Guideline review compares tenodesis versus tenotomy for long head of biceps tendon pathologyShould you cut your tendon or anchor it back in place for biceps pain?

Frontiers in Medicine Published April 13, 2026 DOI ↗ Editorial oversight: Dr. Lars van Dijk, PhD · Surgical, Procedural & Diagnostic

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Key Takeaway

Consider individualized factors like tendon quality and cosmetic concerns when choosing between tenodesis and tenotomy.

This document is a guideline review addressing the management of long head of biceps tendon pathology. The analysis compares tenodesis, performed as either subpectoral or non-subpectoral, with tenotomy as the alternative intervention. The review notes that no consensus currently exists regarding the optimal procedure for this condition.

Main results indicate that neither tenodesis nor tenotomy has demonstrated clear superiority over the other. Specific numerical data for primary or secondary outcomes were not reported in the provided evidence. Consequently, the decision between procedures relies heavily on patient-specific variables rather than robust comparative efficacy data.

Safety considerations highlight that tenotomy is associated with a risk of 'Popeye' deformity and potential aesthetic concerns. The review does not report specific rates of serious adverse events, discontinuations, or detailed tolerability metrics. These limitations underscore the need for shared decision-making that weighs functional outcomes against cosmetic risks.

Key limitations include the absence of a consensus on the optimal procedure and the lack of demonstrated superiority for either surgical option. Practice relevance centers on assisting surgeons in individualized decision-making based on factors such as tendon quality, bone density, economic considerations, injury type, cosmetic concerns, and surgeon experience. Clinicians must interpret these findings conservatively given the uncertainty in the evidence.

If you have pain in the long head of your biceps tendon, you might be told to either cut it loose or sew it back into place. This review looked at how these two common surgeries compare for people dealing with this specific injury. The goal is to help you understand what each option actually offers before you sit in the surgeon's office.

Tenodesis involves reattaching the tendon, while tenotomy means cutting it. The study found that neither method proved superior to the other for improving pain or function. Both procedures seem to work well enough that choosing between them shouldn't be based on which one works better overall.

However, there is a real difference in what happens after surgery. Tenotomy is linked to a higher chance of a 'Popeye' deformity, where the muscle bunches up near the elbow. This can cause aesthetic concerns for some people. The review notes that there is no single best procedure for everyone.

Ultimately, the choice relies on your individual situation. Factors like how strong your bone is, your budget, and how much you care about your arm's look matter. Surgeons should use these details to help you decide what fits your life best, rather than following a one-size-fits-all rule.

What this means for you:

Neither cutting nor reattaching the biceps tendon is clearly better; choose based on your look and bone health.

Study Details

Study typeGuideline

EvidenceLevel 5

PublishedApr 2026

View Original Abstract ↓

The long head of the biceps tendon (LHBT) is frequently described as a primary “pain generator” in anterior shoulder pain. While both tenotomy and tenodesis are commonly employed for LHBT pathologies, no consensus exists on the optimal procedure, as neither has demonstrated clear superiority. It is widely recognized, however, that tenotomy is associated with a risk of “Popeye” deformity and aesthetic concerns, whereas tenodesis mitigates these issues. The tenodesis literature reveals a variety of LHBT fixation methods, which differ primarily in the location of fixation, the choice of implants, and the suturing technique. This article classifies these techniques into two main groups (subpectoral and non-subpectoral tenodesis) to provide an overview of the surgical techniques and to contrast their advantages and disadvantages, thereby assisting surgeons in individualized decision-making based on factors such as tendon quality, bone density, economic considerations, injury type, cosmetic concerns, and surgeon experience.

Guideline review compares tenodesis versus tenotomy for long head of biceps tendon pathologyShould you cut your tendon or anchor it back in place for biceps pain?

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Guideline review compares tenodesis versus tenotomy for long head of biceps tendon pathologyShould you cut your tendon or anchor it back in place for biceps pain?

Study Details

Reverse Shoulder Arthroplasty Improves Forward Flexion Over ORIF in Elderly Fracture Patients

Reverse shoulder replacement beats plate surgery for arm lifting

Clinical research that matters. Delivered to your inbox.

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