- The long head of the biceps tendon (LHBT) is a well-recognized pain generator in the shoulder.
- “Biceps tendinitis” is a catchall term that describes pain related to the LHBT stemming from a wide array of different lesions. Our recent research efforts have helped expand our understanding of this important disease process (1-6).
- Biceps tendinits may occur independently or accompany other common shoulder ailments such as rotator cuff tears.
- SLAP (Superior Labrum Anterior Posterior) are tears of the labrum where the LHBT attaches to the socket within the shoulder joint. Sometimes a SLAP tear is the source of pain, while other times the LHBT may be the culprit.
- Biceps and SLAP are complex and evolving topics. Dr. Taylor will discuss with you in detail during your visit.
- Biceps come from Latin “bi” meaning “two” and “ceps” meaning “heads”, because this important muscle attaches to the front of the scapula by two different tendons (heads).
- The short head is the most important for function and enables 90% of power.
- The long head of the biceps (LHBT) is quite meager in comparison and contributes little to strength.
- The glenoid labrum is a soft tissue structure that goes around the rim of the socket (glenoid) forming a bumper that helps to deepen the shallow socket.
- The LHBT attaches to the labrum at the top (superior) part of the glenoid within the shoulder joint.
- The LHBT then leaves the shoulder joint and travels along the front of the shoulder within the “bicipital tunnel” before it merges with the short head and becomes muscle.
- Repetitive overhead activities
- Fall onto outstretched arm
- Traction to the arm
- Shoulder conditions such as impingement and rotator cuff tears
- Pain in the front of the shoulder
- Vague pain deep within the shoulder joint
- Painful clicking within the shoulder
- Sensation of a “dead arm”
- Shoulder weakness and fatigue
- Physical examination
- Areas that reproduce pain
- Special tests to elicit pain
- Range of motion
- X-rays look at the bony structures of the shoulder for abnormalities
- MRI scan may be useful in some cases
- Ultrasound guided injections to the bicipital tunnel assist in diagnosis and treatment.
Does MRI always show biceps disease? No. Recently we compared MRI reports with surgical findings from a large group of patients undergoing shoulder surgery and found that, when present, lesions were often unrecognized by MRI (5).
Does arthroscopy always show biceps disease? No. In our award winning study just published in Arthroscopy Journal, we showed that only 55% of the LHBT could actually be seen during routine shoulder surgery and that 45% of 277 patients with chronic biceps related pain had “hidden” lesions (1-2).
Physical examination remains king? Dr. Stephen O’Brien devised a series of physical examination maneuvers called the 3-Pack that we have shown the most effective tool available for diagnosing biceps disease when present (6).
What are nonsurgical treatment options? Biceps tendinitis is incredibly common, and fortunately the vast majority of people get better without needing surgery. Anti-inflammatory medications by mouth, changing your activities to avoid those things that produce pain, and structured physical therapy are the most useful first line treatment.
What are surgical treatment options? In a small subset of patients surgery may provide the best opportunity for recovery of function and alleviation of pain. Treatment options include tenotomy (surgeon cuts the LHBT thereby relieving painful tension on the tendon) or tenodesis/transfer (surgeon cuts the LHBT and moves it to another location) (3-4).
- Non Surgical – vast majority of patients get better without surgery
- Oral anti-inflammatory medication
- Activity modification to avoid activities that cause symptoms
- Physical therapy
- Ultrasound guided steroid (cortisone injection)
- Surgery is used in a small subset of patients with persistent symptoms.
- SLAP repair is performed in young patients without evidence of biceps tendinitis.
- Biceps tenotomy (cutting the LHBT) is an effective treatment in patients over the age of 65 years.
- Biceps tenodesis/transfer (cutting the LHBT and moving it to another location) is an effective treatment for younger/active patients with biceps tendinitis.
- Taylor SA, Khair MM, Gulotta L, Dy CJ, Baret NJ, Newman AM, Pearle AD, O’Brien SJ. Standard Diagnostic Glenohumeral Arthroscopy Fails to Fully Evaluate the Biceps-Labrum Complex. Arthroscopy. 2014 Dec 10 [Epub ahead of print]. Arthroscopy 2015 Feb; 31(2):215-24.
- Taylor SA, Fabricant PD, Bansal M, Khair MM, McLawhorn A, DiCarlo E, Shorey M, O’Brien SJ. The Anatomy and Histology of the Bicipital Tunnel of the Shoulder. JSES. 2014 Nov 18 [Epub ahead of print].
- Taylor SA, Fabricant PD, Baret NJ, Newman AM, Sliva N, Shorey M, O’Brien SJ. Midterm Clinical Outcomes for Arthroscopic Subdeltoid Transfer of the Long Head of the Biceps Tendon to the Conjoint Tendon. 2014 Sep 17. [Epub ahead of print]
- Kelly AM, Drakos MC, Fealy S, Taylor SA, O’Brien SJ. Arthroscopic Release of the Long Head of the Biceps Tendon: Functional Outcome and Clinical Results. Am J Sports Med. 2005 Feb;33(2):208-213.
- Taylor SA, Newman AM, Baret NJ, Delos D, O’Brien SJ. MRI Fails to Fully Evaluate the Biceps-Labral Complex. [Manuscript Under Review: Arthroscopy 2015]
- O’Brien SJ, Newman AM, Taylor SA, Dawson C, Gallagher KA, Bowers A, Nguyen J, Baret N. The Accurate Diagnosis of Biceps-Labral Complex Lesions with MRI and “3-Pack” Physical Examination: A Retrospective Analysis with Prospective Validation. Orthopaedic Journal of Sports Medicine 2013 1: DOI: 10.1177/2325967113S00018.