Biceps Tendonintis and Tendon Tears
The biceps is a muscle originating from two locations in the shoulder. The long head of the biceps originates from inside the shoulder joint attaching to the labrum and the short head of the biceps originates at the tip of the coracoid process of the scapula. The biceps muscle bellies are located on the front of the arm and help to flex the elbow and rotate the forearm by means of attachment to the radius (forearm bone) at the elbow. Both ends of the biceps can be injured either from a fall, sports injury or cumulative trauma causing wear. Injuries to these biceps tendons can cause pain and weakness causing loss of motion, loss of function and impairment.
Tendonitis is a common source of pain associated with the shoulder and elbow. In the shoulder, biceps tendonitis is often associated with tendonitis and/or tearing of the rotator cuff. It commonly occurs in athletes participating in repetitive overhead activities such as throwing, tennis and repetitive lifting or pushing.
With tendonitis of the biceps at the shoulder there is commonly pain in the front of the shoulder that radiates into the front of the arm and even as far as the forearm. The pain is typically worsened with overhead activities and rotation of the arm such as reaching behind your back or out to the side. There can also be a sensation of snapping or locking with certain motions of the shoulder when the biceps is injured. This can even be associated with an instability of the biceps in the shoulder in which it moves in and out of a groove in which it runs.
The biceps tendon can be torn both partially or completely. This is usually associated with a popping sensation and the development of a noted “Popeye” deformity of the biceps from shortening of the muscle. When the biceps (long head) ruptures at the shoulder this is often associated with some degree rotator cuff damage. The rupture of the biceps can result in the noted “Popeye” deformity and some loss of strength in flexion of the elbow (5%). Commonly the biceps may have some cramping type pain for a period of time but this usually resolves. When the biceps ruptures at the elbow the impairment associated with the rupture (complete tear) causes more significant limitations. There is usually a 30% loss of flexion strength at the elbow and a 40% loss of strength in supination of the forearm (rotation of the hand and wrist outwards).
Treatment of the Injured Biceps
Tendonitis and partial tearing of the biceps can often be successfully treated with non-operative measures. This can include observation, avoidance of the causative activities, icing and anti-inflammatory medications (oral and injectable). Additionally, physical therapy exercises can help to maintain range of motion and strength in the shoulder and arm. If a reasonable course of non-operative treatment has failed then surgical interventions may be indicated. At the shoulder this usually involves a tenodesis of the biceps at the shoulder. This can usually be done using arthroscopic techniques and often there will be other damaged tissues that may need treatment such as the rotator cuff.
Rupture (complete tearing) of the biceps tendon at the shoulder commonly occurs in patients over the age of 60. If the deformity and limitations of the injury described above are acceptable then non-operative measures are indicated. If the needs of the patient require a surgical intervention then, Dr. Lenarz performs a biceps tenodesis. Occasionally, this will require a small incision on the arm to retrieve and repair the tendon because it will not be accessible arthroscopically due to significant retraction.
Rupture of the biceps tendon at the elbow usually requires surgical intervention. The significant impairment associated with this rupture will necessitate repair in order to return the arm to an acceptable degree of function. Dr. Lenarz performs a distal biceps tendon repair which can be done through a single incision on the forearm. The surgery will need to be performed within the first two to three weeks after the injury to avoid the tendon scarring which can significantly complicate the surgery.