What is the biceps tendon?
The biceps tendons attaches the biceps muscle to the shoulder and the elbow. At the shoulder the biceps tendon splits into two heads called the long and short head. The long head stabilizes the shoulder joint and is part of the rotator cuff.
Injury to the long head of the biceps muscle is the most common type of biceps injury. Lesions on the long head of the biceps tendon and are a common source of pain and disability. These lesions can also result in rotator cuff damage and rupture of the biceps tendon.
Biceps tendinitis is inflammation of the biceps tendon that can impair the ability to perform the normal routine activities of daily life like brushing your hair or turning a screwdriver. Inflammation is most common in the long head of the biceps tendon. It can occur as a primary problem or be related to a co-occurring shoulder problem.
The vast majority of biceps tendonitis is the result of micro tears in the tendon due to a lifetime of normal wear and tear and in some cases arthritic changes of the glenohumeral joint. In young athletes it is caused by overuse from baseball, softball and volleyball, gymnastics and swimming. It is also associated with overhead and manual labor.
Co-occurring shoulder problems include rotator cuff tendonitis and degeneration, shoulder dislocation, labral tears, shoulder impingement, or arthritis. 90% of cases of rotator cuff tears occur with biceps tendonitis, and 45% of cases have biceps instability.
It is a relatively common problem that presents as aching and pain at the front of the shoulder that is exacerbated with overhead activities, pain that radiates down the front of the arm from the shoulder, a clicking or audible popping sound, shoulder weakness, pain at rest and at night. Pain can begin suddenly or develop slowly over time.
Dr. Petrigliano will review your medical history and ask about the history of your pain. He will perform a complete orthopedic exam including assessing shoulder posture, and symmetry, swelling and tenderness, and perform range of motion testing and strength. He will palpate the tendon using various tests and if it causes pain, it is a positive sign for biceps tendonitis.
He will order x-rays and may order an ultrasound and MRI to evaluate the tendon and the rotator cuff and identify other shoulder conditions that are associated with biceps tendonitis.
Initial management is nonsurgical including rest, activity modification and NSAIDs anti-inflammatory over the counter and prescription medications. Physical therapy will focus on restoring muscle balance and strengthening rotator cuff muscles. Focused stretching may be ordered. If symptoms persist, he may order ultrasound-guided steroid injections. If this fails to improve pain, he may offer surgery.
Biceps tenodesis and tenotomy are two common surgical treatments. Both are typically performed arthroscopically. Both are reliable approaches to manage isolated and combined lesions of the rotator cuff and labrum.
Arthroscopy is a minimally invasive procedure, which involves making a small incision and using an arthroscope (a thin tube with a camera attached) to view the inside of your joint.
Biceps tenotomy is a quick and simple arthroscopic surgical procedure that involves cutting the long head of the tendon from its attachment to the shoulder allowing it to retract. This procedure is very effective for pain relief. However, it has downsides. Tenotomy removes the damaged and inflamed tissue but can cause biceps weakness and discomfort and can lead to a ‘Popeye’ biceps deformation. This may be acceptable to older more sedentary patients, but younger and active patients prefer biceps tenodesis. Recovery is also faster than with a tenodesis. A sling is necessary for the first few weeks post op followed by 6-8 weeks of physical therapy to restore range of motion and strength.
Biceps tenodesis is an arthroscopic surgical procedure that involves the repair of the biceps muscle to treat a full or partial tear. During a tenodesis the long head of the tendon is severed from its attachment on the shoulder socket and attached to the upper arm bone. It reduces the risk of the ‘Popeye’ deformity.
The goal of biceps tenodesis is to stabilize the shoulder joint and restore normal function and motion, as well as to reduce pain associated with a damaged or torn biceps tendon. If may be performed as a single procedure or as part of other shoulder repairs.
Recovery from a tenodesis involves a sling for the first 4-6 weeks, rest, pain management and six weeks of post op physical therapy. Full recovery can take about three months.
Why choose Dr. Petrigliano?
Dr. Frank Petrigliano is an orthopaedic surgeon who was fellowship trained in sports medicine and shoulder surgery at the prestigious Hospital for Special Surgery where he provided care to athletes of all ages. He currently serves as the head team physician for the LA Kings hockey team and associate team physician for USC Athletics. Dr. Petrigliano is a renowned orthopaedic surgeon and researcher who employs state of the art treatments and procedures to get you back to your active life and back to sport. He always treats his patients with compassion and respect. Dr. Petrigliano is located in El Segundo California, and serves greater Los Angeles, Beverly Hills, the South Bay, and the Santa Clarita Valley. Contact Dr. Petrigliano to schedule a consultation today.
At a Glance
Dr. Frank Petrigliano
- Associate Professor of Orthopaedic Surgery at USC
- Chief of the Epstein Family Center for Sports Medicine
- Team physician for the LA Kings and USC Athletics
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