Proximal Bicep Tendonitis/Tears
Patients will often experience pain localized to the front of the shoulder with radiation of pain down the upper arm.
Patients will often experience pain localized to the front of the shoulder with radiation of pain down the upper arm.
What is the proximal biceps?
The proximal biceps tendon is a rope-like structure that connects the biceps muscle to the top of the shoulder socket (glenoid). The biceps muscle is the large muscle in the front of your arm and has two tendons that have separate attachments to the shoulder. The proximal biceps tendon is the most commonly damaged.
Why does the proximal biceps tendon become damaged?
Damage to the proximal biceps tendon most commonly occurs from a lifetime of wear and tear involving the shoulder. This damage is accelerated with overuse activities, especially repetitive overhead activities commonly performed by swimmers, tennis players, baseball players and overhead laborers. With overhead activities, the biceps tendon can rub against the Acromion bone. Damage to the proximal biceps tendon begins with inflammation (i.e. proximal biceps tendonitis). If this inflammation continues, tears and eventual rupture of the proximal biceps tendon can occur. Tears and ruptures can also occur acutely and are often seen in those who lift heavy objects (i.e. weightlifters, manual laborers).
It’s important to realize that proximal biceps tendonitis and tears are commonly seen in patients with other shoulder conditions such as impingement syndrome and rotator cuff tears.
Symptoms:
Pain and tenderness over the front of the shoulder that is worsened with activity, especially overhead activity, is the hallmark symptom. Patients may occasionally experience a snapping sound or sensation in the shoulder. Patients with a proximal biceps tendon rupture may notice a deformity of the biceps muscle as a result of the proximal biceps tendon being completely torn away from the shoulder socket, likened to a “Popeye arm”.
Diagnostic Testing:
An x-ray is usually ordered first to evaluate the shoulder joint and to rule out other causes of pain such as arthritis and fracture. An MRI may be ordered if the diagnosis is unclear or the soft tissues of the biceps tendon need to be visualized in greater detail.
Treatment Options:
Non-operative treatment is the 1st line treatment for proximal biceps tendonitis and consists of activity modification and physical therapy, even if the Biceps tendon has ruptured. Cortisone injections may be considered in patients who only have inflammation of the tendon.
Surgical Treatment:
One surgical option, called a biceps tenodesis, involves removing the damaged portion of the proximal biceps tendon and reattaching the remaining portion to the upper arm bone (humerus). Removal of the damaged portion of the proximal biceps tendon usually resolves symptoms.
A second surgical option, called a biceps tenotomy, involves releasing the damaged proximal biceps tendon from its attachment to the shoulder socket. Unlike a biceps tenodesis, the proximal biceps tendon is not reattached to anything. This option may result in a “Popeye deformity”. Biceps tenotomy is less invasive as it involves shoulder arthroscopy. Arthroscopy involves making very small one inch incisions over the shoulder and introducing a small video camera into the shoulder joint and other small arthroscopic instruments to remove the arthritic clavicle. Shoulder arthroscopy is minimally invasive and can result in less soft tissue disruption, less pain, and minimal scar formation.
It is important to note that the difference in strength after biceps tenodesis compared to biceps tenotomy is negligible (REMEMBER: The biceps tendon has a second, very strong, attachment to another bone of the shoulder). This is the reason why patients with a proximal biceps tendon rupture do not have to undergo surgery as their only real issue is usually the “Popeye deformity”. Biceps tenodesis in the case of a proximal biceps tendon rupture is usually only performed for cosmetic purposes.
Dr. Steven Lee is Chief of Hand and Upper Extremity, and is part of the teaching faculty for the Lenox Hill Sports Medicine Fellowship (which is the oldest sports medicine fellowship in the country), and is currently the Associate Director at NISMAT, which is the first institute in the country dedicated to sports medicine research. Dr. Lee has many years of experience successfully treating proximal biceps tendonitis and tears.
Learn more about scheduling surgery.
Recovery Expectations:
If patients undergo a biceps tenotomy, then, the patient will be in a sling for comfort purposes only, usually for a few days to a few weeks. If a biceps tenodesis is performed, this sling is on for 4 weeks, followed by physical therapy for several months. Relatively normal function occurs at about 3 months, although the patient may improve in subtle ways for up to one year.
Immediate Post-Operative Instructions
Please refer to the following pages for more information:
*It is important to note that all of the information above is not specific to anyone and is subject to change based on many different factors including but not limited to individual patient, diagnosis, and treatment specific variables. It is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific orthopedic advice or assistance should consult Dr. Steven Lee or an orthopedic specialist of your choice.
*Dr. Steven Lee is a board certified orthopedic surgeon and is double fellowship trained in the areas of Hand and Upper Extremity Surgery, and Sports Medicine. He has offices in New York City, Scarsdale, and Westbury Long Island.