Shoulder pain may be due to many causes such as rotator cuff tendinosis, shoulder joint arthritis and frozen shoulder. However, in some less common cases, the long head of the biceps can cause shoulder pain. So, can a long head of biceps tendonitis cause shoulder pain? And how do we separate it from other common causes?
What is the long head of biceps tendon?
The biceps muscle is a large muscle that sits at the front of the arm. Many people think that the biceps only acts on the elbow. However, the muscle and more specifically the tendon plays a role in helping the important rotator cuff tendons in the shoulder.
There are two tendons that attach the biceps muscle to the shoulder: the ‘long’ head and the ‘short’ head. The long head passes into the shoulder joint through a groove in the arm bone and then a hole in the rotator cuff. Finally, it attaches to the top part of the labrum.
Problems with the long head of biceps
Most problems with the long head of the biceps tendon present with pain at the front of the shoulder. In addition, clicking or snapping is common. Also, problems in the long head of the biceps are commonly associated with rotator cuff tendon problems. So, treating the rotator cuff tendon pathology is important as well.
Common problems of the tendon include:
- Long head of biceps tendonitis: Tendon swelling and inflammation can cause pain at the front of the shoulder.
- Biceps tendon subluxation/dislocation: In some people with rotator cuff tears, the biceps tendon may not be held in the groove in the upper arm. The tendon may snap out of the groove. When the tendon is unstable, we call it subluxation; when the tendon snaps out of the groove, we call it dislocation.
- Biceps tendon rupture: With increasing damage, the tendon can be torn off completely from its attachment. The tendon retracts back into the arm causing a bulge in the biceps. When the biceps is flexed, it often looks like a ‘popeye’ muscle.
Treatment of long head of biceps tendonitis
In general, treatment depends on the pathology. For long head of biceps tendonitis, simple treatments including ice, anti-inflammatory tablets, and physiotherapy are effective. In more severe cases, injection therapy can help. Some doctors use cortisone directed to the groove containing the inflamed biceps tendon. Cortisone reduces tendon inflammation and pain but may lead to rupture. Others use hyaluronic acid or PRP. It is important to use ultrasound as evidence suggests improved accuracy and effectiveness compared to blind injections.
For biceps subluxation or dislocation, we suggest surgery. Surgeons can cut the tendon also called tenotomy. Alternatively, they can cut the tendon and reattach it to the bone. Therefore, the muscle retains its function but the shoulder problem resolves. Surgeons call this procedure tenodesis.
More on cortisone shot for biceps tendonitis
Generally, we target the biceps tendon sheath containing the long head of the biceps. The needle is placed carefully in the sheath using ultrasound guidance. It is important not to inject the tendon structure with cortisone due to the risk of rupture.
Evidence suggests that injecting the biceps tendon sheath with ultrasound guidance improves accuracy and effectiveness. Also, side effects are reduced. All in all, we should use ultrasound guidance for biceps tendon sheath injections.
Torn biceps tendon treatment
Most biceps tendon tears involve the long head close to the shoulder joint. Most cases of a torn long head of biceps tendon present with sudden pain, swelling, and bruising in the upper part of the biceps muscle. Sometimes, the biceps muscle bunches up and looks like a ‘popeye’ muscle.
In general, we avoid operating on these common ruptures because pain and function are not significantly changed. However, we operate on biceps tendon ruptures that occur close to the elbow joint.
Final word from Sportdoctorlondon
Long head of biceps tendon problem is less common than other shoulder problems such as rotator cuff tendonitis, frozen shoulder, or AC joint arthritis. In general, we often see biceps tendon injuries with rotator cuff injuries. Moreover, treatment for this condition is similar to rotator cuff tendonitis.
Other common shoulder conditions: