AANA Masters Experience Course 2015: Problems of the Biceps Tendon

By Joseph C. Tauro, MD. Follow on Twitter @OCSM_

2015 AM LogoLast week, I was in Los Angeles at the annual meeting of AANA, the Arthroscopy Association of North America. The mission of AANA is to promote and educate orthopedic surgeons in the broad field of arthroscopic surgery, which can be a less invasive way to remedy serious joint problems. At the meeting, I discussed problems of the biceps tendon, which originates on the top of the socket of the shoulder. So let’s look a bit into biceps problems this week!

The biceps, as the name implies, has two heads. The long head travels between the front and top tendons of the rotator cuff. Problems with the tendon can cause significant shoulder pain.

biceps photo 1
Problems can include fraying or partial tearing of the tendon, instability of the tendon so that it snaps in and out of place, or complete tears of the tendon. Symptoms include pain in the front of the shoulder as well as a popping sensation with motion of the shoulder.

Since the biceps tendon is in such close proximity to the rotator cuff, problems with the rotator cuff often overlap with biceps problems, causing pain to be not only in front of the shoulder but also over the outside and back near the shoulder blade. A complete rupture of the biceps tendon can cause a “popeye” deformity of the biceps because the muscle belly drops down when no longer attached to the socket.

biceps photo 5
Treatment of biceps pain almost always starts with non-surgical treatment, which includes anti-inflammatory medications or topical creams, physical therapy, and occasionally a cortisone injection. After a complete tear of the long head of the biceps the pain usually subsides after a few weeks and since the short head is still attached, the function of the shoulder and elbow does not suffer significantly.

We may elect to accept the popeye deformity and leave the tear alone. In high demand patients or those concerned with the deformity, the tendon can be repaired, usually through a small incision on the upper arm where we re-attach the tendon lower down, into the arm bone (the humerous). This is called a biceps tenodesis.

biceps photo 4It’s actually partial tears and instability of the biceps long head that can cause persistent pain and may require surgery if they don’t respond to medicine and physical therapy. In young patients with tears right at the attachment on the socket (a SLAP lesion), we usually do a direct arthroscopic repair. A biceps tenodesis is often a better option in older patients or if the tendon is unstable. A simple option is to simply cut the tendon (a biceps tenotomy). The pain goes away but some patients will wind up with a popeye deformity.

Tears of the biceps where it attaches on its other end on the elbow are a different problem entirely. Since this is the only attachment of the biceps at its far end, a complete tear almost always needs repair. But that’s a discussion for another day!

Leave a reply