What is the biceps tendon?

The biceps tendon is a long cord-like structure which is located in the front of the shoulder. It originates from the top of the shoulder socket (the glenoid) and exits the joint through a bony trough (the biceps groove). Below the shoulder, this tendon becomes the long head of the biceps muscle. The short head of the biceps is a continuation of the conjoined tendon which originates from a bony hook (the coracoid) at the front shoulder blade. Thus the biceps muscle, which functions to bend the elbow and rotate the forearm, has two anchor points in the shoulder region.

Who gets biceps tendon injuries?

In general, these injuries occur more frequently as we become older. As we age, our tendons lose their elasticity and slowly becomes stiffer and more "brittle". The blood supply which nourishes the tendon also diminished with age. These degenerative processes may be more pronounced in sedentary individuals, but may be lessened with proper and regular exercise. The well-conditioned individual, however, is not immune from biceps tendon injuries as over-training can also harm an otherwise healthy tendon.

How do biceps tendon injuries occur?

As mentioned above, age, inactivity, or over-acitivity, can weaken a tendon which may lead to injury due to the decreased ability to endure repetitive motions and sudden loads. Because of it's location, the biceps tendon may also be injured from a direct blow to the front of the shoulder. Some individuals develop bone spurs in the biceps groove or under to the top of their shoulder blades (the acromion) which can lead to wear and tear of their tendons. A less frequent injury is a dislocation of the biceps tendon from it's groove.

This is usually seen in combination with a tear of the subscapularis tendon or the rotator cuff tendon, which normally help hold the biceps tendon in it's groove. The biceps tendon can also be injured at it's attachment site on top of the glenoid. This usually involves an avulsion, where the tendon is pulled off the bone and it's unstable.

What happens to the tendon when it's injured?

If the tendon or it's sheath (which encases the tendon) is irritated, it becomes inflamed, resulting in pain and swelling. This condition is called "tendinitis." Mild injuries can also result in microscopic tearing of individual tendon fibers. As the severity of an injury increases, larger tears can occur to the point where the tendon is partially torn or even completely ruptured. If a rupture occurs, the long head will usually fall distally toward the elbow. Biceps muscle function usually remains nearly normal because if it's dual attachment proximally.

How are biceps tendon injuries treated?

Initially, rest, ice, and gentle anti-inflammatory medicines are all that is usually needed. Sometimes an injection with strong anti-inflammatory medication such as cortisone is needed to control the pain and swelling. Severe cases, which fail to improve, may require surgical treatment.

What does surgery involve?

Surgical treatment depends on the nature and extent of damage to the tendon. If only a small portion of the tendon is damaged, a simple arthroscopic shaving (debridement) of the torn fibers may be all that is needed. If a significant portion is involved, a biceps tenodesis may need to be performed. This is done by arthroscopically removing the torn tendon stump from the inside the shoulder joint and then, through a small skin incision, attaching the remaining tendon to the bone in the upper arm (humerus). If the biceps tendon is completely ruptured, causing the muscle to bulge in the upper arm, a tenodesis can be done only if the distal portion remains near the top of the shoulder. A tenodesis is not done if the tendon slides too far distally because doing so would require unacceptably large incisions. If the tendon has been partially avulsed from it's origin on the top of the glenoid (SLAP lesion), it can be arthroscopically reattached using miniature screws and sutures.

What is the usual post-operative course?

A simple sling is all that is needed for the first few weeks after surgery. Immediate use of hand is encouraged but no heavy lifting is allowed. Four to six weeks of healing is required before a gradual return to moderate and then heavy lifting. Desk work and light-duty work can usually be resumed with the first week or two. Return to heavy labor usually takes 2 to 4 months.

Who can I call for more information?

Please feel free to contact us and ask one of our physicians for a referral. We will be happy to answer your questions and evaluate your shoulder in the Clinic.

Don Buford, M.D. © 2008