Biceps Tendon
Quality Care from an Adelaide-Based Orthopaedic Surgeon
The long head of the biceps tendon (LHBT) is a cord-like structure in the shoulder joint that originates from the supraglenoid tubercle and runs through the bicipital groove of the humerus. It plays an important role in overhead activities and arm function, facilitating shoulder and elbow movements. There are various types of pathology associated with the LHBT, including tendonitis, impingement syndrome, SLAP tears, and instability.
Causes of pathology
Several factors can contribute to the development of long head of biceps tendon pathology. These may include:
Repetitive overuse: Frequent overhead activities or repetitive motions involving the shoulder joint can lead to chronic inflammation and degeneration of the tendon, causing tendonitis.
Aging and degeneration: As individuals age, the tendon may undergo degenerative changes, becoming frayed or weakened, which can result in impingement syndrome or SLAP tears.
Trauma: Acute injury or trauma to the shoulder, such as a fall or direct blow, can cause damage, leading to instability or tears.
Shoulder instability: Pre-existing shoulder instability, such as recurrent dislocations or subluxations, can put excessive stress on the biceps tendon, leading to instability or subluxation of the tendon.
Symptoms
Pathology of the long head of biceps tendon can manifest in various symptoms, including:
- Pain: Persistent or intermittent pain in the front of the shoulder or upper arm, which may worsen with overhead activities or lifting.
- Weakness: Decreased strength and power during shoulder and elbow movements, particularly when flexing or supinating the forearm.
- Clicking or snapping sensation: Some individuals may experience a clicking or snapping sensation in the shoulder joint during specific movements.
- Limited range of motion: Reduced ability to fully flex or extend the elbow, and limitations in shoulder mobility.
Types of pathology
Tendonitis: Inflammation of the long head of the biceps tendon due to overuse or repetitive motions, resulting in pain and swelling.
Impingement syndrome: Compression or impingement of the long head of the biceps tendon within the shoulder joint, leading to pain and limited shoulder function.
SLAP tears: Superior Labrum Anterior to Posterior (SLAP) tears involve damage to the superior portion of the labrum, often accompanied by biceps tendon involvement. This can cause shoulder pain, instability, and reduced strength.
Biceps tendon instability/subluxation: Disruption of the normal anatomical position of the long head of the biceps tendon, leading to instability, subluxation, or dislocation within the bicipital groove.
Treatment options
Non-operative treatment
Non-operative approaches are often attempted initially to manage long head of biceps tendon pathology. These may include:
Rest and activity modification: Avoiding activities that exacerbate symptoms and allowing the tendon to heal.
Physical therapy: Specific exercises and stretches to improve shoulder strength, stability, and range of motion.
Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) may help reduce pain and inflammation.
Steroid injections: Corticosteroid injections into the shoulder joint can provide temporary relief from pain and inflammation.
Operative treatment: Arthroscopic-assisted subpectoral tenodesis
If non-operative treatment fails to provide relief, operative treatment may be necessary. Arthroscopic-assisted subpectoral tenodesis is a common surgical technique used to treat pathology of the LHBT. This involves first detaching the tendon from within the shoulder joint, then reattaching the tendon to the arm bone through a small incision near the armpit. This procedure is minimally invasive and can be performed on an outpatient basis. Older treatments involved simply releasing the tendon, which was effective for pain relief but left the biceps unattached at the top of the arm, causing cosmetic deformity and bicep muscle weakness.
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