When patients hear the term biceps tenotomy, they often become confused or anxious because it sounds like a major or unusual operation. In reality, biceps tenotomy is a well-known orthopedic procedure used to treat certain painful problems involving the long head of the biceps tendon inside the shoulder. In the right patient, it can be a practical and effective way to reduce pain and improve function.[1][2]
In my practice, I often see patients in Dhaka and across Bangladesh who have shoulder pain that does not come from just one structure. The shoulder is complex. A patient may have rotator cuff disease, inflammation, stiffness, arthritis, or biceps tendon pathology at the same time. When the long head of the biceps tendon becomes a persistent pain source, surgery may sometimes be needed if non-surgical treatment has not given enough relief.[1][2][3]
One important point I want Bangladeshi patients to understand is that biceps tenotomy is not a procedure done for every case of shoulder pain. It is usually considered in selected patients after careful assessment. The goal is not simply to “cut a tendon” and hope for the best. The goal is to remove a damaged or persistently painful tendon from being a constant source of irritation in the shoulder.
What Is Biceps Tenotomy?
Biceps tenotomy is a surgical procedure in which the long head of the biceps tendon is released from its attachment inside the shoulder joint. This tendon runs through the shoulder and can become inflamed, frayed, unstable, or associated with other shoulder problems such as rotator cuff tears.[1][2]
Which Part of the Biceps Is Involved?
Many patients think the biceps is only an elbow muscle, but the upper part of the tendon has an important relationship with the shoulder. The long head of the biceps tendon begins near the top of the shoulder socket and travels through the front of the shoulder. Because of this location, it can contribute to shoulder pain, especially when it becomes inflamed or degenerative.[1][2]
In simple language, tenotomy means releasing this problematic tendon so it no longer keeps rubbing, pulling, or generating pain inside the joint.
Why Would a Patient Need Biceps Tenotomy?
Biceps tenotomy is not usually the first treatment. Most patients are initially managed with rest, activity modification, physiotherapy, pain control, and sometimes injections depending on the diagnosis. But if the tendon remains painful or clearly damaged, surgery may be considered.[1][2][3]
Problems That May Lead to Tenotomy
I may think about biceps tenotomy when a patient has:
- chronic biceps tendon pain that does not improve with non-surgical care
- long head of biceps tendinopathy
- partial tearing or fraying of the tendon
- biceps instability or subluxation
- associated rotator cuff disease
- shoulder pathology seen during arthroscopy where the biceps tendon is clearly contributing to pain[1][2][3]
In many cases, biceps tenotomy is not done in isolation. It may be performed together with another shoulder procedure such as arthroscopic treatment for a rotator cuff problem or other intra-articular pathology.
Biceps Tenotomy Versus Biceps Tenodesis
This is one of the most common questions I get from patients once surgery is discussed. Tenotomy and tenodesis are related but different procedures.
The Key Difference
- Biceps tenotomy: the long head of the biceps tendon is released
- Biceps tenodesis: the tendon is released and then reattached to another location[1][2][4]
Both procedures aim to address painful biceps tendon pathology. The choice depends on factors such as age, activity demands, cosmetic concerns, muscle cramping risk, associated shoulder disease, and surgeon judgment based on the specific case.[2][4]
Why Tenotomy May Be Chosen
In selected patients, tenotomy may be chosen because:
- it is technically simpler
- it avoids implant-related issues
- it can reduce operative time
- it may work well for lower-demand or older patients
- it can be appropriate when pain relief is the main goal[2][4]
However, it is not automatically better for every patient. The decision should be individualized.
What Symptoms Suggest the Biceps Tendon May Be the Problem?
Not all shoulder pain comes from the biceps tendon. But there are certain features that raise suspicion.
Common Symptoms
Patients may complain of:
- pain in the front of the shoulder
- pain with lifting or overhead use
- discomfort during pulling motions
- pain during sports or gym activity
- weakness or fatigue in the shoulder
- pain that overlaps with rotator cuff symptoms
- clicking or a feeling of tendon irritation in some cases[1][2][3]
Because shoulder structures overlap, the symptoms are not always perfectly clear. That is why examination and, when needed, imaging are important.
How I Evaluate a Patient Before Recommending Surgery
Before recommending biceps tenotomy, I assess the patient carefully. In my practice, I do not want to label every front-of-shoulder pain as a biceps problem. The diagnosis should be built from history, examination, and when needed, imaging such as ultrasound or MRI.[1][2][3]
What I Usually Look For
I usually consider:
- the exact location of pain
- whether there is night pain
- whether overhead activity worsens symptoms
- whether there is a history of trauma
- signs of rotator cuff disease
- stiffness or frozen shoulder features
- instability symptoms
- response to previous treatment
- imaging signs of biceps pathology or associated shoulder damage
This helps distinguish isolated biceps-related pain from broader shoulder disease.
What Happens During a Biceps Tenotomy?
Biceps tenotomy is often performed arthroscopically, which means through small incisions using a camera and specialized instruments.[1][4] This allows the shoulder joint to be inspected and any associated pathology to be identified at the same time.
General Surgical Idea
During the procedure, the surgeon identifies the diseased long head of the biceps tendon and releases it from its attachment. If other shoulder problems are present, they may be addressed during the same operation, depending on the treatment plan.
I usually explain to patients that the procedure itself is only one part of the recovery story. The postoperative plan, pain control, rehabilitation, and expectations are equally important.
