Huw David

Biceps - Tendonitis

Arm BicepsThe biceps, as the name implies, comprises of two parts or tendons connecting the biceps muscle to the shoulder. The shorter of the two tendons is attached to the shoulder blade away from the shoulder joint and is rarely the source of problems. The long head however travels over the front of the humeral head (ball) and passes deep into the shoulder joint attaching to the edge of the glenoid (socket). Consequently, symptoms arising from inflammation or damage to this tendon are common.

The tendon may become inflamed as it passes over the humeral head giving rise to pain felt over the front of the shoulder. As with subacromial impingement, symptoms are often activity related. Rest, ice and use of anti inflammatories may be all that is required. Occasionally an injection of the tendon sheath will be recommended. Wear and tear changes may develop within the tendon in older patients leading to a spontaneous rupture of the tendon often following a lifting or wrenching incident. The initial pain and bruising settle relatively quickly though the individual may be left with a somewhat bulbous appearance to the biceps muscle commonly referred to as the Popeye sign*. Furthermore, the pre injury shoulder discomfort often lessens once the tendon has ruptured and this is the basis  for why a surgical division of the tendon (arthroscopic biceps tenotomy) has become a popular and successful procedure as it is a means of removing the inflamed segment of tendon within the shoulder. In the younger who develop this condition it may be more appropriate to tether the divided tendon end to the underlying bone (biceps tenodesis) in order to enhance strength.

Injuries may also occur in those who have not previously suffered problems and the tendon may also become detached from the edge of the glenoid (SLAP lesion) or dislocate as a result of a wrenching injury. Both conditions are amenable to surgical repair.