The Biceps tendon: The biceps tendon is one of the most common structures in the shoulder to generate pain. There are different reasons why the longhead of Biceps (LHB) cause pain.
These are:
Biceps tenoditis – inflammation of the biceps tendon: due to a lifetime of normal shoulder movement or repetitive strenuous exercises.
SLAP lesion (superior labral anterior posterior tear) this is where the biceps tendon is partially or completely torn of its insertion at the superior pole of the glenoid.
Biceps sling tear– the biceps is kept in the bicipital groove by a ‘sling’ formed by the supraspinatus and subscapularis tendons. If one of the ides of the sling tear the biceps can window wipe into these tendons and cause pain and eventually can lead to a torn rotator cuff tendon.
Biceps tendon tear– due to wear and tear usually.
Shoulder instability that leads to a SLAP lesion.
Clinically the shoulder pain anterior to the joint. The patient will have pain on palpation of the bicipital groove. And a speed test or yergason test can be positive. The treatment includes: 1.Rest 2.NSAIDS 3.Cortisone injections 4.Bicepstenodesis or a biceps tenotomy. Difference between a tenodesis and a tenotomy: The long head of biceps is one of two Tendons of the 2 muscle bellies of the bi(2)ceps. It is responsible for 5-10 percent of the supination of the forearm and flexion of the elbow. If the tendon is cut (tenotomy) one does not notice the loss of above mentioned two movements as the short head of biceps does 95% of the function of the biceps tendon. On younger patients we tend to do a tenodesis for cosmetic reasons as well as in people with thin arms. If a tenotomy is performed on can end up with a so called Pop eye lesion (bigger muscle belly) near the elbow. One can have cramps in the popeye lesion for about 8-12 weeks postsurgery then it goes away. In bigger less muscular arms one does not even notice the popeye lesion. For a tenodesis the arm must be kept in a sling post-op and rehab commence once the sling is removed. Patients can have pain over the site where the tenodesis is performed which tend to disappear within 6 months post-surgery. Some patients with a tenodesis can also end up with a popeye lesion.
