Biceps Tendon Injuries
The biceps tendon is a thin noodle-like structure that runs from the upper arm (humerus) into the shoulder joint. There are two heads of the biceps muscle (hence “bi” meaning two), the long head and the short head. The short head attaches to the inner shoulder blade at a spot called the coracoid process and the long head is just that, a longer thinner tendon that runs in a groove in the upper humerus bone into the shoulder joint. As a result of the close proximity of the long head of the biceps to the rotator cuff, the long head biceps tendon is susceptible to tearing and irritation, just like the adjacent rotator cuff. Because of the anatomy of the long head biceps tendon, it frequently is diseased along with the rotator cuff. Sometimes because of inflammation, irritation, or tearing, Dr. Obermeyer will treat the biceps tendon with a procedure called a tenodesis, where the tendon is removed from the painful position in the front of the shoulder to where it can no longer cause pain at the upper humerus. Essentially this procedure involves transferring the tendon from the original native position deep in the shoulder to a more tolerable position in the front of the humerus.
The biceps tendon can sometimes forcefully rupture from the front of the shoulder where the long head detaches from its normal position deep in the shoulder. Because of the muscle pull, the biceps tendon will retract and bunch up in the arm. Sometimes this will leave the biceps muscle at the arm lumpy and balled up, a condition called a “popeye” sign in reference to the visible arm muscles of the fictional character Popeye the Sailor Man. When the long head biceps tendon ruptures and the muscle bunches up in the arm, the shoulder can be bruised and painful. Dr. Obermeyer recommends you have this evaluated, sometimes with MRI, because sometimes surgical reattachment is considered or another coexistent injury to the rotator cuff can be present. This is a treatable injury, and patients that have a biceps tendon repair at the shoulder have very favorable outcomes with complete return of function. Surgical reattachment of the tendon can also restore the visible appearance of the arm to make it look normal again, effectively restoring the contour of the muscle and alleviating the “popeye” sign.
If I have pain in the biceps does that mean my biceps is injured?
Pain at the biceps muscle or tendon can sometimes be caused by an injury or irritation of the actual biceps tendon, but not always. Sometimes pain at the “biceps” can actually be caused by a phenomenon called referred pain, where a problem higher in the shoulder, as in the rotator cuff, bursa, or shoulder joint can become diseased, and the pain is felt further down in the arm. In other words the injury or problem is further up near the shoulder but the pain is felt in the arm. Either way, this pain should be evaluated as it can be reflective of a structural problem in the shouder. Dr. Obermeyer will inform you on the cause and likely source of the symptoms, and inform you on what the options for treatment will be.
What is a biceps “tenotomy”?
A biceps tenotomy is a procedure where the painful biceps tendon is severed from its position deep in the shoulder and let free, which often times can alleviate pain from biceps tearing or irritation deeper in the shoulder. Sometimes this is performed in conjunction with a rotator cuff repair. Although biceps tenotomy can alleviate pain, this procedure sometimes can cause the cosmetic deformity called the “popeye sign” as noted above which can be unpleasant to patients, and can sometimes cause cramping with vigorous or heavy activity, especially in younger patients. Dr. Obermeyer will review with you the recommended treatment that is best in your case. While sometimes biceps tenotomy is a perfectly acceptable alternative many more active patients will elect for the tenodesis procedure, which is done arthroscopically and noninvasively, in a manner that does not prolong recovery time.
I have a SLAP tear. Why was my doctor discussing the biceps as treatment?
The labrum is a bumper of cartilage that deepens the shoulder joint socket called the glenoid, much like the bomper on a pool table. The upper portion of the labrum is an area called the Superior Labrum (the S and L in “SLAP” which stands for “superior labrum anterior to posterior”) and is the location where the long head biceps tendon makes its attachment deep in the shoulder. There are a variety of injuries that can cause a SLAP tear and sometimes this is a result of a forceful pulling of the biceps and labrum off its attachment site in the shoulder, similar to the uprooting of a tree. This can cause pain, clicking, and difficulty with overhead activities such as throwing a ball.
When a painful SLAP tear is diagnosed, one of the treatment options is a cleaning or “debridement” of the SLAP tear and a transfer of the biceps tendon, which effectively removes the pull on the SLAP tear. This procedure allows the biceps tendon to be reattached to its anatomic position, while removing the pain from the SLAP tear deeper in the shoulder. Sometimes if the SLAP tear is causing further problems, as in the setting of a shoulder dislocation or when a cyst develops (called a spinoglenoid notch cyst), the tear should be repaired. If you were diagnosed with a SLAP tear, Dr. Obermeyer will describe how the tear occurred and what the recommended treatment is.
Schedule an orthopedic appointment
If you have symptoms consistent with Biceps Tendon Injury, call our office or book an appointment with shoulder surgeon Dr. Thomas Obermeyer. Dr. Obermeyer specializes in diagnosing and treating shoulder injuries. Dr. Obermeyer has orthopedic offices in Schaumburg, Bartlett, and Elk Grove Village, Illinois. Dr. Obermeyer regularly sees patients from throughout Illinois including Hoffman Estates, Palatine, Elgin, Streamwood, Arlington Heights, and Roselle communities.
At a Glance
Dr. Thomas Obermeyer
- 15+ years of training and experience treating complex shoulder and sports medicine conditions
- Expert subspecialized and board-certified orthopedic care
- Award-winning outstanding patient satisfaction scores
- Learn more