What is the biceps?The biceps is the large muscle at the front of the upper arm. It is attached to the shoulder blade at the top of the arm and to the radius bone of the forearm. At the shoulder it has two tendons: the short and the long heads.
The long head of the biceps (LHB) attaches at the top of the shoulder socket (glenoid) and joins the labrum that surrounds the socket. The LHB runs through the shoulder joint and down through the bicipital groove, under the pectoralis major tendon, before joining the short head and becoming the biceps muscle.
At the elbow the tendon blends and there is one (distal) biceps tendon that attaches to the radius forearm bone.
Description of photo
What biceps injuries are seen around the shoulder and how are they treated?The long head of the biceps causes pain and problems around the shoulder far more commonly that the short head; and problems can be seen throughout the length of the long head of the biceps tendon.
The main problems are:
- 1) SLAP tears
- 2) Biceps tendonitis
- 3) Biceps degeneration with rotator cuff tears
SLAP tears – superior labrum antero-posterior tearsThe biceps attaches to the superior labrum at the top of the shoulder socket. Tears of the superior labrum, SLAP tears, are caused by either sudden acute injury, such as a sudden wrenching or traction on the arm, or by chronic repetitive overhead injury.
Symptomatic SLAP tears are treated with SLAP repair using a keyhole approach in younger patients and with a biceps tenodesis (the biceps is fixed down to the upper arm) in older, but still active, patients. SLAP repairs are performed by placing anchors into the bone that have sutures (stitches) attached. The stitches are passed around the labrum, which holds the tissue down while it heals. Biceps tenodesis can be performed by either keyhole surgery or a mini-open (small cut) procedure. The tendon is released from its attachment to the labrum and removed from within the shoulder joint. It is re-attached to the upper humerus (arm bone).
Biceps tendonitisThe biceps can cause pain and irritation as it runs in its groove at the top of the arm bone (humerus), known as bicipital tendonitis. Pain is felt at the front of the shoulder and patients can often point to site of the pain. Long head of biceps pain, particularly when degenerative, can be treated with biceps tenotomy (simple release of the tendon within the shoulder) or tenodesis (the biceps is fixed down to the upper arm) in younger active patients. The options can be discussed with your surgeon.
Biceps degeneration with rotator cuff tearsThe biceps tendon can also be damaged in conjunction with rotator cuff tears or due to degeneration in more elderly patients, and we know that the biceps tendon can be a pain generator in the shoulder. If there is a problem with the biceps, and the patient is having surgery for a rotator cuff tear, the biceps will undergo either tenotomy or tenodesis.
What are the potential complications?The risks of surgery are low, with very low risks of infection, bleeding and nerve injury. Specifically, SLAP repairs have a risk of shoulder stiffness or non-healing. The risk of non-healing increases with age and therefore SLAP tears in older active patients are treated with a biceps tenodesis procedure. Biceps tenodesis procedures have a small risk of failing resulting in a “pop-eye” appearance of the biceps, if this occurs, pain in the biceps settles within a few weeks and, while the cosmetic appearance remains, patients function well and lose little strength.
What rehabilitation is necessary after surgery?
SLAP repairs and tenodesis
Following a SLAP repair you will be in a sling for three to six weeks. Physiotherapy will commence within a week of surgery and you will be allowed to move your shoulder in a protected way soon after repair. Driving can resume four to six weeks after surgery, when safe to do so.
As there is no repair to protect after a tenotomy, rehab starts immediately post-operatively and any sling provided can be discarded with a few days of the procedure, as pain allows.
A big thank you to Simon and his team for their care, patience and perseverence looking after me through all stages of both shoulder and elbow surgery.
Since the shoulder stabilisation I have continued my sailing and fitness training without the worry that my shoulder might dislocate; and I don’t have to think twice whether my ulnar nerve will hinder any progression in my sports.
With their amazing help, I’ve been able to get back to sailing competatively and am now a double National champion.
After multiple shoulder dislocations Charlie helped me set a route for recovery, which has been nothing but smooth sailing. Surgery went successfully and I am well on my way to playing the sports I was previously. Would highly recommend.
Simon successfully operated on my frozen left shoulder in 2012 with fantastic results. This year he has overseen and advised treatment for my frozen right shoulder (via hydrodilation injection). His unrivalled experience in orthopaedic shoulder treatments, coupled with his reassuring bedside manner and excellent results, gave me huge confidence throughout. I’m hugely grateful to have my quality of life back and wouldn’t hesitate to recommend his services. Thank you Simon.
I had suffered with a painful shoulder and pins and needles for three years following a right shoulder fracture and failed half joint replacement prior to meeting Mr Pennington. He explained the situation in a way I could relate to and I’m delighted to say my revision shoulder replacement has gone well and for the first time in years I can use my arm and am pain free. I was even able to walk my daughter down the aisle 3 months after surgery! Many thanks.
I would like to thank Charlie Talbot and his team for the operations performed on both my shoulders and also the aftercare put in place after my operations. I have played golf since I was 12 years of age and thought at one point that I would never get back to playing again. Charlie was always very positive and told me that he would get me playing golf again. Well, I have now been playing golf for nearly 2 years. Before surgery I had a handicap of 12 and I am now down to 9, not bad at the age of 68. So many many thanks.
I had PRP injections into my right elbow last year and within 3 months I was pain free, a year on it is more or less 100% better. Fabulous I would recommend it to anyone with Tennis Elbow, in fact I have gone back again this year to get my left elbow done. Thanks Simon.
Mr Pennington I really wanted you to know how very thankful I am for the excellent care & treatment you and your staff gave me. It really meant a lot that you were so clear, friendly & professional and listened to me – so thank you again.
After more than four decades of shoulder problems with a total of three surgeries the full shoulder replacement surgery by Mr. Talbot has changed my life beyond expectations. I am now able bodied for the first time in years and pain free.
Thank you to Mr Boyle and team for the excellent care and attention both before and after Replacement Shoulder surgery, using the Tornier Simpliciti procedure. After very many months of severe pain and lack of movement I was pain free from day one. Now, after nine weeks, the shoulder and arm movement continues to improve, beyond expectation, with physiotherapy and exercise. I am extremely grateful for all the continuing care.
Following two years of recurrent problems with my left shoulder I was recommendedto Consult Mr Neil Pennington. I had the opportunity to have my surgery quickly and at my convenience, this fitted well around my professional and home commitments. The surgery was carried out as a day case procedure and Mr Pennington visited me following the surgery to explain everything. My operation was a minimally invasive procedure so my recovery was straightforward with only a few restrictions; in fact I was encouraged to keep my shoulder moving. I was driving and back to work after 2 weeks – after 2 years of pain and sleep disturbance I found this operation to be life changing! I found Mr Pennington to be a very professional and compassionate surgeon and he is surrounded by a whole team of professionals that gave me the utmost confidence in the care and treatment I received.
I would like to thank Mr. Talbot and the amazing team of nurses, physiotherapists and support staff for their care and support during my recent visit to the Duchy Hospital, Harrogate, for a replacement shoulder. The care and attention I received was unparalleled. The pain free movement I now have has changed my life.