You can feel your biceps muscle at the front of your arm when you bend your elbow and turn you palm towards your face. This muscle inserts as one fused tendon into your forearm, but has two distinct tendons at its upper end. The main tendon (short head) at the upper end inserts into the coracoid process of your shoulder blade. This is outside of your shoulder joint and rarely causes problems. The second, less functionally important ‘long head’ tendon, passes through the shoulder joint on its way to the top of the glenoid (the socket of the shoulder) where it inserts into bone. It is this long head that frequently contributes to pain in the shoulder and sometimes ruptures. Your biceps muscle has two functions: one is to help bend your elbow, the second is to provide twisting power in your forearm (supination) (e.g. screwdriver use).
Long Head of Biceps tendinopathy
Often patients report a gradual onset of pain felt at the front and inside the shoulder, which is made worse by pulling up your arm (weight training) or on twisting your forearm (e.g. screwdriver). They mat also have a painful area at the front of their shoulder
Ruptured Long Head of Biceps
A degenerate tendon can rupture causing the muscle to retract down the arm. This can alter the contour of your biceps to give a ‘Popeye Sign’. Patients typically describe a sudden tearing and pain, sometimes with bruising tracking down their arm. Normally however, there is then resolution of symptoms after a few weeks, often when the patient has had a previously irritable shoulder. Occasionally active patients (e.g. manual workers) complain of cramping in their arm when doing repetitive tasks after long head of biceps rupture,
Proximal biceps tendon problems are rare in the under 40’s. If young people do get symptoms, it may be due to incorrect sports technique, or shoulder motion problems. ‘Cross-fit’ and other intensive strength training programmes may overload the biceps tendon and cause symptoms. A superior labral (SLAP) tear can also affect the long head of biceps insertion. Degenerative tendinopathy generally occurs in patients aged over 40 years, becoming common as we get older than 65 years. Degenerate proximal biceps problems may co-exist with rotator cuff tears.
A degenerate long head of biceps tendon is a potent pain generator in the shoulder. If your symptoms haven’t settled with non-operative measures, then you may require surgery. Sometimes your problem with the biceps tendon accompanies other problems in your shoulder that need surgical treatment. The biceps may also be noticeably damaged at surgery, in which case it is better to have it dealt with.
Making the right choice about the best treatment for you means getting the right information. During your consultation, please do feel free to ask Mr Granville-Chapman to explain anything that you do not fully understand, and for his advice about the pros and cons of any treatment.