Proximal Biceps Tendon Injury


What is a proximal biceps tendon injury?  

Biceps tendon tears in the shoulder are a common source of shoulder pain. The biceps is often considered a major "pain generator" in the shoulder, and tears in the biceps are commonly associated with rotator cuff conditions. Your biceps tendons attach the biceps muscle to bones in the shoulder and in the elbow. Two tendons attach the biceps muscle to the shoulder: the "long head" tendon that attaches the muscle to the top of the shoulder's socket and the "short head" that attaches it to the front of the shoulder.

The long head of the biceps tendon is more likely to be injured because it is vulnerable as it travels through the shoulder joint to its attachment point in the socket. Fortunately, the biceps has two attachments at the shoulder. The short head of the biceps rarely tears, and because of this second attachment, many people can still use their biceps even after a complete tear of the long head.


What causes proximal tears of the biceps tendon?

In many cases, torn tendons begin by fraying. As the damage progresses, the tendon can completely tear, sometimes with a traumatic injury. When you tear your biceps tendon, you can also damage other parts of your shoulder, such as the rotator cuff tendons. Your risk for a tendon tear also increases with age, repetitive shoulder overuse, smoking, and steroid injections. There are two main causes of biceps tendon tears:

  • Injury – If you fall on an outstretched arm or lift something too heavy, you can tear your biceps tendon
  • Overuse – Many tears are the result of a wearing down and fraying of the tendon that occurs slowly over time as we age. It can be worsened by repeating the same shoulder motions again and again. Overuse can cause a range of shoulder problems (including tendinitis, shoulder impingement, and rotator cuff injuries), and having any of these conditions puts more stress on the biceps tendon, making it more likely to weaken or tear.


What are the symptoms? 

The most obvious symptom will be a sudden, severe pain in the upper part of your arm, depending on where the tendon is injured. Other signs that you may have torn a biceps tendon can include:

  • Sharp pain at the shoulder
  • Sometimes an audible pop or snap when the tendon tears
  • Bruising of the upper arm that may extend to elbow
  • A feeling of weakness in the shoulder or elbow
  • Cramping of the biceps muscle with strenuous use of the arm
  • Trouble rotating your arm from a "palm down" to a "palm up" position
  • A bulge in the upper arm (“Popeye muscle”) 


How are proximal biceps tears treated?

In many cases, people with a torn tendon can still function normally and the pain typically resolves over time. Mild arm weakness or arm deformity may not bother some patients, such as older and less active people. In addition, if you have not damaged a more critical structure (such as the rotator cuff), conservative management may be the best option. This can include rest, ice, activity modification, anti-inflammatory medications, and physical therapy.

 In order to fully relieve shoulder pain, the biceps tendon tear may need to be addressed. Patients who develop cramping of the muscle or pain, or who require complete recovery of strength, such as athletes or manual laborers, may require surgery. Surgery may also be the right option for those with partial tears whose symptoms are not relieved with nonsurgical treatment. In these cases, Dr. Potts may recommend surgical intervention with a biceps tenodesis to reattach the torn tendon. Surgery is quite safe, with few complications, and can restore nearly all of your arm strength and function.

A biceps tenodesis may be performed as an isolated procedure but more often is part of a larger shoulder surgery, such as a rotator cuff repair or shoulder labral repair.