Long Head of bicep tear and tendinitis

What are the signs of long head biceps tendinitis or a tear of the biceps tendon at the shoulder?

When the biceps tendon has tendinitis or a tear at the shoulder, it causes pain at the front of the shoulder that radiates toward the elbow and increases at night. When the biceps tendon tears at the shoulder, patients may hear a sudden pop and notice a visible change in the shape and look of their arms (Popeye muscle). So, pain and weakness in the shoulder are common symptoms.

In this article, you will learn more about the long head biceps tendinitis and the long head bicep tear, as well as how to heal thanks to an orthopaedic surgeon.

What is a shoulder tendinitis?

The biceps muscle attaches to the shoulder bone via the long head of the bicep tendon. Therefore, biceps tendon injuries can affect the shoulder joint and lead to shoulder tendinitis or long head bicep tears. In some cases, shoulder impingement syndrome can also occur, where the tendon gets pinched between the bones in the shoulder socket, leading to inflammation and damage. 

In some cases, shoulder tendinitis can progress to involve the biceps tendon, leading to tearing or even rupture of the tendon. This can cause significant pain and weakness in the affected arm. Injuries to the supraglenoid tubercle can also contribute to the development of shoulder tendinitis, as it can lead to abnormal pressure on the biceps tendon and surrounding structures.

What are risk factors?

Shoulder tendinitis and biceps injuries like the tearing of the long head of the biceps tendon can be caused by a variety of factors, including:

• Repetitive motions or overhead activities that involve the shoulder joint, such as throwing a ball, may overuse and strain on bicep muscle and the head of biceps tendon. It can cause a severe shoulder pain.
• While lifting a heavy object, the bicep tendon can rip around the elbow (for example, a couch or a refrigerator).
  Poor posture or body mechanics during physical activities lead to shoulder tendinitis and biceps tendon disorders.
• Insufficient warm-up of your shoulder muscles before exercise or physical activity can also a factor of the development of shoulder tendinitis and partial lesions of bicep tendon.
• Shoulder impingement syndrome, which occurs when the tendons or bursa in the shoulder socket become compressed or pinched, cause inflammation and irritation of the head biceps tendon.
• The instability of the rotator cuff muscles, which support the shoulder joint, increases pressure and cause rotator cuff injuries and biceps tendon injuries.
• Shoulder weakness from age-related degeneration or wear and tear on the tendon creates tendinitis or tearing of the long head of the biceps tendon.

What are the possible repercussions?

Chronic long head biceps tendinitis may cause biceps tendon tear in the future. Moreover, the inflammation causes severe pain on the back side of the shoulder, which limits activity. A spontaneous tear of the long head of the biceps at the shoulder does not affect function, but does affect how the arm looks. Moreover, the tendon sheath (covering) may get thicker as tendinitis progresses.

What are the surgical interventions?

There are several surgical interventions available for shoulder tendinitis and tearing of the long head of the biceps tendon. Some of these procedures include:

• Arthroscopic debridement: This is a minimally invasive procedure that involves the use of a small arthroscope camera and surgical instruments to remove damaged soft tissue and bone spurs from the shoulder joint.
• Biceps tenodesis: The treatment of biceps tendon pain involves detaching the damaged biceps tendon from the shoulder socket and reattaching it to a different location on the bone. This can be done either by an open incision or arthroscopically. In addition, the clinical outcome is very encouraging!
• Biceps tenotomy: This procedure involves cutting the damaged biceps tendon from the shoulder socket, allowing the biceps muscle to still function while eliminating the pain caused by the damaged tendon.
• Rotator cuff tendon repair: Sometimes, tendinitis or biceps tendon tears can be associated with damage to the rotator cuff muscles. In these cases, surgical repair of the rotator cuff injuries may be necessary to address the underlying problem.

What are the non-surgical treatments?

There are several nonsurgical treatment and physical therapy options for active patient with a long head biceps tendinitis or a proximal biceps tendon tear.

• Rest and ice with cold packs
• Physiotherapy
• Ultrasound-guided cortisone injections may be prescribed.

Surgery is not required for an isolated tear of the long head of the biceps.

What is the surgical treatment?

Chronic tendinitis of the long head of the biceps can be treated arthroscopically (tenotomy and repair using biceps tenodesis). This technique uses very small surgical instruments inserted through short incisions. The shoulder can be mobilized the following day.

About the procedure

• Outpatient arthroscopic procedure
• Length of procedure: 45 to 90 minutes
• Regional anesthesia (the entire arm and shoulder are blocked) by an anaesthesiologist. The patient remains conscious during the procedure.
• If the patient would like to be sedated, a mild, short-acting sedative can be administered.

Post-surgical recovery and medical advices

Patients may be escorted home approximately one hour after their surgical management procedure. The block numbing the shoulder pain wears off after approximately 6 to 18 hours. It is recommended that patients take pain relievers medication and activity modification during the first few days after surgery. A post-operative follow-up is required two weeks after the procedure to remove the patient’s stitches and see how the patient recover from the postoperative pain.

About recovery

After your surgery, we’ll work closely with you and your physical therapist to ensure a smooth recovery process. You will be instructed with detailed aftercare instructions, including exercises and stretches to help your shoulder regain strength and mobility.

• Patients are usually suggested to keep their arm in a sling for several days to allow the shoulder to rest and heal properly
• Non-physical activities may be resumed the next day if pain levels permit.
• Patients can resume non-strenuous activities during the first week (cooking, driving, writing, typing).
• Light and flexibility exercises must be performed starting the first several days to minimize the formation of adhesions.
• The recovery time for fully strenuous activities after approximately three months (exercise, swimming, tennis, carpentry). It is important to be complete recovery before starting strengthening exercises or overhead lifting to avoid any new tears.

Recovery rate: 90%
Complication rate: less than 1%

Trust An Expert For Your Shoulder Surgery

A long head biceps tendinitis can significantly impact your daily life, but you don’t have to suffer with sharp pain. Seek medical attention and get pain relief with Dr. Marc Beauchamp and our experts. At our clinic, we prioritize your recovery time and offer personalized treatment options to take care of you before, during and after. Our goal is to help you resume your normal activities without any discomfort.

Dr. Beauchamp is a renowned orthopaedic surgeon who specializes in treating elbow and shoulder pain. He has been treated successfully in many shoulder tendinitis cases from a partial or complete long head bicep tears, rotator cuff tears, to issues with the glenohumeral joints. With patients trust and reviews, he is considered as one of the best surgeons in Montreal.

Don’t let a painful shoulder hold you back any longer – book an appointment with Dr. Beauchamp at his surgery clinic today!