The long head of the biceps muscle attaches to bone via tendons—one at the shoulder and one at the elbow. The biceps muscle is important for bending the elbow and supinating the forearm (rotating the hand to the palm up position). At the shoulder, the biceps tendon runs in a groove on the bone of the humerus (arm), makes an almost 90-degree turn, enters the shoulder joint between subscapularis (front) and supraspinatus (top) rotator cuff tendons, then attaches to the top of the glenoid (socket of the shoulder joint). The biceps is held in the bony groove of the humerus by the transverse humeral ligament and portions of the coracohumeral and superior glenohumeral ligaments. After an injury to these restraining ligaments, the tendon may begin to move in and out of this groove with shoulder motion, resulting in a condition known as biceps instability. The abnormal motion of the biceps tendon damages and tears the tendon as it crosses back and forth over the bony edge of the groove. Injury to these restraining ligaments is often associated with a partial or complete tears of the subscapularis and/or supraspinatus rotator cuff tendon. Over time, or with significant injury mechanism, the biceps tendon can rupture completely.
If there is no associated rotator cuff tear, complete proximal biceps ruptures can be treated conservatively with physical therapy. This will result in some visual deformity of the biceps in thinner patients but will not limit function. Many patients elect surgical biceps tendon repair or require surgery to repair associated rotator cuff tears.
Partial ruptures and biceps instability typically cause pain and require surgical intervention to either release the biceps tendon (biceps tenotomy) and complete the tear or remove the damaged portion of the tendon and repair it just below the shoulder joint (biceps tenodesis.)
Dr. Chudik makes a limited, open incision, identifies, carefully releases, and mobilizes the chronically ruptured and scarred biceps tendon. The muscle is stretched and repaired as close to its proper, functional length as possible.
You may return to unlimited activities when there is no pain and full shoulder range of motion, muscle strength and endurance, and functional use has been restored. This usually requires four to six months following a rotator cuff repair. Dr. Chudik will tell you when it is safe to resume all activities. Dr. Chudik has special protocols for returning to throwing and golf.