Tenodesis of the long head of biceps is most commonly used for the surgical management of biceps tendinopathy, but may also be used for lower-demand patients with type 2 or 4 superior labrum anterior-posterior (SLAP) tears, either as an open procedure or arthroscopically. The loss of the intraarticular biceps doesn’t affect the stability of the shoulder in cadaveric models, but seems to remove this portion of the biceps as a pain generator. The procedure is being performed with increasing frequency, and about half are performed arthroscopically. However, the proportion of these surgeries performed arthroscopically is increasing at a faster rate, particularly in the USA. This may be due to the improvement in specific devices that allow a more easily reproducible result. The advantage of an arthroscopic biceps tenodesis is related to the smaller incisions and the ability to address other concomitant pathology.

Arthroscopic biceps tenodesis may be performed using standard anterior and posterior portals with the addition of two specific anterior portals, a viewing portal approximately 5 cm from the anterolateral corner of the acromion, and a biceps portal created from out to in using a needle to guide placement. We perform it using a specific interference screw, although several different implants and techniques exist. The decision regarding implant choice is surgeon dependent.

Ultrasound scan (USS) may reveal evidence of bicipital tendinosis or increased fluid surrounding the tendon; a guided injection may provide temporary relief providing further localizing evidence of pathology.