovery

With Subacromial Decompression:

• Can progress shoulder faster
• Still respect biceps restrictions

Warning Signs

Contact your surgeon if:

• Sudden pain or popping at tenodesis site
• Visible bulge in arm (possible failure)
• Significant weakness not improving
• Signs of infection
• Loss of motion

Expected Outcomes

Typical Results:

• Pain relief: Excellent
• Strength: Near-normal (>90%)
• Appearance: Normal contour
• Function: Full return expected
• Patient satisfaction: High

Long-Term:

• Most return to full activity
• Strength comparable to unaffected side
• No long-term restrictions once healed
• Recurrence rare

Key Takeaways

1. Protect the biceps early — No resisted elbow flexion for 6-8 weeks
2. Gravity-eliminated first — Progress to upright gradually
3. Light weights initially — Start with 1-2 lbs at week 12
4. Progress slowly — Tendon healing takes months
5. Full recovery expected — Most return to normal activity
6. Don't lift with operated arm — Even light objects count

Biceps tenodesis has excellent outcomes when the tendon is allowed to heal properly. The key is patience during the first 12 weeks when the biceps must be protected from meaningful resistance. After that, progressive strengthening leads to full recovery for most patients. Trust the process, respect the restrictions, and you'll be back to full strength.