Pathology of the biceps tendon (tendinitis or injury)

Biceps is a muscle in the arm,containing two tendons. Through a tendon, it attaches to the scapular promontory (coracoid bone), while the second tendon crosses the shoulder joint to attach to the articular part (glenoid cavity) of the scapula.

This second portion of the tendon is called long head of the biceps (LHB). This may present an inflammation of the tendon (tendinitis) or injuries (fracture, disinsertion).

Tendinitis occurs more often in some athletes (golfers, tennis players, weights pitcher, baseball players…).

Caring for these lesions is sometimes complex and multi-disciplinary.

Biceps tendinitis can also be found in patients with associated pathologies (torn rotator cuff, acromioclavicular joint arthrosis, shoulder instability…).

Disinsertion injuries or tendon tears can occur after sports or major physical effort, as a result of a fall (with arm stretched forwards) or spontaneously in patients with pathological changes of the rotator cuff tendon.

The main symptom is pain; it is located on the outer face of the shoulder to the front, radiating to the front of the arm.

Contraction tests with resistance are positive. Patients no longer get to sleep on the painful shoulder and every arm movement becomes difficult because of this pain.

Further examination will be performed to confirm the diagnosis (arthrogram, MRI or shoulder ultrasound).

Treatment of these injuries is complex. It takes into account the type of injury, patient’s age, sports, job, and existence of associated injuries. In the first period, an anti-inflammatory and analgesic treatment can be prescribed, kinesiotherapy sessions, as well as infiltration of cortisone-based products. If the injury is found by X-rays, then we consider a surgical repair using arthroscopy (minimally invasive), often within a very short hospitalization period (day care).

Several methods are described.

Tenotomy is a cancellation of intra-articular biceps insertion through a tendinous section.

In young patients, after tenotomy, this bicipital tendon can be fixed below, on the humerus, to avoid intra-articular conflicts (tenodesis).

Biceps injury repair (especially SLAP) by suture. We use anchors attached into the bone; their threads will be used to repair the injury.

Of course, all these are done by arthroscopy.

In the postoperative period, arm will be held in a sling, for a period of 2 to 5 weeks. Rehabilitation will be adjusted depending on the technique used. It could start 1 to 2 weeks after surgery, with passive movements in a first stage (executed by the physical therapist) and only then with active mobilization carried out by patients to contract the muscles. Recovery of shoulder function should be complete in about 2-3 months after the intervention and resumption of sporting activities could be considered in approximately 4-5 months, depending on the type of sports.

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