Biceps Tendon Injury
Understanding and treating biceps tendon tears and tendinitis
What is a Biceps Tendon Injury?
The biceps muscle has two tendons that attach it to the shoulder: the long head and short head. The long head tendon is more prone to injury as it travels through the shoulder joint. Injuries include tendinitis (inflammation), tendinosis (degeneration), partial tears, and complete ruptures.
These injuries often occur with repetitive overhead activities, rotator cuff problems, or sudden traumatic events. While the injury can be painful initially, many people adapt well with appropriate treatment.
Causes and Risk Factors
• Sudden heavy lifting
• Forceful biceps contraction
• Direct trauma to shoulder
• Sudden pull or jerking motion
• Repetitive overhead activities
• Age-related tendon degeneration
• Shoulder impingement
• Rotator cuff tears
• Smoking and poor tendon health
Symptoms
• Pain in front of shoulder
• Tenderness over biceps groove
• Pain with overhead activities
• Weakness in arm flexion or rotation
• Sudden sharp pain (pop sensation)
• Visible bulge in upper arm (Popeye sign)
• Bruising along the arm
• Weakness in arm flexion and supination
• Relief of previous shoulder pain (if chronic)
Diagnosis
Physical Examination: Speed's test, Yergason's test, and assessment of biceps muscle position and strength.
X-rays: Usually normal but help rule out other conditions.
MRI or Ultrasound: Visualize tendon tears, inflammation, and associated shoulder problems like rotator cuff tears.
Treatment Options
Suitable for: Older adults, partial tears, low activity demands, complete ruptures in non-dominant arm.
• Rest and activity modification
• Ice and NSAIDs for pain/inflammation
• Physiotherapy to strengthen remaining muscles
• Gradual return to activities
Most people adapt well despite visible Popeye deformity
Indications: Young active individuals, athletes, cosmetic concerns, need for full arm strength.
Tenodesis: Reattaching tendon to the arm bone
Tenotomy: Releasing damaged tendon (simpler procedure)
Outcomes: Surgery restores near-normal strength and eliminates deformity. Recovery takes 4-6 months.
Recovery Expectations
Non-Surgical: Pain improves in 6-8 weeks. Full recovery in 3-4 months. Minimal functional limitations for most activities.
Post-Surgery: Sling for 4 weeks. Physiotherapy begins early. Strengthening at 8-12 weeks. Return to sports at 4-6 months.
Long-term: Both approaches provide good outcomes. Choice depends on activity level, age, and personal preferences.
