Biceps Tendon Injuries

What is a biceps tendon injury?

The biceps muscle has two tendons at the shoulder. The long head starts at the top of the socket, on a cartilage rim called the labrum, and travels over the ball of the shoulder and down a groove in the upper arm bone. It is a frequent source of front-of-shoulder pain. Problems include tendinitis (inflammation), fraying or partial tears, instability within the groove, and complete ruptures.

Biceps injuries often go along with other shoulder problems, especially rotator cuff tears and labral tears, which is why a full exam matters.

What does it feel like?

Tendinitis causes aching at the front of the shoulder that is worse with overhead activity, lifting and reaching, and often at night. A complete rupture of the long head can come with a pop and bruising, and a bulge in the upper arm (a “Popeye” bulge) as the muscle belly moves down. Many people lose a little strength bending the elbow and turning the palm up, but are surprised at how well the arm works.

Do I need surgery?

Usually not. Tendinitis and many tears of the biceps tendon settle with rest, anti-inflammatory medicine, targeted physical therapy and sometimes an injection. A complete rupture of the long head at the shoulder is often treated without surgery, especially in older or less active people, because the arm tends to function well afterward. The main trade-offs are a cosmetic bulge and, in some people, cramping and a small loss of strength.

When is surgery considered?

Surgery is considered when:

• Pain continues despite several months of non-surgical care
• The tendon is unstable in its groove or badly frayed
• The tendon is injured along with a rotator cuff tear or labral tear that needs repair
• A younger, active patient or a manual worker wants to keep the muscle contour and strength after a rupture

What are the surgical options?

There are two main procedures, done arthroscopically:

• Tenotomy releases the tendon from the socket and lets it drift down. It is simple and recovery is quick, but a bulge or cramping can follow.
• Tenodesis releases the tendon and then reattaches it to the arm bone with an anchor or screw, which preserves the shape and tension of the muscle.

The better choice depends on your age, activity, job and body type. Dr. Stepanyan will discuss which fits you.

Should I get a second opinion?

If you have been treated for “shoulder tendinitis” for months without improvement, it helps to have the biceps, cuff and labrum looked at together. Request a visit and bring your MRI.

Where can I see Dr. Stepanyan?

Dr. Stepanyan sees shoulder patients in Glendale, East LA and Santa Fe Springs.

What does recovery look like?

These are the typical stages in Dr. Stepanyan’s physical therapy protocol after a biceps tenodesis. After a tenotomy, recovery is faster. Your own plan may differ.

1. Weeks 0–4

   Protect the repair

   You wear a sling except for exercises. You do not actively bend the elbow against resistance. Elbow, wrist and hand motion, pendulum swings and gentle shoulder motion start right away.

2. Weeks 4–8

   Restore motion

   The sling comes off. Active elbow bending begins without resistance, along with progressing shoulder motion. Light isometrics and bands begin as tolerated.

3. Weeks 8–12

   Begin strengthening

   You have full range of motion and return to activity. Gentle resisted elbow bending begins at about eight weeks, with strengthening limited to three days a week to avoid irritating the rotator cuff.

4. Week 12 and beyond

   Full activity

   Restrictions are lifted, and elbow-bending strength is built up. A home program maintains gains.

Dr. Stepanyan’s therapists follow his written biceps tenodesis protocol. If anything here differs from what you were told, follow your own plan.