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Biceps Tenodesis

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Rehabilitation after isolated biceps tenodesis, protecting the tenodesis fixation through staged return of biceps loading.

Updated Jun 2026
Illustrasyon ng biceps tendon na muling nakakabit sa ulo ng buto ng itaas na braso.
Biceps tenodesis: ang mahabang ulo ng tendon ng biceps ay muling in-anchored sa buto ng braso. Kieran Hirpara 4.0

Ang pahinang ito ay isinalin ng makina at hindi pa nasusuri ng isang doktor. Ang bersyong Ingles ang siyang opisyal.

Ang protokol na ito ay sumasaklaw sa rehabilitasyon pagkatapos ng biceps tenodesis kay Dr. Kieran Hirpara sa Mater Private Hospital Rockhampton, kung ang operasyon ay ginawa nang arthroscopic (keyhole) o sa pamamagitan ng maliit na bukas na hiwa malapit sa harap ng kilikili (open subpectoral technique). Dalhin ang pahinang ito o ang PDF nito sa iyong unang bisita sa physiotherapy upang manatiling koordinado ang iyong rehabilitasyon. Ang iyong rehabilitasyon ay unti-unting pinapahusay ng iyong physiotherapist sa pamamagitan ng mga yugto sa ibaba, depende sa pag-unlad ng iyong balikat at braso.

Ang protokol na ito ay para sa isolated na biceps tenodesis. Kung ang iyong operasyon ay kasama rin ang rotator cuff repair, sundin ang rotator cuff repair protocol sa halip; mas mabagal ang bilis ng paggaling ng repaired tendon.

Kung mayroon kang anumang alalahanin tungkol sa iyong sugat pagkatapos ng operasyon, makipag-ugnayan sa mga kwarto. Madalas na nakakatulong na kumuha ng litrato ng sugat at ipadala ito sa pamamagitan ng email para sa pagsusuri.

Ano ang inaasahan

Sa isang biceps tenodesis, ang long head ng biceps tendon ay binabalewala sa orihinal nitong anchor point sa loob ng balikat at iinayos sa itaas na buto ng braso (humerus) sa halip, gamit ang isang anchor o turnilyo. Kailangan ng panahon ang bagong attachment na gumaling nang maayos sa buto, at ang mga unang linggo ng rehabilitasyon ay inayos upang protektahan ito.

Ang biceps muscle ay may dalawang tungkulin: ito ay yumuyuko sa siko at ikinakataas ang palad pataas (supination). Dahil dito (hindi karaniwan sa isang operasyon sa balikat), ang mga unang restriction ay karamihan ay tungkol sa siko: sa mga unang linggo, ang siko ay gumagalaw nang passive (gagawin ng ibang kamay o ng iyong physiotherapist ang pagyuyuko) upang hindi hihingin sa gumagaling na tendon na humila. Ang pagbuhat at pagdadala gamit ang operated na braso ay hindi payagan sa maagang yugto para sa parehong dahilan. Ilang posisyon ng balikat na nagdudulot ng tensyon sa tendon ay limitadon din sa simula: pag-ikot ng braso palabas higit sa humigit-kumulang 40 degrees, at pagkuha ng braso sa likod ng linya ng katawan.

Magdudulot ka ng sling sa loob ng humigit-kumulang tatlo hanggang apat na linggo, kasama ang habang natutulog, at unti-unting babawasan ang paggamit nito mula sa ikatlong linggo ayon sa kaginhawaan. Huwag magmaneho ng hindi bababa sa anim na linggo pagkatapos ng anumang operasyon sa balikat, kahit na matapos ang paggamit ng sling; ang iyong surgeon ang magbibigay ng clearance na magmaneho, karaniwan sa ikalawang review sa anim na linggo.

Ang paglalakbay sa isang tingin:

  • Yugto I — Pagprotekta sa tenodesis (humigit-kumulang ang unang apat na linggo)
  • Yugto II — Aktibong paggalaw (linggo 4–6)
  • Yugto III — Pagpapalakas (linggo 6–12, na may resisted biceps work mula sa ikasampung linggo)
  • Yugto IV — Pagbabalik sa buong aktibidad (linggo 12 pataas)

Ang mga range ng linggo ay tipikal kaysa fixed, at ang iyong physiotherapist ay magpapatuloy sa iyo base sa kung paano gumagaling at gumagalaw ang iyong braso, hindi sa kalendaryo. Ang physiotherapy ay karaniwang nagsisimula sa loob ng unang isang o dalawang linggo pagkatapos ng surgery, at ang iyong unang appointment ay detalyado sa iyong discharge pack maliban na lang kung ikaw ay pumili na ayusin ang sarili mong.

Yugto I — Pagprotektahan ang tenodesis (Linggo 0–4)

Ang mga unang linggo ay tungkol sa pagpapahintulot sa tendon na mag-ayos sa buto habang pinapanatili ang paggalaw ng mga kasamang bahagi. Ang iyong kamay, pulso, at mga daliri ay mananatiling aktibo mula sa simula. Ang iyong siko ay igagalaw araw-araw, ngunit pasibo: hayaan ang iyong ibang kamay na gumawa ng pagliko at pag-ikot ng palad pataas/pababa, upang manatiling relaxed ang biceps. Ang balikat ay igagalaw nang dahan-dahan sa loob ng mga limitasyong nasa ibaba, gamit ang mga ehersisyo ng pendulum at mga galaw na may tulong. Gumamit ng yelo para sa pagpapagaan ng sakit, uminom ng gamot pang-alis ng sakit bago ang iyong mga ehersisyo at sesyon ng pisikal na terapiya, at panatilihin ang sling, kabilang ang pagtulog. Huwag magbitbit o magdala ng anumang bagay gamit ang na-operahang braso, at huwag magmaneho habang kailangan ang sling. Ang mga magaan na gawain na may suporta sa forearms, tulad ng pagsusulat o pag-type, ay karaniwang okay depende sa kaginhawaan.

Para sa iyong pisikal na terapeuta:

Mga Layunin

  • Protektahan ang tenodesis fixation habang ito ay nag-aayos sa buto
  • Alisin ang sakit, pamamaga, at ang inflammatory response
  • Buong passive elbow at forearm range of motion; komportableng passive shoulder range of motion sa loob ng mga limitasyong nasa ibaba
  • Panatilihin ang scapular function at posture

Pamamahala

  • Sling ng humigit-kumulang 3–4 linggo, kabilang sa gabi, na unti-unting binabawasan mula sa linggo 3
  • Passive range of motion ng siko: flexion/extension at forearm supination/pronation
  • Active range of motion ng pulso at kamay; pagpi-piga ng bola
  • Passive at gentle active-assisted range of motion ng balikat sa loob ng mga limitasyon: pendulums, flexion at scaption hanggang sa 90 degrees sa simula, na unti-unting pinapalawak depende sa kaginhawaan; external rotation hanggang sa 40 degrees; internal rotation hanggang sa 45 degrees
  • Scapular setting at retraction (may suporta ang braso), na unti-unting lumilipat sa scapular isometrics; cervical range of motion at trabaho sa posture
  • Cryotherapy para sa sakit at pamamaga; analgesia bago ang mga ehersisyo at sesyon
  • Isang roll ng tuwalya o maliit na unan sa ilalim ng siko kapag nakahiga sa likod, upang maiwasan ang shoulder extension

Mga Precautions

  • Walang active elbow flexion at walang resisted forearm supination; ang biceps ay mananatiling unloaded
  • Walang active shoulder range of motion; walang external rotation na higit sa 40 degrees; walang shoulder extension o horizontal abduction na lumalampas sa neutral
  • Walang pagbitbit o pagdadala gamit ang na-operahang braso
  • Walang friction massage sa proximal biceps / tenodesis site
  • Walang pagmamaneho sa loob ng anim na linggo (ito ay sumasaklaw sa anumang operasyon sa balikat)

Mga Kriterya para makapag-proceed

  • Naayos ang sugat at maayos na kontrolado ang sakit
  • Buong passive elbow flexion/extension at forearm rotation
  • Komportableng passive shoulder range of motion sa loob ng mga itinakdang limitasyon

Yugong II — Aktibong paggalaw (Linggo 4–6)

Kapag nawala na ang sling, ang braso ay nagsisimulang gumalaw gamit ang sarili nitong lakas. Ang balikat ay unti-unting lumilipat mula sa mga galaw na may tulong patungo sa aktibong paggalaw sa lahat ng direksyon, at ang siko ay nagsisimulang yumuko at lumiko nang aktibo, ngunit pa rin nang walang bigat. Ang biceps ay gumagalaw, ngunit hindi pa gumagana nang buo: panatilihin ang pag-angat sa minimum (walang hawak na mas mabigat kaysa isang tasa ng tsaa gamit ang brasing ito) at iwan ang pagtutulak, paghila, at pagdadala sa kabilang bahagi. Karaniwang komportable ang magaan na trabaho sa mesa sa yugong ito. Maaaring magmaneho muli mula anim na linggo, pagkatapos ipahintulot ng iyong doktor at kung kaya mong kontrolin ang sasakyan nang komportable at ligtas.

Para sa iyong pisyoterapeuta:

Mga Layunin

  • Unti-unting pagbawi ng buong aktibong saklaw ng galaw ng balikat at siko
  • Normal na mekaniks ng scapula kasabay ng paggalaw
  • Pagsisimula ng submaximal na isometrics ng balikat
  • Magaan na paggamit ng braso sa antas ng baywang para sa mga pang-araw-araw na gawain

Pamamahala

  • Aktibo-at-tulong na paggalaw ng balikat na unti-unting nagiging aktibong saklaw ng galaw sa lahat ng patlang (halimbawa, pag-unlad mula sa lawn-chair, pag-slide sa pader at riles, supine flexion patungo sa standing scaption)
  • Aktibong pag-yuko/pagtuwid ng siko at supination/pronation ng forearms, nang walang resistensya
  • Submaximal na isometrics ng balikat: internal rotation, external rotation, abduction, adduction
  • Patuloy na pagpapatatag ng scapula at trabaho sa postura
  • Masahe ng peklat habang tumatanda ang sugat; walang cross-friction sa site ng tenodesis
  • Pag-stretch ng posterior capsule (cross-body, sleeper stretch) kung kinakailangan
  • Paglalakad o stationary bike para sa fitness; walang weight bearing sa pamamagitan ng apektadong braso

Mga Paalala

  • Walang resisted na trabaho para sa biceps; walang pag-load ng elbow flexors o supinators
  • Walang pag-angat gamit ang operadong braso; hindi pa maaaring tumakbo
  • Iwasan ang sobrang pag-stress sa gumagaling na tendon sa pamamagitan ng agresibong pag-stretch o manual therapy

Mga Kriteryo para Magpatuloy

  • Buong, walang sakit na aktibong saklaw ng galaw ng balikat, siko, at forearm
  • Tamang mekaniks ng scapula kasabay ng paggalaw at magaan na paggamit
  • Mabuti ang kontrol sa sakit

Yugto III — Pagpapalakas (Linggo 6–12)

Ang pagpapalakas ay nagsisimula nang dahan-dahan at gumagana mula sa baluktot ng balikat palabas: ang mga kalamnan ng rotator cuff at scapula ang unang pinapalakas, gamit ang mga elastic bands at magaan na timbang sa mababang load at mataas na paulit-ulit na galaw. Ang resisted biceps work (curls at resisted palm-up rotation) ay hinihintay hanggang linggo 10, pagkatapos ay nagsisimula nang magaan at unti-unting pinapalakas. Ang mga publikadong protocol ay nagpapakilala nito kahit saan sa pagitan ng linggo 6 at linggo 10; ang protocol na ito ay sumusunod sa mas protektibong dulo ng sakop na iyon upang bigyan ang tenodesis fixation ng pinakamahabang panahon bago ito iload. Ang karaniwang mga gawain sa araw-araw ay dapat na halos bumalik na sa karaniwan sa yugtong ito, at mula sa mga linggo 8 ay maaari ka karaniwang bumalik sa pagtakbo, pagbibisikleta at golf, ayon sa gabay ng iyong physiotherapist.

Para sa iyong physiotherapist:

Mga Layunin

  • I-normalize ang lakas, endurance at neuromuscular control
  • Ibalik ang function mula sa antas ng baywang hanggang antas ng dibdib patungo sa overhead

Pamamahala

  • Panatilihin ang buong range of motion ng balikat at siko sa buong yugto
  • Isotonic rotator cuff strengthening: internal at external rotation na may magaan na resistance, mula sa neutral na posisyon na umaabot patungo sa 90 degrees ng abduction
  • Scapular program: prone series na umaabot sa buong yugto; resisted serratus punch, low row, push-up plus progression (pader, counter, tuhod, sahig)
  • Resisted biceps curls, supination at pronation mula linggo 10; maikling lever muna, mababang load, mataas na paulit-ulit na galaw, maingat na pag-progres
  • Rhythmic stabilisation at diagonal (D1/D2) patterns; closed-chain stabilisation work
  • Pagbabalik sa pagtakbo, pagbibisikleta at golf mula sa mga linggo 8, na may tamang mechanics

Mga Paalala

  • Iwasan ang long-lever resisted elbow flexion at supination sa maagang yugto
  • Walang mabibigat na pag-angat o pagdadala hanggang sa mabawi ang lakas
  • Walang paglangoy o pagtapon sa yugtong ito
  • Ang pagpapalakas ay hinihintay hanggang sa ang range of motion ay malapit na sa buo, at nananatiling walang sakit

Mga Kriteryo para mag-progres

  • Buong, walang sakit na active range of motion na may normal na scapulohumeral rhythm
  • 5/5 rotator cuff strength sa 90 degrees ng abduction sa scapular plane, at 5/5 scapulothoracic strength
  • Tinatanggap ang pagpapalakas nang walang pag-flare-up ng mga sintomas

Yugto IV — Pagbabalik sa buong aktibidad (Linggo 12 pataas)

Ang huling yugto ay isang unti-unting pagbabalik sa mas mabibigat na trabaho, mga gawain sa itaas ng balikat, at isport. Karamihan sa mga tao ay pinapayagan na bumalik sa gym, manual na trabaho, at recreational na isport sa pagitan ng tatlo at apat na buwan, habang unti-unting pinapataas ang bigat; ang mga atleta sa overhead at contact (paghahagis, paglangoy, mga isport na may raket) ay dahan-dahang ibinabalik sa loob ng mas mahabang panahon, madalas na apat hanggang limang buwan o higit pa. Patuloy na lumalakas at nagkakaroon ng kumpiyansa ang biceps sa loob ng mga buwan pagkatapos nito, kaya ang progreso sa yugtong ito ay sinusukat base sa kaya ng braso, hindi sa petsa.

Para sa iyong physiotherapist:

Mga Layunin

  • Buong lakas at kapangyarihan nang walang mga pattern ng pagpapalit na galaw
  • Katatagan at kontrol sa mga galaw na may mataas na bilis at partikular sa isport
  • Pagbabalik sa normal na mga gawain sa isport at trabaho

Pamamahala

  • Multi-joint at compound na pagpapalakas, habang unti-unting pinapataas ang bigat
  • Plyometric na pagsasanay na nagsisimula sa ilalim ng taas ng balikat gamit ang parehong braso, pagkatapos ay lumipat sa single-arm at overhead
  • Mga programa ng interval na pagbabalik sa isport para sa mga naghihagis, naglangoy, o mga isport na may raket, kung angkop
  • Tugunan ang lakas at kontrol ng core at balakang upang hindi magpapalit ang balikat

Mga Paalala

  • Dahan-dahang pag-unlad sa mga ehersisyong nagpapatibay sa harap ng balikat (halimbawa, bench press, upright row)
  • Ang pagbabalik sa isport ay sumusunod sa clearance, na may humigit-kumulang 90% na lakas kumpara sa kabilang braso at walang sakit na kontrol sa mga galaw na may mataas na bilis at partikular sa isport

Pagkatapos ng iyong protokol

Ang mga yugto sa itaas ay naangkop mula sa mga publikadong protokol ng rehabilitasyon para sa isolated biceps tenodesis: Massachusetts General Brigham Sports Medicine, ang Department of Orthopaedic Surgery ng University of Virginia, The Ohio State University Wexner Medical Center at UW Health (University of Wisconsin). Ang mga hanay ng linggo ay karaniwan imbes na nakatakda, at ang iyong patuloy na rehabilitasyon ay indibidwal na pinamumunuan ng iyong pisyoterapeuta, na nagtatrabaho kasama ang kumpanya, batay sa kung paano gumagaling ang iyong braso. Ang pahinang ito ay nagtatrabaho kasama ng pangkalahatang payo ng kumpanya tungkol sa paggaling; tingnan ang pamamahala ng post-operative na sakit at pag-aalaga sa sugat. Para sa operasyon mismo, tingnan ang biceps tenodesis. Ang ebidensya sa likod ng protokol na ito (pagpapatibay at paggaling, desisyon sa pagitan ng tenodesis at tenotomy, mga rate ng komplikasyon at pagkabigo, at kung paano pinipili ang bilis ng rehab) ay buod sa seksyon ng ebidensya, na available bilang PDF mula sa itaas ng pahinang ito.

Reviewed by Dr Kieran Hirpara · 10 June 2026.

Want the clinical detail? Read the clinician version.

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Evidence & references

This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Biceps Tenodesis — Post-operative Rehabilitation Evidence Summary

Topic scope: the evidence behind post-operative rehabilitation after isolated biceps tenodesis (re-anchoring the long head of biceps to the humerus) — fixation methods and their healing implications, when to protect versus load the construct (active elbow flexion and resisted supination), shoulder ROM restrictions, return-to-activity timing, and the failure/complication profile (Popeye deformity, fixation failure). The combined cuff-repair pathway defers to the rotator-cuff-repair protocol and is out of scope here.

Defining principle of the surgical rehab here: a tenodesis is a healing construct that must be protected — the tendon has been detached from its native anchor and fixed into bone, and that bone–tendon interface needs weeks to heal. Because the biceps bends the elbow and turns the palm up (supination), the early restrictions are unusually centred on the elbow, not the shoulder: active elbow flexion and resisted supination are the loads that pull directly on the fresh tenodesis, so they are deferred while the construct heals. The shoulder itself is generally less restricted — only positions that tension the tendon (external rotation past ~40°, extension/horizontal abduction behind the body) are limited early. This is the inverse of a rotator-cuff or labral repair, where the shoulder is the protected structure.

A. THE PROCEDURE & WHY THE REHAB IS SHAPED THIS WAY

In a biceps tenodesis the long head of biceps is released from its origin on the superior glenoid/labrum and re-fixed into the proximal humerus, most commonly with an interference screw, a suture anchor, or a cortical/unicortical button (or combinations). The location is either suprapectoral (higher, usually all-arthroscopic, in or above the bicipital groove) or subpectoral (lower, usually open, below the pectoralis major tendon). Both achieve the same goal — remove the painful intra-articular biceps as a pain generator while preserving the muscle's length-tension relationship to avoid a Popeye deformity and cramping.

The rehab is built around the time for the tendon to incorporate into the bone tunnel/socket. The biceps' two actions — elbow flexion and forearm supination — are precisely the movements that load the tenodesis, so resisted/active use of these is staged in last. Shoulder motion is restored earlier because most shoulder positions do not pull hard on the construct.

B. EVIDENCE BY THEME

1. Tenodesis vs tenotomy — the decision upstream of rehab

Tenotomy (simply releasing the tendon) and tenodesis give broadly equivalent pain relief and function, but tenodesis trades a slightly more demanding recovery for a lower rate of Popeye deformity and cramping/fatigue, particularly relevant in younger, leaner and more active patients. A prospective double-blinded RCT and multiple reviews support this trade-off [Castricini RCT; Frost/Hackney review; Slenker review]. Moderate–strong (RCT + SR). This is why a tenodesis — and therefore a protected construct needing staged rehab — is chosen in the first place.

2. Fixation strength and what it permits

Interference screws and suture anchors both provide clinically adequate fixation; biomechanical load-to-failure figures vary between studies and clinical outcomes do not differ meaningfully by fixation type [biomechanical cadaver series; clinical comparisons]. The practical point for rehab: the construct is strong at time zero but the biological bond to bone is what is healing over the first 6–12 weeks — which is why loaded elbow flexion is deferred regardless of the hardware used. Moderate (biomechanical + clinical cohorts).

3. Does the rehab pace actually need to be slow? — the key controversy

The traditional protocol protects the elbow for ~6 weeks before active flexion and reserves resisted biceps work for ~10–12 weeks. However, Mazzocca et al. challenged this: in 105 open subpectoral tenodeses (dual-fixation button + interference screw) rehabilitated with immediate, unrestricted motion and no postoperative restrictions, the failure rate was only 2.2% (2 of 98) at minimum 2-year follow-up, with excellent ASES/DASH scores. Both failures occurred early (5 and 9 weeks). The conclusion: with a robust dual-fixation construct, early mobilisation is reasonable and may improve outcomes [Mazzocca, JSES 2018, DOI 10.1016/j.jse.2018.02.061]. A subsequent comparison of early versus delayed active ROM reached similar reassurance [PMID 34458384]. Moderate (single-arm cohort + comparative). This protocol nonetheless follows the more protective published pace — it is the safer default across mixed fixation methods and does not assume a dual-fixation construct.

4. Complications and failure rates — what rehab is protecting against

A review of 1,526 shoulders found a low overall complication rate: persistent anterior shoulder pain ~11–13%, Popeye deformity ~4.6–4.7%, with no meaningful difference by fixation type or location; reported fixation failure/re-rupture is ~0.8% [Nho/Virk review, DOI 10.1016/j.jse.2018.09.005]. The small early-failure window (the Mazzocca failures at 5 and 9 weeks) is exactly the period the protective phases cover. Moderate (large pooled review).

5. Suprapectoral vs subpectoral — does it change rehab?

A systematic review and meta-analysis of arthroscopic suprapectoral versus open subpectoral tenodesis found comparable clinical outcomes and complication profiles [DOI 10.1177/2325967120945322]. The rehabilitation pathway is therefore the same for both techniques — this protocol covers arthroscopic and open subpectoral alike. Moderate (SR-MA).

C. PHASED POST-OP TIMELINE (isolated tenodesis)

Consistent with the synthesis protocol. The hallmark is protect the elbow (no active flexion / no resisted supination) while keeping the hand, wrist, scapula and most of the shoulder moving.

Phase Window Sling ROM Strengthening Notes
I — Protecting the tenodesis Week 0–4 Yes, incl. at night; wean from ~wk 3 Passive elbow flexion/extension + forearm rotation; active hand/wrist; gentle shoulder PROM/AAROM — flexion/scaption to ~90°, ER to 40°, IR to ~45°; pendulums None (biceps stays unloaded) No active elbow flexion, no resisted supination; no shoulder extension / horizontal abduction past neutral; no lifting/carrying. No driving while in the sling.
II — Active movement Week 4–6 Off Progress shoulder AAROM → AROM all planes; active (unloaded) elbow flexion/extension + supination/pronation begins Submaximal shoulder isometrics Biceps moving but not working — keep lifting minimal (≤ a cup of tea). Driving once out of sling and able to control the car safely.
III — Strengthening Week 6–12 Off Maintain full ROM Cuff + scapular strengthening from wk 6; resisted biceps curls / resisted supination from ~week 10 Resisted biceps deliberately last; published protocols introduce it wk 6–10, this protocol uses the protective end. Running/cycling/golf from ~wk 8.
IV — Return to full activity Week 12+ Off Full Progressive load, power, sport-specific Gym/manual work/recreational sport ~3–4 months; overhead/throwing/contact staged over ~4–5 months+.

Branch point — combined cuff repair: if a rotator cuff repair was performed at the same time, the rotator-cuff-repair protocol takes priority (sling ~6 weeks, ROM restrictions, slower strengthening, ~5 months total). The surgeon confirms post-operatively which pathway applies.

D. KEY CONTROVERSIES / EVIDENCE QUALITY

  1. How fast is safe? The strongest single piece of rehab-specific evidence (Mazzocca 2018) suggests immediate unrestricted motion is safe with a robust dual-fixation construct (2.2% failure). But this is a single-arm cohort with one specific construct; it does not license fast rehab across all fixation methods. The protective default remains the prudent generalisation. Moderate.
  2. Tenodesis vs tenotomy is well studied (RCT + SRs) and favours tenodesis for cosmesis/cramping — but this is the indication decision, not a rehab-timing trial. Moderate–strong.
  3. The rehab protocol timings themselves are consensus/expert, drawn from published academic physiotherapy guidelines (MGH Brigham, UVA, Ohio State, UW Health) rather than head-to-head rehab RCTs. Week ranges are typical, not trial-derived. Weak/consensus.
  4. Resisted-biceps start week varies (6–10) across published protocols; the choice of week 10 here is a deliberate protective bias, not a trial-supported threshold. Weak/consensus.

E. EVIDENCE-STRENGTH FLAGS (summary)

  • MODERATE–STRONG (RCT / SR-MA): tenodesis vs tenotomy equivalence with lower Popeye/cramping after tenodesis; suprapectoral vs subpectoral outcome equivalence (SR-MA).
  • MODERATE (cohorts / large pooled review): immediate-unrestricted-motion safety with dual fixation (Mazzocca, 2.2% failure); low overall complication profile (1,526-shoulder review — Popeye ~4.6%, fixation failure ~0.8%); fixation-type clinical equivalence.
  • WEAK / CONSENSUS: the post-operative rehabilitation protocol itself (academic PT guidelines, no defining rehab RCT); the specific week-10 resisted-biceps threshold.

CITATIONS

RAG corpus (180,000+ Orthopaedic articles)

  • Mazzocca AD, et al. Immediate physical therapy without postoperative restrictions following open subpectoral biceps tenodesis: low failure rates and improved outcomes at a minimum 2-year follow-up. J Shoulder Elbow Surg. 2018. DOI: 10.1016/j.jse.2018.02.061
  • Complications of biceps tenodesis based on location, fixation, and indication: a review of 1526 shoulders. J Shoulder Elbow Surg. 2019. DOI: 10.1016/j.jse.2018.09.005
  • Biceps tenotomy versus tenodesis: a review of clinical outcomes and biomechanical results. J Shoulder Elbow Surg. 2011. DOI: 10.1016/j.jse.2010.08.019
  • Biceps Tenodesis Versus Tenotomy in the Treatment of Lesions of the Long Head of the Biceps Tendon in Patients Undergoing Arthroscopic Shoulder Surgery: A Prospective Double-Blinded Randomized Controlled Trial. Am J Sports Med. 2020. DOI: 10.1177/0363546520912212
  • Outcomes and Complications After Primary Arthroscopic Suprapectoral Versus Open Subpectoral Biceps Tenodesis for SLAP Tears or Biceps Abnormalities: A Systematic Review and Meta-analysis. Orthop J Sports Med. 2020. DOI: 10.1177/2325967120945322
  • Arthroscopic Proximal Biceps Tenodesis at the Articular Margin: Evaluation of Outcomes, Complications, and Revision Rate. Arthroscopy. 2014. DOI: 10.1016/j.arthro.2014.08.024
  • Clinical and Biomechanical Evaluation of an All-Arthroscopic Suprapectoral Biceps Tenodesis. Orthop J Sports Med. 2014. DOI: 10.1177/2325967114553558
  • All-Arthroscopic Suprapectoral Versus Open Subpectoral Tenodesis of the Long Head of the Biceps Brachii Without the Use of Interference Screws. Arthroscopy. 2016. DOI: 10.1016/j.arthro.2016.07.007

Literature (URLs)

  • Early Versus Delayed Active Range of Motion After Open Subpectoral Biceps Tenodesis. PubMed. https://pubmed.ncbi.nlm.nih.gov/34458384/
  • Complications of biceps tenodesis based on location, fixation, and indication: a review of 1526 shoulders. PubMed. https://pubmed.ncbi.nlm.nih.gov/30573431/
  • Mazzocca — immediate PT without restrictions (minimum 2-year follow-up). PubMed. https://pubmed.ncbi.nlm.nih.gov/29804912/
  • Interference Screw vs. Suture Anchor Fixation for Open Subpectoral Biceps Tenodesis: Does it Matter? PMC. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2553411/

Published rehab protocols (patient-guidance — basis for the phase structure)

  • Massachusetts General Brigham Sports Medicine. Rehabilitation Guidelines for Biceps Tenodesis. https://www.massgeneral.org/assets/MGH/pdf/orthopaedics/sports-medicine/physical-therapy/rehabilitation-protocol-for-biceps-tenodesis.pdf
  • UVA Department of Orthopaedic Surgery, University of Virginia. Isolated Biceps Tenodesis Post-operative Rehabilitation Protocol. https://med.virginia.edu/orthopaedic-surgery/wp-content/uploads/sites/242/2021/06/Isolated-Biceps-Tenodesis.pdf
  • The Ohio State University Wexner Medical Center. Biceps Tenodesis Clinical Practice Guideline. https://medicine.osu.edu/-/media/files/medicine/departments/sports-medicine/medical-professionals/shoulder-and-elbow/bicep-tenodesis-2020.pdf
  • UW Health Sports Medicine, University of Wisconsin. Rehabilitation Guidelines for Biceps Tenodesis. https://bynder.uwhealth.org/m/8a7c2438102f495f/original/Rehab-Guideline-Biceps-Tenodesis.pdf

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