In this video, Dr. Bennett describes various common biceps injuries and some options for treatment and repair. If you suspect you have a biceps injury or a shoulder injury, please call our office for an evaluation. Contact our Sugar Land office at 281-633-8600 or our Houston office at 713-234-3152.
– – Number four is biceps pathology The biceps actually is a long, thin tendon that comes up, actually you’ve got the biceps muscle here, but you’ve got the biceps tendon that’s about the size of a fettuccine noodle that goes all the way up the anterior [front] aspect of the shoulder and dives deep into the joint. You also have the distal biceps which is down below. It’s important to differentiate the two.
Today we’re talking about the long head of the biceps which is up top. The way biceps injuries usually present is with people who are very active. They like going to the gym and doing a lot of preacher curls or working out with the weights. Some of those people may notice a little strain or a little pull in the anterior aspect of the shoulder.
Another possible way to injure the biceps is through repetitive throwing motions. We see this in a lot of patients who are volleyball players, or pitchers, or throwers, or sometimes patients that have a lot of loose joints.
There are two mechanisms and two pathologies here we’re going to talk about. First off is a biceps rupture or biceps tendinosis. A tendinosis is when you have damaged tendon. In the tendon, you get these small micro tears that you can’t see, and those micro tears become degenerative and become what’s called a tendinosis. That weakens the tendon and sometimes can lead to a rupture of the tendon.
Looking at the shoulder here. Here’s the ball and the socket of the shoulder joint. Once again in the front of the shoulder you’ve got the biceps muscle here, down here. Then you’ve got the tendon that runs in the front of the shoulder and then dives down deep into the insertion site which is at the top of the glenoid up here. Many times what happens with repetitive activity in the biceps is that sometimes you can get small tears in that biceps, small injuries that heal in over time. Sometimes it can form some scar tissue. That creates a little fluid accumulation. Then you can develop a tendinosis which is like a swelling or abnormality or weakening of that tendon.
Sometimes you’ll get to the point where you’re doing an activity and you’ll feel a pop like somebody snapped you in front of the shoulder. Then you notice a lot of fullness here and a lot of bruising, and you get what’s called a Popeye deformity. The reason it’s called a Popeye deformity is because the biceps ruptures up here. It retracts, and then this biceps becomes a little bit more full because you’re removing the tension of the biceps. You get a larger biceps down distally. From a functional standpoint is doesn’t necessarily affect your function per se, but from a cosmetic stand point it may look a little off because you’re asymmetric now because of your biceps. One’s pumped like that, like a Popeye deformity. One looks normal.
If you catch this before it ruptures, there are some treatment options for that. You can actually do what’s called a biceps tenodesis where you actually release the biceps up top and you bury it into tuberosity here or into the shoulder with a screw to hold that tension on the biceps so it doesn’t rupture and give you that Popeye deformity. Although you can still function with a Popeye deformity, you may just have occasional muscle cramps. Some may patients may describe occasional weakness as well. From a general functional stand point you can still do the majority of your activities.
The next injury that we see a lot regarding the biceps is something called a superior labrum anterior to posterior tear. It’s also known as a SLAP tear. You read about it and hear about it baseball players, and pitchers, and volleyball players. This usually occurs when you have the biceps here and you’re doing the repetitive throwing motion of the arm moving the arm back and forth. It puts a lot of tension on this biceps.
The way I like to describe it to patients is if you’re trying to pull a root out of the ground. You grab that root and you rock it from side to side slowly to loosen that root and to pull it off. Same thing’s happening with the biceps. With the repetitive rotation in the tarsal forces across the biceps at this anchor, what happens is that stress continues to occur rocking this biceps side to side that it actually loosens and it tears right at its insertion site.
If you look at the cup here which is the glenoid, if you look at it straight down the pipe here this is what it looks like. It almost looks like a pear with a stem on top. This is the labrum around the glenoid cup bone here. This is the biceps, and this is where it inserts. The tear usually occurs right up top here. That’s just one type of tear. That’s the most common type. It’s actually called the type two tear.
There are a number of different types of tears there you can get. You can get sometimes splits into the biceps itself. You get splits into the labrum here itself. Either way it’s all secondary to that same torsional motion that I’m talking about regarding pulling and stressing that insertion site creating a painful popping sensation when these people are throwing or doing their activities. Pitchers will notice a drop in their velocity. Volleyball players will notice the inability to spike or swing their arms because of the severe pain and the popping sensation. Same thing with swimmers. The best way to diagnose this type of injury is with an MRI arthrogram which we usually recommend going to your physician for an examination and possibly a test to rule this out.
For an appointment at our Sugar Land office, you can call 281-633-8600. For our office near the Houston Galleria, please call 713-234-3152.