Proximal Biceps Tendon Injuries
What is it: Proximal biceps tendon injuries include: (1) tendinopathies (often overuse injury); (2) subluxation, or abnormal movement of the tendon within the bicipital groove; and (3) rupture of the long head of the biceps.
How does it present: In isolated biceps tendinopathy, patients may present with anterior shoulder pain. However, it is more commonly associated with other rotator cuff or labral injury presentations. Subluxation of the biceps tendon can present with a popping or catching sensation in the anterior shoulder that may occur with overhead or internal or external rotation and is often associated with pain. Again, this condition frequently associates with other rotator cuff injuries. A complete tear of the long head of the biceps can also occur and is usually caused by a resisted forceful flexion of the elbow. In these cases the patients present with pain, swelling and some weakness in elbow flexion and supination of the forearm. (Note: This is in contrast to a distal biceps tendon rupture that results in significant weakness and inability to flex at the elbow and supinate.)
Common exam findings: Biceps tendonopathy is sometimes associated with rotator cuff injuries and/or labral tears. It will often test positive on a Speed's Test or Yergason's Test. If you palpate the proximal biceps tendon in the bicipital groove while the patient internally and externally rotates the humerus, you may detect greater tenderness on the affected side. For subluxation of the biceps tendon, appreciate the movement of the tendon in the groove using a similar motion. With a complete rupture of the long head of the biceps, you may see the "popeye" sign as your patient flexes the elbow against resistance and the muscle belly retracts.
Tests and treatment: X-rays may be considered to evaluate for bony pathology as clinically indicated. Evaluation of the biceps tendon for tendinopathy subluxation or tears could be done with ultrasound or MRI if needed. Treatment of a tendinopathy or subluxation is often conservative. If clinically indicated, the MRI or MR arthrogram may be needed to assess for rotator cuff or labral pathology. Surgical correction of a recurrent subluxation can be considered in resistant cases. Proximal biceps tendon ruptures are often treated conservatively with a rehabilitation program, with only a mild residual strength deficit resulting. In younger patients, athletes, or those that need to do repetitive or heavy lifting for their job, a surgical repair should be considered.