The biceps muscle has two tendons in the shoulder – the long head of biceps tendon (LHB) and short head tendon (see image).
The LHB is approximately 9cm long and has to travel through a narrow groove at the front of the shoulder. It then has to bend through 90° to enter the shoulder joint and then attach to the labrum at the top of the glenoid. This has arisen through the process of evolution, as the human shoulder blade has moved in position from the side of our body to the back. This development has allowed us to throw but has had a few unforeseen consequences. One of these is the strain placed upon our LHB tendon.
This rather tortuous course places the tendon at a risk of inflammation. When the LHB becomes inflamed this can lead to pain at the front of the shoulder known as biceps tendonitis. Biceps tendonitis can occur on its own or be associated with rotator cuff problems both impingement and tears.
Biceps tendonitis can be very painful. In slim people tendon can often be felt at the front of the shoulder and can be very tender. The pain can then extend down into the biceps muscle in the arm.Pain develops at the front of the shoulder, worse when lifting weights in front of the body and lifting overhead.
Biceps tendonitis can usually be managed without surgery. Treatment usually consists of a period of rest from lifting accompanied with anti-inflammatories and physiotherapy. The physiotherapist will optimise the movement of the shoulder and rotator cuff to place less strain on the biceps tendon.
If pain still persists despite non-operative treatment then surgery can be considered. Surgery can be either with a ‘Tenotomy’ or ‘Tenodesis’. If a rotator cuff tear is confirmed an arthroscopic rotator cuff repairis often required. This will include treatment of the LHB tendon, which is often partially torn, inflamed, swollen, unstable or dislocated.
In a ‘biceps tenotomy’ procedure the long head of biceps tendon is released from it’s attachment in the shoulder joint, allowing it to fall down into the upper arm and out of the shoulder joint. This removes the damaged, inflamed tissue by releasing it from the joint.