Biceps Tendon Tears or Strains

Biceps Tendons

There are three main biceps tendons.  At the top of the biceps, there are two anchors for the two parts of the biceps muscle, long head and short head.  The long head goes up and through the front of the shoulder, into the joint, and attaches to the labrum and glenoid.  The short head connects to the coracoid of the scapula (shoulder blade).  The two muscles then join together at the bottom of the arm and for a common tendon (distal biceps tendon) that inserts on the radius bone.

Short Head of the biceps:  It is rare to have any problems of the short head of the biceps tendon.  Irritation is treated with rest and anti-inflammatories.

Long Head of the biceps:  This is the most common location to have biceps problems.  The long head goes through a very tight tunnel in the bone and any swelling or irritation can make the fit tight and painful.  The long head can have irritation (tenosynovitis), partial tearing, tearing at the anchor point, dislocations out of the groove, subluxation out of the groove or complete tears.  Complete tears can cause retraction of the tendon and often hurt only for a few weeks to months but then do not cause much long term difficulty.  All the other bicipital conditions can cause significant shoulder pain.

Distal biceps tendon:  The distal tendon does not often get partial injuries or tendonitis but can have complete tears.  Complete tears of the distal biceps causes a loos of biceps function and requires surgical repair.

Non-Surgical Treatment

Long head: Rest, ice, anti-inflammatories, physical therapy, and cortisone injections are all great options for proximal biceps injuries.  There can work well for many of the bicipital conditions but may not provide complete relief in some patients.

Distal Tendon: Success with non-surgical treatment of a complete distal biceps tendon tear is limited.

Surgical Treatment

Long Head: If surgical treatment is needed,  options include debridement, release, or tenodesis.  Tenodesis is the most common surgical treatment.  Tenodesis is removing the tendon from inside the shoulder and moving its anchor point to the humerus.

Distal Biceps:  Distal biceps repairs involves one or two small incisions.  The torn tendon is sutured, brought back to the bone,  and secured into a hole drilled into the bone.  It will then heal to the bone over a number of weeks and eventually function well.

Surgery FAQs

  • How long does surgery take? Approximately 1-2 hours
  • What kind of anesthesia will I need? General Anesthesia is the most common.
  • How long will I be in the hospital? Many patients can leave that same day, occasionally Dr. Petre will have you stay one night in the hospital
  • Is surgery safe? All surgery has risks; however, this surgery when compared to all other surgery is very safe.
  • Will I need physical therapy? Yes.  Physical therapy is crucial to an excellent outcome.
  • How long before I can return to work/school? For jobs and academics that require minimal physical exertion  many people can return in a few days to 2 weeks.  For jobs that require heavy lifting or exertion, it is safe to plan 3 months off.
  • How long before I can return to my sports?  On average, 4 to 6 months.
  • How long before i can drive a car? All patients must be off pain medicine before driving.  Many patients can return to driving in 2 weeks or less once they feel completely safe operating a vehicle.
  • How long will I need pain medicine?  Most patients need 3-5 days of pain medicine and sometimes up to 2 weeks.  If you are still having pain requiring narcotic pain medicine after a month, Dr. Petre may ask you to see a pain specialist.
  • How long will I need a brace or sling? 2 weeks.

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