Biceps tenotomy has earlier pain relief compared to biceps tenodesis: a randomized prospective study

  • Elshaday S. BelayEmail author
  • Jocelyn R. Wittstein
  • Grant E. Garrigues
  • Tally E. Lassiter
  • Melissa Scribani
  • Richard D. Goldner
  • Christopher A. Bean



 Surgical management for long head of the biceps (LHB) tendinopathy with either biceps tenotomy or tenodesis is a reliable, but debated treatment option. The aim of this prospective, randomized, single-blinded study is to evaluate differences in pain relief and subjective outcomes between biceps tenotomy versus tenodesis for LHB tendinopathy.


 Subjects were randomized and blinded to biceps tenotomy versus arthroscopic tenodesis intra-operatively. Outcomes evaluated included subjective patient outcome scores, pain, and cosmetic deformity. Subjective outcomes scores and pain were analyzed using a two-way ANOVA, controlling for concomitant rotator cuff repair. Binary outcomes were compared using Chi-square tests.


 Thirty-four subjects (31 male, 3 female) with a median age of 56 (range 30–77) were enrolled. Twenty subjects were randomized to tenotomy and 14 to tenodesis. Fifty-six percent had concomitant rotator cuff repairs. The mean VAS pain score at 3 months was lower with tenotomy versus tenodesis. 2-year follow-up demonstrated no statistically significant differences for VAS, ASES, or SANE. 15/20 (75%) subjects with biceps tenotomy reported no pain medication use at the 2-week postoperative visit versus 5/14 (33%) for biceps tenodesis. Popeye deformity was found in 5/20 (25%) of tenotomy subjects versus 1/14 (7%) in tenodesis subjects.


Outcomes appear similar between biceps tenotomy versus tenodesis; however, the tenotomy group demonstrated greater incidence of cosmetic deformity but an earlier improvement in postoperative pain.

Level of evidence

Treatment Studies, Level II.


Bicep tenodesis Tenotomy Randomized Prospective Arthroscopy 



The funding was provided by the Piedmont Orthopaedic Research Foundation.


Research funding was awarded from the Piedmont Orthopaedic Research Society.

Compliance with ethical standards

Conflict of interest

Dr. Garrigues received research support from Arthrex and Smith & Nephew. No other authors have relevant disclosures or conflict of interest.

Ethical approval

This randomized, prospective, single-blinded study was approved by the Institutional Review Board of the Durham VA Medical Center, ID number 01407.


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Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2019

Authors and Affiliations

  • Elshaday S. Belay
    • 1
    Email author
  • Jocelyn R. Wittstein
    • 1
  • Grant E. Garrigues
    • 2
  • Tally E. Lassiter
    • 1
  • Melissa Scribani
    • 3
  • Richard D. Goldner
    • 1
  • Christopher A. Bean
    • 1
  1. 1.Department of Orthopaedic Surgery, Durham Veterans Affairs Medical CenterDuke University Medical CenterDurhamUK
  2. 2.Midwest Orthopaedics at RushRush University Medical CenterChicagoUSA
  3. 3.Center for BiostatisticsBassett Research InstituteCooperstownUSA

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