137 patients with lesions in the long head of the biceps tendon (LHBT) and small- to medium-sized rotator cuff tears were randomized to undergo either tenotomy or tenodesis. The purpose of the study was to compare the clinical and radiographic outcomes between the two treatments. Outcomes included the American Shoulder and Elbow Surgeons Score, simple shoulder test, visual analogue scale pain scores, range of motion, cosmetic changes, elbow motor power, and magnetic resonance imaging, measured to a minimum of 12 months postoperatively. Findings indicated no significant differences between treatment groups for range of motion, or pain and functional scores. Elbow motor power in supination was significantly greater in the tenodesis group compared to the tenotomy group, but flexion and pronation were similar. Additionally, the tenodesis group had a lower incidence of Popeye deformity compared to the tenotomy group (5.6% vs. 19.6%).