Shoulder tendinitis and tearing of the long head of the biceps tendon

What are the signs of 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). They may also experience weakness in the shoulder.

What are the possible repercussions?

Chronic tendinitis is sometimes the cause of a biceps tendon tear. The inflammation causes 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.

What are the non-surgical treatments?

There are several non-surgical treatment options for people with biceps tendinitis or a proximal biceps tendon tear.

• Rest and ice
• 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

Patients may be escorted home approximately one hour after their procedure. The block numbing the shoulder wears off after approximately 6 to 18 hours. It is recommended that patients take pain relievers 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.

About recovery

• 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).
• Pendulum exercises must be performed starting the first several days to minimize the formation of adhesions.
• Patients can resume more strenuous activities after approximately three months (exercise, swimming, tennis, carpentry). It is important to let the shoulder heal before starting strengthening exercises so as to avoid any new tears.
• Recovery rate: 90%
• Complication rate: less than 1%