The biceps muscle has two tendons: the short head tendon which inserts into the coracoid and the long head of biceps tendon (LHB). The long head travels from along the anterior part of the humerus into the groove between the tuberosities and inserts on top of the glenoid socket. Evolution has moved the shoulder blade from the side to the back of the chest and as a consequence can result in abnormal strain on the tendon.
Tendonitis:
Due to its unusual position tendon strain can result in inflammation. Pain at the front of the shoulder and occasionally radiation of pain down into the biceps muscle indicate tendonitis. First line of treatment options are physiotherapy, anti-inflammatory medication and cortisone injections. If this treatment fails surgery should be considered. The tendon is typically released from the insertion and either transferred into the humerus (tenodesis) or released and allowed to retract into the arm (tenotomy) Studies have shown that there is very little difference in function between these two techniques and both result in a high percentage of patients satisfied after surgery. Tendonitis also commonly occurs with rotator cuff problems.
Subluxation:
When the supporting ligament covering the groove is insufficient the LHB can subluxate and cause pain. This is usually associated with a tear of the subscapularis tendon.
Surgery is normally required to avoid further damage to the subscapularis tendon
SLAP Lesions:
The upper part of the shoulder socket anchors the LHB. If the insertion of the LHB is damaged vague and deep shoulder pain with mechanical symptoms such as popping and clicking is felt.
The definition of these ‘tears’ is derived from the location of the LHB: Superior Labrum Anterior Posterior lesions. Partial tears, fraying and degeneration are often due to aging and respond well to non-operative treatment. Complete detachment with no major displacement sometimes require repair or a tenodesis/tenotomy. Displaced tears with a flap displaced into the joint or extension into the biceps tendon require surgical treatment.