What is tendinitis of the long head of the biceps
and when does it require surgical treatment?

The biceps is a muscle located on the front of the arm that rotates the forearm externally (supination). It also bends the elbow and helps raise the arm in front of the body. Only one tendon (distal biceps) attaches at the elbow (to the radial tuberosity). There are two attachment points at the shoulder: one (short head of the biceps) at the coracoid process of the scapula, and another (long head of the biceps) inside the glenohumeral joint at the top of the labrum.

The sheath that encases the long head of the biceps can become inflamed, either inside the joint or in the bicipital groove just outside the shoulder joint. This inflammation generally causes pain at the front of the shoulder that may radiate to the front of the arm, along the biceps muscle. Episodes of inflammation can be treated nonsurgically using traditional methods (rest, ice, physiotherapy or a cortisone injection).

In some cases, the part of the biceps that lies within the shoulder joint may gradually tear, so much so that later, for example, due to a forceful contraction, the tendon tear becomes complete. When this happens, the biceps muscle may migrate toward the elbow crease (distally). A spontaneous rupture of the biceps rarely affects functional capacities and does not cause chronic pain. Therefore repair of this tendon is rarely necessary. The most unfortunate consequence of this type of rupture is primarily aesthetic.

Surgical treatment of disorders of the long head of the biceps is reserved for problems of chronic pain with a partial tendon tear.

It involves completion of the tear at the point of attachment to the superior labrum (long head biceps tenotomy) and, possibly, reinsertion of the biceps tendon onto the humerus (long head of biceps tenodesis). This type of intervention is often combined with rotator cuff repair surgery, since rupture of the long head of the biceps is frequently accompanied by a rotator cuff tear (a finding of a long head biceps rupture should therefore alert us to this second diagnosis).

” My pain was gone from the moment of the operation and no more sleepless nights. Best money every spent. “