Biceps Tendon Injuries

What are common biceps tendon injuries?

When people injure their bicep tendon a variety of conditions can arise. The patient can have inflammation of the bicep tendon (biceps tendonitis) or may have sustained a more disabling injury such as a tear of the tendon itself. The tendon helps to attach the biceps muscle to the bone. The biceps muscle is at the front of the arm and plays a vital role in shoulder stability along with flexing the elbow and rotating the wrist. The long head of the biceps tendon, which is often the most clinically relevant tendon of the shoulder travels through the rotator cuff and attaches to the superior labrum.

Biceps Tendonitis

Biceps Tendonitis refers to inflammation of the biceps tendon. This can cause severe shoulder pain as the biceps tendon is one of the main pain generators from the shoulder.

Biceps Tendonitis often is the result of repetitive shoulder movements and overuse, and in some cases can be worsened by other shoulder conditions (rotator cuff disease, shoulder instability, osteoarthritis, and trauma). Patients often will experience pain at the site of inflammation. In some instances, the superior labrum is torn, known as a SLAP (superior labrum anterior to posterior) tear which can impact the long head of the biceps tendon.

Biceps Tendon Tears

On some occasions, damage to the bicep tendon can progress or result in a tear (rupture) of the tendon.

There are two types of tear patterns:

• A partial tear (not completely through the tendon)
• A complete tear (the tendon is completely torn from the bone)

When this occurs, depending on the location of the tear, a bulge or visible deformity of the upper arm can appear.

• At the shoulder joint: A proximal biceps tendon tear is an injury to the biceps tendon as it enters the shoulder joint or where it attaches to the superior labrum. This is more common with rotator cuff injuries and older adults.
• At the elbow joint: A distal biceps tendon tear occurs at the elbow joint and a loud “pop” is common when the tendon tears. This is more common in middle-aged men, and heavy lifting.

How are these conditions diagnosed?

Dr. Zahab Ahsan and Sincer Jacob have extensive experience in diagnosing bicep tendon injuries. You can expect to have a physical examination, x-rays, and possibly ultrasound and/or MRI if indicated to assess the extent of the tendon injury and ensure there are no other injured structures.

What is the treatment?

Treatment of a bicep tendon injury is dependent on the severity of the disease, and location. We think broadly in our approach (non-surgical vs. surgical).

Non-Surgical

Many patients with biceps tendonitis will have a customized treatment plan that will likely entail rest, ice, anti-inflammatory medications, and a physical therapy program. The combination of these items leads to a decrease in bicep tendon pain. In some cases, a corticosteroid injection may be necessary and of benefit. Dr. Zahab Ahsan and Sincer Jacob may perform these injections under ultrasound guidance to ensure proper placement of the medication giving you the best chance of success. If non-surgical treatment is ineffective then surgery may be indicated.

Surgical

In more severe cases of bicep tendonitis, and disabling tears of the bicep tendon, a customized surgical approach may be recommended by Dr. Zahab Ahsan and Sincer Jacob. This decision is reached based on patient goals. Dr. Zahab Ahsan commonly performs a minimally invasive arthroscopic surgery called a biceps tenodesis. This procedure removes damaged portions of the biceps tendon and re-attaches the remaining tendon to the upper arm bone. By removing the injured tendon tissue, pain and inflammation become decreased. This allows for restoration of normal shoulder motion and function.

In some cases, the biceps tendon cannot be repaired by this method, and the damaged tendon tissue may be released from the attachment site. This is called a biceps tenotomy.

If you have any questions regarding bicep tendon injuries, please contact Dr. Zahab Ahsan or Sincer Jacob.