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Commonly asked questions about the Biceps tendon

Q:

Where is the biceps tendon?

A:

The biceps muscle is located in the front part of the upper arm. It has two attachments in the shoulder and one attachment in the elbow. Problems most commonly arise with the long head of biceps which is attached to the socket of the shoulder joint. The biceps muscle has several functions in the body including elbow flexion (biceps curl) and forearm rotation. In the shoulder joint, it helps to control the acceleration and deceleration of the arm during overhead activities such as throwing, pitching and cricket bowling.

Q:

What problems can occur with the biceps tendon?

A:

Pathology of the biceps tendon includes tendinitis, subluxation and rupture. All these conditions cause pain at the front of the shoulder and are intimately associated with rotator cuff disease.

Q:

Why do these problems occur?

A:

They occur as a result of overuse of the arm. They may occur following a fall onto the arm, heavy lifting as well as repetitive overhead activities.

Q:

I was lifting something heavy and felt something ‘pop’. Since then, I have noticed a lump in my upper arm, although it is relatively painless, is it serious?

A:

The lump is often referred to as the Popeye deformity and is caused by a rupture of the biceps tendon. The rupture can occur distally in the elbow or proximally in the shoulder. A distal rupture requires urgent surgical repair, in order to restore elbow flexion strength and forearm supination. A proximal rupture is invariably associated with rotator cuff disease and a visit to your doctor is advisable.

Q:

What further investigations are most useful?

A:

Ultrasound is the investigation of choice. It is non invasive and is quick and easy to perform. When the long head of biceps tendon is unstable, it can sublux out of its normal place and this is best detected by ultrasound during continuous screening whilst the arm is moving.

Q:

Can the torn biceps tendon heal on its own?

A:

No. The tendon is usually heavily degenerate (see photo) and has lost its normal function.

Q:

What treatments are available?

A:

Treatment involves either releasing the biceps tendon attachment from the shoulder (biceps tenotomy) or detaching the attachment from the shoulder and subsequently reattaching the tendon to the humerus (tenodesis). Both these procedures can be done by keyhole surgery, usually combined with an arthroscopic rotator cuff repair at the same time, as the rotator cuff is usually torn.

Q:

Should I have a tenotomy or tenodesis?

A:

Whether to have a tenotomy or tenodesis will depend on the individual but generally speaking, a tenotomy is easier to perform and the recovery is much quicker. Tenodesis is preferable for young athletically demanding patients. For further information, please refer to further reading.

Further Reading:

Treatment of the painful biceps tendon – tenotomy or tenodesis?
F Lam, D Mok.
Current Orthopaedics October 2006; 20(5): 370-375.
pdf file

Arthroscopic view of the normal long head of biceps tendon as seen inside the shoulder joint
biceps tendon

Arthroscopic view of a tear of the long head of biceps tendon
biceps tendon

Arthroscopic view of rupture of long head of biceps tendon
biceps tendon

Arthroscopic tenodesis of the long head of biceps to humeral head
biceps tendon

The ‘Popeye’ deformity that may occur following rupture of biceps tendon
Popeye deformity
Popeye deformity
Popeye deformity
Popeye deformity

The information on this website does not replace medical advice. If you have a medical problem please see your doctor or consultant.