What is Proximal biceps tendonits/tear?
The proximal biceps tendon is an anatomic structure in the shoulder that commonly gets inflamed (tendonitis) or tears with acute/chronic injuries. This structure is called the appendix of the shoulder because it does not have much function in the overall strength or motion of the shoulder. The proximal biceps tendon is commonly inflamed when other aspects of the shoulder are not properly working or there are other aspects of the shoulder that are inflamed.
Mechanism of Injury
Issues with the proximal biceps tendon usually start off with a generalized inflammation or achiness in the shoulder. This can progress to become a chronic pain the front or anterior aspect of the shoulder and causes difficulty or pain when reaching behind to grab something (ie. A bag in the backseat of a car or reaching back to grab your seatbelt). The tendon can tear or rupture with an acute event or even after a long time of dealing with an issue. The end result is what is commonly called a “Popeye” deformity of the upper arm.
Diagnosis and Symptoms
The proximal biceps tendon commonly causes pain in the anterior (front) aspect of the shoulder. Pain is experienced when reaching back to grab something with an outstretched arm/elbow. Physical exam findings exhibit pain directly over the biceps tendon in the shoulder and can be seen with a positive Speed’s test. This is a test with the arm fully extended, palm up and the examiner will ask the patient to elevate the arm against a resistance. Radiographic imaging includes x-rays to look the bone structures in the shoulder and MRI/ultrasound to evaluate the soft tissues in the shoulder.
Treatment
The acute inflammatory stages are best treated with non-operative management which includes rest, ice, anti-inflammatories, and decreasing activities. Physical therapy can be helpful in stretching and strengthening the muscles around the shoulder joint, working on better posture and focusing on the core. Cortisone injections or biologics can help to reduce the inflammation as well. If these symptoms do not resolve despite conservative management, one could consider surgery to release the tendon or release and reattach the tendon. Recovery from surgery can take up to 6-9 months for full recovery.
However, if the proximal biceps tendon tears on its own, then this is most commonly treated conservatively without surgery. The pain will not be long term and patients normally regain full function, even if there is a cosmetic Popeye deformity. The Popeye deformity will not affect the long-term function nor will it hinder anyone from regaining full capacity of their shoulder. Two Hall of Fame NFL quarterbacks, John Elway and Brett Favre, both had this type of injury and both went on to win Super Bowl championships without reattaching the biceps tendon.
For more information, please consider the following links that were produced by the AAOS.
https://orthoinfo.org/en/diseases–conditions/biceps-tendinitis
https://orthoinfo.org/en/diseases–conditions/biceps-tendon-tear-at-the-shoulder