Long Head Biceps Tendon Tear

Long Head Biceps Tendon Tear

A long head biceps tendon tear, also known as a biceps tendon tear or a proximal biceps tendon tear, occurs when the long head of the biceps tendon, which attaches to the shoulder joint, becomes partially or completely torn. The long head of the biceps tendon is one of the two tendons that make up the biceps muscle in the upper arm.

The biceps muscle has two tendons that attach it to bones in the shoulder and forearm:

1. Long Head of Biceps Tendon: This tendon attaches at the top of the shoulder joint, specifically at the top shoulder socket known as the glenoid.
2. Short Head of Biceps Tendon: This tendon attaches to the coracoid process of the scapula (shoulder blade) and merges with the long head of the biceps further down the arm.

A tear in the long head of the biceps tendon can occur due to various factors, including:

• Traumatic injury, such as a sudden force or impact to the shoulder.
• Overuse or repetitive strain on the tendon, which is more common in athletes who perform overhead motions or activities.
• Degenerative changes that can occur with aging, leading to tendon weakening and potential tears.

A tear in the long head of the biceps tendon can occur due to various factors, including:

• Pain in the front of the shoulder that can radiate down the arm.
• Weakness in the affected arm, particularly when trying to lift or rotate the arm.
• A “pop” or tearing sensation at the time of injury.
• Bruising and swelling in the upper arm and shoulder.
• Popeye deformity.  This is when the top of the biceps retracts and the muscle bunches up like a ball

The severity of the tear can vary, ranging from partial tears to complete ruptures. The choice of treatment for a long head biceps tendon tear depends on the extent of the injury, the patient’s symptoms, and their individual circumstances, as mentioned in the previous response. Treatment options include conservative measures like rest and physical therapy or surgical interventions such as biceps tenodesis or biceps tenotomy. The goal of treatment is to relieve pain, restore function, and improve the patient’s quality of life. The treatment for long head biceps tendon tears can vary depending on the severity of the tear, the patient’s symptoms, and their individual goals and needs. Here are some common treatment options for long head biceps tendon tears:

1. Conservative (Non-Surgical) Treatment:
   a. Rest: Avoid activities that exacerbate the symptoms and allow the torn tendon to heal naturally.
   b. Ice: Applying ice to the affected area can help reduce pain and inflammation.
   c. Physical Therapy: A physical therapist can prescribe exercises to strengthen the surrounding muscles and improve range of motion. They may also use modalities like ultrasound or electrical stimulation to promote healing.
   d. Pain Management: Non-steroidal anti-inflammatory drugs (NSAIDs) or other pain medications may be prescribed to manage pain and inflammation.
2. Surgical Treatment:
   a. Biceps Tenodesis: In this procedure, the torn or damaged long head of the biceps tendon is surgically reattached to a different location, typically on the upper arm bone (humerus). This is often done when conservative treatments fail or for individuals who have persistent symptoms.
   b. Biceps Tenotomy: This surgical procedure involves cutting the damaged portion of the long head of the biceps tendon and allowing it to retract. This is typically considered for older individuals or those with lower physical demands who want relief from pain and do not require the cosmetic appearance of a full-length biceps muscle.
3. Rehabilitation: Following surgery, or even with conservative treatment, rehabilitation is crucial to regain strength and function in the affected arm. Physical therapy is typically recommended to help patients regain strength, range of motion, and function gradually.
4. Activity Modification: Patients are advised to modify their activities and avoid movements or exercises that may aggravate the condition or put undue stress on the biceps tendon.

The choice of treatment will depend on various factors, including the patient’s age, activity level, overall health, and the extent of the tear. It’s important to consult with a healthcare professional, such as an orthopedic surgeon, who can assess the specific situation and recommend the most appropriate treatment plan for a long head biceps tendon tear.  At Total Orthopedics and Sports Medicine we have orthopedic surgeons who are shoulder experts who can guide you in the correct choice for your injury. 

About author

Dr. Charles Ruotolo, M.D.

Dr. Charles James Ruotolo is the President of Total Orthopedics & Sports Medicine, and Long Island orthopedic surgeon. Dr. Ruotolo specializes in the latest up-to-date procedures in shoulder arthroscopy and knee arthroscopy. This includes the arthroscopic treatment of shoulder instability and dislocations, rotator cuff repair and shoulder replacement surgery, as well as arthroscopic anterior cruciate ligament reconstruction and meniscal surgery.

all posts by Dr. Charles Ruotolo, M.D.