Biceps tendinosis is a degenerative condition of the two tendons that connect the biceps muscles, the muscles at the front of the upper arms, to the shoulder bones. One of these, the long head biceps tendon, runs from the muscle to the labrum, the layer of cartilage that deepens and cushions the socket to help stabilize the shoulder joint. The condition is usually the result of an athletic injury or due to the natural aging process and can be very painful.
Biceps tendinosis is typically found in patients who have also experienced biceps tendinitis, which occurs when the tendon around the biceps muscle is inflamed. Biceps tendinosis is typically characterized by deep aches and pain within the shoulder, which may worsen when the arm is lifted over the head.
Biceps tendinosis is diagnosed by evaluating the patient’s medical history, the severity of the symptoms and the overall range of motion in the shoulder. Conservative treatments are usually effective for this condition. These may include ice packs to reduce swelling and pain, anti-inflammatory medications, physical therapy, corticosteroid injections and avoiding activities that require overhead motions. If symptoms persist after 3 months of conservative therapies, a biceps tenodesis procedure to relieve pain and restore full function to the arm may be necessary. This surgery is most often performed as part of a more extensive shoulder operation, such as the repair of a rotator cuff.
Distal Biceps Tendon Repair and Reconstruction
The biceps tendon connects the biceps muscle, which is located in the upper part of the arm, firmly to the bone. The biceps muscle allows the arm to flex at the elbow, and to rotate the forearm so that the palm faces up. The distal biceps tendon, which is located at the crease of the elbow, may separate from the bone if tremendous force is suddenly applied to the elbow. This results in a diminished ability to flex the elbow and rotate the forearm against any kind of resistance.
Surgery to repair and reconstruct a torn distal biceps tendon should be performed soon after the injury occurs because the tendon retracts farther into the upper arm as time passes, making repair more difficult. Surgery involves making either one or two incisions across the front of the elbow and repairing the tendon so it anchors to the bone. It may be anchored in a number of ways, including by running sutures through the tendon and then attaching the sutures to anchors that have been placed in the bone. Or, instead of anchors, sutures may be run through holes that have been drilled in the bone.
Recovery takes months, with movement initially restricted, possibly by a splint or cast. When the elbow is again functioning properly, strengthening exercises are begun. Complications from this type of surgery are rare.