The Biceps tendon starts at the top of the arm and inserts at the elbow. It is called Biceps because it has two (bi) tendons at the top of arm.
Biceps Tendinitis
The long head biceps can cause pain when it starts to get inflamed inside the shoulder joint.
Once inflamed it can cause pain at the front of the shoulder joint, difficulty lifting and performing overhead activities.
Diagnosis
The diagnosis of Long Head Biceps tendinitis is usually diagnosed with a combination of clinical history, examination, MRI or ultrasound scan and occasionally a diagnostic steroid injection.
Treatment
The surgical treatment for symptomatic Long Head Biceps Tendinitis is a ‘Biceps Tenodesis’. This involves keyhole surgery to release the biceps tendon from its origin inside the shoulder and fix it into a different position so as to let the tendon heal and prevent the inflamed tendon from rubbing inside the humeral head.
Alternatively, it can be treated with a biceps tenotomy. This is the complete release of the tendon from inside the shoulder. The outcome is exactly the same as a tenodesis but it can give rise to a bunching of the biceps at the bottom of the arm called a ‘popeye’ sign.
Long Head Biceps Rupture
On occasion the tendon can rupture by itself if the inflammation gets severe and occurs over a long period of time. It can also happen in association with a rotator cuff tear. If it ruptures on its own people usually find that the pain eases. People may have a bulge at the bottom of the arm called a ‘popeye’ sign. For a couple
of months you may feel some cramping in the biceps whilst the muscle settles into its new position. Once settled a long head biceps rupture does not cause a
functional problem in most people but can give an aesthetic issue, with the bulge in the arm. The majority of patient are not bothered by the look of the biceps as the pain has settled.
Treatment
The main treatment for Long Head Biceps rupture is to treat the rotator cuff pathology if it causing symptoms. Otherwise in most people once the cramping has settled down it does not cause any functional problems.complete release of the tendon from inside the shoulder. The outcome is exactly the same as a tenodesis but it can give rise to a bunching of the biceps at the bottom of the arm called a ‘popeye’ sign.
The distal biceps tendon sits at the bottom of the upper arm at the elbow, and connects the biceps muscle to the forearm. The biceps tendon is the most powerful muscle for turning the forearm upwards. The action is that same as using a screwdriver.
Distal Biceps Tendinitis
Inflammation of the distal biceps tendon presents with pain in the front aspect of the elbow. People report pain in the elbow when lifting heavy objects and turning the forearm.
The diagnosis is confirmed with a either an ultrasound or MRI scan.
The treatment is based around a sustained physiotherapy regime. Physiotherapy can be made easier with pain killing steroid injection around the tendon.
Distal Biceps Tear
The biceps can tear when it undergoes a large force and subsequently tears away from its insertion into the forearm. People report a lump which bunches up at the top of the arm. These can be left alone however in some patients there is benefit in repairing the tendon back to its insertion in the radius. If left alone there is some minor loss of strength in the flexion of the forearm.
The patients that will benefit are those who are working and their job involves turning the forearm, such as a joiner or plumber.
Surgery
The biceps tendon can be reattached via a surgical procedure. This involves an incision on the front of the forearm near the elbow. The tendon is retrieved from its retracted position and stitched back to its origin in the forearm. It is a day case procedure hence you will in and out of hospital on the same day.
Aftercare
Following the operation, you will normally have a bulky dressing covering your wound. This is then removed to reveal the sticky dressing at 48 hours until 14 days following your operation. The stitches will dissolve and do not require removal. You will require a wound check either at the hospital or your GP practice at 14 days.
After surgery you can gently start moving the elbow mediately but you cannot fully straighten the elbow. You should not lift anything heavy for at least 6 – 12 weeks. The tendon can take up to 3 months for the tendon to fully heal to the bone. You will generally wear a sling for anything up to 6 weeks depending upon how strong the repair is. Usually the sling can be discarded at 4 weeks with a strong repair.
Stiffness
Due to pain after surgery, patient may be reluctant to perform exercises. If you do not gently rehabilitate your elbow it can become stiff and you can develop a stiff joint.
Anaesthetic Risk
Anaesthetic in the modern era are extremely safe however there are still minor risks associated with the different techniques which the anaesthetist will discuss with you before your surgery.
Infection
(1%) is a risk with all surgery. In the majority of cases these are infections around the wound and can be treated with a course of antibiotics. The more unusual deep-seated infections however can require admission to hospital and surgery to clean the wound out if necessary.
Nerve Injury
Is a potential but very rare risk with this surgery. Often the nerves at greatest risk are the tiny nerves supplying skin in the area of the wound and cutting through these may result in an area of numbness that is not often troublesome. Patient may also report numbness down the forearm which generally resolves within a few months of surgery.
Recurrence
Normal tendons do not rupture and hence there is small risk of re- rupture if the tendon is over strained again.
