Shoulder Arthroscopy

Partial Biceps Tear, Biceps Rupture and/or Biceps Tenodesis

Repairing Tears of the Biceps Tendon

The biceps muscle starts at the elbow, passes up the arm and splits into two tendons. The shorter tendon ends at the coracoid process of the scapula (“shoulder blade”) and the longer one enters the shoulder joint. There the longer end (the “long head”) attaches to the top of the socket (glenoid) at a cartilaginous lip that covers the edge of the socket (the labrum). 

A biceps tendon rupture typically involves a partial or complete tear of the longer tendon. It is more common after the age of forty. Prior to the injury, these patients often have a long history of inflammation of the tendon (chronic biceps tendonitis). It is usually due to years of wear and tear on the shoulder. It is often associated with repetitive overhead lifting, chronic inflammatory tendonitis and a heavy lifting injury, or a more severe sudden traumatic injury. In other cases, sometimes younger patients, it can be caused by a single acute traumatic event. A torn biceps sometimes occurs during heavy weightlifting or from actions that cause a sudden load on the upper arm, such as a hard fall with the arm outstretched during competitive sports. Forced extension of the elbow against resistance or a fall in a position that forces the tendon to trap between the humeral head (ball of the shoulder) and the ‘sharper’ bone edges of the scapula or acrominon can also cause a tear or rupture.

Tears of the biceps tendon at the elbow are a different problem. Both heads of the biceps muscle joint and attach in one common location on the proximal radius. They are a major elbow flexor and these tears should, in general, always be repaired. This discussion is focused on the long head injuries.

Treatment

Many partial and even complete tears can be treated without surgery. A well performed physical exam by an orthopedic surgeon and an X-ray of the shoulder are often the best ways to see what treatment is most appropriate. About 50% of Biceps tendon ruptures are associated with rotator cuff tears. If there are signs and symptoms associated with w rotator cuff tear further testing may be needed. When a patient has significant symptoms, an MRI is frequently required to make the diagnosis of other shoulder problems associated with a biceps rupture.

Surgery is often reserved for those patients with evidence of other concomitant shoulder problems. When the long head of the biceps is completely torn, the acute soreness is resolved and muscle itself is painful with activity, a Biceps tenodesis may be required. Biceps ruptures are also frequently associated with bone spurs near the tendons path into the shoulder joint. When these are painful they should be removed. If the MRI confirms the rotator cuff is torn, it should be repaired at the same time.

Biceps tenodesis is a surgical procedure to anchor the ruptured end of the biceps tendon to the upper end of the humerus. Dr Reznik performs arthroscopic evaluation of the shoulder to check for other related injuries to the shoulder first. Once any rotator cuff issues are treated, if a tenodesis is needed, it is done through small incisions over the front of the humerus. The tendon itself can be fixed in place with a special absorbable screw, sutures or both. The surgery is done an out-patient basis with a goal of restoring strength to the affected arm.

Fig 1: An Intra-articular view (inside the ball and socket of the shoulder) of a normal biceps tendon.	Fig 2: An inside view of a torn biceps tendon.
Fig 3: The tendon delivered through a small incision.	Fig 4: Sutures placed to facilitate the repair.
Fig 5: Tendon reattached to the bone in a new location.

Page 2: Post Operative instructions after a Biceps Tenodesis