What are biceps tendon disorders?
The biceps muscle has two tendons at the shoulder; the “long head” runs over the top of the arm bone and into the joint, anchoring to the labrum. Because of this exposed path, it is vulnerable to wear and inflammation.
Problems range from tendinitis (inflammation) and instability (the tendon slipping out of its groove) to a complete rupture. These disorders very often accompany rotator cuff tears and impingement, as the structures sit and work closely together.
Signs and symptoms
- checkPain at the front of the shoulder that may radiate down the upper arm.
- checkA deep ache worsened by lifting or overhead activity.
- checkA snapping sensation if the tendon slips in and out of its groove.
- checkA “Popeye” bulge in the upper arm if the tendon ruptures.
Causes & risk factors
- Age-related tendon wear, most common over 40.
- Repetitive overhead lifting or sport.
- Associated rotator cuff tears and impingement.
- A sudden heavy load, which can rupture a worn tendon.
How it is diagnosed
Examination tests for tenderness over the tendon’s groove and pain on resisted movements. Ultrasound and MRI assess the tendon and, importantly, the rotator cuff alongside it — since the two problems frequently coexist and are best planned together.
Treatment options
Conservative care
Activity modification, anti-inflammatories and physiotherapy settle most cases of biceps tendinitis.
Tenodesis
A troublesome or unstable tendon is re-anchored lower onto the bone, relieving pain while preserving strength.
Tenotomy
In selected patients the tendon is simply released — a simple, reliable option that may leave a cosmetic bulge.
A long-head rupture often settles with little loss of strength, and many are treated non-surgically. Surgery is considered mainly for pain, cramping or cosmetic concern — or when the cuff is being repaired at the same time.
Recovery & outlook
Non-surgical cases improve over several weeks with rehabilitation. After surgery, the arm is protected briefly and then strengthened over a few months. Outcomes are generally very good, with reliable pain relief and a return to normal use of the arm.