INTRODUCTION​

• The biceps muscle has two origins in the shoulder area and one insertion in the elbow area. 

• Most biceps problems involve the long head of the biceps tendon, which originates inside the shoulder joint on the superior labrum

• Different pathologies exist, but the most common ones are

• Biceps tendinitis: Inflammation of the biceps tendon 

• Biceps tear: Partial or complete tearing due to degeneration or injury

• Biceps instability: An injury to the biceps sheath can lead to instability

 

CAUSES

• Repetitive overhead activities can predispose to proximal biceps injury, from tendinitis to tear

• Tearing of one of the rotator cuff tendons (subscapularis) can lead to proximal biceps instability

 

SIGNS AND SYMPTOMS

• Pain in the front of the shoulder with certain arm positions, including overhead work

• Tenderness over the biceps tendon in the front of the shoulder

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TREATMENT​​

• A course of physical therapy can be considered in patients with proximal biceps pathology. This includes dynamic stabilization of the shoulder with the goal of offloading the proximal biceps tendon

• Anti-inflammatories such as ibuprofen may help decrease inflammation

• Surgery can be considered if patients fail conservative management. Surgery consists of either a biceps tenotomy (where the tendon is released at the shoulder area) or a biceps tenodesis (where the injured portion of the biceps is removed and the biceps is reattached in the proximal humerus). Both surgeries are arthroscopic with multiple very small incisions. Results are very good with surgical management with most patients achieving pain relief without significantly compromising function. 

PREVENTION​

• Avoiding repetitive overhead activities may decrease the chance of developing biceps tendinitis or tearing

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