Rotator Cuff / Bicep Tenodesis Surgery; Recovery Log

[R0IDS]

Started PT today. My shoulder was a little stiff at first but it actually was able to move quite a bit more than expected.

The thing that worries me is when i have my arm straightened out and lifted my bicep feels pretty tight, including my armpit where the incision was made. I REALLY don't want the anchor to come out.

Has anyone experienced this when starting PT?


***EDIT****
Update, the tightness under my arm on on my bicep ended up being the scar tissue. This really went away after the physical therapist started scraping the scar around week 7-8.

[tkdnj]

Started PT today. My shoulder was a little stiff at first but it actually was able to move quite a bit more than expected.

The thing that worries me is when i have my arm straightened out and lifted my bicep feels pretty tight, including my armpit where the incision was made. I REALLY don't want the anchor to come out.

Has anyone experienced this when starting PT?

Absolutely experienced that. Remember they did a whole lot of cutting and drilling, so you have a massive amount of inflammation in there, and that area will be EXTREMELY tight. A big part of your PT is to SLOWLY and methodically stretch the area. Only a PT knows how to do that properly and safely. What you are feeling is normal. DO NOT push it, do EXACTLY what the PT says, and speak up if something doesn't feel right. The PT will be able to explain what you're feeling and why. Also, not every surgery is the same, so again, speak up, so the PT can respond accordingly (either with an explanation or pulling back a bit)

[userKJRQDHET0J0]

tkdnj,
thanks for this tread, it has been helpful to me! Recently I tore my long head tendon, and develop the Popeye arm. I have had the tendon reattached (feb 4th) using a Subpectoral Tenodesis procedure, with button device.

while it only been a few days out of surgery, i am able to do supported movement of the arm, and I'm noticing that i still have noticed the same Popeye deformity. i see my Dr in a week and he says to not worry to much about it, lol.

i have seen that there are different way to reattach the tendon and locations to attach to the humerus.
Anyway, was wondering what procedure(suprapectoral or subpectoral) you had done, how your bicep is looking 6months plus post surgery? while I do not expect the appearance to return to pre injury, I was hopeful of that it would look at least a little like normal? So, I'm looking to see what out comes others have had long term post injury/surgeries?

Any feedback is appreciated!

[tkdnj]

tkdnj,
thanks for this tread, it has been helpful to me! Recently I tore my long head tendon, and develop the Popeye arm. I have had the tendon reattached (feb 4th) using a Subpectoral Tenodesis procedure, with button device.

while it only been a few days out of surgery, i am able to do supported movement of the arm, and I'm noticing that i still have noticed the same Popeye deformity. i see my Dr in a week and he says to not worry to much about it, lol.

i have seen that there are different way to reattach the tendon and locations to attach to the humerus.
Anyway, was wondering what procedure(suprapectoral or subpectoral) you had done, how your bicep is looking 6months plus post surgery? while I do not expect the appearance to return to pre injury, I was hopeful of that it would look at least a little like normal? So, I'm looking to see what out comes others have had long term post injury/surgeries?

Any feedback is appreciated!

I don't know which procedure I had but I can tell you this. My right shoulder had extensive rotator cuff surgery 6 years ago which included bicep tenodesis. That bicep tendon had minimal healthy tissue so the surgeon had to make a large incision to be able to grab some healthy tissue to use to attach it to the bone. That bicep recovered strong, without a popeye look, but less of a peak on my bicep than I had before. But, it was such bad shape before the surgery that I consider the surgery and recovery a huge success.
I had my left shoulder done almost one year ago. Again extensive rotator cuff surgery with bicep tenodesis. This bicep looks exactly like it did before, nice round peak. And here's the good news for you: It had a popeye look for the first couple of months! Like your surgeon, my surgeon said don't worry about it, and sure enough it looks perfect now!

[userKJRQDHET0J0]

Thanks for the quick reply, and optimistic prognosis. I will give it the required healing and recover time. Though i may need to lean on you for Dr referral, if the recovery hits the skids. while I'm confident in my Dr ability(based on referrals and sports med reputation), he did seem kinds of indifferent to doing the procedure, as I'm not an athlete (I'm very active in gym and field sports) and to him this is just a cosmetic procedure for non athletes. He was the third Dr to tell me its only a cosmetic procedure,LOL. But at least he agreed to do the procedure the other just flat out refused, uggh.

Again thanks for your reply!

[90Annie]

Hi All,

Thank you for keeping this thread going. It has provided some very useful information, although reading it does have me a bit apprehensive at the prospect of facing a Bicep Tenodesis.

First of all, I'm not a bodybuilder, nor do I do many weights if I'm being perfectly honest, I found this thread when looking up online on what to expect from the surgery. The surgery is a result of a car accident 4 years ago, my consultant did mention this surgery the first time I saw him, but given my day job, I decided to try the conservative route first. Unfortunately, 4 years after the crash, the conservative route has not been successful.

I'm a Physical Education teacher and I'm a bit worried about how much getting the surgery will affect the day job. I intend on putting the surgery off until the summer to try and limit the time I will need off work, but realistically would anyone have any idea how long away from a job like Phys Ed teaching I'm likely going to need?

Between now and the surgery, I'm thinking of trying to increase the amount of resistance training I do in order the get the muscles about the shoulder biceps as strong as I can as I would hope that that would help the recovery post-surgery. Open to correct if I'm wrong?

Any other advice would also be appreciated?

[tkdnj]

Hi All,

Thank you for keeping this thread going. It has provided some very useful information, although reading it does have me a bit apprehensive at the prospect of facing a Bicep Tenodesis.

First of all, I'm not a bodybuilder, nor do I do many weights if I'm being perfectly honest, I found this thread when looking up online on what to expect from the surgery. The surgery is a result of a car accident 4 years ago, my consultant did mention this surgery the first time I saw him, but given my day job, I decided to try the conservative route first. Unfortunately, 4 years after the crash, the conservative route has not been successful.

I'm a Physical Education teacher and I'm a bit worried about how much getting the surgery will affect the day job. I intend on putting the surgery off until the summer to try and limit the time I will need off work, but realistically would anyone have any idea how long away from a job like Phys Ed teaching I'm likely going to need?

Between now and the surgery, I'm thinking of trying to increase the amount of resistance training I do in order the get the muscles about the shoulder biceps as strong as I can as I would hope that that would help the recovery post-surgery. Open to correct if I'm wrong?

Any other advice would also be appreciated?

It really depends how physical you are when you teach. If you just get bicep tenodesis and not a full rotator cuff repair, I would assume you could be back teaching in four to six weeks, again that’s assuming you’re not doing much with the repaired bicep tendon. As far as resistance training to prepare for the surgery, I would talk to a physical therapist and do exactly what they tell you.
Good luck

[R0IDS]

So Yesterday marks 11 weeks after my right shoulder biceps tenodesis surgery.

To sum up, this surgery has been amazing for me so far. Starting about week 6 I felt like I was 100%, even though range of motion was closer to 95%. No pain whatsoever, though I still had to be careful with my day to day according to my doctor because the bone healing around the anchor is at its weakest from 6-8 weeks.

Now at 11 weeks I have 100% range of motion and I'm getting ready to start resistance PT next week. Last week I threw a tennis ball in PT, I was a little worried because I hadn't thrown anything in months, but there was no pain at all, if felt like I could really sling it, but I didn't. I was a QB in high school and could throw about 50-60 yards, but just before my surgery a 25 yard throw hurt and I needed to throw with very stiff mechanics to protect my shoulder. Based on how my shoulder feels right now I believe I'll be able to sling a football hard again!

My biggest disappointment with the surgery so far is the shape of my bicep. I used to have a pretty nice peak, which now looks . I realize it could be from not lifting in over 3 months, but I don't think it will return. I'll come back after lifting for a few months and report on strength and muscle shape/size.


I do have a question for the thread: I'll be moving across the country in 5 weeks, which will be 16 weeks post Op. Is it safe to assume I can do PT/strengthening stuff on my own after that or will I need to get a physical therapist in my new location?

[tkdnj]

So Yesterday marks 11 weeks after my right shoulder biceps tenodesis surgery.

To sum up, this surgery has been amazing for me so far. Starting about week 6 I felt like I was 100%, even though range of motion was closer to 95%. No pain whatsoever, though I still had to be careful with my day to day according to my doctor because the bone healing around the anchor is at its weakest from 6-8 weeks.

Now at 11 weeks I have 100% range of motion and I'm getting ready to start resistance PT next week. Last week I threw a tennis ball in PT, I was a little worried because I hadn't thrown anything in months, but there was no pain at all, if felt like I could really sling it, but I didn't. I was a QB in high school and could throw about 50-60 yards, but just before my surgery a 25 yard throw hurt and I needed to throw with very stiff mechanics to protect my shoulder. Based on how my shoulder feels right now I believe I'll be able to sling a football hard again!

My biggest disappointment with the surgery so far is the shape of my bicep. I used to have a pretty nice peak, which now looks . I realize it could be from not lifting in over 3 months, but I don't think it will return. I'll come back after lifting for a few months and report on strength and muscle shape/size.


I do have a question for the thread: I'll be moving across the country in 5 weeks, which will be 16 weeks post Op. Is it safe to assume I can do PT/strengthening stuff on my own after that or will I need to get a physical therapist in my new location?

1. The shape of your bicep is unpredictable. My first surgery 6 years ago (right shoulder/arm) my peak never came back. My last surgery one year ago (left shoulder/arm), my peak came back as good, if not better, than before. In both cases bicep tenodesis was a part of overall rotator cuff surgery. (Note my right arm had more damage than my left)

2. For both my surgeries I completed formal PT before 16 weeks (and my surgeries included much more than just bicep tenodesis). I started light weight training (on my own, not in PT) after 16 weeks the first surgery, and after 13 weeks the second surgery. So you should be good to go

[Taipan13]

So Yesterday marks 11 weeks after my right shoulder biceps tenodesis surgery.

To sum up, this surgery has been amazing for me so far. Starting about week 6 I felt like I was 100%, even though range of motion was closer to 95%. No pain whatsoever, though I still had to be careful with my day to day according to my doctor because the bone healing around the anchor is at its weakest from 6-8 weeks.

Now at 11 weeks I have 100% range of motion and I'm getting ready to start resistance PT next week. Last week I threw a tennis ball in PT, I was a little worried because I hadn't thrown anything in months, but there was no pain at all, if felt like I could really sling it, but I didn't. I was a QB in high school and could throw about 50-60 yards, but just before my surgery a 25 yard throw hurt and I needed to throw with very stiff mechanics to protect my shoulder. Based on how my shoulder feels right now I believe I'll be able to sling a football hard again!

My biggest disappointment with the surgery so far is the shape of my bicep. I used to have a pretty nice peak, which now looks . I realize it could be from not lifting in over 3 months, but I don't think it will return. I'll come back after lifting for a few months and report on strength and muscle shape/size.


I do have a question for the thread: I'll be moving across the country in 5 weeks, which will be 16 weeks post Op. Is it safe to assume I can do PT/strengthening stuff on my own after that or will I need to get a physical therapist in my new location?

It's been well over a year since your last post and I'm interested to hear how things are going with you, I know you were concerned with the shape of your biceps and I'm hoping once you got back training the muscle responded accordingly, please let us know, thanks.

[Taipan13]

I had a similar surgery, but the doc said it took him more time than expected to reattach the tendon and he didn't get to clean up the rotator cuff as he hoped.

The pain surprised me after the surgery, but when I saw the 4 inch incision it made sense. I was living in the Middle East when I had it done, so the strongest thing I got was some tylenol.

I was 41 at the time I believe and the recovery and rehab went pretty well. In 6 months I could do all the lifts I wanted and just had to build the weight slowly.

Now being a couple years later, I notice no real difference in bicep shape and it has caught up and passed my left arm just a bit as it is my dominant side. I have always been prone to impingement and I now feel safer working my repaired arm as the tendon no longer goes through the shoulder.

Good luck and have patience.

Did you have open biceps tenodesis and how long after the rupture did you have the surgery?

[thefeeny]

Brief history: I tore my left rotator cuff (supraspinatus, large tear, delaminated, retracted etc) back in 2019 and had it successfully repaired. I went through the ups and downs of recovery until at about the 9 month mark, when I had quite a setback, which caused intense, constant burning pain in my trapezius. Well, I put up with that for 2+ years, being consistently told by multiple specialists that my setback was the result of a neck / nerve issue. In addition, my left elbow also went, apparently I had both lateral and medial epicondylities at the same time! ... Now, I'm no doctor, but being told my neck was messed up, and knowing my elbow was messed up, I couldn't help but wonder if the repaired shoulder being right in between those two was somehow to blame! Anyway, I very reluctant (mostly out of desperation/hope) had neck surgery, fusing and replacing discs in my neck, which I do not recommend. My recovery from that has been uncomplicated, but I believe it was unnecessary surgery.

With the passage of time, I overcame both those surgeries and have been doing pretty well, until Jul-23 when I felt some pain doing hanging leg raises (touch bar slowly with toes) in my right shoulder. About 6 months of physiotherapy, 3 scans (2 ultrasound, 1 MRI) all showed no damage, nothing to see here - my sports doctor, physio and surgeon all agreed and said there was no serious problem. So I kept trying to overcome "nothing to see here"... But I kind of know my body and I knew what I was feeling and that was pain increasing and output/capability decreasing.

Eventually my shoulder surgeon diagnosed bicep tendonopathy and offered a bicep tenodesis. I had that done just before christmas -- 5 weeks ago at the time of posting this update. Surprise... when they went in there, they found not only a bicep tendon hanging on by a thread, but a full thickness tear of supraspinatus ... at least this time, it was a smaller tear (about 1cm) -- and the bicep was certainly a mess. So, tenodesis and cuff repaired successfully.

This was a bit of a relief, as for 6 months I'd been told I had no problem, resulting in significant uncertainty about how to conduct myself when it came to sports activities. At least now I know that there was a problem that was causing me issues, that wasn't getting better and needed to be "fixed".

This thread remains one of the best resources for people going through this procedure. It's not straightforward, and as I experienced last time, can have complications quite some time after surgery.

This time around has been easier than last time. I was able to sleep in bed almost immediately, whereas last time I needed to sleep in a recliner for 3 months! A big help there was some advice from a physio about how to use pillows for maximal comfort. In my case, that was basically to get a small cushion and wedge it into my armpit and then sleep on the other side, with the operated arm on top.

I am also instructed to wear a sling when out and about, but am allowed to remove it when in the home and sleeping -- the key advice is to not lift or load my operated arm for the first 6 weeks. I am however encouraged to use both hands, eat with my operated arm etc -- and have a few passive and slightly active exercises to do -- on my previous shoulder I was instructed to do absolutely nothing for 6 weeks for comparison.

In terms of general exercise, I was a bit out of it for the first 3-4 days, but after that point I was back on the stationary bike every day. By day 7 or 8 I was working both legs and my other arm as well. I keep my sling on when working out to remind myself not to use that arm -- although the surgeon at week 4 said I am ok to put both arms on the bike handles at this point. I am ok with any exercise as long as it doesnt torque or jostle the injured shoulder, which I am trying to keep quiet -- one handed burpees and jumping squats/lunges are out for now :-)

So I am alternating, 1 day cardio only on the bike, 1 day full body (minus 1 arm) workout.

This time around I am told I can be fully out of the sling at 6w, start doing passive/active range of motion, and in great news, can start strengthening at around the 9 week mark. That'ss much better than last time, where strengthening started at 12w, and then only isomertric holds were permitted for the next 2w.

Will update here from time to time. Hope to be cleared to return to gentle flat water paddling at around 4 months. Will of course follow all instructions given by surgeon and PT religiously.

PS: About 50% of the people I paddle with have now all had rotator cuff repairs - WTF!

[tkdnj]

This thread remains one of the best resources for people going through this procedure. It's not straightforward, and as I experienced last time, can have complications quite some time after surgery.

So glad this thread is helping some of you. That was my hope when I created it :-)

[thefeeny]

All going to plan. Not the most fun journey, but it's certainly progressive, and this being the second shoulder I've had done makes things a little more familiar.

Things are still a bit sore through the day, particularly in mornings. Last time, I kept my bicep tendon, this time around I have had a tenodesis, and that area that used to be occupied by the long head biceps tendon is probably the most painful. The area on the outside of the shoulder, where the supraspinatus was attached is relatively pain free, except for when I forget I've had surgery and move too quickly, at which point it hurts sharply pretty much from elbow to neck!

At this stage, for general living:

• I can now effectively wield a fork, and even slice a loaf of bread.
  In fact, I can do most things so long as my elbow close to my body.
  That includes being able to competently wipe in the bathroom again.
  That also includes washing dishes, wiping the bench and cooking. The chore holiday was good whilst it lasted...
  I am sleeping reasonably well, lying on my non-op side, with a pillow between the op-side elbow and my body.
  I can now walk long distances comfortably without a sling, including naturally letting my op-am swing.
  Oh, I can also drive again, which is useful, though I wouldn't want to drive long distances just yet and I have to push the car door open by reaching across my body with my non-op arm.
  My arm-pit, which had been glued shut, is getting closer to being normal (due to aeration from all the above)... I'd forgotten about the armpit factor.

For rehab (seeing physiotherapist weekly):

• I have been given some active exercises, the hardest being to raise my straight arm, using my muscles, whilst bent over at 90 deg at the waist. It's progressing slowly.
  I am allowed to do rows (red band), external and internal rotation (yellow band).
  I am also instructed to gently push my external rotation range with a stick.
  I do all this 2-3x a day, slow, controlled movements, rep ranges of 10-15.

For exercise, alternating daily between:

• 1h on spin bike I can now hold both hands on handlebars for most of that time -- I had to build to that as initially it got quite sore after a minute or two.
  Full body workout, 2 legs, 1 arm, 1 core, nothing that torques operated shoulder. Mostly using DBs and cables/bands.
  From next week (around week 8) I believe I can introduce some jogging ... with my arm either in a belt loop or sling. I hate that sling... so it might be a belt loop.!

[thefeeny]

Things are progressing normally. Still a bit stiff and painful in mornings particularly. ROM is getting back to normal, a bit tight with internal rotation and arm behind the back, and a lateral raise with just my arm weight is still tight too.

I am allowed to do a few things with "appropriate" weights... when it comes to standing rows and lateral pulls, I'm allowed to go towards 75% - 80% of normal.

However, for things that directly involve the rotator cuff, I've been told that even if it "feels" OK to do, I should match the weight to what the rotator cuff can bear. So, I happily built to 8kg dumbbell floor press, 8kg rear deltoid row and 8kg bicep curl -- I was told to drop it back to no more than 5kg, as for these exercises, the bigger muscles (pec, deltoid etc) would kick in and do the work, masking what the poor rotator cuff was going through.

Makes sense I guess, meaning Im stuck on 5kg for the next 2 or so weeks, then maybe I'll be permitted to gradually build. At 5kg, so far, I can't really tell if my bicep has a different shape after the tenodesis. I do still feel pain at the incision and area where the tenodesis / bicep attachment was moved to.

I am also permitted to hold up to 12kg statically with my arm by my side, and do something like squats and lunges that way. Better than nothing.

I am able to try paddling my surfski in flat gentle conditions for a short period from tomorrow, which is exciting. I should also be allowed to ride my road bike outside (I've been on a trainer indoors) from next week. The main concern keeping me from riding outside has been that if I fall I'm risking a re-tear, whereas this chance reduces at the 4 month mark.

Apparently, the supraspinatus takes a good 4 months to properly attach, and keeps improving for a while thereafter.

That's it for now. Will be back in a few weeks

[tkdnj]

Things are progressing normally. Still a bit stiff and painful in mornings particularly. ROM is getting back to normal, a bit tight with internal rotation and arm behind the back, and a lateral raise with just my arm weight is still tight too.

I am allowed to do a few things with "appropriate" weights... when it comes to standing rows and lateral pulls, I'm allowed to go towards 75% - 80% of normal.

However, for things that directly involve the rotator cuff, I've been told that even if it "feels" OK to do, I should match the weight to what the rotator cuff can bear. So, I happily built to 8kg dumbbell floor press, 8kg rear deltoid row and 8kg bicep curl -- I was told to drop it back to no more than 5kg, as for these exercises, the bigger muscles (pec, deltoid etc) would kick in and do the work, masking what the poor rotator cuff was going through.

Makes sense I guess, meaning Im stuck on 5kg for the next 2 or so weeks, then maybe I'll be permitted to gradually build. At 5kg, so far, I can't really tell if my bicep has a different shape after the tenodesis. I do still feel pain at the incision and area where the tenodesis / bicep attachment was moved to.

I am also permitted to hold up to 12kg statically with my arm by my side, and do something like squats and lunges that way. Better than nothing.

I am able to try paddling my surfski in flat gentle conditions for a short period from tomorrow, which is exciting. I should also be allowed to ride my road bike outside (I've been on a trainer indoors) from next week. The main concern keeping me from riding outside has been that if I fall I'm risking a re-tear, whereas this chance reduces at the 4 month mark.

Apparently, the supraspinatus takes a good 4 months to properly attach, and keeps improving for a while thereafter.

That's it for now. Will be back in a few weeks

Good to hear, having gone through it twice it sounds pretty typical to me. I started lifting weights very strict and light at four months, but it took a little over a year to feel normal again. I admit that between the four month mark and when it felt normal at 12-14 months I had gotten pretty frustrated, but it was all well worth it. Keep listening to what the experts tell you. Right shoulder was 9 years ago, left was 4 years ago and they both feel great today. I lift weights very intensively with no issues or pain