Biceps Tendon Disorders

The biceps tendon has two muscle ‘heads’ that contribute to it, the long head and the short head. The long head goes through the shoulder, where it often has problems. It can fully tear, partially tear, become painfully degenerative, or sublux/dislocate out of its groove. Any of these conditions can lead to pain in the front of the shoulder.

Sometimes the long head of the biceps tendon completely tears. This may occur after it has been painful for a while due to degeneration, or without any preexisting symptoms. The tear often occurs with a pop, with some pain, swelling and bruising over the front of the shoulder. The biceps muscle usually retracts down the arm a little bit, causing it to look larger and more balled up. This is known as the ‘Popeye sign’. A biceps tear at the shoulder is different than a biceps tendon tear at the elbow. When the biceps tendon tears at the elbow, then both biceps muscle heads are detached, leading to significant weakness it is not repaired. In this case, almost all active patients will want to have it repaired. However, tears of the long biceps tendon at the shoulder still leaves the short biceps tendon intact and leads to only a loss of 5-10% of biceps strength. Consequently, these are usually not repaired. If a young active patient desires to have the long biceps reattached, this can be done through a small outpatient procedure, but it is not necessary to have it repaired. In fact, some well-known NFL quarterbacks had biceps pain until it fully ruptured, had no treatment, and then were finally able to throw pain-free and went on to win super bowls.

Regardless of the specific problem with the biceps, 95% of the time or more, the biceps problem is due to a rotator cuff problem. Therefore, most biceps problems are initially treated similar to how rotator cuff tendinosis /degeneration is treated, with a therapeutic strengthening program and often a steroid injection. If that doesn’t work, then the biceps tendon can be treated arthroscopically at the same time that the underlying rotator cuff problem is addressed. The long biceps tendon is ‘tenodesed’, which means that it is anchored to the top of the humerus bone just outside of the shoulder. It still works the arm, but the diseased portion is removed from the shoulder, relieving the pain. This works very well. In rare cases this can occasionally occur on its own, as happened to my left shoulder, which still works great.

So if your long biceps tendon is causing you shoulder pain and you desire to have it arthroscopically tenodesed (removed from the shoulder and reattached just outside the shoulder), be assured that this is fairly common. Biceps problems are frequently found in association with rotator cuff problems. The biceps tenodesis is not very painful, is still performed as an outpatient, and doesn’t have many additional restictions compared to the rotator cuff surgery alone. In fact, as it’s performed at the same time as any rotator cuff surgery, you probably won’t even notice that it was done.