Bicep problems

The most common complaints in bicep tendon injuries include:

• Pain at the front of the shoulder, radiating to the front of the upper arm
• Pain with moving the upper arm and the arm behind the head
• Painful clicks, popping feeling
• Loss of strength, 'dead arm feeling'

The long biceps tendon, like the overlying tendon blade, can be wedged between the head of the upper arm and the roof of the scapula. After chronic impingement, the biceps tendon can either partially or completely tear off. The biceps tendon lies in the bicipital groove before entering the shoulder. This bicipital groove ends in a strong ring (biceps pulley) formed by lateral spurs of the anterior and posterior tendons (subscapularis and supraspinatus) and by a fibrous band (coraco-humeral ligament).

When tears occur in this ring (either at the front or the back), the biceps tendon is no longer stable. This is accompanied by pain, especially turning (rotations) and reaching movements of the arm.

The biceps tendon can also further cut into or tear the ring. This creates inner tearing of the tendon blade (e.g. rotator cuff).

The diagnosis of a bicep tendon injury is based on:

• The story and clinical examination (clinical tests)
• Ultrasound: dynamic examination, tracking the biceps tendon in the groove when turning the arm inward and outward
• NMR/MRI, CT scan with contrast agent

Surgically, this type of injury is treated via biceps stenotomy, or detaching the biceps at the attachment in the shoulder. The biceps tendon then drops into the bicipital groove. This way, pain due to the (nerve rich) tendon rubbing against the surrounding structures is solved relatively easily and simply. The sacrifice or ‘cutting through’ of this tendon is not associated with any significant loss of strength.

Any formation of a swollen bicep is not usually accompanied by pain or discomfort. After the procedure, the arm may be moved without any limit and loading is allowed so long as it is below the pain threshold.

Latest publication date: 02/08/2024